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 David and Lorraine 

Here’s the thing about posting once a week: first you have to write something. No write, no post. Usually ideas ricochet around my head. Me! Me! Use Me! Not this week. Maybe they’re on vacation. Or sleeping in. Or on strike. 

OK. Let’s see. Hmmmm. Surely there’s more to milk from our trip to the UK. For instance. People there are so well spoken, so droll, so understated. The national ethos is reflected in business names and public notices. “Keep Edinburgh clean. Bin your trash!”

“I’m from the States. I’ve never seen “bin” used as a verb before!” I exclaim to the rain-coated older lady standing under the bus shelter with this exhortation running along the roof rim. She looks at me politely. Too politely. I smile broadly and tip my chin up at the writing above her head, then step back to point and shoot. 

She looks up. “Ah!” 

“Mind you,” she lilts in a beautiful Scots accent, with a twinkle in her eye. “There’s not a bin to be found anywhere up or down this street!” 

OK, good start. Now what?  

Nothing.  I want to grab my brain and shake it: Wake up! Ordinarily, the first idea ignites a second, which sparks a third, and so on, the writing rushing forward like a brush fire. I resist feeling discouraged. I must be patient. Receptive. Something will come.

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...

Today is the last day of our two-week trip in the U.K.  And it’s the first that I don’t feel like I was left in a pocket and run through the wash cycle. Jet lag. A wee problem, that. Son kept me company in this misery. Hubby wakened daily raring to go. Good he was nobbled by incipient arthritis of his hips, or we’d have killed him. 

Befogged from flying across the Atlantic instead of sleeping, we no sooner stepped off the plane than the problem solving that IS travel began. How to get from the airport to London (train). From the train station to the hotel (tube, or underground). In the tube, which line, and then which platform. All this while buffeted by surging and eddying crowds. 

My jangling ganglions stuck out at least a foot from my body. Hubby, bright eyed and bushy tailed, laughed at me. Shamed, I let him lead us onto the wrong train. 

Copernicus' seditiously suggests Earth is NOT the center of our solar system. Is that a twinkle in his eye?

“What’s your take on that Zoe?” friend Marsha asked me. We belong to the same CSA. She referred to a new member. 

“She’s OK, I guess. Haven’t talked to her.” 

“I think she’s snooty.” 

“You do?” 

“I smile, say hello, and get ignored. Who does she think she is?!”

“You think she’s snubbing you?” I was surprised. 

“What else?”

“Come on!” 

Marsha raised an eyebrow.

“When she looks down and scurries by me, I think: shy, depressed, or maybe she grew up wild in the woods, this is her first exposure to people.

Or, maybe she’s just preoccupied, thinking heavy thoughts.”  

“She’s rude,” Marsha insisted. 

I shrugged. “Anyone whose eyes land on mine, I greet. If they don’t greet me back, so what? I’ve been well mannered. I’ve stretched myself against my own shyness. I’ve met my own standard.” 

“One brush-off, I’m done.”

“Really?!” I was astonished. “You’ll never greet Zoe again?” 

“Nope.” She was astonished back. “You would?”

“Well, sure. I’m assuming she’s more insecure than I am. Plus, you know, maybe she’s just having a bad day. Or a bad year.”

I look at Marsha searchingly. “We all crave acknowledgment, don’t you think?  Especially if we’re shy. In fact, your hurt reaction proves my point!” 

“Hmph!”

Look at this! Same event, two utterly different reactions. And here’s the critical point: Each reaction yields its own plan of action. 

Let me whip out my shrink magnifying glass for a closer look.

Captain’s log, Starday Sunday afternoon…

I come to from a three-day migraine, convinced Son’s graduation barbeque and pool party is two weeks away.

“No, D, it’s next Sunday.”

The Twilight Zone theme floats around my head. Full work-week ahead. In-laws arriving Wednesday. Pool not opened. Fifty people coming. Nothing started. I want to EEEEEEKKKK! but can’t: too drained from the migraine.      

More proof that Murphy’s Law rules.  Whine? Roll with it? Whine.

Hubby and Son open the pool. Yuk. Disgusting. I sigh. I go on-line and order a huge fort float. Hoping for the best? No. Locking myself in to getting that water sparkling clean.

I ponder the menu and dash off the first of many to-do lists. I’m exhausted.

Hubby and Son promise they will do whatever I ask, without attitude. Really?

“Your command is like an order!” quips Hubby.

OK then. Forward march. 

THREE PART SECRET JUST REVEALED!!!

Got by you? Here it is, stripped down:

•  Keep a sense of humor.
•  Accept help.
•  Soldier on.

Simple in theory. But tough in the implementation. In other words, it's a spiritual practice. Sigh.

You can stop reading now if you want. That’s the gist.  If you're a glutton for detail, read on.

“You’re so busy! How do you do it?” I’m asked, not infrequently, about my writing process.

“With difficulty,” I usually quip. But, it got me thinking. How do I do it?  

It’s simple really, but not obvious.

It’s all about identifying your Modus Operandi (M.O.), your fundamental operating assumption(s).

By definition, we don’t question assumptions. Until…. 

One day, I noticed— very important, the act of noticing— that when I’m writing regularly, I am happy.

Yet— I also noticed— that I wrote only after taking the garbage out, at the end of the day when I was tired, or on edge that Son would interrupt my train of thought to ask for a ride. What’s up with that? I asked my self.

A-ha!  I wrote last, and then only with the dregs of the day’s energy. No energy left, no writing.  Sound familiar?

There it was, my self-defeating M.O., naked in the light of awareness. In a flash, I got it, and— Ciao baby!— committed to the new M.O.: