Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Sunday, January 10, 2010

The post that wrote itself

So last night was about my feelings/shock/sadness for Dr. Brain. I could go on, because this is hard to cope with. I meant to say a few more sentences, but I obviously need to talk about this, so here goes.

Dr. Brain is more than a doctor. She is one of the people I trust the most, someone I've literally trusted with my life many times. She is also the person in my life not related to me who I have known the longest, internet friend who I've not physically seen in years, aside. Almost 7 years now. That may not seem like much, but my life and knowing people has been a bit different. I grew up in a small town where I knew everyone for the first 18 years of my life, but when I left there I really left, and I don't know anyone from that time. I was in touch with someone from school for a while this summer, and that kind of seems to have blown over. Then in college I was so extremely depressed in the last 2 years that I effectively lost all my friendships without meaning to. People were friendly but few stayed in touch after graduation and that tapered off quickly. I haven't talked to anyone from grad school since graduation; my growing bipolarness the last year of grad school really isolated me and it didn't take long to have no real relationships there, especially since our last semester we were only together for like 3 hours/week. And work relationships haven't exactly been my best thing; I talk to one ex-co-worker occasionally, but that's about it. And thanks to being so sick I just haven't developed relationships outside of work. So, in order, I have my family who obviously hae known me my whole life; my one college year friend who I email with who has known me a long time, like too long to do the math right now (this is the same person from my email about quitting last week); Dr. Brain; Dr. Body; and Dr. Mind, and a bunch of short-term relationships. Dr. Mind is about to meet a big milestone; in March he'll have treated me longer than anyone else. I'm sure it's already more sessions than the other long-term therapists, but this will be the longest time period too. But Dr. Brain has been my doctor since May 2003 and was involved with my care since June 2002 as she supervised my therapist, something that she was very involved in because my therapist had minimal experience with bipolar patients. And the goal was always for her to become my doctor; she wasn't my doctor sooner only because I was in a 6 month clinical trial. At the end of the trial, even though it had long been discussed that she'd be my doctor, things were very complex and I needed a doctor who could commit to monthly visits and being available as needed. She agreed to tack me onto the end of her schedule at a time when the rest of the practice would be closed, as long as my therapist assured her I was not dangerous. When I met her I was very nervous; I'd had a great experience in the clinical trial and would have loved to continue with that doctor, which he offered except my insurance didn't cover him. I'd had bad experiences with every previous psychiatrist until the trial, and so I was very wary. She won a great deal of my trust when she started to give me a test I have given many, many times and I stopped her and told her I had the answers memorized. Rather than act like this was remotely a challenge she just made up her own version. She was the first person to test my cognition in a way that showed me without her saying that I had cognitive issues. (Could not name the vice-president was one; I remember how horrified I was at that, but it made me realize there were reasons I had trouble with some things).

I remember the first time I realized exactly how different she was from my prior doctors. The doctor I had for nearly a year prior to the clinical trial, the one who saw me for 8 minutes per month and would write that I was doing great, just a little depressed, when I was somewhat suicidal, when I couldn't eat or even bother to put on pajamas before crawling into bed every night, had barely ever bothered to return calls. The only one she did return was after I had spent 2 solid days crying after my "friend" decided to try to test exactly how suicidal I really was, and then all she did was prescribe ativan. Which helped, but she didn't assess ever how sick I really was.

I had a really hard time back then making myself call for help. I didn't do it alone; I did it when I was pushed by a friend. Sometime in the first months of seeing her I called her and left a message. I expected to either hear nothing or to have message from a secretary. Instead, at 10 PM my phone rang and it was her in person. That continued; she always called back. Eventually she got email access for her practice and then I was/still do, able to email her directly. Which I've done many, many times over the years. And she's taken time to respond, even sometimes just to offer encouragement when she could have ignored something that wasn't medical.

When my sister got married I was in the midst of starting Risperdal. It had been helping at a super low dose (I had to start extremely carefully because I'd been on 2 other antipsychotics and had very bad reactions to both, one of which puts me at risk for recurrence of that reaction, so all antipsychotics are treated with care and we tried to avoid them. I was already depressed, I was coping with the loss of my favorite patient ever, a man who had no family and who I'm sure I'm about the only person who still remembers him, and my sister's bridesmaids and my sister (who was just stressed and taking it out on me as she had her whole life until then) were rather mean. One of the bridesmaids kept pushing me around and getting mad at me for being different than they were. My sister was mad because I didn't wear as much makeup or what I wore was too subtle or something. Everything I said or did was wrong, and I wound up absolutely humiliated because my very shaky hands from high dose lithium made me spill a few drops of Pepsi. To me I was used to that and typically just would wipe it up and go on, but apparently my doing everything wrong all day long was too much for one of the bridesmaids, who grabbed my can from me and poured me my drink. They told me what to do, got mad at me for not doing things as they said, and were generally angry at my personality, which is more quiet. (Keep in mind also that I hadn't been a bridesmaid until a week before the wedding when one dropped out and didn't want to be but felt obligated. I also was having without realizing it a massively bad reaction to Risperdal with enormous amounts of swelling and a dangerously high blood pressure, but that wasn't discovered for a week, and that it had gone on so long wasn't understood until the wedding pictures came back and I was extremely puffy. Guess what pictures I hate seeing now?) After the wedding I called her answering machine and left a long, tearful message telling her I needed more meds asap, that it had been awful and I was miserable and that I thought my relationship with my sister was probably over forever which would just add to my depression. She was in immediate contact with me, extremely sympathethic and caring. That next 6 months was dreadful as I tried to figure out my family and went on and off of many, many meds trying to get my blood pressure under control. (Finally putting me on a BP med was Dr. Body's first act as my physician). That year Christmas was an unbearable thought. She called me Christmas Eve to be sure I was ok. (She's Jewish so it's not like she was in the midst of a party or anything, but still....).

She has continually gone out of her way for me. She's fought insurance so many times I can't count, right down to telling my disability case manager in front of me once that the disability company was making things so much harder for me that if they didn't stop throwing random obstacles at the case (once something was denied because she wrote outside the box because she was out of space) that she'd be forced to keep me off work significantly longer due to my inability to handle the stress they were causing. That time she also called HR at my company to let them know that they had the worst disability insurance she'd ever dealt with. Another time a med was denied by my insurance. She faxed them every single day until they approved it, which a notation that said "for life" because they didn't want to deal with her anymore. She's spent a minimum of an hour per month with me, often longer, sometimes 2 plus hours. She's missed precisely one month in the almost 7 years, and that was for her mastectomy.

When she came back to work after her surgery I had been taken off the patch until she approved it because of my rash when I was sick. I had left a desperate message as had Dr. Mind. I was the first patient call she returned.

Basically, this is someone who really cares about me, and I care a lot about her. I cannot imagine having another doctor. In fact, another doctor would be very difficult for me as she makes a huge effort to see me without disrupting my work schedule since my visits are so frequent. But mostly it's because she is a doctor who makes sure I know she cares about, even loves me. And that is a precious thing.

This is so far from what I started to write tonight, but there it is. I guess I feel no separation from this as I would have with so many doctors/therapists in my past. This is someone I care deeply about who is going through something awful. And right now that matters more than anything else, including the things I was going to say about what she thinks of my current status/response to Emsam, the fact I exposed her to a cold that may be a very bad one given my exposure to 2 people who had what may have been influenza (which I kind of hope since they're better now and I have had the shot for both kinds) or might just have been bad colds. Whatever it is, it is not what she needs with a weak immune system. Nor is it even important that my BRAND NEW FURNACE BROKE (in caps because I'm mad; did not need this) and the repair people haven't called back and it's freezing in here and my furnace is only 7 weeks old and I want to go to bed and instead have to wait for them to fix it.

1 comment:

Michal Ann said...

Interesting: the word verification code is "likerso"---yes, you like her so!

Your doctor is wonderful. I can imagine how attached you've become. You've had a long and intense time together. It certainly does sound like she loves you. She likes to support you with great care and generosity. Her work is a great part of her reason for living and you are especially important to her.

I detected in your last note that you feel a responsibility to be a "good" patient and to ease her stress. I'm sure you'll do all you can within the difficult "chemistry" adjustments but please please don't feel in any way responsible for your dear doctor. She knows how to draw healthy and necessary boundaries but she "writes outside the check boxes" for you because she cares for you in a special way. Yes, you're that special to those who have the privilege to know you and understand your challenges. Continue being that blessing. Your heart goes out to her as hers has gone out to you. God hears your prayers and I am joining you.

Proverbs 3: 5-8

Trust in the LORD with all your heart
And do not lean on your own understanding.

In all your ways acknowledge Him,
And He will make your paths straight

Do not be wise in your own eyes;
Fear the LORD and turn away from evil.

It will be healing to your body
And refreshment to your bones.