New Yorker 2011A few weeks ago, we discovered that a now-former employee skimmed $3300+ from the practice in cash co-pays between January and April. The betrayal of trust was devastating.  Looking back, there were warning signs. But I didn’t see what I saw. I— my mind, not my real Self— didn’t want to. 

What normal person expects such behavior? Why would she do that? It’s so self-defeating. Why is she like that? It makes no sense. Why? Why? Asking why leads only to an infinite loop of whys. Which doesn’t help you regain your equilibrium, make you feel better, or help you figure out what to do. 

Four in a hundred people lack a conscience and most of them blend in. Sooner or later, into each life, a sociopath must fall. My mind denied, but my body knew. It sent me signals of unease and mistrust, then waited for me to catch up and accept it. 

Accepting reality, not understanding it, is what helps. Why? (Ha.) Because: Acceptance clarifies, leading to right action. I wrote up a summary of the evidence, drove to the police station and pressed charges.

The axis of the world tilted back into place. Eating lunch washed the bad taste from my mouth. I felt like a watered plant packing for my Mother’s Day gift from Hubby and Son: a writing weekend at Rowe with Dan Gediman of the NPR radio series, This I Believe. What do I believe? For starters: Trust, but verify. Ha. What else do I believe? I couldn’t wait to find out. 

The phone rang. It was Rowe: Dan Gediman cancelled. Despondency swamped me. I needed to get away, to chew on something nutritious, to recharge.  “If you’d like to transfer to another workshop, we’ll give you a $100 discount on the tuition,” Rowe said. I liked. 

I signed up for Awakening Your True Voice, with Jean McClelland. OMG. What have I done?

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.

1. dementia
2. depression
3. 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. 

For the past week, I’ve reveled in the simple pleasures of being home: eating fresh food, 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...