Not In Kansas Anymore...

Click your heels, and see if home is where you hang your hat, or somewhere else inside yourself as this simple, postmodern girl takes on L.A.

Friday, August 21, 2009

Good Times, Bad Times

Not MY favorite Led Zepplin song, but alas, I'd mistaken this title to the one I was thinking of ( "Rock and Roll". You know: "been a long time since I'd rock n' roll/been a long long long long lonely tiiiiiiime". " ) Oh well, that's what I get for trying to be hip and clever at my age....

Anyway, I digress. Here's the Good News:

My medication is working again. HOOOOO-RAY. Master P, after some consideration and debate from yours truly, decided to jack up my current antidepressant a fairly large amount all at once- kind of a leap for a flyweight like me. He was not optimistic ( I believe the quote was "After a certain point you have to consider the Law of Diminishing Returns. You can do this, but I don't expect roses and ponies to come out of it.") . Fortunately, I can go in there and surprise him with unexpected roses and ponies next appointment.

So I finally feel more like myself than I have in 3 months, have successful avoided hospitalization, and am breathing a sigh of relief. All I can say is: I hope it sticks. Usually I don't worry about that, but, well.....his comments left me a little wary of jumping around the room with TOO much enthusiasm as of yet. He has a point: I'm right smack in the middle of the "theraputic zone"( read: the range of milligrams the manufacturer decided was the ideal dose for efficacy.

Obviously, lots of people use the medication WAY below that range, and see efficacy, and improvement, but technically, they shouldnt be seeing any change at all. The theraputic dose , in addition to being the range with the most efficacy, is also --allegedly-- the minimum amount of the drug to be administered to see ANY change in the patient at all. Prior to this dose, nothing's supposed to happen. I have always thought that was a totally wack idea, but that's another topic.). It has taken me, I should mention 8 years to get here ( I've been on this drug and functioning fine for 8 years and have crept up to this range slowly, as is to be expected as tolerance levels increase as a natural course of treatment). So technically, that's REALLY good. ( I should also explain that people with chronic major mood disorders go through these setbacks and increases as a natural course of treatment, and sometimes, have to add all kinds of....what should I call them? Addendum medications? That boost the efficacy of the primary med, or assist in tangential symptoms, etc....and sometimes, they have to change EVERYTHING altogether every couple of years, depending on the severity of their disease. So when I say "that's really good", I mean " that's REALLY amazingly lucky, too". Just FYI.)

However....( and you knew that was coming)....the class of medication that my antidepressant IS, ( an SNRI , not too dissimilar to an SSRI , an important point of comparison in what I'm about to say) has a problematic possibility of doing what's so eloquantly referred to in the medical world as a "poop out". Frequently SSRI medications ( like Prozac, which is where this phenomena was first noted-- "Prozac Poop Out") tend to be really great for about 3 months and then they drop off sharp like a bad coke high and leave you hanging. This speeds up the tolerance/dosing game by a great length and is constant uphill battle should you need to keep taking SSRIs for a long period of time. Now, as I noted, I dont take JUST an SSRI, I have the "N" on my side, which is supposedly doing double duty to keep things in check (Master P calls my antidepressant "the lion of the pharmaceutical world with regards to depression. It's the one to beat. " Apparently after it came out, other companies started rallying to create similar products for their own offerings, to varying success.....). STILL I guess I'm just worried that for whatever mysterious reason these things happen, now that I'm in "the zone", my "S" will drop, which is the one that I can't really spare. ( Seratonin, btw, is what's usually indicated in OCD , which I also have, and without fail, shows up when I get depressed, and makes things problematic to a wretched degree.). I'm probably worried about nothing, especially since Master P GAVE me an SSRI to ADD to my cocktail if I needed it. But I think I've already noted that I don't want to do that, unless times get desperate.

Which leads me to the Bad News:

My doc....I think I've explained this before, but.....he's kind of this SuperBrainGenius Guy, who is every other doctor's Last Resort. If they have a patient they can't get to respond to treatment or who won't comply or who is just plain puzzling, they send them to HIM. Needless to say his office is a wildly overscheduled zoo. And he's the one who's always on outcalls talking people out of hairy situations, because after 30 years, he's seen it all and is cool as a cucumber.

I got lucky, by one simple twist of fate, to end up with him ( I was in the hospital, didn't like the doctor I was assigned-- she was a total moron-- and people I trusted suggested him, so I switched. Talk about landing in a pot of jam by sheer stupid luck). Because of that, I always thought I was one of his "easier" patients; I hadn't been sent there because I was scientifucally confounding. On a more practical level, I figured I was one of his easier patients because I a.) don't do stupid shit like try to smoke my medication in my crack pipe ( yes, true story), b.) call and need to go into the hospital every time my disabilty check runs out because I'm out of money for coke ( yes, also true), c.) I'm not bipolar, so he never has had to come get me out of lockup half out of my head thinking I'm Jesus or something ( that's pretty common in general with bipolar), d.) I don't complain very much about stuff I know he can't fix ( like stupid job stress or whatever) and insist that he fix it and e.) I do everything he says, and if I don't like what he's saying, can argue the points from a medical perspective, so we always come to a compromise.

Except the other day, he informed me, in a bit of frustration ( not AT me, just sort of trying to solve the problem) that indeed, I AM one of his "difficult" patients. I said, "WHAT?" He said, "Not PERSONALLY, Jessica, you're fine. ( Oh good; I see those points for not being a pain in the ass and avoiding smoking my meds in my crack pipe DO count for something....). But your brain chemistry- it's difficult. You have idiosyncratic reactions to things that I've seen clinically, so I know you're not making it up. That's hard because of course, we as doctors want to prescribe something and see a textbook response. Of course, none of my patients are textbook, so don't feel alone. I'm just saying, usually I give my depressives an antidepressant, and then I see them stabilize. And then you hope that their life gets a bit better for them; you know, they get a good job or they find a partner and their life buoys them up, because you just can't count on the drugs. Its been hard for you, so it's harder ON you, and you know, that's just a tough thing to wrestle with."

Okay, that made me feel like the world's ULTIMATE LOSER: I felt like he was saying, "Well kid, here's the deal. You got a bum rap with this disease. Not only that, but your disease doesn't respond to standard treatment, so we gotta get creative. Furthermore, your life is really crappy-- though I don't blame you for it-- which makes getting you out of episodes harder. " Oh, gosh, THANKS. I left the office feeling a little doomed. Because what am I supposed to do? Become a nun? Live at home with my parents? Never date again? I know people WAY sicker than me who are married, have kids, are doing well. WHERE DID IT ALL GO WRONG!?!? Is there some guidebook I failed to read, or some wrong turn I took somewhere? I mean, seriously. Because I'll go undo it right NOW.

*UGH*. That was a bad day. A really bad bad day.

In other not-so-great news, I got this in my mailbox two days ago:

Dear Jessica :

We enjoyed meeting with you during your Jump Start interview.
While we were impressed with your application, essay, background and experience, we have concluded that other candidates’ qualifications more closely match our criteria for entrance into this session’s Jump Start program. We sincerely regret that we cannot offer you a position in this session’s Jump Start program.
You have our best wishes for success in your future endeavors. We will retain your information and send you an email prior to the start of our spring Jump Start session and offer you the opportunity to apply again.
We appreciate your interest and the time you have invested in interviewing with us.

The Jump Start training team

Um, WHAT? I thought I totally had that one in the bag. I really, really did. Everyone else did too, including my friend Lori who went through the program herself and introduced it to me! I ROCKED that interview. Understandably, I was really upset and disappointed. Sassy tried to cheer me up, though:

You just can't take it personally. I know, I know, it seems like the ultimate personal rejection. But CLEARLY you are more than QUALIFIED. Obviously that wasn't the factor that left you on the losing end. We'll never know what it was in reality, but it might help to dream up a few fantasy ones that soothe the wound... i.e:

* you weren't nearly crazy enough
* you've made getting better look far too easy
* they were looking for someone who speaks Mandarin
* they were looking for someone who speaks Mandarin, is a licensed bricklayer, and is also a notary
* they already have two redheads and the crazies can't tell them apart.
* they were fearful that you would too easily become the target of several of their clients prone to stalking

Truth is, we'll never know the truth. But *WE* know it's not because you are lacking in an REAL and MEASURABLE way. Just like acting, sometimes the choice is completely arbitrary and unfair.

I responded:

Okay, that was pretty funny. And I agree: it is a complete mystery as to why I might not have been chosen.

And while I hate to point it out, some of your "you didn't speak Mandarin" goofing might have been right. I'm sure that maybe they needed to fufill a quota of people who COULD speak Mandarin/Spanish/Filipino, for REAL, as unfortunately those populations go wildly and pathetically underserviced in the mental health community.

Plus, they are a national not-for-profit, who KNOWS what other criteria they needed to fufill to keep their funding? I'm not saying that to be cold, but I DO only have depression and anxiety/PTSD/recovering alcoholic/sexual trauma survivor. Maybe they needed me to have bipolar or schizophrenia or be a veteran or have left an abusive husband, or been homeless. I'm not being flip. I'm serious.

Still: *meh*. Finally a place where I can do some good, and flop.

And while I knew and still know I am more than qualified for the positions, maybe it isn't the right time for ME right now; who knows? I swear to God this life is all about turning the next corner to find out ......OOPS, thank goodness I didn't pick this week to stop sniffing glue ( from "Airplane", remember?).....I just hope the next thing around the corner actually pans out into something good. If it doesn't, I'm going to stay inside untill New Year's and hide.

Thanks, honey. XOXO

I really mean that last part. This whole year has got me feeling loser-ific right now. I mean,
I'm trying. Through no fault of my own ( really) everything that's happened this year has just made me feel like (a LOSER in all caps, just like that!). I've bet and counted on what I had analyzed, considered with heart and mind, and vetted as sure horses and they have failed! And at the last minute, as a shock, too ( I'm talking about my relationship with MC, too. I spent SO much time just checking him out and getting to KNOW him as a person before I even agreed to let him COURT me. I turned him down flat at first! Then it all goes south on a dime because of things I couldn't even BEGIN to anticipate. ) ! I'm just exhausted and it's only August.

I know for certain this time it wasn't some carelessness or pathology of mine that caused any of these failings: not my choices or my judgement or even my psyche. It has all just HAPPENED, and I don't deal with that very well. I like fair. I like order. I like things to make sense. Lately they don't, and I'm afraid of what's around the next corner.
It's one of those times where I just have to have faith, and I am so BAD at that. It's funny because when this was all starting to happen, I ran across this quote of Paul's ( the saint, not just some random Paul...;).... and I'm glad it was Paul that popped up, because he's one of my favorites): "his grace is enough." Then in the middle of the worst of this summer someone else quoted it to me, so I thought, okay. I'm listening. And let me tell you, laying back and saying, "I'm doing what I can, and I'm going to count on grace to carry me the rest of the way that I can't do" has been HARD.'s been helping. Sometimes I say it through gritted teeth, but I'm working it.


TO finish out my theme, I guess that last bit ( about grace) is a Good, for what it's worth. So, give me that big drum solo out, Mr. Bonham. I'm just going to keep putting one foot in front of the other and see where it leads me next, and pray for the best.