For the past week, I’ve reveled in the simple pleasures of being home: eating fresh, sleeping in my own bed, fearing for my life from Hurricane Irene. As dawn dissipates night, my state of usual mental health returns.  Which highlights how cognitively scrambled I was for the two weeks we traveled in the UK. How emotionally unstrung. How demented. From jet lag.

The discombobulation wasn’t as bad— but almost— as that on-call-night-from-hell when I was an intern. The first two years of residency training, I was on-call every third or fourth day, depending on the clinical rotation. Which meant a thirty-six hour shift, usually with no sleep, every three or four days. 

I had just finished admitting a patient to the floor from the E.R. It was 4:30 a.m. At 6:00, the regular workday started, leaving an hour-and-a-half to catch some zzz’s if, pleasepleaseplease, the pager didn’t go off.  I bolted from the desk to go to the call room and the pager went off. A sick feeling impossible to describe came over me. 

When the E.R. nurse told me the patient was 86 years old, a nursing home resident, febrile and delirious, I knew: urinary tract infection, blood culture, IV. I put my head down on the desk and sobbed, completely undone. Why? I had to calculate the osmolality of the IV fluid and could not call up the equation. It was gone. 

Maybe I fell asleep and dreamed this, but I left my body, rising up up up to look down from above on my sobbing self. As if watching a silent movie (because there was no sound), I observed my shoulders heave, the back of my head bobble on arms folded on the desk, my white-coated spine shake on the chair seat. And then, suddenly, I was back in my body, feeling the wet on my cheeks, hearing my sobs, and Hubby’s hand shaking my arm. Urgently.

“D?! What’s wrong?” I’m ordinarily stoic. To see me so fraught must have freaked him out. Hubby rotated through medicine at the same I did, on a different team. I lucked out we were both on call that night. If it had been anybody else, I couldn’t have confessed my shameful memory lapse.

He wrote down the equation on a torn strip of progress note paper, kept his arm around me while I composed myself, and sent me off with a hug when we parted. “You’re fine. You’re just sleep deprived.” Just sleep deprived. 

We take our complex cognitive faculties completely for granted. At least I do. Or did. Not any more. Respect is in order, for how tenuous these capacities are, how easily disrupted. I still can’t get over that I threw out thirty pounds— Sixty dollars!— worth of unused return train tickets. "Don't worry about it," Hubby said. "You were just jet lagged." Just jet lagged.

The tickets for the first leg of the excursion were in my wallet. I had zipped the returns in my passport holder with my passport. That’s the kind of thing I do to keep things organized. Foolproof. Until jet lag proved me a fool…. What are these doing in here? I asked myself and tossed those tickets in the trash, my mind blank. Inconceivable. But it happened. The switch powering my brain flipped off momentarily, inexplicably and without my awareness. 

The experience reminds me of a former elderly patient Leslie, may she rest in peace. Leslie suffered a lifetime of chronic depression refractory to treatment. Nothing I prescribed helped either. Therapy made her feel worse. Then she was diagnosed with renal failure, which worsened rapidly, and ultimately proved her demise. 

One day she came in and told me, “I’m rotting from the inside out.” What a horrible, depressive thought, I thought. Being younger and knowing more than I do now, I argued with her. “That’s the depression speaking.”

But she insisted she was describing concrete reality. “I know my brain is breaking down. I’ll tell you how,” she said grimly. “I took an absolutely necessary little gadget, my E-Z pour milk carton holder, and threw it out. Don’t know why.  Just did it. My mind was gone. Is gone. My milk holder is gone. My hands are too weak to hold the milk carton without it. ” She broke down, and wept. 

There are some things you can’t know until you’ve experienced them. I feel for Leslie in a way I couldn’t at the time. For now I have felt the terror. The terror of losing my mind.  Her brain breakdown was probably caused by uremia. Mine (mercifully) by transient jet lag. 

Hubby and I travelled for six weeks in Europe after we graduated med school. “Did I go through this then?” I asked him. He shook his head. That was twenty-five years ago. Apparently my brain just doesn’t roll with stress like it used to. Aging. It’s reality. 

Basic recommendations for minimizing jet lag include being fit and rested. I’m fit, but started the trip exhausted. I should have taken a week off to rest BEFORE the trip. Ha. Next time. 

Further recommendations include drinking lots of water during the flight (to counteract the dehydrating effect of conditioned cabin air), which I didn’t. And to avoid caffeine, which again, I didn’t. That lovely cup of coffee I drank as soon as I got off the plane cleared the fog completely. Within ten minutes, I was astonished to feel normal, possibly better than normal, albeit briefly. (Is this what crack addicts, alcoholics and junkies feel when they get their fix? I suspect so.) 

On the return flight I drank more water than I thought possible, and no coffee. That night in my own bed, I slept a sound and restful sleep, the first in two weeks. Bliss. 

PHOTO CREDIT: JL Mitch