BY DISTANT LIGHT

Happy New Year, everyone!

Though I write about healthcare, I thought I would indulge myself, and explain my story to all who have wondered about my recent absence. It is a narrative I carried alone, trapped in my own world, blinded to the chaos that was slowly tearing me apart. I succumbed, badly, to the an illness that has haunted me all of my life, the mental illness of depression, the parasite that lies below the deepest level of consciousness, feeding you lies, repeating your defeats, feeding off your despair, until you either collapse from exhaustion or end your pain.

I had been pushing myself, exceedingly, for the last 2 and half years. I felt the parasite awakening, yet I attempted to do the impossible; ignore its subtle screaming, the terror it inflicts when you are alone with your thoughts. For alone I found myself, isolated by choice or design, tackling problem after problem, ignoring the parasite, smashing through problems without processing the damage they were doing, until my system collapsed.

It’s all one system, one’s emotions and one’s body. If depression, and its children: anxiety, hatred, isolation, fear, insecurity and self-loathing are not addressed, the body will find other ways to express the darkness. Be it an ulcer, a bad back, fatigue, headaches, or a general malaise and inability to enjoy life, the parasite will do its damage.

Pushing myself, to the limit. Imagine it this way: You’re Mad Max (or Furiosa) driving the War Rig, pedal to the floor, both V8 engines screaming in protest. You smash through smaller vehicles, bashing them off to the side. But the obstacles add up, and the War Rig takes damage. Engine one starts to overheat. Armor shreds from your frame. A tire blows. Yet the pedal is still to the floor. You empty the tank of nitrous oxide into the engines, blowing one, the remaining engine howling in protest. You reach an incline. Ignoring the clutch, you shift from 5th to 3rd, pedal still to the floor. The War Rig begins to rattle and shake, parts flying off. Eventually, the remaining engine explodes, and the War Rig falls to pieces, a wreck of burning metal. Max is thrown from the vehicle, smashing into the unforgiving sand of the cruel desert, critically wounded.

To put in medical terms, I was pushing myself, as the War Rig, for far too long. I had goals, achievements to tend to. Yet the universe kept throwing me deep curve balls, as it will do. When my mind was stuck in overdrive, my amygdala, the part of your brain that senses danger, had put my system in constant fight or flight mode for far too long. I was not resting myself properly, as my body was continually flooded with cortisol and norepinephrine. One can only run this way for so long. I had run this way for over 2 years. Eventually, my system was shut down by a final, dark act. I collapsed.

To recap succinctly, in 2019, I left a relationship of 13 years after I confessed to an opioid addiction. In 2020, I started school to study healthcare, and become a Medical Assistant. I pushed myself very hard, as I had not exactly excelled as a student in my early 20’s. It paid off with good grades, yet it was a difficult ride, much more than I thought it would be. In early 2021, as I waited 4 months for my license to come through from the Department of Health, I continued to push myself. I self-studied and achieved 4 more front-line healthcare certifications. I continued to study.

This was not without its difficulties. In January of 2021, I was so blinded by my trust of a psychiatrist who had helped for nearly 30 years, that I ignored the obvious fact that this physician had collapsed himself. I found him prescribing me painkillers or benzodiazepines. I would give him the drugs in exchange for cash. At one point, I was doing a drug deal with my psychiatrist in front of my apartment, in his nice car. Looking back, this is absurd, yet somehow I still trusted this man. The parasite was already blinding me, and I did not think the logical response through.

In February of 2013, I lost my father at the age of 92, weeks shy of his 93rd birthday. When a parent dies, there is a long list of logistics that needs attention: the estate, bank accounts, retirement and pension notifications, cremation, writing obituaries, and much more. My mother and I called it the ‘Dad List.’ My beloved mother, who still luckily is with me, was in rough shape, so I tackled the Dad List myself, practically alone, even yet as I continued to push myself with studying, learning, writing a new book. I had no time to grieve.

I had been tending to my older Niece, a young woman I love dearly. She had been suffering a similar ailment, and I was in constant communication with her. I watched as she herself collapsed, yet I refused to let this happen.

In early March, I was contacted by the mother of Brown Eyes, a post I had written earlier (you can find it further down). These were not easy conversations. Yet I refused to acknowledge the emotions.

I started having siezures, inexplicably. I chalked them up to bad panic attacks, though they were quite different. This was the pain I carried trying to find a way out.

In April, my wayward and dysfunctional psychiatrist suddenly announced he could no longer practice. He gave me no referral to another physician. This is the civil crime of abandonment, to say nothing of his felony of prescription fraud. My anxiety started to flare up. I suddenly had no access to the medications he had prescribed me.

At this time, my practitioner license was approved, and I began work at a community clinic in Seattle. It was a bad fit from the beginning. The clinic tried its best, but it was poorly run, with the small budget they had. There were constant violations of the CDC’s Standard Precautions. When I brought this up to the Lead MA, for the third time, she informed that it was not a priority for her. I was assigned with a provider, an MD who, despite a caring heart, did not exactly have her head in the game. She was constantly late, and expressing her personal problems. She never had a kind thing to say about me, but instead complained about my rooming speed. I squared that away quickly. She would still be with her first patient, and I had already roomed her next two, and I would find myself in the lobby telling her 4th patient that she was running late, if they’d like to reschedule. Once, I politely and professionally explained to this MD, as she treated a patient, that another treatment option may be a better idea for a particular type of wound. She agreed. Afterwards, in our small station, she turned to me and said: “You know things.” Yes. Yes I do. I over-studied. I paid attention. I had intended to make healthcare my life.

Eventually, this job did not work out. The Lead MA and I had a heated discussion, and I resigned. She did not take this well.

During this time, though I had no psychiatrist, I was able to get my medications squared away by general practitioners at XXXXXXXXXX.

It was not long before I found a second job. I joined the big leagues, XXXXXXXXXXX. My first few weeks there were fantastic. I was doing, successfully, procedures I had never been trained on, only after a few words of instruction from an RN. I took to it easily and comfortably. When the Lead MA returned from PTO, she immediately did not like me. She bullied, harassed me, and was inappropriate, since the Monday she returned. By that Thursday, I had heard enough. I calmly called her out on her behavior. She became emotional, borderline irrational. Later that day, she was observing me room a patient. I apparently did something wrong, even though by that time I had roomed countless patients. The Lead MA shouted at me, and proceeded to strike me. Hit me. Commit 4th degree assault.

I spoke to her immediately afterwards, telling her that it was never okay to strike another employee. She became hysterical, spouting histrionics that I could not understand. The event left me shaken. Two horrible MA jobs in a row. I was able to secure a few days off, after I wrote to HR to lodge a complaint. Before I left, the Clinic Administrator informed me that the Lead MA would be keeping her job and her position. I did not understand how this was possible. In any line of work, no matter what your station, there is only one repercussion for striking an employee.

When I returned from my leave, I met immediately in a conference room with the Clinic Manager and some freeloader from HR. For 20 minutes, they berated me for all the mistakes I had been making. I was shocked. I was never made aware, by anyone, of any errors I had made. In fact, the only feedback I had received from the Clinic Administrator was an email I received from her in the first week, telling me she had heard great things about me. That’s it. But these two women continued to harass me, 2 on 1. Had I known this was going to happen, I would have asked for representation, be it an attorney, a union representative, or the Terminator. I asked for specifics about my mistakes. I received none. The Clinic Administrator said that mistakes in our industry could cost lives. I took this to mean that I was making deadly errors, that I did not care, yet still no specifics. How insulting. The freeloader from HR informed that these are mistakes that no one should be making, when I finally spoke up in protest. I have no idea what her response meant. The Clinic Administrator informed me that in the coming days, she would explain the specifics of my grievous errors. She never did.

Eventually, they brought the Lead Ma into the room, the woman who had committed a crime against me, yet was protected from losing her job by the nepotism and favoritism of the Clinic Administrator. The Lead MA began to cry, mumbled things I could not hear, and would not look nor speak to me. Inexplicably, the freeloader from HR handed us both pamphlets about respecting other cultures and proper body language. I was beyond confused. It is lamentable that I did not keep that pamphlet, as I was running low on toilet paper.

I returned to work upstairs at the clinic. It was hellish, walking on eggshells. The Lead MA would not talk to me, despite my attempts to work things out with her. The Clinic Administrator would not talk to me. It was a disastrously uncomfortable environment. A per diem MA took over my training, yet I found it insulting, as I had already accomplished, successfully, the basics of being an MA at that clinic. The parasite of depression awoke abruptly. My body, which I had pushed so hard, began to shut down.

On the morning of September 24th, I awoke at 2AM to a horrible panic attack. I was not thinking clearly. To put it bluntly: I attempted suicide. I began to overdose on my medications. While I was doing so, Mia, my lovely cat, walked into my room. She and I have bonded, human and animal. I could see the look on her face: What are you doing? I immediately remembered the lesson of Brown Eyes, and thought of the people I would hurt. The first person I though of was my younger niece, who had just left for college in Nebraska. I stopped. I called 911.

Two days after I was released from the hospital, I found out that my younger Niece was in a psychiatric unit herself, for similar reasons.

The best thing that came out of my stint in the hospital was a social worker securing me care with a regular psychiatrist and therapist. This slightly heartened me. When I got home form the hospital, the Clinic Administrator almost immediately called me. She said she called to ask how I was doing, and to explain the call-out procedure. She did not ask how I was doing. Instead, she berated me for not correctly calling out. Hard to do when you’re suicidal. This contemptible woman could not be pried form her precious regulations with a crowbar. I resigned, my second failed MA job.

My collapse was abrupt. I began having the siezures more regularly. I learned these were called psychogenic siezures; not epilepsy, but the brain’s way of expressing inner pain and trauma. I could not sleep. My fatigue was overpowering.

My new psychiatrist, and my new therapist, helped me a great deal, and continue to do so. The psychiatrist reported my old psychiatrist for malpractice, abandonment, and prescription fraud. She began to unravel the medications the previous doctor had piled on me. She is a skilled provider.

Yet, initially, my recovery was slow. Stops and starts. I felt empty inside. A burned out, empty shell of a desolate man. Wandering the wasteland, alone.

Only it turns out I was not alone.

After a particularly grueling relapse, I reached out to people who knew me, people I had not seen for a while, but dammit, I could use someone to talk to. My Angel, my wonderful friend, forced me into a stronger recovery. I reached out.

Several people contacted me. I am forever in their gratitude. To suffer alone is like an injury that has become infected, refusing to heal.

It was worth noting that my problems were not taking place in a vacuum. As I fell, the world fell around me, and continues to fall. The Old World is gone. We have all suffered the effects of this terrible virus, on one way or another, and our society has not handled it as well as it could, to put it lightly. Sadly, the ineptitude, and the countless deaths, continue.

It is also worth noting, strongly, that my suffering is by no means unique. My pain does not make me special. I am seeking not pity; I am merely explaining my absence.

When I engaged, finally, with other people, it was shocking to hear their own tales of damage. Wounds that haunt them still. Each of us in our own way is broken.

One of the strongest pieces of advice I heard was from an old classmate. She did not ask me the details of my experiences outlined here. She simply said that life will damage us all, and we one day took a walk, enjoying the present, the here and now, as winter in Seattle closed in.

Another former classmate said that she would keep me in her prayers, and that she would always be available if I needed to talk. She suggested a helpful Bible verse. I am agnostic, but to know that someone cares enough to share something that is deeply helpful to her, and to include me in her petitions to her God, was profoundly uplifting.

I reconnected with a great old friend, and old manager of mine at Chase Bank. She told me her stories. They, understandably, damage her still. Yet she is such a beautiful, compassionate and caring person. It moved me when I heard how badly she had been mistreated by life.

Perhaps the greatest connection I made was a completely random one. Someone, a stranger I did not yet know, reached out to me. Her story of life damaging and tormenting her was so much worse than mine. Yet she and I had the same outlook, the same determination to live. And this wonderful person is my mirror, so similar are our stories. We connected quite strongly, and to have her in my life is a gift, as my recovery grows stronger.

The last month or so has been a powerful turnaround for me. My belief in myself has increased dramatically. For a while, I thought about giving up healthcare. But I am no victim. I love healthcare because I am good at it. I enjoy it. I will return to it, very soon.

My recovery is nearly complete, yet this is a condition I must be aware of for the rest of my life. The siezures are gone. I get regular sleep. I get regular exercise. My passion for healthcare has returned. I am still dealing with fatigue, but my care-team is well aware of this.

I have clawed my way out of this hole. In the future, I will not push the engines so hard. And when life throws me obstacles, as it surely will, I will confront and embrace them. Each of them is a moment of potential growth. I am secure enough in who I am to not be afraid of my emotions, and to finally, after a very long time, feel them freely. Though I may carry the memories of the damage, I am one of the living.

Yet so many in our world are suffering, far worse than me. It is up to me, and all of us, to help when we can. Love and compassion, their day is coming. Each of us must do our place. Do not ignore the suffering of others, or your own. Now more than ever, our world needs this.

This we all know; the years travel by quickly. But my tale is not my own tale, it is the tale of us all, in one way or another. And we must listen, and remember, so that this dark age we live in, and the mistakes we have made; we must tell the young ones of tomorrow. It is hurtful, as the Old World is now gone. Yet time counts, and keeps on counting. Getting back what has been and has been lost is no easy road. But this is our fate, and we must travel it, and no one knows where it’s going to lead. The light at the end of the tunnel must stay lit, for all of them that are still out there, suffering alone. Because if I can do it, anyone can seize the distant light, and come home.

Thank you.

Andrick Schall

1/1/2022

RIP: RKS

TY: HF

GOOD-BYE BROWN EYES; YOUR STORY IS NOT OVER

BROWN EYES – 1997

I first met in her in mid-May, both of us in a strange place in a strange state of mind. Neither of us could adequately explain what brought us to that place, but her company there in that isolated pocket of sadness was an unexpected source of happiness, of companionship, and, eventually, guilt. But for those two weeks, she was my rock, my angel, and above all, someone who understood.

She had the most beautiful brown eyes. In fact, that’s what I called her: ‘Brown Eyes.’ Peering into them was as if I were at the edge of deep pool of still, dark waters, both calming and dangerous at the same time. There were several of us there, about twenty, but Brown Eyes was the only one close to my age; myself, 23, Brown Eyes, 22. We hung close to each other those two weeks. Practically every hour of the day.

Soon, however, we understood that it was pain, a deep hurting, that brought us to that place. Sometimes, a mind will work against its own, the cause of which could be a host of things, and will damage that soul, driving them down, causing pain, causing despair, madness, and, all too often, death.

Brown Eyes was an incredibly gorgeous young woman, both to the eyes and to the mind. She was caring, compassionate, prone to giggling, and a devoted listener. She radiated a warmth that I was instantly drawn to, a solace in a world gone mad.

Yes, we stuck together. We loved each other’s company, yet we were both afraid, both hurting. No wonder, then, that we were drawn to each other. But though our time together was brief, the days we spent together were full of closeness, friendship, and a kinship that I will never forget. Brown eyes and I used to have wonderful times together. We played poker, told hilarious stories about ourselves while we smoked cigarettes on the patio, we watched (and mocked) the nightly film, we ate together, and sometimes we were just together. We were as close as two young people could be in a place such as there. We shared a bond. We shared everything.

I remember once, one of the older residents, at one of our sessions, noticed the spark between Brown Eyes and myself. She remarked: “You two are going to get together when you get out of here, aren’t you?”

We both blushed. Brown Eyes managed a: “Well….” I smiled broadly, in the hopeful affirmative.

But Brown Eyes was hurting. Deeply. I so wanted her to get better, to see that she had value, to myself and to the world. Once, when we were journaling together, she had written ‘I am hopeless’ repeatedly across her worksheet. That crushed me. No one is hopeless. All life is precious.

I never discovered what brought her to that place, but her pain, so evident when it manifested, was so profound, so powerful, I could not help but be wounded further myself. I would find herself alone, trying to sleep, but crying. The suffering Brown Eyes would be curled up into a ball, clutching a Roald Dahl book, no doubt a book from her childhood, from a happier time. I went to her then, and felt her pain, stronger than my own. I did not understand it wholly, but I knew what it was like. I would hold her. Our little world, however, was constantly monitored. Such is the nature, the precautions the physicians must take, when two young people find themselves in the psychiatric unit of an old hospital on Seattle’s First Hill.

I remember what brought me there. I had been diagnosed with clinical depression only a year before. The treatment was still new to me, and I was battling old demons at the same time. Note to self: certain medications and alcohol are a terrible mix. My physician saw the signs as I collapsed, the ideations. Thus, this was how I met Brown Eyes.

Her eyes. Those deep worlds of both pain and compassion; never will I forget them. I remember the day Brown Eyes was discharged. She had given me her phone number. I will always remember this moment, the last time Brown Eyes spoke to me: “Please,” she said, “Do call.” I promised I would.

I don’t know why, but I waited a day. Perhaps I wanted to give her time to reacclimate with her family. Perhaps I thought it too early, for whatever reason. This is a regret that haunted me, ate at me, damaged me for several years.

I eventually did call her, the next morning after breakfast. The phone just continued to ring. I called several times that day, but no answer, no machine. The phone would just continue its incessant ringing. Finally, that evening, someone picked up. “May I talk to Brown Eyes, please,” I asked. The voice replied: “Who’s calling?” There was a sense of disbelief, and also inconvenience in his voice. “This is Andrick,” I replied, “A friend of hers from the hospital.” There was a long pause, followed by deep sigh. Finally, the voice, an uncle, spoke: “Brown Eyes is dead.”

My world collapsed. My time in the hospital was extended. I recall very little of the first few days afterwards. And yet, even in those dark days, I strongly disagreed with Brown Eyes: There is always hope. With the skill of the mental health providers at the hospital, and the daily visits from my psychiatrist, I improved. I wanted to improve. My father, whom I recently lost, would visit me everyday. Friends would call me, offering support. This is crucial to a recovery from a mental illness: a strong social support system and a team of dedicated professionals. And recover I did, more determined than ever to live. This was the first gift that Brown Eyes left me with: the will to push on, to live, to change the lens and see the world, and myself, as a wonderful place to be. This was her second gift to me: suicide will destroy those left behind.

RECOVERY

I was not in the hospital much longer. Though I had learned painful lessons, this is often how one learns and grows, especially in the assessment of those lessons. Pain is there to teach.

My psychiatrist was very skilled. He was both a physician of the brain, and a psychologist of human behavior. My Doctor was a rare breed then, and now, practically, an anachronism.

I have written on this before:

Now, these days, an unfortunate schism has happened: the divorce of psychiatry and psychology. But in 1997, I was very fortunate to have my physician and my confidant in the same office. Our visits were for an hour, several days a week after my discharge, as I began the healing process. We would discuss medication, but we would also discuss the illness, and the guilt.

Though I had only known Brown Eyes for two weeks, the bond we shared, in that environment, with someone my age who suffered a similar illness, was strong. My Doctor and I spoke of her extensively, and the choice she had made.

For that is what her suicide was: her choice. But the nagging guilt still gnawed at me; why didn’t I call sooner? What if I had said something different in our time together? What could I have done?

My recovery was strong. I returned to acting. The local theater community in Seattle was a strong source of support. I loved to perform for an audience, an emotional release you might not be able to tap offstage. I worked in hospitality, and rose to the position of Operations Manager. I switched to banking, where I eventually filled the same roll, with Chase Bank for fifteen years. I tried my hand at writing, and had a couple of books published (they were not very good, nor well received…. it turns out I am better at writing essays than I am at writing novels). At the tender age of 47, I made another choice, one of the best I have ever made. And so now I find myself in healthcare. Ironic, perhaps, but a profession I love nonetheless.

But those early years after the hospital were a steep climb. And yet, recover I did. Those who have recovered from a mental illness are aware that this is an affliction that may forever be a part of them. But, along the way, you learn skills, and ways to cope, so that each time the affliction attempts to return, you know what to do. Oftentimes, this involves one the hardest things there is to do: ask for help.

But there was always that little demon in the back of my mind, worming its way into my consciousness: that feeling of guilt. Eventually, as part of the healing process, you must accept that certain things are not your fault. There was nothing I could have done. Brown Eyes had made her decision. I understood her pain; I understand why she did it. Sometimes, the dark night of the soul is so powerful, one sees the only relief as oblivion. It was a decision I myself could never make. This was her choice. It was not my fault.

SUICIDE IN AMERICA

Suicide is the most destructive act one can do to those that love them. Survivors of those who have lost loved ones are often adrift emotionally and mentally, sometimes for years, or for the rest of their lives.

It is a difficult subject to broach, as it always stirs feelings of confusion, sadness, resentment, depression. Those who have lost loved ones to suicide oftentimes find themselves alone and misunderstood. Conversations can be awkward. The guilt can be overpowering.

Survivor’s guilt can lead to complicated grief, a kind of post-traumatic stress disorder than can degenerate into depression. Most of us have faced death, and we feel the hole it leaves within us. But to lose a loved one to suicide is a wound that is very difficult to heal.

Yet talk about suicide we must. Here in America, though we have faced profound problems for the last year and a half (to put it rather lightly), we have the resources and intelligence to address this problem. And a problem it is:

https://afsp.org/suicide-statistics/

In 2020, over 48,000 Americans died by suicide, making it the 10th leading cause of death in the country. On average, 132 Americans died by suicide every day.

Suicide is to succumb to the darkness, but it is also a desperate cry for help: a staggering 1.4 million Americans attempted suicide.

Suicide is the 4th leading cause of death of those aged 35-54.

A statistic that is absolutely heartbreaking: suicide is the 2nd leading cause of death of those between the ages of 10 and 34.

Every day, 22 American military veterans take their own lives. That is 1 suicide every 65 minutes. This number is appalling and unacceptable. No matter what your stripes, these men and women put their lives on the line every day, for very little money and insufficient appreciation.

THE LACK OF MENTAL HEALTH RESOURCES

Though suicide is obviously a profound problem in the United States, there is an unfortunate lack of resources for the mentally ill. At every clinic I’ve worked at, nearly every provider has decried the lack of options and availability for those who are on the edge. But, these physicians do their best. If one is depressed, and contemplating suicide, it is better to seek help from any Doctor than none at all. Every Doctor you will meet, every Nurse, every Medical Assistant; all of them will do their absolute best they can for you. I have worked among some of the best. They are dedicated to their craft, and to helping you heal as best as they possibly can.

Though we have come a very long way in understanding and accepting the existence of mental illness, we still have quite a ways to go. The social stigma still exists. The lack of awareness, though decreasing, is still present. There are often limited options and long waits to see a mental health professional. And, though I realize this is a subject of debate, healthcare in America can be egregiously expensive, and oftentimes, recovering from a mental illness takes in-depth and lengthy care.

WHAT YOU CAN DO

First and foremost, if you are having thoughts of suicide, and have made plans: CALL 911.

If you are depressed, or feel that life is not worth living: reach out for help. See a Doctor. See your religious counselor. Talk to a friend or family member you can trust.

If you are a survivor of losing someone to suicide, take care of yourself. It will take time to heal. As so above: reach out for help, wherever you can find it. Someone out there knows what you are going through. You are not alone.

In fact: Anyone suffering from depression or thinking of hurting themselves; please realize, you have value, you have a future, and you are not alone.

National Suicide Prevention Lifeline: 800-273-8255

Veterans Help Line, for those currently serving: 800-342-9647

Disaster Distress Helpline: 1-800-985-5990

suicidepreventionlifeline.org

https://afsp.org/ (American Foundation for Suicide Prevention)

https://www.nimh.nih.gov/health/topics/suicide-prevention/ (National Institute of Mental Health)

https://www.mentalhealth.va.gov/suicide_prevention/data.asp (for veterans)

https://www.militaryveteranproject.org/22aday-movement.html (for veterans)

https://youth.gov/youth-topics/youth-suicide-prevention (for teens and young adults)

As the saying goes: I would rather listen to your story than attend your funeral.

PROJECT SEMICOLON

Project Semicolon, stylized as ‘Project;’ is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative. It was founded in 2013 by Amy Bleuel of Wisconsin, who lost her father to suicide in 2003. Tragically, Bleuel herself committed suicide in 2017.

Project Semicolon defines itself as “dedicated to presenting hope and love for those who are struggling with mental illness, suicide, addiction and self-injury”, and “exists to encourage, love, and inspire.” A semicolon ( ; ) is used as a metaphor: the author could have ended the sentence, but chose not to. “The author is you and the sentence is your life.”

Today, one might see or notice people with the semicolon tattoo. Many celebrities have been seen with such a tattoo. I dislike it when entertainers use their positions of prominence to talk about politics, but if they are bringing awareness to mental illness, more power to them.

My heritage is far too Teutonic for a tattoo; hence, my necklace. I swear I’ve got a little Bigfoot in the family tree, somewhere…

https://projectsemicolon.com/

IGY6

IGY6, or: I’ve got your six (I’ve got your back) was inspired by project semicolon, created by military combat veterans to advocate for suicide prevention and awareness. One may occasionally see a veteran or first responder emblazoned with “IGY6;22.” The number 22 represents the number of combat veterans who commit suicide every day.

https://www.theigy6.com/

BROWN EYES, 2021

It was not until earlier this year that I accomplished something that I had neglected to do, perhaps unconsciously. I have lead an exciting and successful life; setbacks, here and there, to be sure, but with my new education and my new love of healthcare, I have a great future to look forward to, full of potential. But it occurred to me, 24 years later, that I never officially said goodbye.

It took a little digging on the internet, but I found it. I drove across town, and visited Brown Eyes’ grave.

There was an outpouring of emotion, to be sure, as memories came back. But there was also a sense of relief, of closure that I was not aware I needed. Her grave is on a beautiful, gentle hill, overlooking Seattle. It sits underneath a Japanese Holly tree, surrounded by trinkets and memories of those who had come by.

I said goodbye to Brown Eyes. I said I loved her, that I was not angry with her, and that it was her choice, but I wish she had made a different one. I imagined the conversation we might have had then, had she survived her illness, so long ago, as if we were two old friends, catching up on old times. I have absolutely no idea what happens in the world to come, but if we persist, in whatever form, after death, she will be the first person I hug.

Good bye, Brown Eyes! I remember your spirit, and our memories, both of which I will carry; your story is not over.

Dedicated to Hannah Elaine Harvey, 1974 – 1997

HIATUS

This will be my last blog post for the foreseeable future. Though I have loved writing my observations and thoughts on healthcare, it is time-consuming, and there are things I must move on to. All of you who enjoyed reading my posts, I can’t thank you enough. My website will still be there, and, somewhere down the road, I may post again. Thank you all, and do feel free to contact me.

Thank you all! Wash your hands! Get vaccinated! Take care of yourselves! Take care of each other! Bye for now….

FROM HELL’S HEART I STAB AT THEE

I work in healthcare. I am a Certified Medical Assistant. Children hate me. They can’t see my big, goofy smile through my surgical mask. That matters little. They know who I am. I am the man who keeps Mr. Pain in his pocket.

Millions and millions of Americans hate going to see the Doctor. There are a lot of valid reasons for this. One is primarily economic. American healthcare can be extremely expensive. We are the only industrialized nation that has not figured this out, and there is plenty of debate concerning this; however, that argument is for another time. Millions of Americans also hate going to see the Doctor because they refuse to believe they are sick or in need of treatment. That’s all well and good, you hardy lumberjack, you; but many diseases and illnesses have no symptoms, until the affliction decides to kill you. Millions of Americans hate going to the Doctor because they think that all Doctors are quacks, and are just going to take your money. Well, sorry you feel that way, but I’ll probably be the one taking your vitals when the cancer kicks in that could have been avoided had you seen the Doctor sooner to prevent your illness. Millions of Americans hate going to see the Doctor because they believe Western medicine is impure and inherently harmful. There is nothing wrong with yoga, meditation, or tai chi; in fact, Western medicine has embraced these practices. To a degree; I’m really not sure that chamomile tea and ginger root paste is going to cure your diabetes. Just sayin’. But I posit this: Millions of Americans are afraid to go to the Doctor for one simple reason: they are afraid of needles.

Trypanophobia is the fear of medical procedures, especially needles. This is distinguished from aichmophobia, the fear of sharp things. Also, this is not to be confused with iatrophobia, the fear of Doctors, the White Coat syndrome, why your blood pressure goes up in the exam room even though hypertension has never been a problem for you. But back to the fear of needles. There can be good reasons for this. With an injection or a blood draw, metal is entering your flesh, and you may see blood. On an instinctual level, that’s not supposed to happen; even though on a rational level, it may be necessary treatment for an illness. It’s really as simple as that. But please allow me to elaborate.

In 1995, Dr. J. G. Hamilton, a smart man with a no-nonsense name, published a paper on this topic: (https://pubmed.ncbi.nlm.nih.gov/7636457/). He suggested that the fear of needles has an ancient genetic basis in evolution. Our pre-history ancestors were well aware that sharp cuts or bites could very well be a death sentence. There were no antibiotics; if the wound were to become badly infected, it could kill the injured. There was no healthcare to speak of, save the shaman or medicine man who may try to perform rituals to appease the deity the tribe believed in, as the injured had angered this god, bringing the affliction upon the wounded.

Another evolutionary theory by Stefan Bracha, MD, suggests that one might faint from an injury to demonstrate that a fallen combatant is no threat, and is taken out of the violent melee over the hunting grounds of contention at hand. (https://www.sciencedirect.com/science/article/abs/pii/S0278584606000091?via%3Dihub) You know, I’m still not really sure if possums actually do that. But I digress. Possums are cool.

The truth is, however, you really don’t need to go that far back in our evolutionary history to paint a simple picture of a grown adult’s fear of needles. All of us, when we were toddlers, received several vaccines. The Centers for Disease Control and Prevention has a schedule that healthcare providers follow:

This itinerary is only to 6 years. There are several vaccinations and inoculations after that, and many into adulthood. Many of the diseases listed in this chart have been all but eradicated due to immunizations. However, healthcare deeply respects patient autonomy. There are many parents out there who, for whatever reason, distrust vaccines (anti-vaxxers is the pejorative term) and refuse to get their children vaccinated, because there is a 0.000007% chance the vaccine will cause their child to grow a second head. On a serious note, this philosophy is why measles and mumps have not been completely eradicated, and, sadly, it is often the children who suffer and die.

But regarding a young child getting their shots: I posit a train of thought, a somewhat obvious one, that if one follows, it is quite easy to see why many of us hate needles. You are probably familiar with psychologist Erik Erikson’s eight stages of human development. Of course, unless you are a Scientologist, there is no perfect model for human psychology. Nevertheless, Erikson’s model has been studied and reworked by various schools of human development and psychology. Marysville Universtiy has a great article on this model, as well as others: (https://online.maryville.edu/online-bachelors-degrees/human-development-and-family-studies/stages-of-human-development/). In a healthy environment, trust and autonomy will foster in the growing human in the formative years. These healthy traits are directly opposed at the Doctor’s office.

When we are infants, toddlers, we are coddled, fussed over, and, in a healthy and nurturing environment, we are loved. Our needs are met. We have no responsibilities. Or course, there is discipline and punishment when we don’t get our way, but; again, in a healthy environment, this is for our protection. But. eventually, we are taken to the Doctor. Toddlers in particular, at some level, understand these visits, as much as they are places of potential pain.

When we are administered the vaccinations above, we certainly do not have the mental capacity to understand why we are being hurt by the scary man in scrubs. We are restrained, which is terror enough. Then, a sharp blast of pain appears on the body, usually, in the case of a toddler, on the thigh. This can be quite the traumatic experience for the youngster. I was holding down the legs of a 3 year-old once, while another Medical Assistant was giving him his shot. The young man was quite vocal in his opposition to all this. He really filled the room. And I tell you, a tiny human like that can really summon precocious strength. I didn’t like it, but I really had to hold him down. Generally, the parents are off to the side, although some assist in restraining the child, and all of them usually say things like: “It’s okay sweetie. You’re doing fine.” In the child’s head, nothing is okay, and nothing is fine. These are our formative years. We remember these events, at some level of consciousness. It is quite easy to see, then, why we carry this fear of Doctors, and specifically needles, well into adulthood.

There is a physiological process behind all of this. Most of us are familiar with the concept of fight or flight. This human (and animal) phenomenon is older than the theories of ancient man outlined above. It is ingrained into the very survival instinct off all human beings. It has been with us since we first banged the rocks together, and it continues today, when we go to the Doctor to get poked with a needle.

You have a nervous system, commanded by your brain. The nervous system carries out commands to different parts of your body to tell them what to go do with themselves. The main nervous system, the central nervous system, is divided into several sub-systems. The parasympathetic nervous system is responsible for resting the body when you are relaxed, resting, or feeding. The sympathetic nervous system, on the other hand, ramps your body up when danger is perceived, kicking in the fight or flight reflex. Our ancient ancestors had to do things like run from bears (this would the ‘flight’ portion of fight or flight). When this system kicks in, blood and oxygen and sent to the lungs, and the body is filled with adrenalin, to prepare ourselves to get the hell out of there. This reflex is with us today, although it can be associated with actual, physical danger (car crash, mean dog, airplane turbulence) or societal danger (the boss wants to see you, the principal called, collections just sent you a letter). When this happens, and one is expected to hold still, sitting in the phlebotomist’s chair, blood and oxygen leave the brain, our thinking becomes clouded, and many people either have an intense reaction of fear, or, even the big tough guys, experience vasovagal syncope, a fancy term for passing out. I’ve seen it happen.

But you know, the bottom line is this: it could be a lot worse. Depending on the skill of the healthcare provider, and the type of injection, getting a shot in the shoulder or getting a needle in the arm for a blood draw is pretty low on the pain scale. Needles today are designed to cause as little pain and discomfort as possible.

This is a fantastic article: (https://medicine.uq.edu.au/blog/2018/12/history-syringes-and-needles) The first needles were used in the second century, CE, with disastrous results, and by that I mean fatal. It wasn’t until the mid-19th century that modern needles began to take shape. But I don’t imagine those needles were all that easy to take, let alone sanitary.

Let me wrap it up this way: Have you ever been stung by a bee? That hurts! That’s because it’s designed to hurt. All of us have jabbed one our fingers with a staple before. That hurts! Those are things that are piercing our flesh. Modern needle design, with the hypodermic wielded by a skilled healthcare practitioner, really: Does. Not. Hurt. Sure, it stings a little, but it’s over in a few seconds, your arm may be a little sore afterwards, but trust me, you are probably going to be okay. When I am practicing in a clinic, I am forbidden from giving any kind of assurances, but here on this blog, I’m pretty sure you’re going to survive your shot.

Most of the injections I give are either in the shoulder, the thigh, or, rarely, the back of the upper arm. I occasionally give small injections on the inside of your forearm. Once in a while, the buttocks. I know what I’m doing. There are tips are tricks that I paid a lot of tuition money to learn. I’ll make it east on you. But, not to scare you, there is the occasional injection, rarely given, that are handled by Registered Nurses or Doctors: intraosseous, into the bone. Intrathecal: into the spine. Intracerebral: into the brain. These all sound fun, right? But these are rare, and are administered carefully and with anesthesia by a highly skilled practitioner. There is also, of course, an amniocentesis, which expectant mothers may be familiar with. But there is also cardiocentesis, when a needle punctures the heart. These are just a bit above my paygrade.

So the bottom line is: it’s perfectly okay to be afraid of needles, but it really doesn’t hurt too bad. On the second day of my externship, I have to give a vaccine to a 7 year-old child. She was frightened, scared, and crying. I did not patronize her; I told her it would hurt a tiny bit for just a few seconds, that it was okay to be scared, it was okay to cry, and it would be over quickly. She relaxed a bit. As soon as I injected her, she immediately perked up. “Oh!” she said. “That really doesn’t hurt too bad!” I happily affirmed her, was done in a couple seconds, and withdrew the needle. My mentor said she had never seen a reaction like that from a child. So, I know that needles are scary, and that’s perfectly okay to feel that way, but just remember that 7 year-old girl.

I’ve gotten very good at assessing what kind of patient I have, very quickly. Sometimes, if someone has a healthy outlook on life, but, I can tell, is afraid of injections, I usually try to lighten the mood with a few jokes:

“Well, let’s give this a shot.” “It’s okay not to look; I don’t either.” “I promise you, this won’t hurt me a bit.” “Present: arms!” “Oh… no wonder… that’s the wrong end of the needle…” I’ve got pages of these!

There is one final note to end on, something I neglected to mention. The Dentist. The Dentist uses needles, too. Your gums are much thicker than skin, so the Dentist uses a larger needle. The nonvaccine is very thick, so the needle must remain in gum for a longer time. The Dentist enjoys this. The Dentist is evil. The Dentist enjoys hurting you. The next time you go to the Dentist, bring your holy water, and banish the Dentist back to which they came. I kid! I’ve had some great dentists.

Remember: it doesn’t hurt that bad. Be like that 7 year-old girl! I’ll see you at the clinic!

Peacock Surgery

DISCLAIMER: I HAD NOTHING TO DO, AT ALL, WITH THE FOLLOWING STORY. I AM LICENSED TO PRACTICE ON HUMAN BEINGS. THIS STORY AND PICTURES WERE RELATED TO ME BY… A FRIEND OF MINE. AGAIN, I DID NOT DO THIS.

Peafowl are common birds of the phasianidae family, related to the pheasant. They are found in warm, tropical regions of the world. The male of the species, the peacock, is known for its resplendent display of tail feathers, the peacock train. They are some of the most beautiful birds on Earth.

My friend, who told this story to me, has a friend who owns a no-kill farm out in the country. The place is fantastic; friendly goats, peafowl, war-like geese, chickens, and even the last remnant of the dinosaur, the emu.

Though they may be vastly different than human beings, the peafowl can succumb to very similar ailments and conditions. This story, related to me and not done by me, is the story of a peacock with a very bad cyst.

My friend’s farmer friend had purchased a peacock. At first, he paid no mind to the cyst on the side of the animal’s face. But the cyst grew quite large, and was causing the poor bird problems with its vision and breathing. As you can see, its left eye was nearly useless, as the pressure of the cyst was pushing it out of its socket. It also had a rasp to its breathing, as the cyst was putting pressure on throat. This animal needed help.

My friend, who told this story to me, is quite familiar with cysts. However, he is not a veterinarian. Be that as it may, this appeared to be a sebaceous cyst, a very common growth. They are non-cancerous, and generally filled with semi-liquid or dead tissue. They are formed when the sebaceous gland, which produces sebum to coat skin and hair (or feathers) becomes damaged or blocked. They are typically not a problem, unless they are in a troublesome part of the body, such as this poor bird. Cysts grow slowly, and this beautiful animal would have continued to suffer.

Well, my friend, who is not me, has removed cysts before. It’s really quite simple. A shot of lidocaine, an incision, and then you scoop the gunk out. A course of antibiotics is then in order.

But, my friend had no lidocaine. This would have to be done Viet Nam style. He did, however, have two brilliant surgical assistants who were invaluable in this surgical procedure.

So, in my friend went. My friend did not know this, but a scalpel designed to cut human flesh barely works on a peacock. It took a little slicing. My friend was concerned that the animal would recoil in terror and pain, but it was quite cooperative throughout the entire procedure. More so than any human, actually, and without any lidocaine. Cysts are full of material that has no nerve endings; once you cut through the skin, you’re working with dead tissue. Also, my friend’s farmer friend told me that an animal will frequently settle down in a mixture of calmness and fear once it realizes it has no choice.

After just a few cuts, there it was: a disgusting mass of dead, crumbling, moist material. I will spare that picture. My friend scooped a lot of it out. It was… rather repulsive.

Withing minutes, the peacock’s left eye began to descend into its proper place, and the milky material in the lens all but disappeared. It’s breathing became less labored. Amazing what can happen when you release a little pressure.

Unfortunately, my friend got a little too ambitious when digging out the core of the cyst, and severed an artery. Again, my friend is no veterinarian, but he was confident that there was no major artery in that part of the animal. With some constant pressure applied with sterile gauze, the bleeding stopped.

My friend cleaned out the wound with saline, and applied some animal antibiotics. Every farmer has a bottle lying around: Tylan 200.

The bird looked much better after the surgery, but a little rough. It’s eye had returned to a normal state, and its breathing became better. My friend’s farmer friend kept up with the antibiotics, and I’m happy to say that the bird is doing just fine.

The cyst had been with the animal for quite some time, so it was unused to using its left eye. However, the little peacock brain has returned to normal use of its vision as its vision neurology has healed as well.

So, a happy ending. Again, I had nothing to do with this. It was related to me by a friend. The peacock has returned to his ostentation, and is living a happy life. This is what healthcare is all about. All life is precious.

Update: He’s looking pretty good!

Licensed To Heal

Well: How about this?

Hoo-doggy, but that was a long ride! For the first time since I started down the path to become a Medical Assistant, on January 7th, 2020, I am now completely certified, licensed, and ready to go.

It has been a mind-blowing adventure. Along the way; I left a job of 15 years, I gained new friends, and I lost my father. But now, at the end, I am finally ready to go. I am ready and willing to work.

Yeah, bullcrap!

Thank you, Washington State Department of Health. They are the unsung heroes on the front-lines of America’s War on Competency.

So, there’s certification, and then there’s licensing. In Washington State, any healthcare practitioner, at any level, needs to apply and obtain a license from the Department of Health. Sounds reasonable. I think you need a license for just about everything. Which reminds me, I need to renew my license to flush the toilet. But anyway, my healthcare practitioner’s license. I had heard along the way that it can take 2 or 3 weeks. Hey, no problem. Time for a little break!

Yeah, bullcrap!

I sent in my application to Olympia on January 2nd, certified mail. My instructor had advised me to send it certified, as I would have proof of its arrival. One can also apply online, but my wise instructor said certified mail was the way to go. I filled out the enormous packet of literature, and made my way to the local post office. The USPS informed me that my application would arrive at the Department of Health on Monday the 4th.

Yeah, bullcrap!

My application did not actually arrive in Olympia until January 6th. Well, I know the USPS has been under fire, what with them being a punching bag during the Presidential election, but I suppose I can understand the delay. The thing is, Olympia is about an hour and change drive south of Seattle; I could have driven it there faster! Kind of a scenic drive, too, once you get past Tacoma. The Nisqually Delta is a beautiful sprawl of wetlands.

It would have been a useless drive. The Department of Health, due to Covid, had closed their in-person office. Everybody works at home these days. Except Medical Assistants. So be it. At least now they had my application, and could get started on it.

Yeah, bullcrap!

I called the Washington State Department of Health on January 21st, 2021. I figured this should have been enough time, and that they should almost be done. I spoke with a nice representative. She was very helpful. She told me that they had not received my application.

A-what, now?

The representative informed me that they will start the application process once they have transacted on my application fee, a paltry $145. She told me that she saw no payment under my name.

Hmm.

So I took a stroll up to Chase Bank, where I had worked for 15 years before starting my medical adventures. The nice banker at one of the desks looked up the status of my money order, and saw that it’s status was: ‘pending.’ That means that it is currently being processed, and would post the next business day. ‘Pending’ is a word I would come to be very familiar with.

Well, the next day, I called the Department of Health again. It was a different representative, but he also was very pleasant. He said that they had received my money order and cashed it. Government priorities! I was informed that now that they had the payment, they could begin the application process, but it could take several weeks.

Yeah, bullcrap!

So, I figured I had some time off. I relaxed a bit, cleaned the apartment thoroughly, and defended the Earth against the invading alien horde in XCOM. But I would spend each day practicing my clinicals, going over material, studying. I had to stay sharp. I knew I would be headed to work soon.

I applied for a several jobs; I kind of cast a net. It’s tough for a brand-new Medical Assistant, even though there is a demand. Each facility I interviewed with understood that I was still in the licensing application status of: pending.

A couple of days go by. I call the Department of Health (I’ve memorized the number by this point, if anybody needs it) to where things are. The kindly representative informed that my status was still: pending. He directed me to a website where I could look up the status myself. I navigated through the digital maze of a government website, found my name, and saw my status. There it was: pending.

There is something I need to mention. Way back in 2002, or maybe 2003, I really can’t remember, yours truly committed a heinous, vile crime against the people. Brace yourselves. I was arrested for possession of marijuana. Please feel free to shame me. I deserve it. Funny thing is, several years later, long after I had stopped smoking it, you can now buy it in the store here. Nevertheless, I went through the judicial process of a pre-trial diversion agreement. As this was my first arrest ever, for a misdemeanor, I simply had to stay out of trouble for a year and they would not file any charges. I had briefly consulted an attorney before I sent in my application for my healthcare practitioner’s license, and he informed me, after I read the verbiage from the application, that my situation did not apply. He advised me not to mention it on the application’s list of ‘ have you ever been evil.’ Okay.

Yeah, bullcrap!

The despicable crime I had committed kept nagging at me in the back of my head. I again called the Department of Health, and told them of my sins, breaking down, sobbing. I was admonished, severely, by the almighty representative I spoke with. I groveled, begged. She told me that I should have included the crimes against humanity I had committed, and she was perplexed as to why the attorney had told me to disregard it. She informed me that there was nothing they could do, until they got to the background check phase. I was told that this would delay my application even further.

Yeah, bullcrap!

So I did my due diligence, and contacted the court where I was brought before The Law. They literally could not find my records. Seriously. They told me that a specialist would contact me the next day. The next morning, I saw the email in my inbox. I nervously opened it. It basically said, not using legalese here: “Uh… Dude? That was like, 18 years ago for possession of pot. We don’t really keep those kind of records lying around. Sorry man. Peace out.” However, they did email me an official court letter saying that my records no longer existed. I kept it handy, for when the Department of Health called me out for my misdeeds.

I emailed the records to the Department of Health. I gave them a day and called them, ready for my seething reprimand. A representative (I got a different one each time I called), was rather indifferent to my violations of the sacred laws of Washington State. He had reviewed the court materials I had sent over. He told me that a misdemeanor possession of a substance that was now legal, 18 years ago, was not even a blip on their radar. I though: great! They must have started the background check phase!

Yeah, bullcrap!

The representative told me that they had not yet started the background check phase. I asked what ‘phase’ they might be in. He told me they actually hadn’t started on my application yet.

A-what, now?

I really never found out exactly what they were checking. A background check, sure, but that process, which we’ve all had to go through when we get a job, is a day or two at most. They already had my official transcripts and my proof of passing the exam. You got me as to what else they might have been checking. Driving record? Credit record? Calling my Mom?

I understand, though; to a degree. The Department of Health is overworked, understaffed, and extremely backlogged. But you’d think that they might out a little more urgency into those that wanted to enter healthcare. Especially now. You may have heard of this whole Covid thing. In case you ain’t been keeping up on current events, pal, we’re getting our butts kicked!

Time counts, and keeps on counting. They days go by. My savings dwindle. I really could not have gotten a job in this interim; they’d look at my resume and wonder what a guy with a medical certification is doing applying at Kroger, unless he’s waiting for his license to clear and will bail as soon as he gets it. I keep checking my application status online. It was always: pending. Pending, pending, pending.

I called the Department of Health on March 9th. They informed me that my application was in process. I asked the (again, friendly) representative what stage of the process they were in. He replied: well, we actually haven’t started yet.

Yeah, bullcrap!

This couldn’t go on. I had to do something. Why, I am inclined to write a letter to the authorities! Which is what I did. I wrote an obsequious, begging, pleading email to the Washington State Secretary of Health, Dr. Umair Shah.

Well, sometimes, the squeaky wheel gets the grease. And sometimes, our public officials hear the voice of their constituents. Perhaps. I received this email response on March 17th:

Hello Andrick Schall,

Thank you for contacting Dr. Shah regarding your medical assistant certification application. I have been asked to research your application and respond.

The Department of Health is committed to working with others to protect and improve the health of all people in Washington state. We understand that there is an increased need for all types of medical assistants, and we are sincerely sorry for application delays being experienced.

We received your application on January 20, 2021. Our review and the required background checks were completed, and the certification was approved yesterday. The active status can be verified through http://www.doh.wa.gov, Provider Credential Search.

Thank you for your patience and cooperation with the credentialing process during this difficult time.

With regards,

T. Diane Young

Credentialing Manager

Health Systems Quality Assurance

Washington State Department of Health

PS~ Here’s your license, pothead. (I made that up.)

So, there you go. Sometimes you have to be patient, and sometimes you have to squawk a little. I have two solid job offers lined up, and am mulling them over now. My decision of which job to take is, of course: pending.

Caffeine and Anxiety – Not Always the Best of Friends

 

Caffeine and Anxiety Disorders – Not always the best of friends

Well, who doesn’t like a good cup of coffee. I sure as heck do! What a great way to start the day! You have that first cup, you feel that pick-me-up, and you’re ready to go. You shake off the morning grogginess, and you feel great! At least that’s what your brain is telling you.

Caffeine is the most widely used psychoactive substance in the world. I’m from Seattle, the coffee capital of the world, (even though you can’t grow coffee beans here) and the birthplace of Starbucks. They’ve pumped the brakes a little as the world changes with the pandemic, but basically you can find a Starbucks anywhere in the world. Just turn around. But shoot, I tell you. I remember when it was just a cup of coffee. To each their own, but I do get a little annoyed when I get in line behind someone who wants a double-pump, almond, half-steamed, skim-milk, peppermint Karenchino. It’s just mud! We drink it for the caffeine!

I don’t keep it a secret, and I’m not ashamed of it, but I have an anxiety disorder. How society judges the mentally ill is for another post. My disorder has been largely held in check for a long time now, and I’m functioning very well, despite the recent loss of my father. But let’s take a look at how caffeine and anxiety work together, or, more properly put, don’t work together.

Most folks get their caffeine from coffee, a brewed drink prepared from roasted coffee beans, the seeds of berries from certain Coffea species. This makes caffeine an alkaloid, a naturally occurring organic compound, usually derived from plants. When coffee berries turn from green to bright red in color – indicating ripeness – they are picked, processed, and dried. Dried coffee seeds (referred to as “beans”) are roasted to varying degrees, depending on the desired flavor. Roasted beans are ground and then brewed with near-boiling water to produce the beverage that we all love.

I’m speaking generally of caffeine, but there are plenty of other ways to get the substance in your body: tea, soft drinks, chocolate, and, if you’re feeling like trashing yourself, No-Doz.

How caffeine works, and why it makes you feel good

Your brain does a lot of neat tricks, and it accomplishes them in clever ways. When your neurons, or brain cells, are firing, they are doing exactly that; sending jolts of electricity to one part of the body or the other, telling it what to go do with itself. To aid in this, your brain uses what are called neurotransmitters, nifty little chemicals. There are quite a few different types, and each of them plays either a few roles or many, depending on the need. There is one neurotransmitter in particular called adenosine, a natural central nervous system depressant, which keeps you mellow and composed. Caffeine blocks the actions of adenosine. So you wake up! At the same time, this blockage of adenosine results in the brain releasing other neurotransmitters, namely dopamine, which makes you feel great, and glutamate, which helps ramp up the body. But of course, the caffeine wears off after a while, your neurotransmitters try to return to normal, and you get tired. So time for more mud!

But wait, there’s more! Caffeine also inhibits the release of a neurotransmitter called GABA. GABA’s role is to calm the mind and decrease feelings of fear, stress and anxiety. So when you have a lot of caffeine in your system, GABA cannot do it’s job.

Anxiety Disorders

Anxiety disorder is an umbrella term for several conditions characterized by worry and fear. It is the most common mental illness in the United States; over 40 million people have some form of it. In these challenging times, the disorder has become more prevalent.

At the risk of WAY oversimplifying things, the physiology behind an anxiety disorder is as follows. (Yes, these is a physiologic mechanism behind it; so the next time someone tells you to just calm down and deal with life, tell them to take a good look in the mirror, worry about themselves, and don’t offer unsolicited advice. Or feel free to use stronger language, if you like.) There is a part of your brain called the amygdala. Like most parts of the brain, it plays several different roles. One of the hats that it wears is playing a primary role in fear and anxiety. Studies have shown that people with increased activity in their amygdala are at a much higher rate for depression and anxiety. In the case of an anxiety disorder, the amygdala will overreact to the illusion of fear, if you will, and signal another part of your brain called the hypothalamus. This then will activate your sympathetic nervous system, responsible for the phenomenon known as fight or flight. In doing so, this floods your body with chemicals called cortisol and adrenaline. This action increases blood pressure and pulse, increases muscle tension, and the acceleration of the breathing process. These are well-known symptoms of anxiety. In the meantime, the same mechanism floods your brain with a neurotransmitter call noreprinephine, which mobilizes the brain for action and alertness, at the cost of rational thinking. This is also a well-known symptom of anxiety.

One of the main neurotransmitters that calms the amygdala is GABA. Many psychiatric medications are used to treat anxiety, but some of the most common are a class of drugs called benzodiazepines (Klonopin, Xanax, etc.).

There are, undoubtedly, psychological factors that contribute to an anxiety disorder, but that’s for another time.

When caffeine and anxiety collide

Well then, it is clear that the physiological mechanism of action of caffeine and the physiological mechanism of action of an anxiety disorder can be disharmonious. Excessive caffeine can greatly exacerbate an anxiety disorder. Tremors, difficulty breathing, cognition problems; these can all result when an anxious mind has too much caffeine.

As an aside, I was on benzodiazepines for a time, and I thought I could drink all the coffee I wanted to. I could, for a while. But the chemical storm was raging in my head, and, as strong as benzodiazepines are, caffeine can be much stronger.

My anxiety disorder is well-managed these days, so I keep my coffee to 1 or 2 cups per day. Some individuals with an anxiety disorder find that tea or matcha works well for them, while others may use supplements. Some people with an anxiety disorder are better off avoiding caffeine in their lives altogether. I cannot diagnose, and I cannot give medical advice, but for those of us with an anxiety disorder, the role that caffeine plays in our lives must be considered.

Thanks for reading! Wear the mask, social distance, wash your hands, stay safe!

 

 

Sometimes It’s Good to Wait

“Patience is not the ability to wait, but the ability to keep a good attitude while waiting.”- Anonymous

Well, I THOUGHT I was in the final stretch of my preparation for employment as a Medical Assistant, but there is one more hurdle to jump through, one that I did not adequately see coming.

I have completed all of my academic requirements, with pretty darned good grades. I successfully completed my externship. I passed the National Healthcareer Association’s federal exam. I have been granted the certification of Certified Clinical Medical Assistant.

However, the merciless machine of political bureaucracy, that impacts us all on some level, is the last flaming hoop I have to jump through. And it’s being mighty obstinate.

Every healthcare practitioner in Washington State, from CNA up to MD, needs to be granted a license to practice medicine from the Department of Health, after they have completed their training. Fair enough. I suppose it’s a good thing that the government checks you out before you start treating people. However, Olympia does like to license things. I think we need a license to flush our toilets now. But I digress…

I finished all of my academic requirements, and was granted my credential, in the last week of December, 2020. I filled out the application and sent it off, with a money order for a paltry $145, on December 2nd. I paid for the application to arrive in Olympia on January 4th. My instructor had advised me to send it certified mail. Now, I hate to knock an agency that’s trying it’s best, and has been under political attack for some time now, but I’m not entirely certain that the USPS has their heart in it. I don’t know, maybe book a Tony Robbins seminar with the New York Jets or something.

My application arrived on January 6th. Good golly, Miss Molly. Olympia is about an hour drive from Seattle. If I had known that this was going to be the case, I would have just driven the application down myself. Scenic drive, too, once you get to the Nisqually Delta.

I called the Department of Health later that week, to see if they had gotten the application. They couldn’t find it. Well, alright! Things are going great!

Well, the wheels spun for a little bit, and I called Olympia on January 22nd. Bear in mind, I knew that the licensing was going to be a requirement, but I had figured about a week, at most. Wha-wha! Anyway, the courteous representative I spoke with said that they indeed had received my application, but had only started work on it 2 days earlier.

The representative told me that they were running very far behind, and that it will take some time. I asked him if it would take longer than 2 or 3 weeks. He did not hesitate when he said: Definitely.

I call the DOH every now and then, just to make sure everything is still going okay. The assure me that it is, but it will still be awhile. Every representative I’ve talked to has been extremely courteous and friendly. I guess you can afford to be when hold the power. The big smile says: “You have to wait, jackass! Anything else I can help you with? My pleasure!”

I know the Department of Health is busy. I know they are behind. Covid, you know. That virus, I tell you… Handy excuse for delays. Can’t put a man on Mars yet? Covid.

I suppose, also, that because of the need for healthcare workers (Covid), that there may be quite a few former healthcare veterans who are reentering the field. But really, you would think that the DOH might expedite things a bit for people getting healthcare licenses. Because, you know, Covid.

The DOH, of course, needs to do a criminal background check. That makes sense. But I can’t possibly imagine what else they are investigating about me. My grooming habits? My shoe size? Whether or not I remember cursive and how to hook up a dial-up modem? (Yes on both.) Whether or not I remember to put my pants on everyday? (Most, days, yes.) Are they going to call my Mom or something?

So I sit and wait. The school did warn us that this would happen, but I wish there had been some way to engineer things a little more expeditiously. I had assumed I would be working by about mid-January. That hope collapsed like a Seahaws offensive line, and Russell Wilson is lying dead on the ground.

Even though there is a high demand right now, it’s tough for a new Medical Assistant to find work. Naturally, clinics and facilities prefer experienced people. I’ve had a few interviews, and things went well, but they always ask when I think I’ll get my license. It’s not like they can put a position on hold while they wait for the DOH to press the right buttons. Healthcare needs help now.

But, everything happens for a reason. So they say. I’m not sure I believe that, but, as it turns out, this might not be entirely bad timing.

As it turns out, I could use the time off right now.

It’s no secret, and I’m not ashamed to say it: I have an anxiety disorder. Anatomy and physiology fascinated me in school, and I’ll write a post soon on what goes on in an anxious person’s head.

Over the last month or so, I’ve had several stressors develop. One is being unemployed, and living on my dwindling savings. Another is the licensing process itself. An anxious mind tends to do what’s called catastrophising, playing out, repeatedly, the worst case scenario. I got anxious with the DOH and their delay. What if they find something? What if I filled something out wrong? What if they tell me that I belong in healthcare as much as that loony lady from Georgia belongs in Congress? What if I can’t perform as an MA once I do get a job? My externship was fascinating, but not without its problems. That’s for another post, as well.

The main stressor is my father. He is 92, and has had several strokes recently. My family found out recently that he has weeks, 2 months at most, left to live.

I tell you, there’s a lot of work that needs to be put in when someone is checking out. Calling extended family members, contacting various agencies, that sort of thing. In the meantime, you still have to find a way to experience grief.

I could feel the spiral happening again, and for the first time in a long time, I experienced a panic attack. It’s a horrible sensation. I wouldn’t wish it on anyone. The brain is like any other organ in the human body; sometimes things can go wrong with it.

But, I have a very skilled psychiatrist, Dr. Dispensapill. With a small tweak of my medications, the anxiety has largely abated. It will still be present, along with periods of depression. These are normal as you watch your father die. But there is a difference between situational anxiety and depression and clinical anxiety and depression. With some good therapy, the anxiety has lowered dramatically, and I have had no further panic attacks.

And so, life goes on. It’s really not such a bad thing that I have this time off.

I’ve been going over the healthcare basics again. It’s surprising what I’ve committed to memory, what now comes naturally without having to think about it.

I bought one of those dummy arms so that I could practice my phlebotomy. My brother Pedro says he’s willing to be my human test arm. Er……

I’ve done a ton of writing and research, and will have plenty more posts coming.

And I’ve done that usual trick people do when facing the loss of a loved one: I have cleaned the HELL out of this apartment!

My head is getting screwed back on, and I’m feeling better. But I have grief to come. It’s good then, to have a little time off.

Make every moment count. Don’t be afraid to tell someone you love them. Wash your hands!

Straight A Student!

BAM!  That’s 3 quarters down, 7 classes, all 4.0s. Not bad, for a 47 year old college drop out. I’m well on my way, but I still have some serious work to do. I don’t start the 4th quarter until September 29th (my birthday!), but my foot is still on the gas. A classmate and I are meeting regularly; we’ve already gotten the exam prep books, are making flashcards, and she and I are committing as much to memory as we can. The 4th quarter will be 6 more weeks of classroom instruction, followed by my practicum. I’m not sure where that will be yet, but one day at a time. If all goes well with that, I’ll be eligible to sit for the federal exam.

It’s been an amazing 8 months. I never really thought I would have such an affinity for healthcare, let alone be somewhat good at it, if my grades are any indication. I still have a lot to prove to myself, as I have yet obtain a license and actually treat a patient, but I’m more confident than ever. It turns out, I really love this stuff! Healthcare is really cool! It annoys me when people malign seeking professional medical care. You have a problem, you get it fixed! Although, how we as a society pay for it is a whole different matter…

I’ve got a long way to go, but I’ve learned a lot. I can take your vitals, any of them, however you like. I can clean and dress a wound. I can set a cast. I can stitch you up. I can run an ECG. I can draw blood and prepare the specimen for lab work. I can give you an injection just about anywhere, and I even know how to prepare the dose! I can explain how the law relates to healthcare, and I can talk all day about my new favorite subject, physiology. The human body is an amazing machine. I really can’t help you much when it comes to how the brain works, that’s a little tricky; but if you need to know about the endocrine system or how the circulatory, respiratory, and lymphatic systems work together, just let me know!

Well, back to the books. Wash your hands!

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Medical Terminology (and the ancient Romans were kind of jerks)

Well, the third quarter is underway, and so far it’s going great! I’m taking 2 courses; one is Pharmacology and Medication Administration (this is what the chemical is, this is how I will inject you with it) and Administrative/Clinical review (this class is a lot of fun –  the instructor basically sets up exam rooms, and we practice on-boarding patients; the instructor, playing the MD, then gives us a procedure to carry out with the patient), which ties together everything I’ve learned so far. We are also studying medical terminology, and where it comes from. Not sure why that wasn’t covered in the first quarter; perhaps they just wanted us to get familiar with the jargon before we closely studied the etymology.

Everything in healthcare seems to have a needlessly fancy name, but there’s a good reason for that. Just about every bit of terminology a practitioner uses is either Greek or Latin in origin. There is also the occasional eponymous term, a word named after the person who discovered/invented it (Pap test, Alzheimer’s, Tommy John surgery). I’m oversimplifying the history a bit, but a long time ago, when Hippocrates and his colleagues figured out that illnesses and diseases were actually environmental and not divine punishment (although that unfortunate concept still exists today), and began to actually study the human body, the ‘English’ of the day was either Greek or Roman. Many people in the known world (which was much smaller then, than our own) spoke one of these two languages; much like a good portion of the known world speaks English today. This way, a physician in Rome could correspond with a physician in Roman occupied England, who perhaps spoke a local dialect, and they would know what they were talking about. The practice continues today.

The word ‘doctor’ comes from the Latin ‘docere,’ which means: to teach. It also shares its roots with the word ‘docile.’ The thinking here is that one cannot properly learn and absorb information if one’s mind is not calm and focused on the matter at hand.

But, as it turns out, the ancient Romans could be a little flippant. The word ‘hyster’ comes from the Latin ‘hystera,’ the word they used for uterus (think: hysterectomy). The Romans believed that women got moody and emotional because of their menstrual cycle; therefore, the word ”hystera’ shares a root with the word ‘hysteria.’ Well, that’s charming. Sure, some women do occasionally get a bit out of sorts on their menstrual cycle, but that is not a character flaw or an indication of a psychological or psychiatric disorder. A woman’s endocrine system is simply in overdrive, if you will, forcing an ovum into the uterus. So there you have it. The etymology of medical terminology is fascinating, but glib, dismissive opinions are nothing new.

Wash your hands!

3rd qtr so far

Cute Animal Stories and Physiology

cat nursing puppies

The link above is a very cutesy video, but it had me reaching for my textbook.

According to this video, the mother cat had recently lost her kindle (I love collective nouns) and was, quite naturally, profoundly depressed. This animal foster family took the cat in, and found the cat to be needy, sad and distressed. It was only after the introduction of a litter of puppies that had lost their mother (what is this, a Disney movie?) that the cat came around.

There is an endocrine gland (that means it makes hormones) in the middle of your brain called the pituitary gland, answering to your CNS by way of the hypothalamus, a bridge between the CNS and the endocrine system. The pituitary gland is often called the master gland, because it does a lot of stuff, probably gets paid more. One of the hormones it secretes is called oxytocin. In mammalian females, oxytocin plays a major role in commanding the body for pregnancy, birth, and nursing. However, in both genders, oxytocin, by the very nature of its primary function, also engenders feelings of attachment, belonging, and intimacy. This cat was flooded with oxytocin, was depressed, and needed attention. When the puppies were introduced, the oxytocin returned to its primary role, and the cat became a surrogate mother. At this time, the cat’s pituitary gland produced another hormone called prolactin, and enabled the animal to nurse the puppies.

I’m not trying to reduce the powerful emotions this cat felt, emotions that would also easily occur in a human being, by explaining it away in technical terms. I’m not trying to take the ‘awww’ out of it. Just two things:

1: It is profoundly interesting that external, emotional events have a direct, physiological impact on how your body functions. Your emotions are very real, can be very strong, and, if you need proof, take a look inside and see the physiological process. If someone tells you to suck it up, if someone shames you for mental illness, if someone tells you to stop feeling a certain way, then they are A) ignorant of how the body works, and B) an asshole. “It’s all in your head!” Well, of course. Everything is. But that’s ontology, for another time.

2: It’s also profoundly interesting that we’re looking at two completely different species here. That’s incredible. That speaks to the strength of the survival instinct, but that’s for another time.

Well, I’m procrastinating again. Gotta hit the books. Wash your hands!