The Heroic Patient

imagesSorena wore a black knit scarf around a thick neck, folds between scarf and skin. She came in with reflective smooth skin and frozen brow.  After many botox injections, she increasingly found it difficult to change her expression.  People often accused her of not caring about difficult things they were disclosing, and she realized the issue was, she couldn’t move her forehead.

She had a lot of empathy and was frustrated that people didn’t understand this.

We pulled at this idea for some time, recognizing a tension unplugged for her with each injection, a relief she experienced at visceral level. She just felt like she had to get her injections, driven toward them, like a bee toward the hive.

At some level it takes courage to get through the day.  She sees the effect.  Despite the fact that she should take a break from Botox, she can’t stop and this feels frightening.  She’s freezing her face.  It’s a terrible thing to know she has to stop something she is driven to do. It’s really hard. She’s trying to get through each day.

I told Sorena, “What you do every day to deal with this is brave. It’s harder. You have so much strength. You are doing it. You are getting through.”


I’m considering starting a podcast, “The Heroic Patient.” What do you think?

I want to interview Sorena and others with heroic life journey’s for you to discovery, connect with, increase awareness of, and appreciate.

The idea is to interview a world-community patient who will tell their “story.” It enters through the physician’s office doorway and increases transparency.

Many in our world community do not have a great understanding of what a physician nor a patient do in this exchange. You may think, “Well, everyone is a patient so at some level they do.” But:

  • How many, do you think actually go into a physician’s office?
  • How many variety of physicians does any one patient see in a lifespan?
  • How many get to tell their story?
  • How many of us hear each other’s stories?
  • How many of us understand how a physician solicits the details of a story so someone is “heard?”

If a patient were to learn the ‘behind the scenes,’ thought processes, interview techniques and analysis of the physician, would that be helpful to the patient?  Would the doctor learn from this dynamic interplay, and would the interview process evolve and grow from this? How would this effect stigma of all variety? Who knows?

What do you think? Is there a need for the “Heroic Patient” Podcast? If so, what are your recommendations and opinions?

The idea is that we are designed for connection. It’s friendly, remember? 🙂

Keep on!

Self-care Tip: Get transparent to get connected! Be a friend to yourself.

Best Self-Care Ever! StepBet

move-it

Hello Friends!

This post is a simple plug for one of the best things I’ve ever done for myself.

You have heard me talk about neural grooves and changing habits such as those that are not friendly to Me. In a post, “Pay a Dollar,” I said,

When you feel trapped by your own self, get friendly by remembering this.  You’re mistaken.  You’re talking about a brain groove, not a vampire.  It’s not hopeless.  Not much more, not much less than what it is.  A groove can be abandoned.  New paths can be made and when the stressor hits next time, you will have a longer moment to decide on which behavior to play.  You will have a choice and you will realize more often that you are not trapped by what you thought; you are not hopeless and ugly.

So how long does it take to form a habit? Or break one? To change neural grooves in the brain. Many say, twenty-one days. Others say, you have to do it every day for a year.

This game, StepBet, is designed to get us moving as a habit. I’m loving it. I invite all my patients to join me. My team. My friends! I’m not leaving you out! Smile. Check it out.

You put $40 up that says you will walk a determined number of steps every day, except one, each week for six weeks. If you miss a day, you lose your forty bucks. Some days, I start thinking, …”It’s just forty dollars…(whine – a long high pitched complaining cry.)” The money from those who don’t make it to six weeks goes into a kitty and later dispersed amongst all those who did. Yah! So fun!

Please join me, and let me know how it goes for you.

How StepBet Works

1. Get Your Goals

2. Place Your Bet

3. Step it Up!

Question: What do you do to be kind to yourself, habitually? Please tell your story!

Keep on!

Live Imperfectly, Dad is dying, and I Have no Power.

wilted flower

Living with someone like tomorrow might be their last is much harder to do when it is actually the case.

My dad told me, after my nine-year old niece died, that a parent should never outlive their child.  When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.

When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.

My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying.  He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.

The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character.  He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.

Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?

Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.

In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly.  And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.

Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.

Question: How do you “live well?”

Keep on!

Blood, Sweat, and Imperfections – Mommy Don’t Look!

Naked and Voyer

Naked and Voyer

Blood soaked and layered with fallen governments, the Acropolis remains, a witness and teacher to a summer fling. 

A tour of the Acropolis and its new museum taught much. #1 – Never go on such travel without a tour guide. She made all the difference. Without her, I might have lasted for an hour, or an hour and a half. I would have thought, “Check! Did the Acropolis! Next?” With her, I felt like I couldn’t get enough. Four hours later. Evi was an intelligent, independent woman, making her way in the world, with the talent of putting ideas together. Another mentor to pick up along my life journey. #gratitude.

(I’m going to try to describe Athens, as seen by a psychiatrist. Smile.)

Evi integrated the paradigms at play, seamlessly, and in flow, from the 800’s B.C. to the 400’s A.D. She spoke about the mathematics involved in The Parthenon architecture, the classical culture seen in the architecture such as the emphasis on the human senses, the development of language and democracy, and more.

None of the construction of The Parthenon is “perfect.” The columns slant, and the stairs bow in their middle. All of this is done to capture the human senses. It was constructed so that when you stand at one corner, you can see almost the entire construct, like inflation of air rounds a balloon. When you look straight on, you are almost able to see entirely around the balloon’s girth. The architect sacrificed perfection toward the ultimate and most valued goals – to experience all the human senses to their fullest, and the classical construction. 

The Greeks developed the idea that whatever is created by man, (scantily garbed statues, architecture, ship making, etc…) should demonstrate, but not surpass the excellence of the human at his or her absolute best. Perfectionism smechsonism.

The kids were a bit horrified by the genitals everywhere. “That’s inappropriate!” or “Mommy, don’t look!” with a hand posturing the Stop! sign, improved my experience 10-fold. 

The Greeks in the 400 A.D.’s recognized the irony in the loveliness of human senses; sight, emotions, spirit, intellect, etc, integrated with the flaws. We are greater, in the best of our imperfect self, than the perfect, mathematical, or any other kind of perfection, eg., 1 + 1 = 2, in a perfect world. 

For example, by tilting the columns, the architect understood that it would give an illusion of straight columns, yet still capturing more of the circumference as seen by the individual. Straight would be perfect. Tilted but looking straight is more representative of a human at her best. Never perfect. And the illusion created by the tilted columns made the construct look shorter, thus not surpassing “the human” capacity to sense it’s grandeur. 

Also, the government ruler at the time, Pericles, was the first known leader to integrate a form of democracy. He used citizens and slaves for the labor. Yet he paid them, including the slaves! Furthermore, he gave them freedom in their work to form independent decisions, stating that someone who is told what to do, doesn’t learn anything. Someone who makes their own mistakes, has the opportunity to learn from his mistakes. This was the fulcrum which our civilizations turned on toward human rights and free thought. Pretty powerful.

The Greeks gave their alphabet to the world, from which Latin developed, and thereafter the Latin languages. For example, I never knew that “Agoraphobia,” comes from the location, named at the time, “Agora,” where all the debates were held, again, inspired by this ruler during the 400’s B.C., spurring on freedom of thinking. You can imagine what happened during heated debates. Some people would suffer anxiety in that context, which would deteriorate into a disabling fear of being humiliated by another potential panic attack when in public places.

The priests of the Greek gods served also as their community’s medical practitioners. For example, they used snake venom to both treat headaches and prophylactic against strokes. It turns out that snake venom is an anticoagulant. Totally brilliant. Snake venom in Greek, is called, “physika”, which means “venom.” The caduceus, a symbol that we still use for the physician’s medical practice, shows a snake wrapped around a staff. Later Aristotle used “physika” to name his treaty on nature and the work evolved into “physician.” Way cool. 

The self-care tip: Work your damndest, while embracing and integrating your imperfections along the way, and in this Grecian effort, you will gain the greatest sensorial experience with the world around you, the individual beside you, and your own self.

Question: 1. How do your imperfections enhance your best self? Please tell us your story!

I Can’t Make Friends – Anxiety

voyagerMr. Clark stopped talking and walked to the ringing rotary phone on the wall.

We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.

Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.

It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?

We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.

Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.

A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.” 

You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.

Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.

Fudge! She only wanted to know the Blinking! Time! he screamed inside.

Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?

People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.

Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends. 

Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,

Should I treat?

Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.

When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.

So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.

Self-care tip – Go toward the data!

Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!

NPR interviews Kitty and Michael Dukakis

In an interview with Kitty and Michael Dukakis, journalist Katia Hauser explores the benefits and risks of electroconvulsive therapy (ECT) in treating depression. Kitty shares her first hand experience with ECT and the ways it changed her life, and Michael provides the perspective of a family member.

Dukakis interview

I’m peaking in my career

  
Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of 🙂 ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice.