Day 6 – 30 July 2017

05:25
I wake up before my alarm, before our young dog. Holy sleep hygiene, Batman! I officially am one of those crazy people “who doesn’t need an alarm”. After one week. I take the young dog out and return to bed with the family – The Hub and the dogs. Despite seven hours of sleep, I am still tired. I read in bed until my fitness class.

07:47
You know that moment when you’re working really hard in a fitness class and you feel your muscles burning from effort but you really just want to punch the instructor in the face? Yes, that.

09:05
I love B, my mediation instructor. She is the most amazing person. At 20 years younger than me, I am jealous of her wisdom, her patience, her deep knowing. She is such a gift. B asks me to look for “synchronicity” this week. Aware that she likely is not referring to the album by The Police, I have to Google the term.

09:12
I find my family still in bed, and I am anxious. I made The Hub go to bed with me at 10:30 the previous evening, and he as not happy. Not one bit. I wonder if I have a mess to clean up or if he appreciates my intentions. Typical of our shared stubbornness, he reluctantly admits that he benefitted from the sleep with a qualifier. Always a qualifier. Being married to someone trained in math is a learned skill. Proceed cautiously.

10:32
We arrive home from walking the dogs and survey the contents of our kitchen cupboards scattered about from yesterday’s “flood”. If we want to eat, we have to deal with this mess, and the previous day has left us gun-shy of restaurants. I set to work, draining years-old expired food goods and washing pots and pans that were used to catch water. I know deeply that this moment would not be occurring if I a) stayed up very late and b) consumed ETOH. I am proud of myself.

13:19
I just cleaned the bathroom sink and toilet. What the fuck is happening? One week into this whole structure thing, and I have time to actually take care of and manage my life. I am both not-so-secretly pleased and secretly annoyed with myself. I work hard to not think about the hours that I have wasted in my life.

Late afternoon
I walk to the Salvation Army with a bag of donations and to the Market for meat and produce. Listening to a book on tape, The Case Against Sugar, has the opposite effect. My brain is just hearing “sugar” and then “sugar” and “sugar” again. I then think of every form of sugar that I love. I am also annoyed with the book for a variety of reasons. I cannot wait for it to end and to eat – you guessed it – sugar. My oppositionality can be such a pain in the ass sometimes. It’s like someone spent an hour telling me what to do, and I automatically think, “Oh, yeah! Try that again!”

19:12
The Hub and I have walked the dogs to the corner tavern and sit outside in the patio. I tell one of our favorite servers that I am just having a soda water. She asks the inevitable question, “Why?” I stated that I have to work later and she asks again, “Are you sure?” I think of all that I accomplished that day and say, “Yep.” It is hard in the moment, but the moment passes. The dogs soak up the sun and attention from other patrons.

20:19
I cue the Netflix to continue a series that we started the previous week and notice that I could give a shit. I am not involved and am on my smart phone. I stop myself, pause the show and stated, “I’m sorry. I can’t watch this now. The TV is yours.” I cannot watch TV sometimes; it just doesn’t garner my attention. I think that’s why I drank ETOH while watching television sometimes – to slow down my brain. The younger dog joins me in bed as I read The Ministry of Utmost Happiness. My body is weary, and I am ready for sleep to come.

 

 

An Old Friend

About six weeks ago, I was leaving therapy and had a “doorknob moment”. I looked at my therapist and stated, “It’s like I’m an adolescent and have to figure out how to live.” She enthusiastically replied, “Yes! Exactly.”

Half-way through my life I am figuring out how to live: how to not eat more than needed, how to pause before I act or speak outside work, how to directly ask for what I need, how to say “no” without explanation, how to eat vegetables beyond my small repertoire, how to set boundaries in relationships, how to manage my expectations of others, how to laugh when things go wrong and then wronger, and how to forgive.

You see, I did not plan to be here. Fifteen years ago, when I gained courage from my husband to see a psychotherapist, the script was this:

“[The Hub] will discover how awful I am just like my family has. He will leave, and I will have nothing left. Then I will jump off a bridge into water.”

I actually can tell you which bridge in this City because I walked over it many times, “rehearsing” as it were: gauging the depth of the water (I then could not swim) and noting the lack of witnesses. Now that I think about it, I don’t cross that bridge any more – in car or on bicycle or foot. I haven’t in years …

The first time I remember thinking about suicide, I was 11 or 12. My mother was on some bloody warpath over some small infraction that I could not have imagined then. Trying to drown out the sound of her still yelling at me after sending me to my room, I put the needle on my Mickey Mouse record player. Turning up the music as loud as the little machine could muster, I remember thinking, “I wish I were dead.” Everything got quieter and calmer in my head.

An A student who showed up at mass with her Catholic family every week throughout grade and high schools, I flew under the radar. I never acted out. I never did drugs. I spent my weekends in high school babysitting and saving money for my eyeglasses and clothes. When I didn’t babysit, I went to the video store and rented a movie to watch at home. I ironed church linens. I never went on dates. I didn’t consume ETOH until college. I read voraciously. While the thought of dying crossed my mind during these times, another plan was more pressing: get the fuck out of Dodge.

The proverbial “Dodge” was not of my choosing. After skipping a grade in grade school, I was very young for my class and graduated high school at the age of 17 years. The orders had come in: I had to go to a Catholic college or university, and the Federal aid had to be there. While I wanted to go to a large university far, far away from my family in a large City, there were no funds for transportation; the gas money to drive me to college was limited and that was if the car made it there. Sometimes it did not.

After spending 12 years of education with the same sixty Catholic kids who had all sorts of names for me – their favorite being the then-maligned-label, “lesbian” – I could not wait for a “do over”. I so desperately wanted to fit in, to find my “tribe”, to belong. After all, I belonged nowhere – not at school, not at home, not at church. (I fought my being confirmed and duly lost.) The fact that four other students from my high school went to the same college should have served as a warning, but I did not heed it.

Within weeks of my arrival at college, I again knew it: I was different. No hair bows hung on ribbons on the back of my closet door. I didn’t care about the football team. If the boys only dated girls with bows in their hair, I was never, ever going to get laid. Most students drove nicer cars than my parents had ever hoped to drive. My family took two vacations that crossed two state lines in my life. I didn’t have the clothes, the identity and most importantly – the self esteem. I had spent four years, pulling the grades to get into college and to get the fuck out of Dodge – for this?

With absolutely no emotional maturity to handle all that was thrust at me, I gave up being a “good girl”. I didn’t fucking care. I was going to have fun, g’d damnit. I was going to break every g’d-damn rule that I had so religiously [pun intended] followed since birth and have fun doing so. I found a department at my college that tolerated difference and found a few friends there. However, the faculty might as well placed a sign on the building, stating “Resettlement Agency”, because we all were refugees from the same dictate: go to a Catholic school, be a nice girl and find a good husband. If you can’t do the latter, be a teacher or nurse – a job that would work well for when you have children.

Listening to Tom Waits, The Smiths, Billy Bragg and P.I.L., we did our school work (sometimes) and bitched about the school, our parents and the boys from which we had to choose. I earned honors for my work until I didn’t.

At the onset of my junior year, I realized that if I did not find a job after this education, I would have to go home. I. Could. Not. Go. Home. Home = death. If I were to go home, I knew deeply that I would kill myself. I could not live another day in that house. No, nope, nyet. I cursed my ignorance – that I could choose a “trust fund” or “rich girl’s” major with no clear employment track. I loved what I was learning, but it was not practical. It was a fool’s errand. The joke was on me.

I spent my junior year trying to piece together a more marketable major. My grades fell, and I lost the support of my department. I will never forget crying in front of my peers when a professor stated, “I see nothing of value or interest here.” How the mighty fall. While my thoughts of suicide never translated into a “means” – there was no Internet or Google then – they were omnipresent.

Early in my senior year, I met my now husband at a bar. It is hard to separate my deep love and respect for him now from then; however, I do recall that I thought he was “very hot” and wanted to “hook up” with him. We did – and have been ever since. In many ways, he saved my life by helping me to see what I needed, by helping me to make choices that year – and now – that have kept me alive. I did not go home. Ever again. That choice has had awful consequences that I will discuss another time. But I can without a doubt say this: I did not go home after my senior year of university, and that choice saved my life. I am proud of that decision. It was extraordinarily difficult, and I did it.

As I write this now, I realize that my survival throughout my adolescence, early adulthood and adulthood – until I entered therapy – was always about the “next thing”:

  • “When I get to college, life will [be better in some way].”
  • “When I get married, my life [be better in some way].”
  • When I get [the next job], my life [be better in some way].”
  • When I get a [trinket], I will feel loved.”

The “next thing” would happen, and the hopelessness and anger would sink in all over again. I was different. I was ugly. I was fat. I was fucked. I was awful. My husband didn’t love me. I was “the poor kid”. I heard my father’s voice: “Life is not fair. Get used to it.” Every time one of these punches to the gut occurred, I sidled up to my old friend and felt comfort: “I could end this at any moment.” When things go wrong over and over and it feels “done to you”, you accept that sooner or later, you will take your life.

So, I had resigned myself to the fact that my husband would see what all the others who had left had seen: I was unlovable and deeply awful. He would leave, and so would I.

Through years of twice weekly therapy, I worked through a lot of shit. It wasn’t fun, but I recommend it. I healed through this relationship and still do. Through my training as a psychotherapist, I came to understand how trauma affected my brain, how my attachment pattern plays out in my relationships and how my not acting and suicidal ideation were forms of hope. Over a decade ago, I recall the session in which I looked at my therapist and stated, “I realized the other day that I’m not going to die by suicide – that it is not inevitable.” We both sat in silence for a few minutes, understanding the moment. I was deeply – and still am – grateful for her, for The Hub and all those who loved me in spite of myself during those years. it wasn’t easy to love me. I made sure of that.

My suicidal ideation now is a symptom. I am hawkish on it. If I ever catch myself uttering the phrase, “I am done [with life]” or “I fucking give up [on life]”, I know that I need to readjust. I immediately ask, “Why now?” “What stressors have exacerbated?” “What do I need to do to take care of myself?” It does not happen often – less than once per year- but when it does, I tell my therapist. She doesn’t freak out. I don’t freak out. We just treat it like abnormal blood sugar levels and get back to work.

While my depression is in remission, it is a pernicious disease requiring structure, treatment and vigilance. I never take a good day or the very fact that I am alive for granted. I have a really good life that took about half my life to build.

My Treatment Plan is both out of respect for the perniciousness of this illness as well as for my family and patients. I have spent a very long time wanting to live, now I want to stick around for as long as possible. Oh, the irony.

 

 

Day 5 – 29 July 2017

I did not journal at all yesterday. It was one of those shittastic days during which one starts to imagine the karma from previous lifetimes that brings one to this point in the here and now.

Here is a brief run-down:

  • Water heater in the unit above us cracked, sending gallons of water through our loft ceiling. It took 30 minutes to reach our neighbor for him to come home and turn off the water supply.
  • Whilst trying to get home from work to said home issue, a ride-share driver told me to “relax” after I spilled tea all over myself. (Note to men whom encounter me: telling me to “relax” is akin to telling me to “smile”. You have been duly warned.)
  • Lunch is delayed for said home issue, resulting in my getting hangry.
  • Do you know when you go out to eat, because your family is depleted and you just need to be taken care of but you get the server who really doesn’t want to be at work that day and you spend 90 minutes trying to get someone’s attention who’s laughing with his friends at the bar? Yep. That.
  • Do you know when one attempt at trying to recover a bad day (e.g., dinner at a restaurant) fails and you try again (e.g., sitting at neighborhood tavern patio), thinking that you can get the day back on the rails but then that TOO fails? Yep. That.

At 19:48, The Hub and I walk back into our apartment to see kitchen cupboard contents littering the counters, towels still waiting to be laundered and the smell of wet wood permeating our apartment. It was at that moment that we surrendered to “It’s been a shitty day”, resolved to forgive one another for any “snapping” for the remainder of the day and rented The LEGO Batman Movie and played the game of “guess whose voice that is”.

22:28
I crawl into bed exhausted and ready to start anew. While I hit the sugar again (a cookie that was so not worth it [sigh]) after a failed attempt at dinner, I did pretty d’mn good on a shittastic day. Sleep comes fast.

Demographics and Usage

As much as I try, I cannot write in gender-neutral language for two reasons:

  1. It is confusing to me and, likely, to you the reader. For example:

    “The peace is broken. ‘Can we just leave the driver back there – two blocks ago?’, I ask. In the moment, I know that I am a hypocrite, that I did the same thing at the restaurant earlier: let the intrusions of the City poke at me until I was lashing out, dividing people into us/them. They know it too but say nothing.”

    Who is “they”? The people in the restaurant? My partner? If it’s unclear to me as I edit posts, it likely is unclear to others.

  2. My experience of the world – now more than ever – is rooted in my being a cisgender, heterosexual woman. Yep, that’s what I am. My “partner” – husband (or “the hub”) of decades – is a cisgender, heterosexual man. At some point during the next year, I imagine that I will have an experience tied to being a woman in the world. It seems silly to keep this going only to clarify at some undetermined point in the future.

I will continue to use gender-neutral pronouns (i.e, they, their and them) when speaking generally about my patients and work stress.

G’d, I feel much better now. It was too fucking complicated and wasn’t true to who I am – she, her, hers.

Thank you as I grow and learn.

Day 4 – 28 July 2017

05:31
My alarm went off. I lie in bed, feeling the weight of the week and my age. The dogs stir and look at me; I wonder if they are getting up. I consider my Treatment Plan, this blog and my accountability, and I choose to listen to my body. I reset the alarm to 06:00, wondering if this week has taught me something: I need more than seven hours of sleep a night.

07:59
After arriving at a fitness class, the instructor asked, “How are you?”

“Great! I have had a really good week,” I replied

Stop. The. Bus. This week almost has been a carbon copy of last week in terms of external stressors. Perhaps more so. Damnit. Damnit. Damnit. I feel better due to this flipping Treatment Plan. It just struck me. Fuck. I have been viewing this Treatment Plan and blog as a one-year thing and then “back to normal”. Like a diet of sorts. I really did not think doing these small things would make that big of a difference. I mean, yes, I know what clinical studies show and how I see my patients respond to these changes. However, to be “sitting in it” is much different. I feel so much better – like, really really good. Does this mean … that I … won’t ever … [insert behavior here]

[Imagines self doing Home Alone scream throughout apartment]

Nope. Nope. Nope. Not going there. Today is day four, and that’s all that I am thinking about. I have to focus on getting through the weekend: keeping my sleep schedule and not having a Pilsner are going to take some fortitude and tenacity.

“Are you with me?”, I ask my dog. Who am I kidding? She likes the patios of our City more than me. [eyeroll]

11:03
As I ripped stems off spinach leaves, I knew what I had been avoiding all week: I need a plan for tonight. It’s Friday. Historically in the summer, Friday night has meant meeting my partner and our dogs at one of the neighborhood taverns with a patio, popping open a Pilsner (or three) and sitting in the loveliness of it all. A city that I love. Sarcastic servers. Neighborhood changes. Dogs’ chilling and squinting into the sun. The name on the tavern has changed during the past seven years, but one of our dogs has been coming here on Fridays in the summer for all seven. She commands the patio by lying in the middle, eyeing servers’ trays of food. I feel as if I belong there. Like many urban dwellers, these places are extensions of my 950 s.f. home.

I could go there and order a soda water with a lime, but I know my brain: it’s an asshole. Here’s how it would go: “You’ve worked really hard this week.” “The CDC states that one serving of ETOH a day is not harmful.” “You have the calories left for the day.” And on and on. I know in my heart that I would not make a good choice today. So, I need a plan.

11:09
I call my partner at work, one of the two calls that I typically make every morning. We make plans to see “Atomic Blonde” that evening after work.

Early evening
My last patient was super anxious. Empathy has my cage rattled as well – I feel their anxiety and agitation in the room and in my body. As I turn off light switches and white noise machines, I think ahead to the evening ride to the heart of my City.

Swinging my leg over the top bar, I knew what was inevitable: a long, exhausting ride through Friday evening traffic. My saddle is too low on my bicycle. Whilst I am in the bicycle lane, ride-share drivers, double parkers and taxi cabs cause me to weave in and out of moving and standing traffic. I try to stay in the moment, enjoying music from my speaker and feeling the air move across my face. However, it’s there: the hyper-vigilance of ringing my bell, saying “heads up” and constantly looking over my shoulder and to the right for car doors. I lock up my bike, and my shoulders refuse to release the stress of the ride.

My partner and I planned to meet for a cheeseburger before the film. I arrive first, and the line is at least 30-people deep. I wonder how this could be since it is not lunchtime. “Shouldn’t this area of the City be dead by now?”, I wonder. My partner arrives and reminds me that tourists and suburban teenagers stay long after weary workers head home to their neighborhoods. Getting hangry, I watch every, single person order individually. It has now been 30 minutes, and I want to yell, “How have you not read the menu after 30 minutes in line?! Speed it up!” I am that asshole. Instead, I roll my eyes. As the line shortens, so does my patience and will. I order a chocolate shake. Not. Part. Of. The. Plan. A case of the “fuck its” has set in. I am done. I am toast. I want a g’d-damned shake and about 5,000 people inside this restaurant, outside on the sidewalk and parked in rush hour on the streets to go the fuck away so I can enjoy my evening.

Our food arrives, and we rush to eat it so that we can make it to the movie on time. We step outside onto the sidewalk, bobbing and weaving to get through crowds of tourists and suburban teenagers – some stopping dead in their tracks as they convene to decide what to do next. My legs feel leaden from the previous day’s riding and this morning’s strength training. I am exhausted, and now my stomach feels bloated and gross from the shake. My body hates dairy, and I always crash hard after eating sugar. “Every fucking thing has a consequence. I hate being an adult,” I think.

19:56
The theater lobby is quiet and cool. Everything is hidden now: people-less kiosks at which to buy tickets and paper-less smart phones that hold tickets. My partner buys his beer, and I am jealous and not jealous. I don’t want to drink ETOH, and I want my anxiety and irritability to shut down. We find our seats and settle in.

22:13
The soundtrack to the film was amazing, and I find it on my smart phone for us to listen to on the bicycle ride home. My partner and I manage to avoid right hooks, car doors and drunken pedestrians until we hit a quiet neighborhood street. They pull up beside me, and we smile. This is the best part of every late night ride. It is interrupted by my partner’s annoyance – likely exacerbated by their flight-or-fight response – at a driver’s almost right hook of me. A few blocks later, they comment on the driver again. The peace is broken. “Can we just leave the driver back there – two blocks ago?”, I ask. In the moment, I know that I am a hypocrite, that I did the same thing at the restaurant earlier: let the intrusions of the City poke at me until I was lashing out, dividing people into us/them. They know it too but say nothing.

22:23
We carry our bicycles up six steps in the lobby, and I have seven minutes to get into bed. My partner mentions something about partially reading an email, and I make a passive aggressive comment about their attention-deficit disordered thinking. It was not intended as a low blow, but it landed as such.

22:31
I crawl into bed and try to talk to my partner. They are not having it. We are both depleted. I fall asleep sad and feeling awful.

 

 

Day 3 – 27 July 2017

05:42
Partner: “So do you want me to fix that pork tenderloin tonight?”
Me: “That would be awesome. I’m done early. We could also – ” I don’t finish my sentence: grab a beer? walk for ice cream? They hesitate at the door, waiting for me to finish my sentence.
Me: “Who the fuck gives up alcohol and sugar at the same time?”
Partner: “Only you.”

09:55
I legit woke up at 05:30 – and then promptly moved to the sofa and watched a trashy show that I had recorded the previous evening. Baby steps. My work day does not start until 12:00, and I really don’t know what to do with this time. Fitness classes in which I participate are on different days at different hours. I want to meditate first thing in the morning, but the dogs have to be walked – do I meditate before or after? When do I eat breakfast if my fitness classes are at different times day to day?

Clearly I have not made a daily schedule. I am not procrastinating though. After a birthday a few years ago, I stated, “I am half-dead – if I’m lucky.” I likely am now 52 percent dead. Some might think that it is a morbid way to view one’s life. I don’t. It reminds me to be intentional with my time. Some of the questions that I have been asking of late: “When I am struggling to move or no longer have beloved people around me, how will I view my time spent:

  • watching woman fight on television?”
  • reading mindless drivel on the Internet?”
  • under the influence of substances with (i.e., essentially absent from) people whom I love?”
  • frustrated with transitions that kept me from traveling?”
  • worrying about something about which I have no control?”
  • shopping on the Internet?”
  • yelling at a driver who intrudes upon my space in a bike lane and then feeling guilty for hours?”
  • fuming over a fitness instructor who does not start a class on time?”

I still watch women fight on television, but when I do it, I am very intentional. I.e., “I am going to put my brain into a mild coma and watch crap for one 42 minutes.” When I view it in this manner, I do not get caught in the endless cycle of looking for more to watch (or more time to waste). The Holstee Manifesto hangs in my office. One line reads, “If you don’t have enough time, stop watching TV.” I remind myself of that “mantra” every time that I complain about how little time I have or sit down to watch television.

This whole line of thinking is very new to me. Impulsively I went to a meditation class one day in April. I went back the next week, and my experience was pretty life-changing. I began to view my mind differently. While I am still herding cats in my brain, the cats have changed.

12:45
Someone dear to me says, “Things are shifting. I can tell. You are way less anxious.” I smile, they’re onto me. I’m growing.

13:35
It is hot out, and the air is juicy. Earlier today, I debated “ride share or bicycle” nine miles across the city. “It’s too hot and humid out,” my brain declares. But my brain is an asshole. I live in a City in which the weather graciously – and sometimes not too graciously – provides a reason not to move. I only need to open Accuweather 338 days of the year to say, “Yep, I should take a cab or public transportation.” Ninety minutes ago, I told my brain to bite it and hopped on my bicycle. One mile in traffic, and I am drenched in sweat. It feels awful and good at the same time.

19:02
I lay on the bed, having bicycled somewhere around 20 miles on a sticky, icky day. I wanted to succumb to the allure of sleep, but I knew that doing so would mean waking up at 20:30 and then staying up until midnight knee deep in Netflix. I read the New York Times about the Affordable Care Act, and it’s a good distraction. I tried very hard not to think about how this could impact both my patients and my own healthcare.

22:00
I reluctantly set down my smartphone and pick up a book. I have 30 minutes until bedtime.

 

 

Day 2 – 26 July 2017

07:10
Despite a rough start on day one, I did it! I went to bed at 10:30. My alarm went off at 05:30, and I didn’t want to cut someone. #smallfavors

However, I have work to do this morning. I need to create some type of schedule to accomplish all that I want in a day. Not a list of work appointments or plans – an actual effing schedule with things like – oh, I don’t know – when do I eat? I am excited about this, because I do believe that: 1) it will make following my “Treatment Plan” easier (and I’m all about easier); and 2) it will bring more intention to my days. I’m all about intention these days; more to come …

Oh, and hey, good morning! 🙂

09:22

I was in therapy and mentioned my “Treatment Plan”. Instead of the “Go you!” that I expected, my therapist gave me the internal eye-roll. (I learned from pros.)

“Whatever happened to the ‘good-enough mother’?”, she asked, referring to the work of Douglas Winnicott. I rolled my eyes back at her – not internally.

What she essentially was saying was that I don’t need to be a perfect therapist to help others heal. In practice, failing a patient can produce anger and be as therapeutic as being “perfect”. Is this Plan another ill-fated pursuit of perfectionism for me? I don’t think so … I’m going to have to think about this.

p.s. If she figured this out before me, I am seriously going to be pissed.

12:08
A noon fitness class that I am choosing to leave five minutes early to see a patient in crisis hasn’t started. I immediately feel annoyed and deprived. I HATE RUSHING.  Thank g’d for meditation classes and Headspace. I am able to loosen my grip on my annoyance and anxiety and use the extra time to stretch my hip flexors that are always tight from biking. At least the work of the class burns off most of the emotions. This afternoon feels like one in which I am eking every minute out of it. Ugh.

17:51
I’m going to hang out with a dear friend. We normally split a bottle of Pinot Noir when dining out. O could care less if I drink ETOH or not. However, I am feeling pulled. ETOH – or as I call it, “liquid Xanax” – puts the brakes on my anxiety and work stress. The minute I take a sip, I feel the liquid Xanax muzzle the anxiety, tape its wrists and stow it in the closet. For now. Not tomorrow, when my neurotransmitters ask, “Hey, where’s that ETOH?” as they busy about. FYI: your body AND your brain are both assholes. They love, love homeostasis and work very hard to undo all that we do. Nothing, nothing is without consequence. G’d, I hate being an adult some days.

I recall Brené Brown’s Ted Talk: when one chooses to use a substance, one does not get to choose what to numb. If I numb my anxiety, I numb my joy, empathy and other emotions. In addition, anxiety might be a really good thing at the end of the night when choosing to hop on the subway, walk home or take a cab. Anxiety can be life-preserving. So, do I really want to wipe all of that away? I love O. They are one of those people who make me feel so good about myself, because they truly love me. Really, really love me. And they show it. That’s friendship gold. Do I really want to numb that?!

Kind of. I know, right?! That’s the pull of ETOH for me. I am fortunate to be very smart (i.e., common sense) and bright (i.e., intelligent), but I also have great difficulties shutting off my brain. I also spend the great majority of time around equally or greater bright people, asking tough questions, pondering important matters and challenging me to be better. When do I stop? The first sip.

I prepared O and told them that I wasn’t drinking ETOH for 365 days. Of course, they responded in their typically non-plussed way. Damn, I love them.

21:00
I almost fall asleep on O’s sofa. W.T.F. Who is this person? I make a strangely adult decision, state that I need to go home and get to bed. I have a bedtime now.

21:07
I am on my way home in a cab when a message comes through from my partner. It’s a picture of one of our dogs in his lap. My heart and face smile. I love my family. I love O. I am very fortunate.

Day 1 – 25 July 2017

05:28
I had my Mardi Gras last night for the 365-day Lenten sleep hygiene. Reading therapist listserves, stoking my anxiety about the possible Affordable Care Act (ACA) repeal and playing my favorite word game in the glow of my smart phone, I watched minutes of sleep expire. I. Didn’t. Care. Ask me now about that decision. It was very fucking stupid.

08:17
I just spent 45 minutes walking the dogs and reflecting on this morning. I recalled my reading The Power of Habit by Charles Duhigg years ago and the idea of “one small change” leading to multiple changes. Earlier today – I cannot believe that I am saying this at 08:17 [sigh] – I thought, “Should I eat breakfast? When do I eat breakfast?” This small thought struck a chord deeply inside of me: I have no structure. I wake up whenever approximately eight or nine hours of sleep has been achieved or if some external factor requires it sooner (e.g., a fitness class or appointment with the orthopaedic surgeon). I eat breakfast – normally an RxBar – if I have time or on the way out the door. Sometimes I grab food – fruit, nuts or an RxBar – for time in between sessions, sometimes not. If one were to ask me basic questions about my day, such as “When do you walk the dogs in the morning?” or “When do you eat [insert meal here]?”, I honestly could not answer that question succinctly. I would say, “Well, it depends on my day! I work a lot.” Note the second sentence in that statement: it’s an excuse. Yesterday I was in therapy, and my therapist said: “So, it Netflix’s fault that you don’t go to bed on time.” I kept trying to explain my behavior to her. “So, it’s [partner’s] fault that you don’t go to bed on time.” I really was getting annoyed with her. Where was the damn empathy now?! However, less than 24 hours later, I realize that she was right. I always have a really, really good excuse. My super agile, smart brain will rationalize anything. Seriously – anything.

10:13
I am standing in the lobby of our apartment building with bags of groceries full of healthy, life-promoting food. [slight eye-roll]. No Justin’s Peanut Butter Cups are in the bags. “But it’s the organic, healthy kind of peanut butter cups”, whined my brain earlier at the market. My brain can be such an asshole. Watching the elevator alert count down, I hear the beeping of a delivery person scanning boxes in the mailroom.
He rounds the corner and states, “Hey!” It’s our neighborhood FedEx guy. Always friendly.
“Hey, how are you?”
“Doing good. Was that you sighing? You sounded so tired.”
“Yep, that was me. I got up at 5:30 today, but I didn’t go to bed on time.” [internal eye-roll]
“I got to get up at three a.m. I try to get to bed by 9 p.m., but it’s so hard.”
“Tell me about it.”

Afternoon
A formerly stable patient is at risk of hospitalization. My chest tightens due to anxiety. I make the best clinical judgment, but ultimately I have to trust in the patient that they will follow the plan. I am exhausted from a lack of sleep and want ice cream. Being tired always makes me crave sugar. [sigh] I take a walk and get some cool tea. There’s more work to do, but a member of my patient’s treatment gets back to me and contributes to the plan. I feel better that we’re all on the same page. “Everything will be okay,” I tell myself.

16:55
I am exhausted and paying for last night’s opposition toward “bed time”. I make a choice: take a ding on my treatment plan or be better present for my remaining patients. I take a 20-minute nap while also setting a boundary with myself: I have to go to bed at 22:30 without my phone in my hand.

21:06
I want to go home. I want protein. I am tired. The day’s earlier crisis, sleep deprivation and shame over not hitting my sleep hygiene goal on day one (!) have left me depleted. I want to see my family. I want to be surrounded by love and told that I’m a good person, I do good work and that everything will be okay. However, I have to chart on two patients who are high-risk. If something awful were to happen, I have to prove to a real family and an imagined judge, jury and state licensing board that I did my job, that I did everything I possibly could do to assess their safety and, if necessary, keep them safe. I reflect on my nap, and my shame decreases: I did what was in the best interest of my patients; I made the right choice. It’s then that I realize that “being tired” at work really is not acceptable. Historically, it has not impaired my judgment, but it could. I have to be on my “A game”. The shame washes on the shore of my brain like a never-ending tide. For how long have I been coming to work tired? Then I have to remind myself that I am not a therapist superhero; I am human. As I sit here tired and charting, there are sleep-deprived emergency room medical staff, nurses, pharmacists, truck drivers, and on and on. I complete the notes, leaving the remaining, no-risk documentation for tomorrow. And there it is: the slow clench between my ribs forming. Fuck.

21:32
After texting my partner with my bicycle route, I climb on my bike to ride home. Much of my treatment plan in this blog came up with my patients in the same day. I feel good about myself, knowing that I too am trying to do what they are doing. In other words, as a patient complained about their knowing that going to bed “on time” every night would help their anxiety and productivity, I not only felt the true, annoying struggle of this choice, but I also knew that I was making a real attempt to follow my recommendations. I was going to bed at the same time every night. Granted, I was on day one, but it felt good not to have that nagging, shameful feeling that I was going to spend the rest of my week going to bed based upon some whim or Netflix queue.

The streets are empty and red lights turn green as I approach, as if they too know what I need: my partner, dogs and home. I feel grateful. My legs pedal smoothly in a higher gear, translating a few months of classical Pilates. I cannot run a mile again yet, but I will. I don’t know when I will run a mile again yet, but I will. And then my chest reminds me: all is not well. If I were not a mental health professional, I would turn my handlebars and head to the nearest emergency room, thinking that my heart muscle were failing me. But it’s not. This, my friend, is anxiety. Beneath my sternum, I feel the clench, the reminder that I am not normal. My brain is not normal.

Yes, my brain is not normal. However, what could be triggering my brain now? Were it the high-risk patients? Is it a subconscious reaction to some choice that I might be facing when I arrive home? No, and no. And then, the deep knowing strikes me. The knowing that comes from a unique combination of years of psychotherapy, studying trauma and its effects on the brain, and the wisdom of experience: I suck at transitions. I hate transitions, because I fear transitions. To some who survived a trauma, transitions are the moment in the air between two trapezes – there is nothing but the strength of the previous moment to propel one through.

The immediate survival of a trauma can increase one’s need for control. Children who survive chronic trauma, such as frequent changes in caregiver, neglect, emotional, physical or sexual abuse – particularly before the age of five years – have brains who have been changed forever to respond to stressors. These children (who now can be adults) tend to have higher blood cortisol levels, leaving them in a persistent, possibly low-grade state of “flight or fight”. Earlier in my career, I worked with these children and watched over-stressed mothers trying to put little arms in coat sleeves as the child screamed in a fit of confusion and anger, not knowing what came next. “Does putting on this coat mean I leave mommy? Does putting on this coat mean I go to another, different home?” It was awful to see this wee brain reacting to history and trying to process present. (Thank g’d for the very excellent supervision and psychotherapy that got me through these years. You know who are are.)

There I am on a bicycle that I love in the air between two trapezes – work and home – and there’s not enough time to adjust. I also have to be in bed in less than an hour. Everything is going too fast, and my brain tells my body to remind me. [Chest tightens] But this I know: I’m not dying. My brain just perceives danger when there is none. I just hate, hate, hate transitions – especially ones that go too fast or that I cannot control.

I pedal faster to see my beloved partner and dogs and be in my safe home. All the while, my brain is saying, “I need more time for this.” When I walk in the door, my chest is still clenched. It will take 10 to 15 minutes for it to release.

“I’m not dying. I’m feeling better.”

 

 

Expectations

I did not think the “posting” aspect of this blog through fully. My apologies to my readers. I wanted to capture my emotions and reactions “in real time” throughout the day without the psychological defenses built through time and rationalization. In doing so, the posting process – one post with numerous updates throughout the day – confused me. Not technically – but how would readers know when a day was completed? So, I will write throughout the day, hopefully posting one completed diary entry before my sleep hygiene screen black-out time. If not by 22:00 on the same day, I will have the day’s diary online early the following day.

Thank you.

The Treatment Plan

If one came into my office with a mood disorder (regardless of additional diagnoses), I would assess the following as part of their assessment and, ultimately, diagnosis(es):

  • Their sleep patterns and sleep hygiene;
  • Their relationship with food;
  • Their relationship with substances;
  • How much they move/exercise; and
  • Their compliance with any other health professional’s recommendations.

Most people with mood disorders struggle with these areas of their lives as part of their illness or to cope with their illness. Loss or increase in appetite, hypersomnia (i.e., sleeping too much) and insomnia (e.g., inability to fall asleep or intrusive wakefulness) all are diagnostic criteria for major depressive disorder. In addition, patients who struggle with depression, anxiety or post-traumatic stress can use food or substances to cope with unwanted emotions and their resulting symptoms. As a psychotherapist, looking at how people cope can tell us much about underlying emotional disturbances. Said another way, if one is in a good space in life, they sleep well, eat for fuel and the occasional indulgence, do not abuse substances and maintain or increase their health through activity and following health provider recommendations.

So why don’t people with mood disorders do what is recommended to them to manage their health?! Because their life is one big Whack-a-Mole game of managing different, sometimes conflicting symptoms. There’s another reason: most suck at structure. (You know who you are.) If they are so depressed that they cannot get out of bed in the morning, imagine trying to go to bed “on time” that night. These patients laugh in my face when I ask about their sleep schedule. I could spend the next 500 words, providing examples on how some patients hate – even are oppositional toward – structure, but I have to stick to today’s topic: The Treatment Plan.

For the next 365 days, I am going to follow every single one of the recommendations that I make to my patients. 

My immediate response to typing that sentence: “FML”, which I imagine that I will be uttering much during the next 365 days. However, I truly want to “walk the talk” as a healthcare provider. I also want to be the best damn version of me for however many years I have left on this planet. So, here it goes.

1. Sleep hygiene
Go to bed on time (22:30) and wake up on time (05:30) six days a week. No reading backlit screens after 22:00. One 30-minute nap on one weekend day is acceptable, but not recommended.
Degree of difficulty: 10/10

2. Mindfulness
Meditate for a minimum of 15 minutes per day. Lying in bed for 15 additional minutes to “meditate” does not count. (That hurt.)
Degree of difficulty: 4/10

3. No added sugar or artificial sweeteners
To clarify, naturally occurring sugars, such as in fruit, are allowed. (More on this recommendation to my self and some of my patients to come … )
Degree of difficulty: 7/10 (A 10/10 if I am around my dear friend who is an excellent baker.)

4. No ETOH (i.e., alcohol) or other substances
Nerd alert: I have never tried or done an illegal substance or something not prescribed to me. So, I will be abstaining from the one substance that I do use: ETOH.
Degree of difficulty: 9/10

5. Close all the rings on my Apple Watch
This equates to seven 30-minute workouts per week, twelve hours of standing for at least one minute and meeting a daily caloric “move” goal (currently 800 calories). One doesn’t need an Apple Watch to measure these activity or movement goals, but it’s a consistent, workable measure for me.
Degree of difficulty: 2/10

6. Follow doctors’ orders.
If I’m prescribed a medication that I agree to, I will take it. If a physician orders a test, I will do schedule and complete it. I will not cancel my dental cleanings. (I hate going to the dentist.)

That’s it in a nutshell. It – like my stubborn head – likely is going to be very hard to crack.