When You’re Tired, Rest.
It’s been five weeks of brain drain: memory lapses, unproductive fretting, poor sleep and worst of all: poor flow of post ideas. Enough already.
Denial (No problem, it’ll go away by itself…) is no longer tenable. Time to do something. But… what?
Without knowing the cause of the problem, intervention is futile. So first: think. (Can we not, and say we did?)
What’s the differential diagnosis? Three possibles raise their hands.
dementia
depression
exhaustion
The first is unthinkable. So forget that. Ha. (Sorry.)
What about depression? (What about it?) I’ve had these symptoms for more than two weeks, which meets criteria for the diagnosis. Which justifies a trial of antidepressant. But that’s jumping ahead. (Damn skippy.)
Why? Because psychiatric diagnoses are diagnoses of exclusion. Meaning, all other medical causes for symptoms must first be ruled out and/or addressed. And that would be option number three: exhaustion.
Exhaustion and sleep deprivation are well known to derail cognition and snuff creativity. Have I made a serious effort to rest? Not really. It’s been business as usual: too much going on, not enough sleep, not enough down time.
To test the hypothesis that exhaustion is the cause of my symptoms and rest the cure, what I have to do is… rest. How?
I feel tired just thinking about the pace of my life. Doctor, heal thyself. So. What specifically am I over-doing?
Care-taking others: patients and family.
Administering: home and office.
It’s too much. Too many details. Too many decisions. Too many people pulling on me. From morning to night. Day after day. Etc.
Like Greta Garbo, I want to be alone.
The solution is obvious: I’ll play hooky! I’ll go to Omega for a weekend of R & R (Rest & Rejuvenation)! he he he
Two days later, I drive south to Rhinebeck. The first couple hours on the Northway cut through the ancient evergreen beauty of the Adirondack Park, a six million acre natural preserve. For a timeless hour, I enjoy.
Then orange traffic cones appear, and signs indicating a construction merge. I absent-mindedly barrel along and about a mile later, the left lane narrows into the right. I tap tap tap the brake in a controlled deceleration. A state trooper pulls out of a tangle of construction equipment, flashing his headlights at me.
I know immediately: the ticket won’t sting, it’ll gore.
I sigh, pull over on the verge, roll down the window on the passenger side and put both hands on the steering wheel.
“Good morning, ma’am,” says Mr. Trooper. He’s a young guy with a round face and a newish small red scar puckering his left cheek. “Do you know why I’ve pulled you over?”
I nod regretfully: “Didn’t slow down at the beginning of the construction zone.” He nods yes, and returns to his vehicle to check out my license and registration.
When he returns, I get a lecture (pay attention to signs in construction area, etc.) and a ticket. Not for a moving violation, but for being improperly stopped on the side of the highway. A parking ticket. He’s spared me four points, a heavy fine and an increase in my insurance premium.
“You are so kind! Thank you so much.” He smiles and walks back to his truck. The irony inherent in my grateful receipt of this random act of kindness does not escape me. The lawman lied and I thanked him for ticketing me.
Three hours later, close to Omega, my pager goes off. OMG! I forgot to give it to Hubby! I’m still on the leash! Fear (I really AM losing my mind. And I’m so young.) and anguish roil my stomach, clench me from jaw to toe. Even if the beeper doesn’t shriek again, it might. That will weigh me down all weekend. I sigh and pull off to return the page.
It’s the case manager for a patient with schizophrenia, admitted to the hospital five days ago. “Should I take Leslie for her IM haldol shot (an antipsychotic) today?”
I’m confused. “Isn’t she in the hospital?”
“No. They took her off all her risperidone (an antipsychotic), gave her a prescription for clozaril (another antipsychotic) and discharged her.”
Outrage electrifies me painfully, like I’ve touched a live fence. Such professional incompetence, not to mention bad manners, in combination with insurance mandated premature discharge, is all too common in my rural neck of the woods. Welcome to my world.
Let’s assume they took Leslie off all her risperidone the first day of admission. (Clinically inadvisable, but likely.) It takes approximately three weeks for antipsychotics to wash out. Now five days out, her drug blood level is down about a quarter.
While clozaril is a good medicine, it’s a total pain in the patootie. Patients are mandated by law to go for blood work every two weeks, a physician must OK the results, and only then can the prescription be filled. This protocol requires a patient be reliable, which Leslie is not. And, let’s not forget, she wasn’t even started on it. Just given a script.
Which means Leslie’s psychosis is un-medicated. What will be the consequence of this malpractice, if unchecked? Leslie will decompensate, probably into paranoia, auditory hallucinations, agitation and fear. On MY watch. Thanks for nothing! ASSholes. I breathe. Poor Leslie.
“I can’t thank you enough for paging. Yes, take her for her shot. When is she coming in to see me?”
“Next week. Do you want to restart her risperidone?” We plan for contingencies and sign off. I shake my head. Another irony. First I was mad I got paged, now I’m glad.
Find the frog!
After checking in at Omega, I hang out with the placid frogs sitting around the lily pond by the sanctuary. It is a beautiful tranquil place. The plash of the tiny fountain in the pond, the occasional plop! of a frog jumping into the water, or out of it onto a lily pad, the rising and falling drone of insects, all deeply soothe.
When the mosquitoes come out, I amble to the Wellness Center for a massage. Which hurts like hell, but it’s worth it. Tension releases from muscles. Joints stretch open. I leave a foot taller, relaxed and ready to do… nothing.
At dinner, I make a new friend, Phillipa. She’s an Aussie physician registered for a course. But really, like me, she’s here to rest. We laugh like dry drunks at the best of watering holes as we pinky-swear to resist the siren calls of myriad fascinating lectures, classes and offerings.
Saturday slips by. I take a dance class. I eat whole food lovingly prepared by others. I write in the cafe. Where I receive a text from Son: What’s my social security number?
I’ve only given it to him four times. What’s worse, I actually have it on me. (Note to self: practice being irresponsible.) Agita threatens. I look across the veranda of the cafe at a statue of the Buddha meditating (someone has given him a necklace of fresh flowers), breathe, and let it go.
I return to my room, text Son the number, then stretch out on the bed and read. Let my eyelids shutter out the afternoon sun and nap. I wake up refreshed, and still. It’s such a pleasant feeling, I return to my room after dinner for more, eschewing the dance concert.
Sunday, it rains slowly, a gentle patter against my parka, a low murmur in my ear: Take it easy... Don’t push sh sh… Go slow… No rush sh sh… Sh sh sh…