Don't disregard the demons!

In retrospect, I suppose if had I written this entry even four days ago it would probably sound very different. I’m on the plane right now, 51 minutes from arriving in Auckland, New Zealand for a much-needed mental reprieve feeling all the excitement in the world. This elation and sense of accomplishment is a stark contrast to the weight I carried on my shoulders for the past two months. I have an implausible ability to completely compartmentalize things when I feel productivity may suffer or even one beat off balance. But, over my lifespan I have learned that this is likely more of less-mature coping mechanism that hasn't completely transitioned, rather than a formative tool enabling me to thrive. I know that, yet I haven’t worked to change this bulky part of my psychiatric functioning - until now. Even after my mother died at 15 years old, I didn't make the time to seek specialist advice or counseling for my grief. Well, that's a lie, I do remember meeting a woman at Smitty’s restaurant one evening and leaving, thinking (incorrectly) I could do a better job of dealing with my roller coaster of emotions that came with my mothers death than she could. Needless to say, this one interaction unfortunately turned me off greatly in my adolescence and early adulthood from talking to others, educated or not to discuss what happened in my childhood (which most certainly explains much of who I am today) or work to open this “jack-in –the-box” that continually presents itself. I use this term because every now and then the sleeping giant (the jack-in-the-box) pops up, out of nowhere and forces me to remain cognizant that there are a lot of buried elements of my soul requiring attention. There comes a time when I think we must embrace our weaknesses, in order to becoming stronger, more aware and grounded.

I was and continue to go through so much lability within my mental framework on a daily basis – stress, shock, fatigue, grief and above all a desire to deal with my limitless range of emotions yearning to be recognized. I went to a place of focus, of pure grit and temporarily, I purposefully isolated myself for the first time from others these past couple of months. I was aware of this compartment I had placed to the side and didn't devoid it of acknowledgement. Interestingly, this isolation felt natural for me; I’m typically a very social being who thrives on the presence of others and rarely, spends nights alone at home. I would have horrifying, haunting dream most nights these last couple of months, waking terrified they were true representations or a premonition of what was to come. Things at night got so frightening that I feared staying in my own house alone; here I am a 34 year old woman who couldn't make it through the night without being jolted from sleep with nightmares of having my clothes set out for my death, my partner leaving me or bad news being relayed in relation to my diagnosis. I realized over time that these recurring themes were some of the greatest fears that preoccupy my subconscious thoughts and mind, for which I didn't have the time to acknowledge. I had the insight to recognize and appreciate where these dreams were rooted, but I knew that I would have to suffer through this phase until I had my exams complete. I couldn't let anything get in the way of what I had set in my mind. Not even the zombified state I persisted in and continued to function. I was always just hoping that each night would be better than the last and that eventually as my stress reduced, as would these dreams. Fortunately, I have the most amazing network of people around who allowed me to stay at their homes over this time and my roommate who returned back from her out of town rotation.

When my patients used to come to me and tell me they had difficulty sleeping, I don't think I ever understood really what this meant. I mean, sure, we all have troubles falling to sleep sometimes. We wake, we turn, we worry about our troubles and try to stay on top of social media conveniently (and wrongly) just before bed. I could appreciate that a lack of sleep creates a cycle of ongoing fatigue and patterns repeating themselves. Back in medical school, actually, during my very first clinical rotation in anesthesia I began to have hallucinations that woke me from my sleep. I will never forget this phase of my life. I would wake from my sleep and the patients I had intubated or seen on the operating tables would be laying beside me, or standing over me. This carried on for a few months to the point I went to talk with my GP briefly about what was happening. She gave me some pills, I scoffed and threw them away, deciding I would figure it out, as usual. It wasn't in my dreams or part of my sleeping state and these people continued to prevail in my room, until I would turn on a light and leave the room. I thought I was losing my mind, in a sense I was. The middle of the night insomnia I was experiencing did lead to a great deal of stress for me at a time I was already leading a high stress life. Eventually, these went away but not until I addressed what was ruling a deeper level of my mind and really dug deep to think about this issue. The same is happening to me right now and though I don't fear my own death, I do fear what leads up to it. I don't fear hearing bad news, but I fear what it means for my family, my future and my hopes and dreams.

I can appreciate now what it means to not sleep for nights on end, when you just fear going to sleep while it is dark and you lay in solitude with only your thoughts and the organic noise of your heart racing. Things I hadn’t previously noticed, such as the beat of my own heart in my chest or the thoughts that raced like a merry-go-round were new physiologic variables to control. I now understand when patients come to me and say it is one of the worst things they have experienced, because it affects everything from your cognition, reactions, and ability to cope and have rational thought.

We learn all about the countless ways to manage insomnia and stress as physicians, from non-pharmacological management to medications and psychotherapy. We are taught to think about underlying contributors, considering other medical conditions, chronic pain, medications that may have an effect and psychiatric illnesses. I don't think I ever really considered how great of an impact a new diagnosis would have on my sleep patterns (though knowing it was a variable in my patients), despite all that I have learned as a new physician and throughout my own journey. I’m human just like everyone else who goes through stressful times and uncertainty. Truth is “your demons may have been ejected from the building, but they’re out in the parking lot, doing push-ups.”