Tag: anxiety

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Baseball’s Back!

https://www.indystar.com/story/sports/2019/07/18/brownsburg-little-league-off-hot-start-pool-play-state-tournament/1768585001/

In honor of the beginning of the baseball season, here is an excerpt from my book Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness about the joys and struggles of trying to be a little league hero. Make sure to buy your copy of the book and enjoy this excerpt!

As I stepped into the batter’s box, all I heard was my own breathing. I was looking pretty cool with my fairly new left-handed batting glove. It was black like a ninja suit, sleek in the twilight, though it probably didn’t intimidate anyone. No matter. In my mind, I exuded complete confidence, even though I knew I didn’t have any. I made a sort of pre-swing ritual, tapping the plate with the bat or wiggling it over my feet, combining the styles of multiple professional players. I watched baseball all the time, knew the routines of all the best players in the game. Maybe the reason I’m not better at baseball is because I don’t more accurately mimic Barry Bonds. Kirby Puckett was my favorite player, but his quick bat-wiggle and constant shifting of weight between his feet in the batter’s box was more than a little awkward to replicate— my impression looked more like a waddling penguin waving a flag. Wade Boggs would scribble some Hebrew word in the dirt before stepping into the batter’s box. That must be my problem—I don’t know Hebrew. Why hadn’t  I been born Jewish? I blamed my parents.

These rituals are supposed to calm you, focus your thoughts, and appease your anxiety. If you have played baseball every day for years, that probably works. But it more likely made things worse for me, because it crystallized my presence in the path of an out-of-control pitcher in a pivotal moment of the game. His head rose above the elevated peaks behind him, making him appear nearly twice as big as I was. The literal five-o’clock shadows from the setting sun almost made it look like he was growing a beard. We were only ten years old, how in the world did he have a beard already? Did he have some disease? Did I have some disease? I would most assuredly die if the ball hit me, since the stalling of my puberty compared to his put me in greater danger.

It was the final inning. There were two outs and two runners on base. We were down by one run. I wanted to be anywhere but there. To say that my heart was beating like a jackhammer doesn’t effectively articulate how slow a jackhammer moves compared to a ten-year-old boy’s anxiety. The adrenaline flowed freely through my veins like the endless stream of sunflower seeds spit from the players’ lips. I didn’t like adrenaline. It made me nauseated. It made my knees weak. It made me need to pee. That would be one good thing about striking out—I could use the bathroom sooner. That might take away the sting of the shame and embarrassment I was about to experience. But that also betrays my mindset in athletic competition—I had already decided that I would be out.

I had experienced some nightmares about situations like this. Even though I loved baseball, the potential for moments like this were outweighing the excitement it brought me. All I needed was a single to bring in a run or two; I could surely manage that, right? But why weren’t my teammates better hitters or base-stealers? They could have saved me from this moment. I blamed them for my predicament.

The crowd was a contemptible assembly of entitled parents who assumed their son would be in the majors if only he would just listen to what I’m telling  him  to  do right now, or the stupid umpire realized my son’s entire future is at stake here,  or  the  moronic  coach would  just  let my son pitch instead of playing right field all the time.

Thankfully, that didn’t describe my parents; they knew I sucked, and they loved me anyway.

The crowd contrasted the lovely venue, with the setting sun adorning the rising mountains. The trees surrounding the field blocked what remained of the sun, so what I saw from the plate was the majestic calm of the reassuring palisade. The halcyon beauty of baseball was on full display. I had lived next to the mountains nearly my whole life, so I took their allure for granted. The peaks are close—one could drive there and be on a great hike within fifteen minutes from my house. That probably provided some subconscious stability in life, a comforting source of protection and assurance. But I didn’t really care about such splendor at present—in this moment, the mountains served only to amplify the pressure that I felt bearing down on me as if I were an ant being buried by a growing hill.

The first pitch came in right down the middle, a meatball that any good player would crush for a double— or even a home run. I backed out of the batter’s box as the pitch arrived, assuming any pitch near home plate would hit me. Strike one. This is when I started to get “coaching” advice from multiple spectators.

“Strong swings, crush that ball!” “Wait for your pitch!”

“Don’t let those good ones go by!” “Big hit! We need a big hit right here!”

“Don’t screw up!” I think that one was from my disdainful older brother, none too pleased to have to be at his ten-year-old brother’s Little League game. And he was seventeen, which meant he hated everything.

It probably goes without saying, but ten-year-old pitchers are not skilled at throwing strikes. The ball can go anywhere and hit anyone in the broad vicinity of home plate; I once even saw a pitch go nearly ninety degrees and hit the dugout fence. The batter ahead of me wasn’t much better than I, but he quickly drew a walk. Lucky jerk: he didn’t have to swing; the pitcher and umpire did all the work for him. My primary concern was avoiding getting hit by a pitch. Getting hit by a hurtled baseball hurts, even when it’s “only” going as slowly as fifty miles per hour off the hand of a young pitcher. Did that physical pain pale compared to the more definitive failure of striking out?

I had already decided to swing at the next pitch hoping to get a hit. I usually had to make this decision before the pitch came in as opposed to looking for its location because I struggled to interpret the ball’s path in the split second I had. Major league batters have less than 0.4 seconds to recognize where the ball is, decide to swing, and go through the mechanics of hitting once a pitch is thrown. Yet somehow they do it, deciding not just to swing the bat but know where to swing to make contact and drive the ball where they want it. I couldn’t fathom that. Obviously, I’m not seeing a pitch come in at ninety- five miles per hour with someone who has reasonable control and at least some predictability. But to me, a pitch well under fifty miles per hour wouldn’t have made much difference—I had less than no time to decide to swing.

Just my luck, the pitch wasn’t anywhere near a strike. My swing was futile, a lunge at respectability that ended in an abject poverty of spirit. I was down to my last strike, and I had already mentally gotten myself out. The ball bounced in the dirt ahead of home plate. There is no way that anyone would swing at such a laughable pitch. In times like this, I often listened to the play-by-play broadcasters in my head.

“Boy, Jones is really struggling tonight. He looks as if he has no pitch recognition whatsoever. That last swing was slow and weak; I don’t think he can catch up to these fastballs he’s seeing. He’s not even getting much heat from the pitcher, but it doesn’t seem to matter. He looks so uncomfortable in the box, even though he looks so cool with his batting glove.”

The “color man” on the broadcast chimed in: “This pitcher has been pretty wild. I think Jones should just take these pitches instead of guessing where they may be going. This is such a critical situation in the game that you don’t want to get yourself out by getting into your own head too much and making mental mistakes. He should step out of the box, take a deep breath, and calm himself. This is one of those moments that defines what type of ball player you’ll be. Some thrive in this pressure, some wilt. He’s definitely wilting. His face shows his fear way too much— he looks like he wishes this was all over.”

Then came the encouragement from the crowd as their panic began to match mine.

“Come on, you can do this!” “Keep the game alive!”

“Finish him!” I think this last one was for the pitcher, but I wasn’t sure.

I wasn’t going to swing at this last one. Most pitchers my age throw more balls than strikes, as opposed to a good major league pitcher, who will throw about twice as many strikes as balls. The odds were definitely in my favor. I should be fine not swinging, right? The  announcers on my internal broadcast were right—just take the pitches and make the pitcher get me out. The pitch was coming. Oh crap, oh crap, oh crap, oh crap.

The ball emerged out of the pitcher’s hand in slow motion. I was immediately enveloped in the endless haze of eternity, where the wisdom of the ages resides in the blink of an eye, and I watched as the ball came at me. I  saw all my doubts and terrors as though sentient, dynamic entities coming for me. The lifespan of my anxieties was indeed finite despite their grotesque guise and powerful perseverance. Eternity swallowed me, and I knew everything and nothing at once, felt it all but was left empty. The glory of heaven and the ravages of hell emerged in that fraction of a fraction of a second to tell  me I was something not entirely different from anyone else—someone who would be razed to the ground repeatedly so as to be raised from the ground repeatedly. I would become as strong as I wanted, even though the weights would still be on me. I could push the boulder to the top of the mountain if I stuck with it and was willing to start all over again once it fell back down. The rock that drags me to the depths of the ocean will eventually wear away. My worries of school and girls and grades and friends and the dark and bullies and physical pain and humiliation and loss and being lost and lost and lost and never found surrounded me, and I somehow found it all freeing. It was as if my internal mysteries were opened by a distorted and fractured key; at least they were unlocked. When the pitch arrived, despite its prior perceived lumbering pace, I wasn’t even sure if it was a ball or a strike. This one was audible, a high-pitched dog-whistle of a ball hurtling past me, instantly breaking my trance and snapping me back to reality. Dog whistles are weird, I thought in that split second. Why can dogs hear them when we can’t? And why did they seem to respond to the whistles so well? Would dogs come running toward this pitch? I wondered how the broadcaster would work that in to the teleplay. And why did they call the other guy a “color man”? Wasn’t that a bit racist?

No matter how the announcers would call it, the game was over. There was no  joy in Mudville. At least I could  go pee now. I don’t know if my mind was racing or devoid of all thought, but I hung my head as I walked back to the dugout, underscoring the disappointment I felt for letting my team and their blood-thirsty parents down. The announcers in my head chimed in again:

“Sometimes players make their own future. I think Jones’ obvious fear was a self-fulfilling prophecy—he was out before he even walked to the plate. It’s too bad to see that, especially in such a handsome, brilliant, incredibly gifted kid. I think he’s just relieved it’s over. Too bad—he could’ve been the hero.”

But then I heard my brother yell above the agitated crowd: “Don’t worry, Kyle, you’re still a good-looking guy.”

I wasn’t sure if this was more of his sarcastic wit or a sincere support for his younger brother wrapped in jest. Either way, he was flippant enough to yell in front of everyone how it didn’t matter if we lost the game; thankfully, some semblance of my personal worth remained. What happened here did not define me or my team. There was more to me than a momentary show of poor athleticism. It hopefully reminded us all that there was more to life than baseball. Evidently, there was also personal appearance.

If only the girls also felt that way, I might have found some comfort in his support.

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Gargoyles

https://en.wikipedia.org/wiki/Darth_Vader_grotesque

I think gargoyles are cool. They have that scary façade, looking like they are ready to attack at a moment’s notice. And then there are the REALLY cool ones that are for fun, like Darth Vader on the National Cathedral in Washington, DC, or ones picking their nose, or just making silly faces. I love it.

Their purpose is to protect the cathedral or church from evil spirits, thus keeping the building sacred. (They also serve as drain pipes, and technically many of what we think as gargoyles are actually grotesques, but just stick with me here.) They also seem to be looking out over the city to fight whatever evil may be lurking in the hearts of men.

In my book Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness, I describe my anxiety and depression as a gargoyle:

“[The anxiety and depression] appear as a gargoyle forever watching me. Though I know it should be fake and harmless, its appearance is disconcerting enough that I don’t know what it is or what it may do. I can’t even be sure that it’s really there. But it feels like it is. The gargoyle typically fills the purpose of scaring away evil spirits from sacred spaces, an essential purpose if effective. But sometimes the gargoyle turns and becomes the evil spirit—not only unable to prevent fear, but in fact constantly creating it. The gargoyle becomes no different from the real monster it portrays.”

How do you tame your gargoyle, whatever it may be?

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“Fallible” excerpt

Here are the opening pages to my book Fallible: a memoir of a young physician’s struggle with mental illness. Go to the home page to find out how to get your copy of the book. Enjoy!

photo from aspentimes.com

There are so many ways to describe hospitals that it’s hard to decide which sense I should evoke. Should I describe how cold a hospital is? I once pulled a muscle in my upper leg shivering under an ultra-thin blanket in our call room, not able to get cocooned tightly enough into the fetal position to warm myself during my short break. No, I’ll start elsewhere. 

What about the sounds in a hospital? Alarms go off so constantly that they no longer mean anything. Every hall echoes with the voices of frail people yelling “Nurse!” Medication drawers click. The rubber on the sole of the various staff’s shoes squeaks against the linoleum floor. The beating of keyboards, swish of a mop, and patient’s televisions showing Wheel of Fortune turned up way too loud are unavoidable. Laced through it all are the audible grumbles of the nurses and aides and doctors and janitors and lab techs and radiology techs and ghosts of years past. 

Perhaps I’ll tell you about the smell first, because it’s the most strangling of a hospital’s senses. The fragrance of a hospital is simultaneously intoxicating and revolting. There’s the aroma of cleaning products used to cover up body odor, stale air, suffering, and death. If you go farther inside, you’ll not just smell yeast—tangy, pungent yeast—growing under the fat folds of every patient in the intensive care unit (ICU), but more wade into the thick of it; it flourishes because of the near-inescapable use of antibiotics. Put it all together, and the odor sticks to the beige walls, the equipment, the lights, the charts, the computers, the curtains—the cumulative stench of years of exposure. It permeates the air; no amount of air freshener can cover the stink of health care.  You can even taste the stench of failure inherent in the hospital’s very existence, leaving an imprint like a thumb pressed into a patient’s swollen leg. 

The smell becomes so pervasive that you can’t wash it out of your scrubs. It’s so insidious that hospital workers rarely even notice it; in fact, it’s the absence of the aroma that creates confusion. That scent often becomes a drug. Without it, a physician no longer recognizes their surroundings.

It was in this world that my two-week stretch of night shifts had become a habitual haze. I was only a few months into my intern year, and as time marched on, it felt more like falling than making progress. I endured thirty-hour shifts, a firehose of new things to learn, the constant fear of making a mortal mistake, rarely seeing my family, and no sleep, no sleep, no sleep. My brain yawned, my eyes twitched, my thinking dulled. My concentration flitted in and out. I sometimes stared blankly, void of all thought, my body having shifted into mere survival mode. I was like Albert Camus’s Dr. Rieux tirelessly treating the plague, somewhat conscious of a “bleak indifference steadily gaining” on me in my fog, as I feared treating patients was becoming futile.

I also stank worse than the hospital did. I was running on waxing and waning adrenaline, often drenched in sweat with limited time for showers. Forget what the commercials say: no deodorant lasts for thirty hours in a hospital. Fumes emanated from my crotch, but maybe I’m the only one that noticed them. No, I doubt it. Perhaps the pungent aroma wafting out of the ICU and filling every cranny of the drab, linoleum, fluorescent-lit hospital covered up my odor. I could only hope.

I wanted to be the compassionate doctor who changed lives—a true healer, the renegade physician-cowboy who rides in on his stallion and knows just what to do to save the day. But that resolve, along with my ability, seemed to be slipping away. Was I be losing it this quickly? I still had over two-and-a-half years in my residency. In the meantime, I had to hold on to the hope that practice after residency was better than this. 

It occurred to me that my angst was fueled by my continually disrupted circadian rhythm thanks to a constantly changing schedule. If that was true, it meant that I would snap out of it once my system returned to normal. I also recognized that my harsh lack of sleep had significantly affected the severe anxiety with which I had struggled for many years and had kicked off a nearly crushing depression that began when I started my residency. But I didn’t have time in my schedule to see a therapist, let alone a doctor to adjust my medication. For the time being, I had to wing it mostly on my own. 

That was the reeking, anxious, sleep-deprived situation in which I found myself one night when, just ten minutes into a sound sleep, I was ripped awake by an overhead announcement of a code blue. Translation: someone’s heart had stopped, and that patient would die without our help. 

Climbing out of the deep end of sleep, it took me a moment to realize what was happening. My eyes burned, melting under the strain of my sudden cognizance. Not only did someone’s life now hang on my immediate actions, but I couldn’t even focus on anything for more than a few seconds at a time. But no matter: the abrupt disturbance of my sleep combined with my sleep blindness and the quick realization of what lay before me combined to send the adrenaline coursing through my veins. 

I quickly made my way to the long-term acute care (LTAC) facility located upstairs in the hospital. We rarely saw patients on this floor, it being a cross between a rehabilitation center and ICU stay for those who will be critically ill for a while. Despite not caring for patients in the LTAC, our residency team helped with emergencies there. It smelled even worse than the ICU.

My senior resident and I made it to the unit at the same time as a host of others—nurses, respiratory technicians, an X-ray tech, and a lab tech. The poor gentleman in question—Mr. K—was in his sixties. I knew nothing about him when I ran into his room, but quickly learned that he had developed severe heart failure from a massive heart attack just a few weeks earlier. He also had chronic lung disease, but they had removed his ventilator two days ago. 

It wasn’t a pretty sight. Mr. K’s hair matted to his head from sweat, his obese body limp and lifeless, as he lay flat on his back. His skin blanched, appearing even paler next to the colorful cartoon designs on his nurse’s scrubs. We didn’t know what had happened in the moments before his nurse found him unresponsive, but our best guess was another heart attack. Based on his medical problems, he didn’t have much physical reserve to survive another large medical event; his odds of survival were slim.

As I pried my eyes open and started to see my surroundings, I noticed the tired painting of a flower arrangement on the wall. It had been there for decades, and the paint had faded. Under the buzzing lights, the light tan of the linoleum and walls seemed to exude a sense of defeat. This wasn’t an environment made for healing. Instead, it was purely practical, a time capsule that stood in contrast to the newer, brighter, homier, even sexier hospitals of today. 

We went to work resuscitating Mr. K. My senior resident, the emergency department (ED) physician, and I led the team of secondary staff as the only physicians present. Everyone there was trained to follow the various procedures involved in bringing back the patient, each depending on different levels of heart and lung function. I gladly let one nurse do the intensive work of chest compressions while my senior resident and I worked on inserting a tube into Mr. K’s throat to assist in his breathing. The loud crack of his breaking ribs filled the room, though I was used to that sound by now. It’s a sign that compressions are being done correctly. The ribs protect the heart and lungs from outside trauma, but Mr. K’s heart needed the trauma if he was going to revive. 

We repeated the procedures over and over to get his heart pumping again: evaluate heart rhythm, provide chest compressions, push air into his lungs, administer support medications (such as epinephrine), get labs to determine the root cause and thus ultimate treatment, consult the electrocardiogram, and so on. Mr. K’s heart was not beating, but despite what you see on most television medical dramas—“Live, dammit, live!”—shocking the heart is not always what’s needed in these situations. 

That was the case with Mr. K. We hoped all our efforts would create a cardiac rhythm that would either start the heart pumping or would enable it to respond well by restoring normal rhythm. But this gentleman was not responding to our efforts. He was dead, and it looked like he would stay that way.

The question of how long to perform advanced cardiac life support is always a tough one, and there is no definitive answer. I’ve taken part in a code that lasted eight minutes, and I’ve participated in some that lasted for more than an hour. Ideally, the time spent reviving someone is based on a solid ethical framework and compassion; more practically speaking, it depends on the preferences, disposition, and how busy the physician in charge is. Sometimes resuscitation efforts continue until a loved one arrives at the hospital in time to see the patient “alive” and say their final goodbyes. It has even been found that loved ones have a greater sense of closure and finality when they see the resuscitative efforts, though the organized chaos can also go the other way and cause ongoing psychological trauma to those who see it. There’s just no simple solution.

After about thirty minutes of trying to revive Mr. K and having gone through the prescribed procedures multiple times, the ED physician called it—Mr. K was dead, and we finished trying to save him. I was relieved. I had had enough. My body still wasn’t even fully awake. At multiple points during the resuscitation, I had a thought I never imagined I would have—one I feared proved that I wasn’t the healer I aspired to be, and that I would never be that healer.

I just wished Mr. K would die so we could stop and get some sleep.