Friday, February 28, 2014

This is me

I'm staring down the bottle of pills sitting next to me. It's seemingly innocuous. Transparent orange bottle, light blue lid. A label on it that has my name, the pharmacy information, and the dosage instruction. Its the word in between  that terrifies me: Escitalopram.

After 27 years of fighting my battles on my own, I am being told the burden is too much, and it's time to accept some (chemical) help.

It's been a crazy journey to this point. Over the past 6 months I have had an ever increasing number of physical symptoms that caused concern. They started out so mild I didn't feel the need to mention them to anyone: headaches, slight dizziness at times, feeling shaky when my blood sugar was low, more difficulty sleeping than usual. Each time I had a logical explanation for the origin of every discomfort. Over time though the symptoms increased in both number and severity, and I found myself keeping my mouth shut not out of disregard, but rather the opposite: mounting fear that the symptoms had a more malignant root. Blinding, stabbing headaches, numbness in my extremities, frequent colds that never seemed to quite go away, the sound of blood rushing in my ears at all time, chronic fatigue, gastrointestinal pains, irregular menstrual bleeding, true insomnia. I dealt with it all silently and singularly; terrified of what an investigation would reveal, denying the problems.

WebMD became my worst enemy and my sense of isolation grew as I realized exactly how easy it was to keep these problems a secret from my friends and family. With the majority of my social network now residing outside of South Florida, there were very people I saw face to face on a regular basis, frequently enough that they could pick up that something was not right. At a time when I needed to be reaching out, it was all too easy to retreat into my own self-imposed sequester, and the more I pretended things were ok, the easier it became to hide it from those who cared.

That all came to a halt back in January when on a day off (thank God!), I had such a severe bout of vertigo that I was left essentially immobile for at least an hour or two. The dizziness, lack of orientation, inability to keep any food down, and the pounding in my head forced me to accept the truth that something wasn't right. It wasn't going away. It wasn't getting better. It was time to get help. So I picked up the phone and made my yearly appointment, and then promptly called a few close friends. I can tell you those conversations were not fun. By the end I was beginning every one with "Ok, please don't yell at me because I already know I screwed up by keeping this a secret, but here's what's been going on". But just as I always knew would happen: they were all there for me. Loving me, scolding me, refusing to let me retreat again. Promising to support me no matter what the tests showed. We would face this together.

One unfortunate consequence of working in a medical profession is the internalization of constant exposure to 'rare' diseases. 99% of the time a headache is just a headache. An upset stomach is just an upset stomach. Leg pain is just a strained muscle. However, the majority of what I see is that 1% of the time when it does turn out to be epilepsy, or Crohns disease, or cancer. Needless to say, while I knew my problems would most likely be explained by something easy, the severity and frequency of my symptoms (combined with a pretty frightening family history of disorders) had me on edge. We drew blood for a battery of tests, yet one question stuck out to me when we were done:

"Would you say you are stressed?"

"I mean... I guess so, but actually a lot less so than I have been at other points in my life. Especially compared to a year or so ago, I'm definitely a lot more calm."

"I have to ask though, if everything comes back negative,  are you willing to talk about going on a medication for anxiety?"

"I mean I'm willing to consider anything..."

The question took me aback. Obviously I knew stress could play a factor, but compared to last year with my grandfather's diagnosis/treatment, Lilly's passing, and my friends leaving; or two years ago with moving to a strange new city, financial troubles, and my car engine exploding on me in the middle of traffic; or three years ago when I was waist deep in grad school stress, thesis writing, certification exams, and my internship-- my stress level was actually quite manageable. I looked around my life, and had trouble identifying any particular part that was becoming more than I could handle.

My sleep disturbance have been in existence since I was young; as a baby I had difficulty regulating to normal sleep patterns and as a toddler/preschooler I remember my parents bribing me to at least lay down and pretend to be quiet (Even if I didn't sleep) at nap times. Anxiety and stress have plagued me as long as I can remember; my parents joke they never had to tell me to do well in school or bribe me for good grades, I took all those tasks on myself!  And no one ever needed to scold me, because I was my own worst critic. One small mistake, and I could chastise myself better than anyone!

This is just me, who I've always been, and most likely will always be: slightly high strung, perfectionist, emotionally sensitive, and perceptive. Surely without obvious external stressors, there was no way that for the first time in my life my anxiety was truly too high for me to manage on my own. I was ready to dismiss the whole thing.

My perspective changed, though, over the next two weeks as I waited for the results. During that time I was blessed with the opportunity to chaperone three of my teenage patients on a national trip to New Orleans. We spent the time with other individuals from around the country, eating more food than I could have imagined possible, visiting all kinds of amazing sites, exploring the city with a police escort at our side, and having once in a life time experiences such as kissing an alligator in the bayou and riding on a Mardi Gras Parade float. I can't remember the last time I had so much fun, and felt so free. Suddenly, in coming back to my regular life, I became aware of how heavy the burden of stress and anxiety was weighing down on me.

There's a saying that the only way to boil a frog alive is to turn up the heat gradually. If you throw a frog into water that is already boiling, he will jump right out. However, if you put him in a lukewarm pot and slowly raise the temperature one degree at a time, he will never notice the difference and eventually will be consumed by the heat. (I bet you can see where I am going with this). Certain parts of my life had become that pot. The stress level had risen so gradually (and I had adjusted as needed) that I hadn't even noticed the extreme degree to which it had reached. My anxiety felt second nature, and it wasn't until I left the pot, cooled off in a nurturing environment, and then tried to jump right back in where I had left off, that I realized how unbearable my life had become. How low my motivation had dropped.

So when the tests results all came back negative (except for a few minor ones that are easily fixed), it became obvious that the next step in managing my symptoms was with medication.

Which brings us to tonight, and the insidious bottle of pills still staring back at me.

Part of the fear is rational:

Medications come with side effects. Anxiety medications, in addition to the normal physical ailments, can actually cause your stress and anxiety to become WORSE at first until the chemical levels even out. The idea that I could be potentially making a problem worse without a guarantee that things will get better, is terrifying, particularly when up til now I have been able to manage them on my own.

And part of the fear is slightly irrational:

I'm afraid it won't work. I'm worried that  I will have all the horrific side effects attributed to this medication, and in return experience no relief from the stress of my daily life. But even more than that, I'm afraid the medication will change who I am. As I stated before, I have always been a slightly high strung individual, it's part of who I am. It may lead to some problems, but it also defines some of my best qualities. My attention to detail, my creativity, my compassion for others: it all walks hand in hand with my sensitivity to the dynamics around me. I worry about not being me. People keep trying to reassure me of their friends or family members went on medication and "felt like a whole new person", or "finally became the person they wanted to be". But here's the thing... I like who I am. I may be stressed at times, and I might be intense, a bit high maintenance, and highly sensitive. but This is Me.  The good and the bad, the intensity and the severity, the emotional and the irrational, this is me. I don't want to be anyone else.

And furthermore, ultimately Im afraid that in the event it does work... and it DOES change who I am... that people will like this "new Bethany" better. That I will be faced with choosing between being myself, and being who everyone else prefers me being.

The logical side of myself clearly can tell that the above irrational, worried, and anxiety-ridden thoughts are exactly why I should be going on a medication in the first place.  The fact that trying a simple pill has me in a complete frenzy is exhibit A for why a little help is necessary. But the emotional, irrational, personal side is afraid of being silenced. Ultimately though, something has to give, and I know I can't continue to live the way I have for the past 6 months.

So I'll give it a try. My doctor set an appointment for one month from now, after eliciting a promise for me that I will push through any potential side effects (unless truly debilitating or medically unsafe), and give the medication a chance to work. I, in turn, requested guarantees from my family and friends that they will monitor my behavior and be honest about what they observe. My dad flat out assured me that in the event that he feels I am no longer the Bethany he loves and cherishes, he will support me in getting off the medication (apparently discontinuing it is even worse than going on it!).

So we're trying, starting tonight. And I appreciate your prayers moving forward.

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Thanks for taking this journey with me! I always love to hear your thoughts and promise to respond whenever possible.