Progress Notes (2/27/04)

D (Data) Subject presents with low intensity gradual movements throughout the morning. Initially, she appears to be in a stable mental state. She can readily be seen performing cognitive behavioral self- talk exercises, repeatedly stating, “you can do this”, “you are strong”, “you are a rock”, and “I will make it”. This becomes excessive as she performs tasks that generate anxiety, especially as she washes her legs and changes her bandages. Alone she is strong and independent, however this facade is broken when she speaks with members of her support system. A brief telephone encounter leaves her feeling helpless, yet simultaneously comforted and safe. She obsessively examines her body for changes, assessing size, shape, and pain associated with visible lumps. Tears are evident as she decides to leave the parameters of her immediate environment, though she rebounds quickly once she attempts to find music that is reflective of her mood. Abruptly she changes her demeanor (approximately 4:15), displaying a positive and upbeat attitude, laughing and smiling more than necessary. This change is short-lived as she soon becomes frustrated over small setbacks. She has difficulty concentrating and is unable to accomplish the tasks that she had planned. This leads to a heightened frustration, an inability to hold a single thought, restlessness, and eventually mental and physical exhaustion.

A (assessment) Subject is in denial, as evidenced by her inability to ask for help, honestly assess the situation, or describe her feelings or extent of her diagnosis. She may be demonstrating early signs of depression and/or anxiety symptoms, however this diagnosis requires more observation.

P (plan) Relaxation, guided imagery, and visualization techniques may help the client feel more in control and empowered, as well as relieving some symptoms of anxiety. Expressive therapy may be a potential outlet for this client, as she responds well to the creative and visual arts and gains a sense of purpose when she feels that she is able to accomplish something with a tangible end product. Assertion training will help her ask for help and utilize her strong support system.

Personal Reflection: This client needs to be challenged, creatively and mentally. It is of extreme importance that she finds a way to utilize her support system. She has a strong personality and can be stubborn at times, but she is an active listener and open to new ideas and perspectives.

fat castaway

Dreams are like castaways, in that they drift forever until somehow striking something solid enough to continue life on. It is the bitter will of dreaming, the somnambulant ceaseless hunt of sleeping that keeps at bay whatever wrestles me in sunlight hours.

- Snap -
(Suddenly I’m headless, pitched into senselessness, only voices)

“Common side effects of chemo include fatigue, pain, nausea, hair loss, and anemia — the most prevalent. Anemia occurs when your body doesn't have enough red blood cells. Fatigue is the most common symptom of anemia and the most common and longest-lasting side effect of chemotherapy. Fatigue can steal your physical and emotional strength to fight cancer.”

- Snap -
(A voice calms me, it is mine)

It is a slow measure of side effects and the cumulative needs of things on my mind and body. Imagining how I could best help a loved one in a time of need, and somehow fitting in the making of a relationship on top of all of it. It is catching us in our most precarious of situations, and forcing us to solidify some resolve just so we can both make it out alive (or maybe it’s happy). It forces me to deal with the lesser important things of my life, so that I can make room for the vital ones, and with that recognition at this very moment of my life I can smile a pure smile, something I have not done for a while.

The imminent journey

Wrong, wrong, wrong…

Mornings spent on the edge of the bed; wondering if it was all a dream, if it could disappear, if I could get better? Pre-caffeine tears, breakdowns in the car, dissociative experiences pushing me to create a “best of” list at the end of the day. When will it stop?

Circles, upon circles, and circles again.

Stumbling across words.
Early morning rambling. Nonsensical, but awake. Live, kicking, empty and drained.

I have often looked for an escape, lost and crawling through the microscopic tunnels of my heart. This though will be different; this light will not be rushed to fade.

Lost and found

How better to wrap up such careful sentiment, than in the autumn leaves of memories. To draw back, reflecting in the purity of life lived before a startling revelation or mortality. How else should I begin to sort the priorities of our lives?

The first time she was sick; gone on some distant vacation, hard to hear on the telephone. The first time I heard cancer from her lips, even when raspy on the other end of the receiver, hoarse and choked by swollen lymph nodes and engorged tonsils.

That "Cancer" word changes conversations that you have about "us". It turns a world of chances, into a world of chance, almost overnight. An apartment together in the summer turns into summer spent in chemo-therapy, a thousand, maybe even a million miles away from you.

Suddenly you're on vacation again. Its official, but you don't want to say it. She didn't want to tell me about it, how they suspected the lumps were cancer, how they had to cut them out. Perhaps she just didn't know how to tell me. Ill wait until she is ready, holding back curiosity, its her life, her ailment.

Meanwhile, life courses in and out, vying for my attention with all its might. I just hope to hell that everyone is wrong wrong wrong...

slide

I often sit in crowded cafes and bagel shops wondering how I got left behind. Wondering how I came to be sitting in this chair, in this particular uncomfortable chair, on this day, with these people. I sit cursing this droll town for forcing anyone with a hint of a brain outside their home into a safe place, venting to look -alike friends and people watching. All so they can brag to their cubicle neighbor on Monday morning that they sat for hours this weekend just observing human nature and discussing life in some deeply profound and meaningful way. This blatant lie, this nonchalant attempt at a life worth living, perhaps even fulfilling, will be abandoned in the stiff air of the corporate world. Left to float somewhere between the jelly filled doughnuts and the blinking fluorescent light that has been dying slowly for weeks.

So, I sit here and think these things, these awful, judgmental things about the shallowness of other people. Deep within me something stirs. Is it nothing more than fear? What if I am that uninteresting? Ordinary? Oblivious? What if we all are?

I could believe this just as easily as I would have believed that a folk singer turned pop star would ask me for directions in New York City and chronicle the encounter countless times in front of millions of people. And maybe that is the point. Maybe I knew that my life was so uninteresting that I created these fantastic alter realities in which I was somehow the center of the world. I was the last Russian Princess. I was talking with God in the form of a sheep. I alone could feel the earth move.

But then, I rolled over...

For weeks I was in a daze, my life seemed to evolve without ever asking for permission. Articulation was a lost art, saved for the monks and downhearted blues singers; for those who can embrace their loneliness and somewhere find solace. Was I alive? I remember walking up stairs and not knowing how my legs were moving. I had somehow become disconnected from my body, from reality. Was it the lumps that appeared a few days ago? Did this foreign agent that had entered my life, uninvited I might add, rob me of my sanity or did it just nudge me out of bed?

I needed to feel alive, though every attempt to reach out was sabotaged by a defense system that had been twenty-two years in the making. When it was all said and done, I felt manipulated by my own hands, yet they somehow did not feel like my own. Sensation was a strange partner. Though I caution you that I was not numb, but on the contrary, acutely aware of the mutant blip that had settled in my consciousness.

And then, I woke up...

I stood naked on a cold concrete floor, humiliated that I no longer looked gaunt and emaciated like a dancer, as a doctor who looked younger than my big brother quickly groped my exposed body. He did not gently poke and prod, like you would expect a good doctor would, but rather awkwardly left me feeling violated and felt up by a sexually inept frat boy. This was modern medicine?

I listened as they explained what they suspected, what they could do, how amazing technology had become. I shook my head as they described stages and phases, prognosis and survival rates. These plastic people that were one day the object of my critical gaze now became my lifeline, my holding environment. Were the blind really leading the blind? This is what my gut said.

It was not until the last stitch went in my leg that I felt nauseous and unable to speak. I held my mother's hand and thought about Thanksgiving dinner, cranberry sauce from a can and cold pumpkin pie, my teddy bear, and the look on my grandmother's face the night before she died alone in an unknown bed.

Was this really my life? That is what went through my mind when he said the word cancer.

This is your life. That is what went through my mind when he said it had migrated to my bones.

And then, I started to dream...