This post will be a little more personal than others. Writing helps me straighten out the thoughts bouncing around in my head, and I’ve struggled with an issue I haven’t yet written about. We will see what happens. It is also on the long side, but hey, you have all weekend!
I talked with many patients about suicide over the years. For reasons I don’t understand, I’ve never had a patient commit suicide. But several people related to my patients have killed themselves, as have work colleagues. Funny how we like to make doing such a horrible thing easier to say. Committing suicide feels more civilized than killing oneself. Maybe too civilized, as the damage from suicide extends far and heavily to so many people.
This post is not about suicide except to note that I always thought of suicide as an option of last resort. And I know that some people have used it that way, like a past colleague who was in a dark place but brightened in the days and hours before he took his own life. The worset part of the tragedy is that I know he would have been OK, and happy, had he stuck around. He just couldn’t see it.
I admire those who battle cancer, dementia, and other illness, but I never thought I had that battle in me. My latest battle wasn’t like those battles because the odds were strongly in my favor, and my ‘suffering’ lasted weeks, not months or years. But one similarity is the option of last resort. I admit to considering that option when I learned that treatment wouldn’t be covered by insurance, the costs would keep me from keeping promises about helping with tuition bills, and my life insurance would cover things well if I was gone. And at that time I was not optimistic about my future, as I was on oxygen and still constantly short of breath, with an oxygen saturation of 85% on oxygen (I knew from anesthesia training why oxygen doesn’t help with a shunt).
Those thoughts about leaving my family seem silly now. Insurance came through after my appeal. I’m still on oxygen but I hope to be off in a few months. And I can sit on a couch in our family room without feeling short of breath, or talk with my kids on the phone without feeling like I’m running a marathon.
Even when I was healthy, though, I took comfort in that option of last resort in case I ever had one of `those horrible illnesses that other people battle. In short, I don’t think I realized how precious life is. I love my wife and children and I love my job, my dogs, and so many other things. But I figured I wouldn’t miss them if I was gone.
So how strange to now worry that my life will be taken prematurely. I find myself having thoughts I’ve never had before, worrying that my INR will get too high and I’ll have a brain hemorrhage, or too low and my lungs will fill up with clots. I notice warning labels on medications and read them. I check my pulse-ox several times per day and more, something I mocked my daughter for doing when she had COVID. I worry – is the chest pain when I climb stairs just wound pain, or something from my heart or lungs?
I’m already dreading the echo and perfusion studies I’ll have at 3-months. What if they aren’t getting better? Then what?
And as time passes, my time in San Diego becomes more and more ‘separated’ from my life. The memories feel like they are from a dream or nightmare. The dorm where we stayed looks like a jail cell. I would watch from the window as Nancy walked to the parking structure, drive back, and pick me up at the front door. The nice feelings I had about that view are gone now. The moonset that I watched from my room on a sleepless, post-op night is eerie, not beautiful. The hospital that initially looked so impressive is now a frightening detention center. It doesn’t look like me in those hospital photos. And I don’t want to go back to La Jolla for a vacation, something that I suggested a few weeks ago.
OMG. Do I have PTSD?
I realize that I am an anxious person. I’ve been told that many, many times, and I eventually accepted it. But fear of death? My lack of that fear made me a hero back in 1989 (details in the ‘my story’ section) and contributed to some big problems in my life in 2001 (again, details in the ‘my story’ section). I always figured I could handle being drafted, even though I’m certain I wouldn’t have the courage to enlist.
But the last couple months did a number on me and my feelings have changed. I don’t WANT to drop dead. And I want to do whatever I can to make sure that I don’t. I got a Fitbit and I review my oxygen saturation each morning. I worry every time a get a twinge in my chest. I check my sleeping oxygen saturation each morning. I follow the instructions from doctors and PA’s more than ever before. I can’t believe I’m asking someone half my age, “when will it be safe for me to drive?”
Do I have PTSD? And if I did, so what? Is there any value in putting a label on it?
Let’s review the criteria for PTSD:
A. Exposure to actual or threatened death, serious injury, or sexual violence. Check. True, surgical mortality was only 2% for PTE, but my disease was extensive and peripherl. Most of the few places that do the surgery can’t fix what I had, and 3-yr mortality is estimated to be from 50% – 94%. That’s close enough for me.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Check.
- Dreams? Strange dreams but not about my illness.
- Dissociation? I don’t think so.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). I guess, but I don’t know whether the distress is ‘intense’ or ‘prolonged’ enough.
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Pictures of the room where we stayed before and after the surgery make me uncomfortable, as do most of the photos from that time. But is it ‘m3arked’? That’s one problem with psychiatric diagnoses; so much wiggle-room that you never know the seriousness of a person’s condition.
I guess I only needed one of them to diagnose PTSD, and number one fits.
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Today is the first time I looked at those pictures and I probably won’t look at them again for awhile.
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s) Hmm…. ‘that arouse distressing memories… I talk about the entire process a LOT, as readers know. But I joke, mostly, as it helps me feel in control. I joke about everything (which is one reason they kept me in treatment so long 20 yrs ago, for being ‘incongruent’). Sort of my nature. Honestly I don’t think I have ever had a ‘distressing memory or thought’ in my entire life. They are just memories and thoughts, after all!
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: Gosh, there are a bunch of them. Most of them fit. Check.
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: Again, several fit pretty well.
F. Duration of the disturbance more than 1 month. This all started 7/17/22, so check.
G. The disturbance causes clinically significant distress or impairment in function. That’s a criteria for almost any psychiatric diagnosis. Is my distress significant? I guess so. Check.
H. The disturbance is not attributable to the physiological effects of a substance. Check.
It appears that I meet the criteria, depending on the meanings of ‘significant’ and ‘marked’.
A psychiatrist or psychologist would probably recommend that I ‘see someone. That’s what we call psychotherapy in the Midwest and maybe everywhere else for all I know. “You should SEE someone.”
“Yes, I know. I know. I probably should.”
Then I remind myself: “There is no magic pill for worrying. You will spill your guts, then feel exposed and embarrassed after you leave. Besides, you know all about this stuff. Think of the time it will take. It probably won’t be covered by your insurance. And you’ll probably have to drive an hour to get to his/her office!”
So I’ll think about it. Some therapists would recommend EMDR, but I’m more of a psychodynamic person, as I’ve described before. The good analysts nearby are in Milwaukee, which would be an hour’s drive each way (and I can’t drive for another month). Always a reason to avoid ‘seeing someone.’
But… I AM surprised by how quickly my thoughts about death have changed. And the constant worrying is more and more annoying. My wife and I had some desperate moments before we knew the surgery was going to happen, in the days before surgery, after all the tests were completed. We were both too overwhelmed to think very deeply about anything. But to go from careless about my health to constantly worrying whether I missed a pill? I didn’t expect that to happen. It doesn’t even seem all that funny.
Some nice persons will read this and offer suggestions. I appreciate that, but I’m honesty not fishing for anything, and I need to figure this out for myself. Or maybe I’ll see someone. Something to think about one of these days.
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