Showing posts with label medication. Show all posts
Showing posts with label medication. Show all posts

Friday, November 30, 2012

Why are doctors such a bunch of assholes?



This is the last day of November, which really should be the "cruellest month":  T. S. Eliot was obviously out of his poetic little mind to say it was April. This day is sort of special, and sort of not, because it has now been 22 years since I had a drink. I have to confess I was afraid to write about this before because I thought that, by some far-flung chance, a publisher might see this and conclude I was a drunken sot and completely unreliable. You can't write about your triumphs because they will do you in ever time.

But on to the topic of the day: otorhinolaryngology, or something like that. My problem goes back many months and still isn't resolved. In June of this year we had a very enjoyable week of holidays in San Francisco, but on the last day I started to feel not-so-good, achy and weak, as if I was about to get the flu.




On the plane home I didn't feel so hot either, but as we started to land, oh God. Both my ears began to shriek with pain, as if someone was driving screwdrivers into my head from both sides. It takes about 35 minutes to land a plane, from that first subtle feeling that you're dropping in altitude to the reassuring thud of wheels on the ground. So the agony went on and on and even increased. "Try swallowing," my husband said, as if it hadn't even occurred to me.  Try to patch a gaping war wound with a bandaid.

The really distressing thing is that I never did have that "pop" that indicates the pressure has been relieved. The pain went on for at least an hour after we landed. There is something truly excruciating about an earache, like a whistling icy wind blowing across a bad tooth. L'angoisse, as the French call it.






Feeling rotten and weak and sure I had the flu, I dragged myself into my doctor's office and left about a minute and a half later. She took out one of those ear thingies, looked in both ears and said, "They look fine." I mentioned flu and she said, "Oh, no, it's not flu (with a patronizing smile). It's just a summer cold."

Months went by. I was completely over my "summer cold", but alarming symptoms remained: every time I yawned or swallowed, there was a noise in my left ear, not the "crackle" described by medical web sites but cannon fire on the side of my head. I could not imagine going back to the doc and having her tell me "well, don't yawn or swallow then" (like the old joke: "Doctor, doctor, I have a terrible pain when I do this." "Well, don't DO that!"). Worse than that was a new symptom: whenever I talked, which I can hardly give up altogether, I heard a buzzy, distorted sound on the left side of my head, like an old speaker with a loose wire or a radio not tuned in quite right. This wasn't from the outside, obviously. It was the sound of my own voice feeding back inside my head. It was also very loud.




Months went by. It wasn't going away in spite of my doctor's instructions to hold my nose and blow. It was worse, in fact. I went to a walk-in clinic and saw another doctor who took out the ear thingie, looked in my ears and said, "They look fine." Then she sat there impassively until I left.

More months, more annoying racket in my head. I was SURE something was wrong in there, this COULD NOT be normal! I went back to that second doctor and she told me to hold my nose and blow, then  finally, with considerable arm-twisting from me, referred me to an ENT specialist in New Westminster, about an hour and a half drive from here.

After still more months of discomfort and cannon-fire, my appointment finally came up. I did not have a good feeling about it. I was pretty sure I would be dismissed again. When I entered the office, I was in a time warp. All the medical equipment seemed to go back to the 1950s, antiquated, as if it should be in the Smithsonian. I had to fill out one of those forms, and one question was about medication, so I wrote down what I was taking. It never occurred to me not to.


 


The doctor, an old impassive Iranian guy who looked like he never smiled, never once made eye contact with me and seemed both bored and annoyed. I told him about my symptoms. He looked inside my ears with that little ear thingie and said "they look fine". His assistant stuck a little rubber probe into each ear. The right side was OK; the left side was just excruciating. I tried to tell him about it and there was no response.

The hearing test was normal, which was both a relief (I don't want to be one of those "EH?" people) and distressing: I knew that if I could still hear, he would soon dismiss me.  As a matter of fact, I had better hearing than almost anyone else in my age group. I was not really surprised: when I'm under stress my hearing becomes so hypersensitive, I can hear a watch ticking across the room, loud enough to keep me awake at night.

Fine,  I have better-than-normal hearing. That means I can hear the cannons and buzzes much more clearly!

The doctor's bored look had hardened: his impassive face had turned to stone. With one last gasp, I tried to tell the doc about my annoying, even infuriating symptoms. He said I should hold my nose and blow, then sat there not looking at me. I kind of went, "Ummmm. . ." In an irritable tone, he said, "Everything is fine. You can go."





I had some thoughts after this big letdown. One, I am not a woman of childbearing years. Older women usually get short shrift because subconsciously, they are not perceived as being "productive" in their natural, God-given function of spewing out babies. Two, I made a terrible mistake in filling out the form: I was honest about the medications I am on.

I am not saying this is conscious - or maybe it is - but when he saw the word "lithium", I think he just crossed me off the list of people to be taken seriously. Lithium equals manic-depressive equals fruitcake/hypochondriac/delusional old bag.

Do you think I exaggerate? My first impulse is to be honest in almost every case. Of course there are a few exceptions, but mainly to spare people's feelings.




But have you ever noticed that with most people, a lie goes down much better than the truth? For one thing, a lie can be tailored any way you want. You can unmake and remake reality, bend it and soften it and take the sting out of it, or - best of all - make it so that it flatters the person you're lying to, even if he's a total asshole.  So , yes, yes, yes, we believe you because it's easier on us, the lie is much more palatable.  There are many advantages to this policy, and much more of it goes on than we consciously realize.

There are sub-categories, of course, including the lie of withholding information. This is the one I definitely should learn to practice, particularly with doctors, who are some of the most heartless human beings I have ever encountered. Don't tell me it's because *I* am being difficult. I bend over backwards to accomodate these bastards and they let me down almost every time.




Result: after 5 1/2 months, I still have the cannon-fire and the loose speaker-wire buzzing inside my head, and it's quite possible I will have this for the rest of my life. If you go from doctor to doctor, well, guess what that makes you? One of "those": meaning those crazy old ladies who are so lonely that they will feign illness to get any sort of attention.

I have no idea what to do now.




I deleted the last paragraph of this post because it was just too angry and bitter, though in my mind it contained some truths that badly need to be told. Trouble is, they're pretty unpalatable the way they are and need to be dressed up.  And I'm not too good at that. My attempts to be honest have gained me exactly nothing except a one-way ticket to that prominently-marked door in every medical office. The one with the four-letter word.


Wednesday, October 26, 2011

An almost normal life



A young woman sits in the waiting room of a psychiatrist’s office. She flips through old magazines full of celebrity diets and recipes for lavish desserts, uninterested.

“OK, Sandra, you can go in now.”



Into the throne room. The palace of no return. Or something like that. Since her bipolar diagnosis (and why is everyone suddenly bipolar? Wasn’t it multiple personality disorder a few years ago?), everything has been turned upside-down.




She is on five different medications, two of them to deal with side effects from the other three. These are (supposedly) working in tandem at relatively low levels which are (supposedly) easier on body and brain. Or at least that’s the theory, until the next one comes along.

“Sandra.”

“Dr. Turnstile.” (She has never quite gotten used to that name, which made her guffaw the first time she heard it.)

“So how are we doing these days.”

Not a question, but a statement, always in the plural.











“Oh, we’re. .  . just fine. But to tell you the truth, doctor, it could be better.”

“Feeling a touch of depression lately?” (He picks up his clipboard and begins to make notes.

“A touch. It’s been. . .I don’t know. Remember I told you about my brother?”

”The one who got married last year.”

“No, the other one. I mean. . .”

“Refresh my memory.”

“The one I’ve been talking about for the past five sessions.”



“I detect a note of irritability.” He makes another note.

“Yes, a note. He’s in jail now. Embezzlement. The guy is just too clever for his own good. He’s appealing, of course. I don’t mean that kind of appealing.”

“Explain.”

“Never mind, it’s just a lame joke.”

“So apart from your brother going to jail. . . “

“Oh, everything’s just hunky-dory.”




“I detect a note of sarcasm.”

“That’s because I’m lying. Everything isn’t hunky-dory. You remember my boy friend, Robert –“

“The accountant."

“Lawyer. We broke up. It was. . . I don’t know, pretty bad.”

“Are you taking your medication?

She blinks. “I wouldn’t dream of going off it.”




“Would you like me to raise the doseage on the Seroquel?”

"No.”

“The Lamotrigine?”

“No.”

“The lithium?”

“No.”



“Then let’s discuss non-medication-oriented strategies for managing the mild depression you seem to be experiencing right now.”

“Strategies.”

“Yes. You remember what I told you in our previous sessions. The principles of cognitive therapy indicate that feelings arise from thoughts. If thoughts are excessively negative, emotions will soon follow suit.”

“I always had a problem with that one.”

“Yes, I realize there has been some resistance to treatment. This must be overcome if you are to become truly well.”

Can I be truly well if I’m bipolar?”

“Not in the usual sense. But in a relative sense, as opposed to experiencing severe episodes, then it’s possible for someone with bipolar disorder to live an almost normal life."




“Almost normal. I see. So nut cases can only get so much better before they hit a wall.”

"Sandra, that is a completely irresponsible statement.”

“But I’m just sayin’. There’s only so far a bipolar can go. The chain is pretty short.”







“That’s why it is so imperative for you to adhere strictly to the principles of cognitive therapy.”

“You see, there’s where I can’t follow you. I find it hard to believe that every emotion is just an offshoot of a thought, and that every thought can be controlled.”

“Maybe not every thought. But people have more control than they think.”

“Do they now. Then I wonder why we even need medication.”




“Sandra, you know why. You have inherited a chemical imbalance of the brain which tends to trigger extreme mood swings, which in turn skews your thoughts toward the negative.”

“But the thoughts lead to the mood swings, don't they? I'm confused."

“There is no need to twist my words around."

“OK then, cognitive therapy. That means I’m supposed to reframe negative events – “

"Now you’re on the right track.”



“. . . Reframe negative events so that they become positive. Let’s see. So breaking up with Robert was really a good thing.”

“Yes, yes – continue – “

“No matter how much I loved him, I – I don’t know. I can’t think of anything.”

“How about this for an alternate hypothesis. There is a possibility that this breakup will free you to explore other possibilities. You’re young. There are other fish in the sea.”

“Other fish.”



“Maybe even better fish. Have you thought of that? And how about your brother? Can we shed a more positive light on his situation, which is, after all, self-created?"

“Oh, maybe he’ll turn his life around in jail. Have a religious conversion, write a book, marry some woman on the outside who’s willing to wait fifteen years until he gets out.”

“Again, the note of sarcasm.”

“Yeah, but I just can’t do this. This cognitive therapy, it implies we can control just about every thought, and thus every feeling that we have. We can just decide.”

“Yes, more than most people realize.”




“Isn’t this creating your own reality? Isn’t that what crazy people do?”

“Sandra, you are deliberately poking holes in the therapeutic process.”

“Poking holes. Doctor, I wish it were as simple as deciding how to feel.”

“But to a large extent, Sandra, it is. Cognitive therapy is, after all, the primary mode of treatment in modern therapeutic practice.”

"Then why have they stopped saying that about being gay?”




He looks disconcerted, puts down his clipboard.

“You know. They used to say being gay was something you could change if you just decided to. You know, made up your mind.”

“That was many years ago.” He shifts in his chair.

“In other words: yes, you might be attracted to men, but that’s a choice. You can choose something else, a girl in other words, any time you want to.”

“That’s very simplistic.” He is turning a shade of pink.




“But according to the principles of cognitive therapy, it should work. You should be able to change your feelings of attraction to men just by changing your thoughts. Am I right?”

”The DSM specifically states – “

“Forget the DSM. Say you’re gay. You want to be straight, or your mother wants you to be straight. Hell, let’s face it, even with the progress we’ve made, it’s still easier to be straight than gay. You don’t have to explain yourself all the time.  So, just change your thoughts about the subject and you won’t have those feelings any more! Think about girls instead. Finito. Problem solved.”

“We aren’t discussing sexual orientation now, Sandra.”

“Yes we are. Haven’t you been listening?”




Dr. Turnstile has the look of a fish sliding down a chute and landing helplessly in the ocean. It is imperative that they change the subject before he loses any more ground.

Sandra fixes him with her incandescent blue eyes.

“It just comes down to a decision. Am I right? But the thing is, doctor – you haven’t made that decision yet. Have you?”




A young woman sits in the waiting room of a psychiatrist’s office. She flips through an old magazine with screaming headlines about Lindsay Lohan’s latest arrest on the cover, bored.

“OK, Sandra, you can go in now.”




She tosses the magazine on the table, gets up from her chair and walks into Dr. Turnstile’s office.