Where the %^&* have you been?

I just got off the telephone with my dear friend, O. If you have been following me, you might recall that I love O. Truly, truly love O. Yet, I had not spoken to or seen O in weeks. She lives less than a mile from me! Miles become nations in urban areas. We treat crossing one street as if we were venturing across an international border. What the fuck happened?

I was not living my life with intention. For three weeks. I checked boxes: activity (all days); meditation (50/50): ETOH and sugar (if we’re counting consuming it); and sleep hygiene (if we’re counting sleeping in a bed). [Eye roll.] This is exactly the shit that I was trying NOT to do.

I have really, really good excuses: water in our apartment twice in one week; three acute patients for as many weeks; and some community activism. I also have really lame ones: summer; “I earned it”; “It-was-a-once-in-a-lifetime-concert-so-why-deprive-myself-of-beer”.

It doesn’t matter now though. I had not spoken to O in weeks. I have had sex with my husband less than I would have liked. Everyone who matters to me the fucking most received tasteless dregs while people who do matter got coffee – piping hot, steaming, designs-in-the-foam latté. “I’m that asshole,” I think. However, it is not that simple.

Here’s THE TRUTH:

I started this blog deeply ambivalent.
I was not ambivalent about the goals, but about professional, ethical challenges too numerous to list here. My first goal as a health professional is “first do no harm”.
In a recent NY Times article, the author and numerous commenters debated the ethical conundrums and inherent narcissism of psychotherapists writing about their work. I will not delve into that detail here; however, I would never, ever want a patient to happen upon this blog, recognize my voice, correlate a date and then be harmed in some way. My heart would break. That is not why I do the work that I do.

How honest do I be?
If this were a diary per se, I would write honestly and opening about my emotions. Yet, my husband reads this. Some of my struggles are change and developing within the context of a committed, long-term relationship. Are there parts of a day that should not be made public? If a patient asked me this question, my anxiety would rise due to the answer that I would want to scream: YES.

How the fuck am I going to do this?
Change is a bitch, and I am saying that as a woman who takes no offense to being called a “bitch”. So, let me trip over my feminism and say it again: Change is a motherfucking bitch. I really had no plan other than intentions. I see you eyerolleing, Q [the hub]. Yes, I am the girl who signs up for a marathon in Limerick, Ireland, and am having consistent pain in my leg. That be me!

I have spent the last few weeks, pondering these matters and finding solutions. Honestly, I had none as I sat down to type this. I truly don’t want to abandon this project. Two paragraphs ago, I came to the conclusion that this blog as I constructed it was impossible. And, then, BOOM! I had an idea.

This blog is going to happen. I intend it. I am called to it. However, the current format has to change. For everyone – me, the hub, O, W and my patients. So, here are the new boundaries:

  1. In the next 60 days, this blog will relaunch with “Day 1”.
  2. Posts will occur on a daily basis; however, they will be a delay only known to me of how many days. No actual dates will appear in the titles of posts; one should not associate the actual day of the post with the day on which it was written. Well, you can, but that would be erroneous.

Between now and the “Day 1” post, I will provide additional context on my goals as I previously did.

Finally, I am sorry that I ghosted. Truly not my intention. I do really give a shit. I hope that you know that too, O.

Day Whatever – 2 August 2017

Early Morning
I normally have most of this day to myself. I made choices, shifted boundaries – partially out of true clinical need, partially because I was anxious. I am self-employed; if I am not working, I am not making money. Patients cancel and/or reschedule more in the summer due to weddings, vacations, concerts, baseball games, etc. I regressed in my temporal boundaries and scheduled patients beyond what is normal today: two became five. It is what it is. However, my self-care – a manicure – now is a to do, something to fit in between sessions. [sigh] I put myself here. I know it.

This is accumulative, I tell myself. The result of three weeks of patients’ acuity. I know this and that if I had not been sleeping well, abstaining from ETOH and eating better than average that I too would be facing my feeling stressed as well as depleted. I am not stressed. The clinical decisions that I am making are sound.

However, I have not been reaching all of my goals. I love to meditate, and it has become a “when I have time … ” thing. I always plan on doing it first thing in the morning, but it has not been happening. The sugar thing. Fucking sugar. One serving, and I crave it the rest of the day. Crash, crave. Crash, crave. I know this, but I don’t.

My bicycle is at my office. My goal is to walk the dogs, shower and then walk the four miles to work. I see my first patient 90 minutes earlier than typical today. As my grandmother would have said, “There is no time to dilly dally.” But isn’t life there in the dilly dally?

Morning
As I walked the dogs, I deeply considered that last question, letting our middle-age dog sniff and decide whether or not to leave her scent as well. My grandmother was wrong: there is time to dilly dally. I just have to make better intentions.

Switching the focus from the rings on my Apple Watch, I surrender the notion of walking to work and give myself enough time to meditate. I am on day two (for the third day) of the Anxiety pack in Headspace. The young dog plays at my feet, giving me enough distraction to practice reorienting my attention.

I feel better, more present. Today I will go at half speed and put on flip flops instead of trainers or oxfords. I will be present for my life.

Evening
Fuuuccckkk. One of my patients is severely depressed. What is happening is fucking awful – there are no ifs, ands or buts about it. They are facing awful, awful choices. People sometimes believe that psychotherapy is just being coddled. Hells to the “no”. My patients today truly are examining their lives and, in doing so, are facing gut-wrenching losses. Recently, many of my patients mentioned the book, The Subtle Art of Not Giving a Fuck, so I read it. Manson basically rebrands the Buddhist concept of detachment in more secular, “bro-like” terms. While vast parts of the book were not eye-opening to me, one part did stick with me. Manson states that when we think about what we want (e.g., “a perfect body”), we think about the benefits but not what we would have to sacrifice (e.g., “hours in the gym”). Perhaps it is the way that I work, but my patients are facing deep losses in attempts to create better, more meaningful lives for themselves.

I leave work exhausted and sad with zero fucks to give. Again, I don’t bicycle home, knowing that I will have to close the last Apple Watch ring some other way. I arrive home, plant myself on the sofa and turn on something I never intended on watching. I know, but I don’t care.

Night
There is a ring to close on my Apple Watch. I really want to earn a “medal” that I never have: closing all three rings for one solid month, and it is 2 August. I would have to sit with my “loss” for 29 fucking days. After 21:00, I begrudgingly hunt down the missing athletic sock that my young dog stole. Everything feels harder.

Outside, the rain is light, normally the type of weather in which I cherished a run – like running through a gentle sprinkler on a hot summer day. I feel nothing. I just want this over with. So, I set a goal of one mile on my watch. I have not run a mile in 21 months; it has been 18 months since my first orthopedic surgery, seven months since my last. Here goes nothing.

I run, and my body feels more balanced. It’s more of a jog, but my right gastrocnemius feels stronger – less atrophied – and I am not having to push off so hard with my left knee. I am grateful for K and F, my Pilates instructors who have had me on the jump board. Progress is slow, but I never, ever thought that I would run again. I think of the tendon in my right ankle and wonder about the donor, how they died, what their family’s pain is like from the loss. I am grateful for them.

The mile is slow-going, but I finish. I feel no pain. No tightness or the historical “fuck you” from my right ankle. I have healed. My left knee and hip remind me that all is not balanced, but everything is okay. Everything is good. I run another one-third of a mile, and my left IT band says, “Easy there, ranchero.” I stop running and walk the remainder of the way home.

I feel nothing. This is anhedonia.

 

 

Day 8 – 1 August 2017

Afternoon
The day started out easy and fruitful: walked the dogs for 1.85 miles at 06:00; picked up the car from the body shop at 07:30; grabbed fancy tea before my fitness class; and showed up to said fitness class at 08:30. I even managed to bicycle to work. Check, check, check.

However, four hours later the heaviness of the day weighs on me. My patients are not well – of course they are not well, or they would not be here. However, the last three weeks have been very difficult. It is not spring, when weather fluctuations stir the contradicting moods of my bipolar patients. It is summer – “bright, easy summer”. In this City, patients at intake talk about their mood and how it worsens in the dark, cold winter. I am curious, curious as to why patients are sicker now. The rain and air now rumbling outside match the air in my office: wet and heavy from tears and pain. I cannot shake what I have experienced during the past few hours. It weighs on my heart and mind. I worry that things will not get better quickly enough for some of my patients or – if and when they do – they will have to suffer great losses to affect the necessary changes. It is awful either way.

I think of The Hub, staring at black screens of code and solving problems. I could telephone him, say that it’s been a rough afternoon. He would reply and say the same. It’s true, is it not? His work is difficult, managing the expectations of developers, project managers and his own manager. I could say, “I am worried about my patients’ lives”, trying to convey the weight of the day, but that is not news to him. He knows this about me – that I care, that I worry.

I have progress notes to write, but the motivation that spurred me forward in the morning has been transmuted by my patients. I am lethargic, fatigued and ready to quit. This is the challenge of empathy – understanding what is mine and what is theirs. At moments like these, I think of my friend W and her history of just getting in her car and driving, driving. Silence, freedom, space.

My morning plans with O tomorrow for a walk and tea have been dashed. I need to fit in a patient. It’s the right thing to do – we don’t get to decide when symptoms worsen – AND I am disappointed. I just want to crawl into a ball on the sofa in my office and hate the universe for so much suffering.

“Good time for a change
See, the luck I’ve had
Can make a good man
Turn bad

“So please please, please
Let me, let me, let me
Let me get what I want
This time

“Haven’t had a dream in a long time
See, the life I’ve had
Can make a good man bad

“So for once in my life
Let me get what I want
Lord knows, it would be the first time
Lord knows, it would be the first time”

– The Smiths

Evening
Again, a difficult session. My patient’s anxiety filled me, and I could barely sit still. I felt their discomfort, the constant agitation of their body. I feel so relieved at the end of the session when I can stand up and move, and I wonder how they too literally sit with it. My last session has canceled, and I can go home. All three rings on my Apple Watch are closed, and I decide not to bicycle home. I have nothing left. I am depleted.

Night
The pulled pork from the Sous Vide preparation tastes amazing. I know this, but I cannot taste. It is one of those nights when nothing will satisfy. I know this, but I don’t. I have some cookies, chocolate-covered almonds. Nothing satisfies. Nothing will. I know this, but I don’t. I stare at the television, not caring what is on. I just want hours to pass until my body matches my consciousness.

I lie in bed and open the book. I cannot recall what I last read, where I am in the story. I read, and sleep comes fast – well before my bedtime.

Day 7 – 31 July 2017

08:19
I am out walking the dogs, and I hear the copyright information on Audible for The Case Against Sugar. Thank g’d I am done with that damn book. At least I won’t hear about sugar the next time I go on a walk. As Amy Poehler stated, “Good for you, not for me.”

11:33
I spent the morning writing, and I have not done any work. Fuck, fuck. I have to focus and get some work done. Love my job, hate the paper work.

15:31
I just remembered: “American Ninja Warrior” is on the television tonight. I love that show. I totally want to be a ninja. [Insert eyeroll from The Hub here.]

Evening
I am sad and anxious. Some of the patients that I have seen today are truly struggling. I am processing two sessions in particular, analyzing my every move and asking if it were the right intervention at the right time. I know deeply that there is no “right” thing to do as a psychotherapist (except in areas mandated by ethics or the law). My possible failures as a “good enough” therapist provide an opportunity for my patients to get angry and process all the times that others have failed them; however, the questions still roll like a fog over my mind.

20:38
I am late leaving the office and tired. There likely will not be time for all that I want to do: reply to my meditation instructor’s email, meditate and watch “American Ninja Warrior”. I know that the last item is silly, but I like to dream that one day I could do some of those things. There was a man who competed in his 60s this year …

21:58
Our young dog stands by the door and looks at me. These are the moments in a marriage: give or take. The Hub has worked all night on preparing dinner for the following day, so I pop up and slowly grab the leads. We walk the streets that are surprisingly quiet, and I feel time slipping away. I want to debit my sleep account.

22:28
The Hub and I crawl into bed. My smart phone lingers in my hand, and I can feel the pull to read – The New York Times, The Washington Post, Politico, Celebitchy, the day’s horoscope. I have not even completed the day’s word game. I consider the alternative to my Treatment Plan but know that the backlit device will stimulate my retinal nerves, and sleep vanish by the hour. I need to set my phone down and do so reluctantly, feeling like I’m missing out.