Egoless

If you want a lover
I'll do anything you ask me to
And if you want another kind of love
I'll wear a mask for you
If you want a partner
Take my hand
Or if you want to strike me down in anger
Here I stand
I'm your man
-- Leonard Cohen

I have worn the People-Pleasing Mask, maybe the same thing as the Society-Pleasing Mask, for so long that it has become my primary mask. It has also become second nature to try on masks that others wear to see the world from their perspectives. For example: a bit of research and bang I become, temporarily, a hardcore pro-lifer. A bit more research and bang I become a hardcore pro-choicer. So when I hear, say, a pro choice proponent say, "I just can't understand how anyone can be pro life...", I think that is odd because I find it easy to understand and often sympathize with all sides and their nuances.

When I began developing ideas for a blog I thought of writing as if I were genderless (and attempt to write as bias-less, more on that later) because I have done just that when playing online multiplayer games where people from all walks of life role-play as characters in online worlds created by programmers. It fascinated me when other players would fixate on determining whether I was biologically male or female in real life -- frequently others would conclude if I played aggressively then I must be male but if I played diplomatically I must be female. And this is in the era where most gamers are familiar with sayings like "The Internet: where men are men, women are women, and little girls are FBI agents."

Transcranial Magnetic Stimulation (TMS)

So next time you're in a jungle fight
And you feel the presence near
Or hear a voice that in your mind will lie
Just be thankful that you're not alone
-- Stan Ridgway

TMS tweaks electricity in a person's brain. This causes short-term activity in the brain that has been shown to have longer-term effects in some people. The goal is to decrease troublesome symptoms when the proper parts of the brain are tweaked. That's the summary of how TMS can treat illnesses like major depressive disorder.

In a bit more detail, Transcranial Magnetic Stimulation (TMS, which may also abbreviate the devices "Transcranial Magnetic Stimulators" which provide said stimulation) is a noninvasive way to have neurons fire (or not fire) more (or less) in the targeted region of the brain. It is noninvasive in that the magnetic fields are started outside of the body by a device, typically stationary in a psychiatrist's office, with part of it held to the patient's head. The magnetic fields are directed to pass through hair, skin, skull, etc, then up to several centimeters into the brain without the complications normally associated with electricity contacting the body or invasive anesthesia/surgery. In the brain the magnetic fields "work" on the neurons. How magnetic fields have an influence on neurons and the nervous system in the short-term requires a fair amount of electromagnetism and biochemistry and that, while fascinating, I will not attempt to delve into in this post. How doing this over and over can help some people for weeks or longer after TMS treatments are concluded is a matter of continuing study.

Ketamine Experience Part 5 of 5

So I ask again
Am I so alone and full of pride
To never speak out
This is my world, this is my world
Don't tell me now
I won't feel those words, I won't feel the lies they tell
Can you hear my scream
It's for everyone, for everyone
I am so afraid of living in oblivion
I am so afraid of living in oblivion

-- Anything Box

In Part 4 I continued my "report" to my patient advocate. It continues as shift change begins...

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I bided my time until shift change from day to night, watching more of the dark-themed Criminal Minds marathon. I overheard my nurse on a few occasions say in a joking tone that if she seemed mean it was hormones from being pregnant. Standing in my sock feet with the blanket around my shoulders/arms, I made my way to the middle of the nurse station and eavesdropped during the shift change. I learned that the census at shift change was equal to the number of inpatient rooms (the rooms had giant sequential numbers painted on them). If the names on the cards next to the doors were still accurate, some of the rooms had two patients in them. I was then approached by a night nurse who asked if I needed help, taking initiative I had seen no day shift nurse take. I said I wanted some help but I was waiting until after shift change. She introduced herself and asked me my name and I responded. She said that she was my night nurse and had time to help me now if she could. I practically wept as no one had treated me with such kindness since arriving at the facility. I told her that I had requested with day nurses/doctors that I be put in my own room and that I was leaving first thing in the morning and promised I would not make a mess. She went to a computer to see what she could do.

Ketamine Experience Part 4 of 5

TV, is it the reflector or the director, does it imitate us or do we imitate it
Because a child watches 1500 murders before he's 12 years old
And we wonder why we've created a Jason generation
That learns to laugh rather than to abhor the horror
TV is the place where armchair generals and quarterbacks
Can experience first hand
The excitement of video warfare as the theme song is sung in the background
Sugar sweet sitcoms that leave us with a bad actor taste
While pop stars metamorphosize into soda pop stars
You saw the video, you heard the soundtrack, well now go buy the soft drink
Well the only cola that I support
Would be a Union C.O.L.A., cost of living allowance
On television, the drug of the nation
Breedin' ignorance and feedin' radiation
On television, the drug of the nation
Breedin' ignorance and feedin' radiation

-- The Disposable Heroes of Hiphoprisy

In Part 3 I continued my "report" to my patient advocate. It continues after being prepared for my first slow-and-steady dose of ketamine...

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The Ketamine pump was started for my infusion. The infusion was pleasant and after an hour or so of observation someone brought me some juice, the first food/drink I had had since midnight. I was also offered a blanket which I accepted and wrapped over my shoulders and around my bare arms since I suspected it would still be cold down in the inpatient area. Hard to say when but I was escorted in a wheelchair down to eat my lunch at a table by myself near the TV. I transferred myself from wheelchair to table as my nurse heated my main plate up then I made the meal last for an hour. A Criminal Minds marathon was on the TV and remained on for hours. Note the TV remained on through every meal I witnessed even though my nurse said the rules were the TV had to be off during meals. During this time I saw multiple patients (not visitors, I kept tabs on every one there and could determine who the visitors were when they left) texting on phones and tablets while the nurses/techs seemed oblivious. Also there was one patient who was allowed to keep her shoelaces – I know she was not discharged Monday night because she came and talked to me at breakfast the next morning, wearing her laced shoes each time I saw her. The message received from all this: we have rules, no you can’t have a copy of them, ask if you want to do something, we will threaten you with rule enforcement sometimes, and we are just here until shift change – cue me sounding like a broken record: not confidence-inspiring.

Ketamine Experience Part 3 of 5

Don't worry about a thing
'Cause every little thing gonna be all right
Singin' don't worry about a thing
'Cause every little thing gonna be all right
-- Bob Marley

In Part 2 I continued my "report" to my patient advocate. It continues after being left alone with nothing to do...

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Eventually Male Doctor 2 (in training?) sat down with me and asked if I had any questions. I asked what was the next step for my treatment since the morning talk show that the nurses had increased the volume for on the TV was growing increasingly inane (I question the value of gossip about celebrities in general, this goes double for people with mental health issues severe enough to be inpatient). Most of his answers were vague but eventually he decided to speak to me in private so we went into my room. He roused my sleepy roommate and asked for him to step outside to give us privacy and my roommate left. I do not recall how many times I asked to have my own room but I made sure every doctor and most nurses heard my request and each time I tried to explain the importance of my request without breaking down in tears – I am actually curious how many of these requests were actually recorded in my chart (a couple doctors told me “off the record” that I might have better luck with my request with the night shift). First I asked if there was anything I could say that would keep me as an inpatient past tomorrow morning and he indicated probably not unless they thought I was a threat to myself or others. So I spilled my guts about everything except my passive suicidal thoughts – I needed help but I knew that the longer I was inpatient there, the more depressed and anxious I would get. I cannot underscore how backwards this situation was – I was there trying to do what was right for my mental health but the deck was so stacked against me and I felt my months of planning and therapy leading up to this were not just wasted but being ruined by the most unhealthy environment I have ever been in.

Ketamine Experience Part 2 of 5

And they're coming to take me away ha ha
They're coming to take me away ho ho he he ha ha
To the happy home with trees and flowers and chirping birds and basket weavers
Who sit and smile and twiddle their thumbs and toes
They're coming to take me away ha ha
-- Napoleon XIV

In Part 1 I provided some background and began my "report" to my patient advocate. It continues after I had voluntarily checked into a psych hospital...

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The admissions woman eventually found a way to get to the inpatient area, punched in codes at a couple different doors, and before I was inside a minute a tech (I think she was a tech as she was wearing a different color than what I understand nurses wear) asked if the small bag I was carrying had my stuff in it. I said yes then she looked in my bag to find my prescription bottles, a tube of lip balm, and a cord to charge my mobile phone. She brusquely said that she needed to take all of this from me, and my shoelaces, as a safety precaution. Before I could ask what the policy was for getting access to it, she was walking away with my bag. I then noticed the admissions woman had disappeared with no introductions, never mind handoff. Quite panicked at this point, I told the nurses/techs at the nurse station that I was confused and needed help. Different women at the station tried to calm me down in condescending tones asking what the matter was, what did I want. My wife was with me and saw that I was panicked but she knew the only thing that would help me calm down was information, not condescending questions. I continued to express myself as best as my sweaty, anxious, baffled self could.

Ketamine Experience Part 1 of 5

You can't hide the pain
I can see it scrawled on your empty face
And I feel the hurts
It's in the words you say, they make me want to
Scream out to the world
For taking life for granted and I know
You are by my side
When I turn to hear you cry
I am so afraid of living in oblivion
I am so afraid of living in oblivion
-- Anything Box

In terms of this blog, I don't know how important it is to say I am male but it is somewhat important for context in this long blog entry. I wrote much of this entry in order to present it to the contact assigned to me as a patient advocate for the healthcare company through which I arranged to try ketamine infusions as a depression treatment. I first read it to my assigned patient advocate then I provided the full document to help investigations into my experiences. Identifying details have been obscured in this version.

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I am generally easy-going. I am not litigious. I am not looking for apologies. I am seeking clarity and understanding. I want healthcare professionals with the power to address concerns up to and including culture change to hear what happened to me. I am aware that verbal memory is not perfect so I do not have a lot of verbatim quotes from healthcare staff but this is an honest account of how things appeared to me, a sick and desperate patient, regarding the Ketamine program. I know I am expecting a lot to ask that you put yourself in my shoes as you read this.