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.

Tuesday, October 06, 2009

Oh, Today, let's just call it a do-over already. It hasn't been THAT bad, but I'm already tired and it's not even that late....

The first thing that happened to me when I woke up is that I woke up at 5:30pm. (Yes, I know, you all thought I'd left THAT habit behind. That was before I got sucked into this book . I then proceeded to have bad dreams about Warren Jeffs all night, if that's any sort of pay-the-piper fairness....). Upon waking up, I had this AWFUL feeling, the kind I get when something's about to go terribly, terribly wrong. It's usually not neccessarily something to me or mine, just in general, in the world. (For example, I had the same feeling the morning of 9/11, and I had the intuition to turn on the news, which I never watch. I did, and the second plane had just hit the Tower. Nice, eh? ) I couldn't shake it for anything, but I let it pass because I called my family and they were all fine, and my friends were all accounted for, so what else could I do? Besides, I figured it may be a residue of the Warren Jeffs extravaganza from the night before. If my intuiton were more finely honed, after all, I'd probably set up a stand in my yard and start making some money. Or maybe *I* could set up like Warren Jeffs and call myself a "prophet" and get a bunch of people to do my bidding in a secretive religious sect. Minus the child brides, of course.

Then I went online to my chat group, only to be royally pissed off by our resident scientist, Toxigal. Toxigal is a forensic toxicologist ( hence the name) with a Ph.D, and yes, she is very, very good at her job. She works at THE pre-eminent place for toxicological research in the country, and should be lauded as such. HOWEVER, she is, or so I have come to suspect, along with a few other people, possibly a Fembot. Don't get me wrong: Toxigal is kind and caring and friendly, and often enough, funny. I actually like her-- when she's not acting completely socially retarded by posting what can only be summed up as "highly dim-witted and provocative statements/questions", and assuming they are mere cocktail-party fodder. (It's kind of like,-- using a fictional example-- in the middle of a conversation about dogs, instead of saying, "Oh really? I have a dog, too," she might, let's say, pipe up with "I'm so glad MY dog is fixed; I mean, why wouldn't you want your dog to be spayed? Puppies are so UGLY," or something like that.) I might sound like I'm being extreme here, but this is a woman who once said that she hasn't had sex in 7 years and "doesn't see what the big deal is. I don't miss it." Um, okay. She also recently announced that hasn't had a period in 12 years ( due to a medication she takes to suspend them) and is thrilled. Look, I'm no fan of the whole deal either, but, uh...well, that's just....there's a REASON why we have them, okay??
Not that you could convince her of that, since if it's SCIENCE, it must be GOOD. Which is the premise of my entire beef with her today.

Being a scientist is Toxigal's world, which, all heavens being in their right places, is really quite fine. She just can't seem to warm up to being in tune to subtle nuances of being human very well, sometimes, or grasp the finer points of certain issues, since science, as we all know, is absolute. There are very definitive boundaries, and proofs, and without those, it's all theory. ( Unless you're a theorhetical scientist, or working Way Out There On The Edge of 'We Just Don't Know', like Brian Greene or someone.) I wonder sometimes if Toxigal would like some definitive boundaries and proofs on human experience, because I suspect it would be more comfortable for her. I'm not saying that to malign the woman; I feel for her in that regard. To a degree, I certainly can relate. Haven't I had my share of "I think my head is going to explode" moments in the last few years alone from struggling with that very kind of thing?

But TODAY.....heh. I am done with the compassion for her for right now. She hit below the belt on something, by implying that.....oh, wait. No, she came right out and said it, in her social idiot way! She said I simply didn't have the education to back up my assertions or opinions on a topic, and SHE did, but she "wasn't trying to be snooty or anything. Really, I'm not." In other words, she decided to throw down her Ph.D as a gauntlet.

And if you know me, then you know this: you don't EVER do that to me. First of all, I don't care if your degree is in Piglatin As A Romance Language In the Renaissance Era (or something else I could know absolutely nothing about no way, no how), it's a.) pretentious, b.) rude and c.) demeaning to the person you're talking to. It puts me off, big time. You want to share some information? Okay. You want to play the One-Up game? I'm outta here.

Secondly, you don't do it to me, because while I certainly respect the letters and, as the diploma says, "the priviliges and rights conferred" by any degree earned, I'm not neccessarily impressed by them on their own, and I'm certainly not cowed by them under any circumstance. I'm the girl who as an undergrad caused a tempest in a teapot at her oral defense ( for my degree in Religion, we had to write a thesis and submit to being questioned. I suspect this was to prepare us for grad school. It was a nightmare: I had been already planning and reading for a year earlier than I had to, and it still left me watching "TRL" and drooling into a cup 12 seconds after I graduated, and all the following summer.). I had 2 Ph.Ds and one M.Div candidate arguing amongst each other so intensely that the moderator ( the Chair) had to tell them we were moving on to another question. ( I should probably add that that is a GOOD thing in academia. If you provoke the BigWigs into fighting amongst themselves, you probably have something on your hands.). No one wanted me to write the paper I did; I couldn't get support ( save for my mentor, who was unfortunately on sabbatical in New Fucking Zealand) for it to save my life. However, I thought it out and wrote it anyway, and then I graduated at the top of my class. So, have your alphabet soup- I'll look to you for the book learnin', but I don't neccessarily need you for ideas. My brain works just as well as yours, I have access to the same information, and I know how to research. Thanks.

Lastly, if you do that to me in an area in which I DO actually know something, I. Will. Crush. You. I've had too many stupid boys tell me how stupid/ignorant/silly I was over too many years in my youth to put up with such nonsense now, and I'm well past the age where I will play dumb just to make you feel better, or avoid a feud. And, if I can add a little caveat, please don't tell me I don't have the knowledge base to back up my opinions and THEN claim you're NOT being a snot. That's just passive aggressive and makes me want to slap you.

Toxigal? She made the colossal mistake of pulling the last one on top of the other two, (and put the caveat there for the cherry on top), and that, my friends, was a mistake. I realize that this is, in part, of her fatal flaw: she honestly doesn't grasp that she's being rude, or even stepping over the line with what she's implying ( which is that I was, in essence, a poorly-informed, dangerously outspoken plebian whose commentary could lead others into peril), like I previously explained. BUT: what's worse is that she happened to have been commenting on something we ALL know I have a personal interest ( not to mention personal investment!) in, which is psychiatry/mental health/medicine. A little backstory:

A friend of ours (we'll call her A.) has a complicated psychiatric diagnosis further complicated by chronic pain issues. She's on a shitload of medication, including Oxycodone, two antidepressants, two tranquilizers, an antipsychotic and a handful of others. She'd posted that she STILL couldn't sleep, and was wondering if taking Tylenol PM, which had been helping her doze off the last few nights, was going to be a tax on her liver. In addition to Toxigal, we have a boatload of nurses on the board, and a social worker, then me. All of whom said, "I don't know if you should be doing that...." . Toxigal went so far as to say, "I see people like you all the time at work. And they're dead." (Which is true, since she works with cadavers.). I said, "I don't want to step on your toes, but your doctor is CLEARLY not hearing you, what with this and that and the other and six of those and nine of these. It's only going to take a little to have you not wake up someday. Maybe you should get a second opinion from a different psychiatrist." Fine, right?

We went on to compare notes as fellow mental patients do, and when I heard MORE about A. and her situation ( both from her and later, from our mutual friend Blu, who filled in many a detail about what the past 8+ years have been like for her), I became pretty vehement about perhaps seeking out another opinion. Personally, I felt her doctor didn't know what to do with her anymore, and was reaching her limits, and instead of referring A. to someone else ( as docs are loath to do), she was just piling script on top of script, and putting A.'s health in jeopardy. A. had already stated that she liked her doctor, but she felt like crying over the thought of going back in there and arguing about sleep again, and also mentioned that the psychiatrist and her pain specialist were NOT communicating with each other. I told her that there were many strategies to solve the sleep issue, but the most recent combination of drugs that the doctor had prescribed simply wasn't something I'd ever seen done before, was at best redundant, and, indicated to me that her doc was, in my words, "asleep at the wheel".

Now, we all post our opinions on this board, some more eloquently than others, some more pointedly than others and some more demurring than others, and sometimes, we argue. It usually doesn't last long. I've known most of these women for 5 years now ( save A., who's new to me) and I can pretty much guess where they will fall on either side of a line. Even Toxigal. Still, she threw me for a loop today when she wrote:

again, despite it's name, Gabapentin is NOT a GABA drug. it does not exert it's effect at the GABA receptor.

i think it's great to help a. advocate for her own health, but she has repeatedly said she likes her doctor. she does have to be careful and make sure she is taking everything as prescribed (and she said she is very careful about that), but calling her doctor reckless? really? you just don't have the education to back that up.

i'm not trying to be snooty, really, i'm not, you do have a lot of experience in navigating the system and i think you can offer a lot of help in that regard, but you really need to think twice before calling someone who went to school a helluva lot longer than both of us (a's doctor) irresponsible because you think there's something wrong with prescribing two antidepressants and two benzos (which is extremely common).

i don't think doctors are perfect, and i think they can make mistakes. i think it's wise to help a. understand what she is taking and where problems may lie but please, get your facts straight first.

OH, NO YOU DIDN'T, SISTER. My response:

Gabapentin (Which I take, BTW), is NOT a GABA drug? I guess I'll have to explain that to my psychiatrist, who explained it TO ME that it was. Hm.

Your attempts to NOT be snooty have failed here. No, I don't have an MD on the wall, but I want you to know that I've been navigating this system since I was 19 years old. And I'm not someone who is your average consumer, I'm someone who obsessively researches things in medical libraries (prior to the internet) and in the Physician's Desk Reference ( why, yes, I DO understand how to read the information there- I did manage to take Statistics, and can read a study upside down and backwards). Now I do research online, and my casual conversations with my doctor now ( and with prior doctors) have NOT been on the level of a layperson for YEARS. My doc says to ME, "You know what your options are, I don't have to tell YOU anything, so you tell ME." The man was a boy genius who graduated Notre Dame, UCLA and USC, who invented an Alzheimer's drug in his 30s and is one of the richest doctors in LA. He gets all the patients who are resistant to treatment, and resultingly, is the go-to man in Los Angeles for OTHER docs to talk to. I don't think he's humoring me, as he doesn't particularly have time for that.

My ex, Jack, the psychiatric social worker, has come home countless times ( STILL) and called me and said, "I have a patient who's diagnosed as q, is taking x, y, z, he's acting like g, and the doctor is prescribing d. What do you think?" This is the same man who exhorted me to go back to school and go do what he does, because he thinks I'm better at it than him. He doesn't have time to humor me, either.

In addition to that, I've been privvy to countless hours of anecdotal information, in groups, and in hospital settings. Yes, it's not "scientific", but we all know that when enough reports are made that are anecdotal, it eventually becomes "official" as a side -effect, or a notation. There's plenty of information out there in the form of millions of patients walking around and their experiences. Just because that information isn't on paper somewhere, doesn't mean it's less valid. It's idiosyncratic, yes. But it is valuable nonetheless, TO the patient, TO the doctor treating them, and TO the quality of life they are going to have.

As for me getting my facts straight, the thing is, YOU do not practice medicine either, Toxigal. You are a forensic toxicologist. Yes, you have a Ph.D and spend more time talking with MDs every day than I ever will in my life. However, you deal with dead people and are in a lab all day ( or wherever) and are NOT in the offices or homes of people TAKING these medications. You do not SEE them alive and functioning, or trying to function, on a regular basis. You do not sit there with a prescription pad trying to figure out what to give to someone when they're convinced aliens are landing in their bedroom.

I may not know the EXACT and precise mechanisms of the receptor sites, while you do, but I can tell you I know the basic way the drug acts in the body, its side-effects, both anecdotal and reported, and the class of drugs it comes from, the dangers with one drug + another, and the practice of how things are prescribed, (which I have spent more days doing than I suspect you have in your life). I also have formed opinions about all of it ( like, for example, two benzos + gabapentin + oxycodone, or two antidepressants vs. one) that is highly informed. That isn't neccessarily "facts" or the minutae of science, to which I leave people like you, but it is NOT, and I repeat NOT, NOT, NOT, ignorance. It's the human side of medicine, (which, btw, is why they call it an "art" and NOT a "science"), which I would argue you know very, very little about.

So, you might want to think twice about how much certain people know without a piece of paper to back it up. There are plenty of examples of parents who have chronically or severely ill children who eventually know just as much as the doctors do about options and treatments. Did you ever see "Lorenzo's Oil"? Consider that.

Consider also that YOU said yourself you see patients all the time like her, and they're dead. Well, I think that's telling as well. The fact that she likes her doctor and so forth has no bearing on whether or not she's getting any better, or functioning properly. The fact that certain things are prescribed all the time together or in a certain combination does NOT make it right, helpful, or beneficial to the overall life of the patient. If I've seen that one time, I've seen that A THOUSAND times.

Also consider that Psychiatry is a science that has JUST come into its own in the last 25 years , really. Prior to that they were fooling around in the dark with meds that barely worked and treatments that were at best, totally ineffectual. We still don't know the long-term effects or have longitudinal studies on at LEAST 30% of the meds used commonly today, because it just hasn't BEEN that long. I'm not saying that we shouldn't use them because of that; I'm merely saying that what's done in practice currently is merely standard of practice for NOW. It's not written in stone, no matter how many early studies have been done! So the information you're getting as feedback from the patients and the people who have been walking it for the last 20 years is some of the most valuable information there is.

Lastly, I see A. as needing an advocate. Sometimes mental health patients need one, usually in the form of.....guess what? A psychiatric social worker! Unfortunately, our system is radically overtaxed and overflowing with people just like her who are on a plethora of meds, floating around managed care with docs that don't have time to talk to each other, with no assistance in really keeping it all on track from a professional or a friend, even. So, if you are worried about my advice as a non-specialist, then consider me the very, very informed friend who is trying to help her naviagate the mess when she's feeling too poorly to do it herself. I can't see you having a problem with that, but if you do, frankly, I don't care. I trust myself implicitly, and so do countless friends, relatives, group members and others. I don't need your approval about Psych Patient Treatment: Standards and Practices just because you have a series of letters after your name.

This is as defensive and as pissed off as I wanna get over this with you. I'm going to drop it now, because I don't want to stress out A., or fight with you. I stand behind it, end of story.

And then I hit "ignore this user" on my account because I knew she couldn't back off of it after that no matter WHAT, and I was too hopping freaking mad to even listen to her anymore. I logged out, and then I went to FB, where her status update was "Toxigal doesn't hesitiate to throw the Ph.D down when she needs to." I about had a seizure, and I swear, had Blu not been home to take my call, I'd have had to be pulled off of the woman physically, even though Toxigal lives in Philidelphia. ( FWIW, Blu listened to the whole thing and said, "What do you want? This is the same woman who claimed Chantix was safe for public use because the studies said so,and meanwhile, you and I both had people in our lives going psychotic from it, and other people were already dead from related suicides. The FDA put a warning on it for that very reason a year later, and did she recant? No. Because SHE'S RIGHT, SCIENCE is right, and that's the end of it. " I said, "And isn't it funny that all that, even after the release of the drug into the market, was consdered ANECDOTAL evidence? And now it's on the freakin' BOX. Feh.") The thing is, it's her own field, and she KNOWS how it works- how things that are just labeled "idiosyncratic" often end up as being notated in journals SHE READS. What she doesn't seem to give any credence to is the HUMAN experience that got them there. Presumably because, well....what do they know? OR whatever. Feh!!!

Fembot. The woman is a Fembot. *sigh*.

But as with all things, my day came back to the place it started: when I was on FB, I noticed my old school pal Shirl shooting some love to "Nicki and her family", which would be MC's little sister and his family, too. And I just KNEW, in that moment, what my horrible feeling was earlier in the day: it was something that I had been actually anticipating all summer, and somehow inexplicably certain was going to happen this year. As a matter of fact, when my friend Lori had a family member suddenly pass away about a month ago, I not only a.) had flowers already picked out because I was on some level, prepared, and b.) thought that maybe I had confused HER family death with the one I had thought it was going to be, which was that of MC's dad. ( With some hesitancy, I emailed Shirl and asked what was up, explaining my weird feeling. She was gracious enough to tell me the news. She also didn't even blink at my having had the weird precognition. I've known her for 23 years; I guess it's not surprising to her anymore....).

How I feel about it all can best be summed up in my response to her:


Thank you for letting me know.

I haven't spoken to MC since we broke up and have no inclination to, as even before this, I did not think it would be good for either of us. In light of the cicumstances, I feel doubly that this would be true- I can't see the merit of a recent, painful breakup ex-girlfriend intruding during such a difficult time. That would the height of selfishness.

However, I do care for the family and for MC's feelings at this time, as I am sure they are all quite stricken, and all recent events aside, they are good people who are deserving of support. I did get to enjoy Darell's (MC's dad) company in the time I got to spend with him. So, for those reasons and in consideration of proper etiquette, I would like to send flowers to the funeral home.

I feel that would be appropriate, and not require a response from the family in any way should they not want to even send a generic thank you note when all is said and done. I do not know how any of them, including MC, perceive me at this time, and it's not neccessary to. My main goal is to offer condolences with the least amount of disruption and upset possible.

I'm explaining all of this to you because you are my friend, and as their friend as well, I want to reassure you that I intend no inappropriateness. I am also letting you know because I have a favor to ask: If you do not feel it is out of bounds to let me know where the funeral is being held, when you do know, I would ask you that favor. If this makes you uncomfortable in any way, I will just ask my mother to keep an eye out for a formal announcement.

Thanks for understanding my weird intuition. Maybe I should go into psychic hotline biz.....uh, no.

Thanks, Shirl.

She was very kind, and said:

Jessica ~

I, of course, see no inappropriateness in wishing to offer your condolences. I will certainly let you know when I find out about the arrangements. I believe Herr will be handling things, and as of seven or so tonight it looked like visitation would be Wednesday with a Thursday funeral. But I will confirm this with you when I have the definate arrangements.

Will update you soon,

I considered both options: to send flowers or not send flowers. My concern was that, well, I DON'T know how they're thinking of me right now, so I don't want to upset them by inserting even the most basic of gestures into a difficult time. I also don't want to seem heartless. I also don't neccessarily want or need to hear from him now, or at any time in the near future, which this risks. I talked it out with Blu and with Jeannie, and my consensus was that, as far as my understanding goes, from his perception, MY perception would be that we are on peaceful if distant terms. But even if he really does hate me or they all do, the worst it will get is an eye roll and that's it, since they likely have many, many other things to concern themselves with. And as far that goes, they'll have plenty of eye-rolling moments anyway, dealing with annoying distant family. My contribution will be small, tastefull, as inconspicuous as possible and likely, harmless.

My other consideration was to fully examine my own agenda, which really only came down to what I said to Shirl. Frankly, I'd rather not hear from them/him at all, but if a thank you note came as a matter of course I wouldn't freak. I'd move on and leave it at that. So I'd prefer to err on the side of polite condolences and good ex gf behavior than not, as that is my style anyway.

And my FB status tonight? "Jessica is apparently channelling Alice Cullen, after all." Unfortunately, as it was about a death of someone's parent, it naturally- and appropriately- takes the ego shine right off of it. Very sad. :(