I blasted Celine Dion's "I'm Alive" as I drove to work. My eyes filled with tears and my smile stretched ear to ear.  I have many things to be thankful for, but quite simply, I was just happy to be alive.
They asked me how I felt approaching forty.
"I feel good! I feel the same, and now I will just worry about turning fifty. When I'm fifty, I'm sure I'll just worry about sixty..."
I expressed some of my fears about the intense speed at which time was passing by. 
"I figure I'll probably live until I'm about ninety-five, and it occurred to me that I'm close to approaching the halfway mark. That worries me a little," I said.
I'm afraid of only a few things...snakes, getting pooped on by birds, watching a scary movie (and my husband falling asleep), and death.
I try to convince myself that reincarnation does indeed exist, but deep down I'm not so comfortable with that either. I don't want to take on a different body or be born in some small depressed tumbleweed town, or worse. My kids and I talk about what animals we'd choose to be if we could...a family of birds on a wire, dolphins, and and usually something small and cute. As convincing as I try to be, to ease their own fears of death, I lack conviction. The idea of any loved one leaving this life really scares me.

"After we die, we go to heaven when Jesus comes back to make our earth new again. He takes us to heaven and we are all angels (all white angels with white robes according to my children's Bible)," she told me.
I pictured the pretty white gates covered in pearls, fluffy white clouds filled with smiling angels, and wondered where we would go to the bathroom.
"You won't need to go to the bathroom because you don't even need to eat," she said.
Because I was a kid that cared more about playing then eating, she appeased me for a bit.
"Will we live in a house with our family...and what about sleep? Will we not need to sleep either," I asked.
"You won't need to sleep, and you won't even have the same family that you have now really. Jesus will be our new Father, and everyone will be your family. Everyone will be brothers and sisters," she replied.

"WHAT?!" I was terrified.
I wished she had never said that and I could just go back imagining all the white stuff, harps, and happiness.
A life in which my family didn't look at me with the same set of eyes was just about as frightening as the story I heard the week before that made me think my parents were going to burn in hell for getting a divorce.

I sang the songs, listened with an open heart, and sat quietly and respectfully. Yet, I was filled with just as much fear as I was with joy. 
As I grew older, I sifted through the information a bit differently. My concrete mind morphed into something a bit more poetic and comforting. I came to the conclusion pretty early on that living this life to the fullest was the best way to not be so preoccupied with the hereafter.
Here I am, almost forty years full, and I don't feel near done. A hundred more years doesn't even seem sufficient (but very very wrinkled). 
My dad would tell me that my grandma kept saying she's "ready to go."
She was eighty-three.
Will I feel like that when I am eighty-three? Will I ever grow so tired of this life I am ready to close the curtain?

When Chris and I were living in an apartment in San Diego, we would be woken up almost every morning with Pearl Jam's "Alive" blasting through speakers below us. While Chris loves the sweet sounds of Eddie Vedder, he didn't want to love them before eight in the morning. She was in her early twenties and she lived alone. She was the daughter of the landlord, and moved in one day without either of us really noticing. We quickly knew we had a new neighbor and quickly realize it wasn't a coincidence that the same song played with intensity every morning around the same time. She was just out of rehab, and I never knew much more to the story. As curious as I was, it didn't matter. She was happy to be Alive after what she had faced, and she was ready to start anew. We would be irritated some mornings, but Chris and I never stewed too long over it. We both saw the underlining beauty in our morning disturbance. I think both of us looked slightly inward to find a bit of appreciation even though we never spoke of it. I never really saw her face, that I can remember, but I will never forget her.

I have had patients say they wished they would just go to sleep and not wake up again.
I am able to somewhat empathize and understand their persistent sadness, but I always find it hard to wrap my head around suicide. Sometimes I find myself almost whispering the word due to its unsettling implication. 
I think about how horrible their path in life must be to want it to end far too early.

My eyes fill with tears when I think about how grateful I am to be Alive and healthy, but also because I don't have to know what that kind of sadness feels like. I am lucky enough to cry happy tears over songs, parades and shooting stars. I am able to cry through my struggles, but keep hope through the process.

This Thanksgiving I am Thankful for Life and the chances I get to make other Lives better. 

Every time I sat down to type out my thoughts I'd think, "how can I put all of these thoughts into any kind of organized or concise post?" I have been anything but uninspired, quite the opposite really. Most often I have so many opinions that I struggle to keep them to myself. It's like bottled up laughter in a quiet church..."Must. Keep. It. In."

I figured I'd stick with the most reoccurring theme as of lately.

I work with patients that are desperate to just be "normal," whatever that is. They don't want to live with chronic pain their whole life. They simply want get up and go to work in the morning like everyone else. For some, it's waking up every morning with debilitating anxiety and depression thick as fog.
"Why is it so hard to just be normal," she asked.

I asked Siri to give me the definition of normal, and she responded, "conforming to a standard; usual, typical or expected."
Even though I secretly hoped she'd respond with something clever, I felt satisfied with the expected answer.

I became curious as I often do. Standards change do they not? The 'typical' or 'usual' can change in less then a decade, or even a year!
The new Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, added new diagnostic codes for Binge Eating and Hourding, among others.
A Binge Eating Diagnosis can be applied if a person eats to excess 12 times in 3 months.
I became more curious...and hungry.
Who decided where to set the baseline and limitations?

{I immediately pictured a room full of old white men}

What exactly is "excess?" I suppose it's somewhere along the lines of eating even though you're full.
Does that include snacking when you're bored?
How about when I'm at Disneyland and I have but one day to enjoy the most delicious popcorn on the planet and a mandatory Dole Whip soon after that dish of Mexican food by Thunder Mountain? I'm pretty sure that "Excess Day" counts for double on my watch.
Show me a person that drives through Taco Bell and orders one item within proper calorie range.
The dirt-cheap tallys are almost yelling at you to order more...just because spending $1.29 on lunch seems wrong. I am practically harassed to add on a bag full of value items.

Isn't most of America overweight?
Despite our attempts and slow progression toward cutting back calories and portion sizes, aren't we still way over the mark with 500 calorie frappes and "Buy-one-get-ones?"

I digress.

However eager some people are to assign themselves a diagnosis, there are many that fret over baseline deviation. They perceive their friends and family around them as "normal," and I'd venture to say we have social media to blame for most of it.

We should all know by now that social media sites beg us to post cute and funny anecdotes because let's be real, nobody wants to see your mundane posts about PMS, traffic jams, or what you and your husband argued about last night.
It reminds of me of Barbie commercials when I was a kid. She moved gracefully down the pink slide atop her glittery RV right into the front seat of her shiny Camero. Her shoes slipped on with ease, her hair blew perfectly in the wind, and they could even make it really look like Ken was kissing her...with tongue.
As soon as my Barbie left her box, her hair was knotted somewhere, I couldn't get those tiny shoes on, and her arms couldn't even bend to hug Ken let alone slip him the tongue.

I don't deny anyone's pain, and I don't ignore their depression or anxiety, but perhaps, for just a moment let us really reflect on how challenging this world can be...for all of us. Most of us are just one more day of excess eating away from a diagnosis.
I'd really go out on a limb (cause if you know me you know I like to do that) and suggest that some diagnosis code can be applied to each one of us.
I'm pretty sure I diagnosed myself with plantar fasciitis, sacroiliits, and Trump-supporter-itis just this last year.
Im sure my husband has a few others for me.

You are not alone. People all around you are lying in their bed at night running through and prioritizing their list of troubles. Finding out we are not alone can sometimes be another kind of therapy.

​


Disclaimer: Sometimes pills are good and sometimes pills are bad, but don't let a talkative nurse on some blog be your decision maker.

Dedicated to: That disappointing friend with more than slight deviation from any baseline. Thank you for helping me grow.

An angry ignorant woman yelled at me before the sun had even crept into the sky. I was a nurse out to torture patients, hold them down and stick them with the biggest needle.
She didn't know me.
I wasn't offended.
I knew she cared about her friend. Her worry and frustrations about her friend's suffering left her angry.
She was angry at anyone and everyone that crossed her path.
I'll consider a Nurse Ratched costume for Halloween in her honor.

Within 90 days, we've been subjected to horrific stories of mass shootings, acts of racism without repercussion, cars speeding into brick walls, overdoses, fires, suicide attempts...when do we get to breath some unpolluted air?
How do we continue to look at the colors around us without painting them with cynicism?

I broke down in my driveway after a tiring day and a bout of bad news. Tears fell for my patient, and they fell for so many other suffering souls across the planet. They fell for my kids. One day they will hear their own stories of terror and pain, and they'll start to see the world differently.
They will be surrounded by a world filled with mental illness, addiction, racism and hatred.
I cannot shield them, and I cannot deny.
I can only hope that my husband and I provide them with the tools to cope and to do the right thing.

I sat at a funeral for one, and read the headlines of another and thought, "They were loved by somebody. Someone fought for them and lost." They are now a statistic, and they are now a wound that will form a scar.
They were good people. What happened?
It's depression and it's addiction. It's hatred and it's fear.
It's ugly and I'm tired.

Our society is perpetuating the very stories and scenarios we grieve about, and we don't really want to do anything to change it.
I've splattered different stories and emotions on this screen. They are all mixed up in my head waiting to be sorted out, and perhaps I thought writing them down would help.

The thing is, we can't wait for healing. There is another story developing, another person suffering, someone else driving way too fast, and another someone swallowing way too many pills.
​What will I do tomorrow to make a difference?

“Where’s that strap you were talking about?” 


The patient had fears and preconceived notions about what goes on in the ‘Shock Room.’ 
There isn’t a single day that I do not address a patient or family member’s fear of Electroconvulsive Therapy (ECT). I am constantly reminding them that I show up to work to help patients…not hurt them.
I do not fault their fear. In fact, I worry more about a patient that doesn’t ask questions or disclose reservations. 
The general population is concerned with any bad effects ECT might have on their brain…their personality, cognitive abilities or memory. They might even ask, “What’s the worst thing that can happen to me?” I hold back the urge to tell them, “Pee your pants. That is the worst thing that could happen to you.” How could I not think about my worst fear…peeing myself in front of my coworkers.
I run through statistics first and then try and paint a picture of a typical ECT patient and their experience…and a typical patient does not pee themselves.
A typical patient, does in fact, notice a difference within the first few treatments. The difference might not be significant, but it’s something…and they probably haven’t felt “something positive” in a long long time. They will probably plateau a bit before they reach the desired full treatment response. A full treatment response is different for everybody, but 90 percent of our patients get at least 50 percent better. You can’t buy results like that anywhere…and they definitely don’t come in pill form produced by Eli Lilly.
Patients are picking up their phone again, taking walks outside, getting back to work, going out with friends, and…smiling again. 
Despite the successes of ECT, the fears remain. My job is to help lessen them.
I will offer to walk them around the facility, show them our equipment, and if they’re lucky, I’ll even turn on “The Machine” for them. It’s mostly the men that are intrigued with “The Machine.” They can be so predictable. 
The typical response after seeing “The Machine” is, “That’s it?”
What were they expecting? Even if I try and get really creative I can’t come up with anything grotesque enough to match their perceptions.
I usually steer away from the icky details of the gel, the strap, and the two round cold metal plates that press against their head. This kind of paraphernalia puts odd images in one’s mind…and not the sexy kind of images…well, maybe a little.
People sign up for colonoscopy’s every day and no one gets shown the large scope and lubricant that goes up their rear. Sometimes the details are better left unseen.
The patient is asleep, comfortable, cared for, and always in good hands. The procedure lasts a few short minutes and most patients wake up asking, “It’s over? That’s it?”
That’s it. We do no harm and you still have your dignity, and better than that…you are going to feel so much better in just a few short weeks.
​

We would always spend several weeks during the summer in South Carolina visiting my grandma and family.
I remember the stifling summer heat, the humid night air filled with loud bugs right outside the window. As the fan would spin, I'd think, "this fan is doing absolutely nothing but pushing around hot sticky air...I'll never fall asleep."
Indeed, I fell asleep and woke to the clanging of pots and pans in the kitchen. Oh, please let that mean pancakes with grandma's handpicked blueberries.
We would eat breakfast and run down the dirt path to the dock before nine in the morning. Getting to the boat first meant claiming your favorite seat...mine was always at the very front. The speed of the boat through my hair felt like freedom, and every ripple in the water felt like adventure. We would stay out there for hours.
We skied with 2 skis, 1 ski, and sometimes no skis. We bounced on top of the glassy water in tubes and fished when we were tired. We knew every inch of that big lake with our eyes closed.
The sabbath slowed our pace a bit which usually meant I couldn't listen to my choice in music on the radio. We would stop and rest more, read more, and eat more. My dad would usually suggest we split off into two different boats.
One boat would go out for some ski runs and maybe come back early, and the other boat would go for some ski runs and take its rest time in a quiet cove filled with still water and peaceful drifting...a bit of booze for the adults, loud music and jumping off the side of the boat to pee.
Translation: One boat is going to that mansion in the sky and the other boat is going straight to hell! Which boat are you hopping on?!
I never hesitated for a second.
I was going on my dad's boat, and if that meant going to hell, well at least we'd go together.
I'd ski until my legs shook from weakness. I laid on the front of the boat covered in tanning oil and sang the Grease soundtrack out loud. We would stop in a quiet cove, my dad would sip a cocktail and we'd talk and laugh for hours. How could any part of this mean I was a hopeless sinner? We were enjoying the beauty of the outdoors, enjoying each other's company, and...we were good and happy people. I felt alive, strong and free. I remember thinking, "How could God frown upon this?"
This is my church...no judgement and no guilt...and no panty hose. Amen.

I've sat on my snowboard on top of the highest peak around and had those same thoughts...been swallowed up by the trees of Yosemite, and serenaded by the waves on the beach.
All gods are welcome.
There are no walls to these churches and no doors to push open.

Take me to that church any day of the week.

He lost his wife of 48 years about six months ago. "She had cancer. We survived the cancer, but it was her heart that finally gave out. She died in my arms," he told me. We survived the cancer, he said.

Jim and I found each other while walking our dogs one evening. Our dogs were desperate to sniff each other out, and he seemed eager to cross the street and chat. He told me about his wife within two minutes of our introduction. He was lonely and he was heartbroken. I touched his arm and I listened. His life would never be the same, and I wouldn't be surprised if he followed her within the year. He was pale and thin, and he needed a haircut. He probably hadn't cut it since she passed.

As we said goodbye, I pointed to my house and told him to knock on my door anytime. I asked where he lived so that I could pass his front door on my daily dog walks. Who still cared about him? I hoped he had children...grandchildren.

I walked home and thought about the "Lands of Life," you know, like the different Lands of Disney...Adventure Land, Tomorrow Land...What Land am I in now? I definitely lumped some of my "Lands" together starting "Baby Land" late in life...marriage, baby and new career Land...okay, okay baby came before marriage. I rebelled.

What's next, I wondered? I'm too young for "Everyone-is-Dying Land!"

I thought about my patients...in "Pain and Mental Health Land." How do I avoid suffering? How do I continue to cope with the adventures that life brings? I remind myself I have good parents. I have a loving husband. I have beautiful and healthy children. I wonder, is that always enough? It doesn't seem that way for some of my patients. Why not? Is it really okay to blame estrogen or testosterone...or the lack thereof?

I see the medication lists day after day...antidepressants, sleep aids, estrogen patches, testosterone injections, pain and anxiety pills. How do we continue to wake up in the morning despite our busy, sleep deprived and complicated lives and say, "I CHOOSE TO BE HAPPY!"

There isn't a book on the shelf, a diet to be found, or a therapist to help us...know what to do next.

Sometimes I think I have it all figured it out. You want the answers? Peek over to my desk. I quickly remember how easy it is to teach my patients, but how difficult it is to follow the lessons.

Becca told me, "my psychiatrist said, 'Remember! You are in charge of your own happiness! Then he muttered something about my foot in the past and another in the future...or was it my hand? Or stepping out of the past and looking at the future?'..." She didn't care. Save your hallmark card speech for someone else with the time and give me my drugs. If only a doctor could write a prescription for happiness...oh wait, they can. It's called disability.

It's easy to tell Jim, and everyone else, to choose happy each morning, but the trouble is...they don't always know how. I listen, and I remind them that everyone else they are watching around them also puts one foot in front of the other and they too are barely making it to their destinations.

Look for pieces of pleasure in the struggle. Struggling means fighting for freedom. You cannot be free without it.

{For Jim and for Becca: you are so much stronger than you know...others are watching}

I stretched out in the hammock under two palm trees after dark. I attempted to listen to his soothing voice through my ear buds, and take in the bounty of knowledge spewed at double speed. I drifted. I closed my eyes and tried to focus my attention, but I still drifted. Too many thoughts and emotions swirled in my head to concentrate. I was feeling defeated and misunderstood, frustrated and tired. When do I throw my hands in the air? Mercy.
I had no room in my head for stories of evolution when it was pounding with disappointment. What shall I do next? I'll try and meditate. I left the earbuds in with no sounds coming through. I'll block out the world. I'll figure out what to do next.


I'm reminded of my patient.
What was she like before she started to drift away?
What was she like on their wedding day...besides stunningly beautiful?
She is still gorgeous, but her sadness steals her beauty.
She feels defeat every single day that she wakes up. She stopped caring.
She would barely speak to me and didn't care to read the consent form. I read through it with her.
She paid the risks little attention because that would mean she actually cared about something.
I read on and asked her to sign at the bottom if she didn't have any questions. 
She signed quickly and hopped on the gurney. Get on with it, nurse.

I visited her bedside after she woke up from her second treatment. She was tired, but she was more awake then she had been in a long long time. She thanked me over and over again...she reached for my hand. 
She cared again.

Desperation is a funny thing. You will do anything. What do you have to lose?
The moment a patient starts to feel better, better than they have in years, they start to care. All that they want to fight for in life comes swimming back.
They start to have questions about their treatment. They become insightful. 
Sometimes they may even decide that ECT isn't for them...even though it saved them. The risks they didn't care to read in the beginning are now something they may fret over.
I don't mind. 
You know what that means? It means they are better. 
It means they are ready to fight. They want their life back, and we helped them get to that place.
It's beautiful.

In the treatment room, Doctor Jameela and I cheer and laugh. We are so happy for them. We are grateful for what we get to witness day after day. We also serve as each other's breath of fresh air from time to time. It can be such a sanctuary.
Doctor Joy calls it our Fiji. He is so right.
Our escape and their respite.There should be a hammock in there somewhere.

I opened my eyes, still laying in the hammock. The palm trees were blowing, and the night air was warm and seemed to say, "Life is good." 
It's so hard, but the joys in life wouldn't feel quite as rewarding if we didn't have to work for them.
I created my own Fiji. I instantly felt rested and relieved.
I knew what to do next.
I hope I always do.


To my Doctor Joy and Jameela: I never have to visit the island of Fiji as long as I have you.