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.

 

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.

 

 

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.

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.”