Blogging For Books #4: Insanity

My entry in this month's Bloging for Books contest held by The Zero Boss:



Blogging for Books #4: Insanity (Guest Author: Jennifer Margulis PhD.)
We all encounter adversity in our lives. Once in a while, however, a crisis comes along that tests our ability to bounce back; we wonder whether this will be "it", the apocalyptic event that shatters our dreams and leaves us battered and broken. In most cases, however, we manage to dig deep enough to pull ourselves back up and emerge, if not better people, than at least less neurotic than we used to be.
For this Blogging for Books, write about a time you were pushed to the brink of insanity (figuratively or literally), and how you lived to tell the tale.
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Perhaps it was a bad sign that he never made eye contact. I suppose I should have noticed, and it is the sort of thing I take extra care to notice now. I was too young, in too much pain, and too grateful to be admitted to the pain clinic to find fault.

"Let’s try dolobid," Dr. B said to my patient file.
"Does that mix OK with pamelor?" I asked.

Dr. B raised an eyebrow and flipped through pages. "Pamelor…? Pamelor… a tricylcic? Yes, yes, that’s fine. Hmm. I don’t see depression listed on your intake sheet."

"No, I don’t take it for depression. It’s for panic disorder."

"Hmm. Yes. Well…" Clearing his throat, he left the room.

I smiled. Dr. B’s social awkwardness was endearing, conjuring images of him in college staying in and studying while his roommate went out to parties. I had met a lot of doctors in the past five years, some were charmers and some were scientists. Dr. B was the doctor I knew I needed, a scientist bookworm with an interest in pain management.

Looking down at my breakfast tray, I winced. Cereal and milk, whole wheat toast, scrambled eggs, and herbal tea. It looked good and that was going to be a half-hour struggle at least. Holding my head in both hands I sat up carefully and leaned both elbows on the tray. Letting go of my head with my right hand, I could see the jitters in my vision before I felt the involuntary nodding and shaking. Steadying my chin in my left hand, I cut a small piece of egg with my fork. After a week in the pain clinic, going to physical therapy twice a day, I could open my mouth wide enough for this fluffy piece of egg on a fork to fit between my teeth. On my list of things I will never take for granted again, I added, ‘deliver a forkful of food to my tongue.’ I found myself relaxed and happy. The last time I went through this, the pain was just as severe, but not knowing what was happening to me was the worst part. This time Dr. B and I had a handle on it.

"It’s an idiopathic injury, an A. A. subluxation," Dr. B told me.

"Subluxation? Vertebrae are out of place?" I asked.

"Yes. In your history I see you subluxed at C4-C5, but that is your cervical spine. This is located at your topmost vertebra."

"So, that’s why my head feels like it’s falling off."

"In part. Then there is the associated myofascial pain…"

"What’s ‘idiopathic?’"

"…attendant nerve inflammation… Hmm? Ah, ‘idiopathic’ means ‘without known cause.’"

"But if you don’t know what caused it, how can you treat it? I mean, what if all these muscle spasms are trying to protect something?"

Dr. B reached down and patted my leg twice. I pictured him learning this exact gesture in a class on bedside manner. "You just focus on the program."

With that, he left me to my day of physical therapy, biofeedback training, nutrition counseling, and blood tests. My pain had become a full time job. Exhausted, I crawled into bed and fell asleep. The nurse woke me with my dinner tray and a tiny white cup with a single pill.

"What’s this?" I asked.

"Dolobid," she said. "It’s an anti-inflammatory."

I took the pill and ate half my dinner before falling into a dreamless sleep.


One of the first classes at the clinic teaches how to rank our pain. A "1" is barely there, more of an annoyance. A "4" is livable, but hurtful, like an average headache. A "7" is where people trying their best not to take medication finally give in and take something. A "10" is the worst pain we can imagine. The woman with no knees gave her pain a 6. She told me in physical therapy that they were shattered in a car accident and she had to strengthen her leg muscles before she could get artificial knees. I was amazed to watch her get around very well with two crutches. The other patient I saw regularly was a woman with very short hair and an orange tint to her skin. While it was obvious she hated physical therapy, she came in every day. She was an outpatient, having put in a full eight weeks as an inpatient after a vitamin A overdose. She nearly died and lost all of her hair and eyelashes. She ranked her pain a 9, but I wondered if some of that was ego, her belief that other people would not handle what she had gone through as well as she believed she had. I found it hard to rate my pain. Sometimes, sitting quietly with my head braced, it was like a 4 or even a 3. Other times, it hit 8 or 9, during physical therapy when they insisted I turn my head to the side, or in unguarded moments if I moved to look at something with my head instead of just with my eyes. Even throwing up at physical therapy I refused to rate my pain a 10. I always believed it could be worse.

With my eyes still closed, my mind fighting to return to sleep, my first impression was pure white pain. I openned my eyes to the dimly lit room. I struggled to sit up, soaked strands of hair clinging to my face like seaweed at low tide. My hands shook as I raised them to brace my head. Oh my G-d, I moan to myself. Then, No! I think, don’t give in. OK, I thought. OK. This sucks, but I’m in the hospital, and if evil bad pain is going to happen, this is the best place to be. Using my biofeedback lessons, I tried to lengthen my shallow breaths. Was that weird raspy sound there before? Soaked and dehydrated, I eased my way to the bathroom to splash water on my face. My mirror image startled me. I looked sunburned, the pain drawing little white lines from the corners of my squinted eyes. Without moving my head an inch, I brought a cupped hand of water to my lips and discovered that my jaw had clamped shut. Nooooooooo! My mind wailed. I struggled not to sob, mostly out of fear of clogging up my nose. I climbed back into bed and rang for the nurse.

Time took on an elastic quality, as it does for me in a crisis. When I remember breaking my arm as a child, I see it in slow motion. This night in the pain clinic crept forward like a drunken snail. Muscles cramped and spasmed throughout my body. "Picture your safe place," the biofeedback teacher said in my mind, "and go there." Mine was the little house I built on the bank of the Jordan River. I had stood on that spot once and dipped my toes in. The river was cold. In my hospital bed, I shivered. Where was the nurse?

The hallway was deserted. Even the nurses’ station at one end was empty. A few hours ago I had stood there joking with the nurses on shift. Now the station seemed so far away, the hall impossibly long. My best plan, I decided, was to sit in my doorway, so I could flag down the first person I see. That person turned out to be a kewpie doll of a nurse, with huge blue eyes and blond ringlets. She looked about eighteen.

"I need… you… to call… the doctor," I said carefully through my clenched teeth.

"Oh. They don’t like us to do that unless it’s an emergency," she said, her expression dripping with sympathy.

Pain and frustration squeezed out of my tear ducts. "This… is… an… emergency!"

She pulled a tissue from her pocket and blotted my face. "The doctor really can’t help you with a spiritual crisis."

Spiritual crisis? What the hell was she talking about? "What?" I asked, trying to will away the urge to swat her hand off my face.

"Doctor made it clear you have an anxiety disorder." She shook her head sadly, tsk tsk, poor patient.

"I want you… to listen," I said. "This… is not anxiety. This... is a… drug reaction. Call the doctor. Now."

The nurse sighed and cocked her head. "OK, but he won’t like it."

An hour later when Doctor B came, it was nearly time for breakfast rounds. "I see you had a bad night," he said, reading the night nurse’s chart notes.

My whole body hummed with ache and fatigue. "Bad reaction," I said.

"Hmm…" he said, "I don’t see anything here that would cause a reaction like you describe. Have you been experiencing any stress lately?"

"Other than the bad drug reaction? No."

"I see here you had a lot of pain with muscle spasms last night."

"Yes."

"That’s what the dolobid is for, you know. It helps with muscle spasms."

Mustering up as much determination as I could I said, "I won’t take any more dolobid."

Tapping the chart with his pen, Dr. B frowned at me, then left the room.



At dinner that night, there was a small white cup with a single pill in it.

"What’s this?" I asked the nurse.

Reading from my chart, she said, "Diflunisal."

"What’s it do?" I asked.

"It takes down swelling, helps with muscles spasms."

"Sounds about right," I said and grinned at her. She grinned back and left the room.



When the pain woke me this time it was familiar. "Oh G-d." I groaned to myself, "not again!" I looked at my hands. They were shaking. I touched my face. Wet and warm. No! No! No no no no no! Sitting up I discovered the pain was worse than the previous night. Muscles not yet recovered from yesterday’s strain were being forced to dance and twitch and cramp again. I rang for the nurse. Remembering last night’s empty hallway, I imagined no one would come. What if Dr. B was right? What if this wasn’t a drug reaction? What if this was some horrible new problem I would have to live with?

A nurse poked her head in the door. "You rang?"

"I need… the doctor…" I rasped between sobs, "and… something… for pain. Please… knock me out… I can’t…" A muscle in the back of my neck twisted, jerking my head back and pulling my loose vertebra sharply to one side.

The next thing I knew, the nurse was standing over me with her fingers pressed against my wrist. "Hang in there, honey. The doctor’s on his way."

I visited my little mental house on the Jordan River. I rocked in the chair on the porch to a slow, steady beat, hoping my body would slow and calm. Sometimes all anyone can do is breathe in and breathe out and wait for things to get better.

Dr. B arrived looking rumpled and concerned. His head moved up and down and he read the nurse’s notes in my chart.

"I think this drug must be related to dolobid," I said. "The whole group of them maybe doesn’t agree with me."

Dr. B frowned. "There’s no documentation for a reaction like this to dolobid."

"Well I had one. Plus another one to this new drug."

"That was also dolobid."

"What?"

"There isn’t a single instance listed…" he stammered. "You seem to be the first."

"And the second, " I said. I looked at his face. He looked nervous. "You didn’t believe me," I said, thunderstruck. "You decided I was having a panic attack, so you re-prescribed me the same drug?"

He winced. "I wanted you to realize that it wasn’t the drug."

"Except it was."

We looked at each other for a long moment. It was the only time he ever looked me in the face.

"I don’t think I can work with you anymore," I told him and ended our relationship.