Replying to a Mother’s Rueful Response

awrittenletterDear Mrs. Donahue (names are changed),

Thank you very much for your kind words. I wish I could take credit for my writing style but alas, like my blue eyes, my writing was implanted long before I discovered it. And I doubt that beautiful language is lost on you: my job is to inspire the reader to take action or offer empathy. See, you took action! Your comment had a tremendous effect on me; it was your honesty and so, in return, I will attempt to answer your concerns as best I can.

Is your very bright son Bipolar I or Bipolar II? It’s generally thought by those who have been diagnosed with Bipolar Disorder that life feels better when they’re off medication; which it does at the onset of mania. But (in my case) mania begins to spoil quickly (like peaches), and then the paranoia, insomnia, and hateful accusations begin to fly; if there’s no intervention (hospital, doctor, therapist) my thoughts begin to darken like storms in Nebraska; my withdrawal begins like clouds gathering on the horizon and continues to descend getting ominous and threatening; until the eventual cloudburst of suicidal ideation, developing a plan, and at its worst, scheduling a date. Your impression of his life on and off medications may be accurate, but rather than compartmentalizing your observation, let’s look at it comprehensively: ON MEDS: Ability to function (personally, academically) and a sweet disposition; OFF MEDS: High degree of intelligence and violent. It’s important that your son understands that mania is a false reality often unpredictable and usually misleading. Mania joegordonlevitt-manicprovides “out-of-the-box” thinking, grandiose ideas, risky behavior, and poor judgment. Contrary to what patients who abandon their meds think, their manic behavior is not their true behavior: It’s their mentally ill behavior gratifying their indulgences and oblivious to any consequence. You might want to read my post “Bipolar is not an insanity defense.” Whatever actions he takes while manic and unmedicated will be his responsibility. If he breaks the law he could find himself in a lock-up, brought to trial, and sentenced to the general population of a county jail or state prison to serve his time. And our It’s a risky and poor decision. We all hate our meds: for some, it prevents mania, for others it prevents suicide. His meds keep him safe.

He’s got to come to grips with his “new normal” or he’ll always want to transgress to the embolden and manic life. In the past four years, I have ingested a surprising number of medications (29 pills daily), all of which failed. A friend mentioned Adderall. I now take a tightly monitored volume of Adderall’s generic cousin. It’s the only medication which plucked me from the depths of my depression. Adderall makes you very focused, like an English Pointer zeroing in on a quail; too focused sometimes, almost to obsessive, waving off distractions, even meals. I’ve thought that I’m merely a puppet following Adderall’s direction.  But it’s the only medication that’s made a significant impact on my mood. Every morning I have two choices: 1) Swallow it; or, 2) Don’t swallow it. I swallow it because I’ve weighed the consequence of not swallowing it, and the outcome is, in a word, glum.

When your son turns old enough to be an adult you’ll have to let him go. I strongly suggest that you find some kind of parental support groups, perhaps a therapist to work with you. But remember, it’s impossible to reason with a manic person and it’s impossible to reason with an unreasonably depressed person. When the bipolar patient’s behavior indicates he is manic or depressed and living out-on-a-limb they forfeit rationality and decisiveness; they adamantly oppose responsibility as a clumsy and conspicuous trick by law enforcement or psychiatrists to admit their participation in some wacky activity; they denounce medications as a straightforward blitzkrieg against their mental resistance.  At some point we all return to face, with shock and awe, our manic (or depressed) annihilation of what-was-formerly-known-as-life, understanding that some relationships sustained too much damage and were bulldozed; while others weren’t inhabitable without repair. That’s when you face the costs of abdicating meds to unleash the real you.  And yet you know that the real you would never destroy relationships which you affectionately admired.

He knows precisely what to do because you loved, cared, and taught him.

Now, it’s his life to live complete with failure and success.

Oh yes, and bipolar disorder.

Shame and Regret: The Sting of Social Stigma

First posted in August 2012 Shame And Regret: The Sting of Social Stigma has more of a wallop five years later than four years earlier. We as a race must get something out of persecuting the disenfranchised and marginalized friends, family’s, lovers, idols, and heroes. Maybe we ought to look inside ourselves and find that kernel of fear. Then erase it. And then get back to being compassionate brothers and sisters.

 

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Why are we ashamed by what we do?  We do what we choose to do because we stand to gain something.  Yes, some people are forced, say at gun point, to compromise; some are coerced through drugs and alcohol; and yes, some actions are purely altruistic (ashamed of philanthropy?).  It’s my opinion that consciously withholding or denying or lying about our actions is caused by fear.  Not a generic fear, but a two-tier fear.  The first tier-fear: judgement by others is beyond your control; but the second tier-fear: consequence sits squarely in your lap, and which, by the way, you’d already equated as a potential cost of your unprecedented action.  We all know this simple truth: We have absolutely no control over the actions of others.  That said, we can remove the first tier-fear: judgement by others; we now find ourselves staring down the steely barrel of culpability: we encountered a situation, measured consequence against benefit, and toed the line or stepped across it.  So shame and regret were considered well before we pandered to our hunger, thirst, or warm body (emphasis on warm).

The best possible precursor to a mental illness diagnosis was, until 1973 its own mental illness: homosexuality.  Coming out as a gay man taught me the valuable lesson that there will be people who can’t distinguish between my sexual orientation (which places me in a specific group) and who I am (in general terms) as a fellow human being.  Having learned that lesson years ago I was well prepared to face similar discrimination based upon my mental orientation, i.e. mental illness, e.g. bipolar disorder.  And yet, what is there to be ashamed and regretful about?  Don’t carry the burden of Shame or wear the shackles of Regret; never apologize to anyone irritated by what you have, especially if what you have is a medically recognized disease.

Recently I conducted a thoroughly non-scientific giddy-up poll which asked: What diseases do you think you’d be ashamed to admit having?

Answers?  Anal warts, vaginal herpes, syphilis, gonorrhea. . .what?  Anal warts? Venereal diseases? According to our non-scientific poll of middle-aged men and women, they said that carrying a sexually transmitted disease is the only other human affliction besides mental illness that they would be ashamed of having and which also carries with it a damning social stigma.  STD’s are the result of risky and unsafe sexual activities engaged in by choice. Does mental illness really belong in their company? Really?

Shame and Regret are burdens that those who choose to remain ignorant and judgmental should shoulder.

Not me.  Not you.  And certainly not the neighbor, best friend, Richard Dreyfuss rdreyfuss2
parishioner, bowling buddy, Ryan Phillippe, phillippeprom date, recipient of the first kiss, Girl Scout, Teddy Roosevelt (yes, really), Girl Scout Leader, Sinéad O’Conner, full back,  Metta World Peace ,
mettapeace offensive line coach, movie star, Burgess Meredith, Opera Star, Ronald Braunstein, famous orchestra conductor, infamous commuter train conductor or any one of the other 25% of our world’s population. How about the other 75% of the world’s population loosen the reins of their prejudice.

The Dead’s Etiquette: Returning To Sender

Self-designed stamp for the return of mail to sender.
Self-designed stamp for the return of mail to sender.

Emily Post let me down. Abby offered a half smile. The Post Office just stared at me.

My question was always the same: “At what point can I stop stamping to return my deceased brother’s mail?

Just last week he received a stack of mail three inches high! Perhaps they’re thinking of him as Deadbeat rather than Dead.

He died four months ago at which time I rented a P.O. Box in my neighborhood and had his mail forwarded to it. I designed the “return deceased” stamp. And each step was more painful than the last. With each envelope I was reminded that at some point in my recent past my brother for 58 years disappeared. Poof! Extracted like a tooth, and like an extracted tooth a hole remained reminding me that something had occupied that hole, something I took for granted as permanent.

I still cry when I’m reminded that he’ll never return as though he was exploring the far reaches of dense jungle. And with each damned envelope which I mannerly stamp “Addressee Deceased,” I ache with longing which tumbles to tears then swells to a contemptible bitterness toward companies which mechanically spit out statements completely void of sympathy or understanding or humanity.

I think it’s time to treat their mail like my best friend brother was treated: simply disappear.

Life: It’s All Yours.

  This post, its contents, and its author are not nor pretending to be healthcare professionals giving advice or suggesting treatment for health issues. 
For help with your health you must see a healthcare professional.

If you’re reading this post, chances are that you’re alive like I am, but you didn’t have a motive like I had, to reflect on what does it mean to be alive while the Life of my brother simply floated away like a freed balloon.  Synonyms for alive include methodical references like: aware, cooperative, and sensible. On the other hand, synonyms for Life imply inventive and daring like: animated, vital, and dynamic.

living1I’m definitely alive but am I Living? Living Life now? Living an animated, capricious, passionate, dynamic, vital, and creative Life? Living Life as though I was purposeful rather than predestinedOr has Life as an adventure, those outwardly foolish, expressive, devil-may-care, and goofy ideas of my arrogant youth been bagged and hung in the back of a closet like an unstylish overcoat? I remember exactly when I lost my nerve and consequently my verve. It was when I had to shelve my life as a creative, curious, and lyrical writer in order to be initiated into a wholly alien and inconsistent corporate culture by getting a job, being supervised or managed, have a steady income, and be a responsible adult. I compromised my true self to evolve into one in herds of others that bought into the idea that business is better than a mind full of zany ideas

The week immediately following my brother’s five minutes of death then resurrected by modern medicine, he spent it straddling the threshold between now and ever after. Rick’s life had become a slippery slope with one treatment jeopardizing another, inconceivable mobility issues, and, like a politician caught taking bribes, his dignity was retired by committee, his independence was incarcerated as he was assigned a room on a floor presently occupied by end-stage, incoherent residents. Considering what he’d already forfeited, I knew that my brother Rick, was going to finish what he’d started seven suffering days earlier: his non-negotiable intention to die, right there, there in a generic hospital bed surrounded by generic strangers. It was, after all, his free will that determined he did not want to live a compromised life.  It was then, in the presence of his own conviction that he would end his miracle of life.

Later that afternoon and well into the night I took a long, hard look at my Life, my unconsciousness of it, what I promised the world at birth, and finally, have I kept those promises? Below you’ll find a list based solely on recalling Rick’s life, his courage and his conviction, and finally my own mortality.  I was surprised (to say the least):

  1. Life is a Miracle:  It doesn’t matter to which, if any, spiritual leadership you follow, the simple fact that you, you, not somebody else, but you, faults and all occupy one tiny spot in a universe few can even imagine.
  2. Life knows its job:  Life knows the human genome and like Mr. Potato Head puts us together in a fascinating display of accuracy and symmetry.  None of my Mr. Potato Heads ever resembled each other.
  3. Boldness and Bravery aren’t the same. Boldness is something you do for your self in order to get noticed. Bravery is something you do for others disregarding your own safety. Men and women that are brave get noticed. Not because they were bold, but their actions were brave.
  4.  Join clubs, gangs, or any organization whose sole purpose is benevolence. They’ve been drawn together in order to help others rather than themselves.
  5. Fail as often as you can. Failing implies you tried something new. Failure is knowledge.living6
  6. Success is fleeting and assigned by others.
  7. Keep secrets secret. Secrets are like boomerangs, they always return to sender.
  8. Be unpopular; popular people spend a lot of time being popular. Unpopular people spend more time on their passions.
  9. All Olympian’s, film stars, and scientists who have won, starred in, or discovered a cure forfeited something very precious to dedicate themselves to their sport, their art, or their experiments.
  10. Whatever you’re undertaking, always have a “Plan B.”
  11. If you’re doing, going, or trying anything new, be sure you know a way out before it becomes dangerous.
  12. Be generous. Sure, with money; but with yourself. Everyone is inspirational. Tell your story to others. Truthfulness is inspirational.
  13. Never compromise your character. It’s who you are. Without it you’re nobody.
  14. living5Fear stops everyone at one time or another. But fear can be conquered: Simply dig in your pocket for your determination.
  15. Never quit. Never. Friends, family, strangers will all chide or mock your idea. Expect it. Ignore it. Mockery confirms they’ve heard or seen it. Which is always better than silence.

A Comment Worth Mentioning

aacommentDr. Culpepper writes in response to my recent post, “Thank You, Doctor.”

Dear Mr. Mulligan:

Medicine is a calling and I suspect that you would have served beautifully in this profession. A real physician does not have a job as a doctor, he or she becomes a doctor.

In the process of medical training, one takes on a new life… well, that’s the ideal. Much of the challenges of our healthcare quagmire result from medicine becoming instead a business.  It’s as if church and state combined into a disaster. So it is with healthcare becoming a business. No one begrudged a well paid physician, our community supports that concept. It is instead the focus on business: the margins, marketing, middlemen, and entrepreneurs (some of whom are doctors) that has poisoned this noble profession. Those physicians that are still true to the calling are swallowed up by the toxic agendas and often not seen except floating below the surface.

Please continue pointing to those brave souls. They need the attention and a lifeline.

Dear Dr. Culpepper:

it’s nearly impossible to practice a passionate profession be it medicine, applied sciences, mathematics, art, performing art, music or writing.. aacommentresponse While these passionate professions are often enjoyed by many, they fall far outside the gated community called business.

Your irresistible “calling” metaphor is the perfect rational as to why men and women pursue professions which require the volitional abdication of varying aspects of their human nature like sensibility, acceptance, support or reason. But it also provides a pathway to genuine propriety and inclusion in one of the most reverent and honored professions on a global scale. It is a profession which treats humanity not borders or anarchy or tyranny.

Physicians transcend the pettiness of our human condition to oversee the miracle of humanity. I myself have heard a calling; to ignore convention and weave together language inviting the curious to hear the harmony of words. To others blessed to hear their calling, I recommend you listen to its invitation; yet most discard it as folly. True Callings  never quiet; they continue to knock, disrupting whatever future you planned with doubt and obstacles.; then one day an example of the difference you could make persuades your abandonment of a false life to step off the canyon’s edge and begin your true life.

If it’s fear that stops you, consider your patient’s eyes filled with fear and the strength they see in yours; passionate eyes sparkling with compassion and the quiet strength of a truthful life.

When I Was A Boy, A Doctor’s Insight Was Law

 

aadoctor

When I was a child and was literally dragged to Dr. What’s-His-Face for an annual check-up (less a check-up and more a ritualistic cadence of tsk, tsk, tsk’s) as he poked and kneaded and cold-handedly fiddled with my . . . which backs away from coldness . . . and shy’s away from evaluation like a cub scout whose self-built car elicits jeers from his Scout Master (who also happens to be his dad).  The snap of gloves and odor of soap which resembled anti-freeze gave the doctor time to compose his subtle and sensitive conclusion:  “He’s too fat and getting fatter and his fat is hiding his . . . which, for sanitary reasons may require the removal of . . . which was when I buckled my Indian Beaded Belt and disappeared until hours past dusk when a neighbor found me shivering beneath the front porch.

That incident was a painful secret which I’ve carried on my back for fifty years and continues to cause retreat when doctor’s or lover’s reach out.  Such a sad burden to carry because of one unsympathetic phrase from a stranger who had no right being a pediatrician.  I often wondered how he treated his dogs.

My mother’s ignorance and prostrating to figures of authority always meant that any run-in with any adult possessing even a pinch more aacopauthority than her resulted in stern and week-long pain.  Just what exactly did these arrogant and sadistic adults possess that was never crossed?  They had been appointed to their position because of educated insight which was never, ever, EVER questioned..

Which, of course, perpetuated a multi-century tradition which has continued even to this day.  Most doctor offices have a small-framed notice somewhere above their “All services must be paid TODAY!”  reminder which reads something like,  “My profession hasn’t been questioned or challenged in three hundred years, so don’t try to be the first today!”  And in you go to be examined, quizzed, and questioned only to receive a prescription scribed in ancient Egyptian and an “order” for physical therapy.

aaangryguyDo I sound somewhat angry?  Of course I am!  Doctors get paid enormous salaries yet complain about the escalating costs of malpractice insurance.  Malpractice insurance exists because professionals are trusted and believed and paid.  And for this degree of faith we get an educated guess of what might be ailing us.

But this is what I’m REALLY angry about: Two doctor’s at Froedert Hospital assured me my brother Rich did not suffer a stroke based on a CT scan.  It was 48 hours later when I insisted they perform an MRI.  Voila’!  A clot in a vein feeding the occipital lobe (responsible for eyesight).  Because of unconscionable arrogance my brother is legally blind while these two doctors suffer NO consequence.  Upon discharge from Froedert, I was told that Rich was totally blind due to A) The Stroke and B) A severe seizure two days later.  I made decisions based upon the information told to me by staff in the Stroke Unit.  And guess what?  He isn’t blind!  Albeit his eyesight has been significantly compromised, but his field of vision is approximately 17″ in diameter!  And the staff at Froedert?

And the worst example of guesstimating occurred this past weekend when Rich suffered a severe heart attack.  The errors in order of aapuzzleddocappearance: A) Someone at the acute rehab facility removed his DNR bracelet, yet never informed the paramedics that he had a DNR order in effect; B) The paramedics, unaware of the DNR order, couldn’t inform the ER staff;  C) When Rich went into arrest they performed heroic measures to yank him back to life including five minutes of chest compressions resulting in several broken ribs and the insertion of a temporary pacemaker to maintain his heart rate (why didn’t anyone call me while they repeatedly beat Rich?  They called me after!)  D) An ICU doctor called me and informed me that the ER stepped beyond Rich’s wishes and now, NOW I’ve got to decide if and when we reverse their . . . their, what . . . their adrenaline infused jump to action?  And when YOU do decide he will . . . be gone.

For nine hours I held firm to Rich’s wish: DNR. And I would honor his wish just like I’ve always honored him. And I aastoplightwouldn’t allow my own emotion, hope, or desire to shake my resolve. I spent nine hours picking up strength like a child picks dandelions. And upon my arrival at his room in the ICU he was semi-conscious, breathing on his own, and occasionally howling in pain as he coughed with broken ribs. The equivalent of The Cuban Missile Crisis was over and Rich, contrary to what the ICU doctor emphatically informed me, was alive, on his own, without my intervention. And even though he’d crossed that line, he’d come back, I think, just so we could laugh at the old, standard jokes as though it was the first time we’d heard them!

And those doctors? The heroic and uninformed professional, and the cardiac-specialized professional made two BIG mistakes and continue to work without consequence for their egregious and painful errors. Alas, that three hundred year old tradition continues.

 

My Brother Rick (aka Dikes, Rich) Condition Post-Stroke

asstroke3Last Thursday, a few minutes past noon, I called my brother Rick in Milwaukee (it had become a ritual of sorts especially while driving), and he answered in an odd tone which gave me pause. He began to complain of escalating nausea to which I urged him to see his personal physician.  He failed to remember his physician or the terrible diabetic wound which almost led to amputation or his two-month in-patient hospital stay. I astroke1told him I’d call 9-1-1 and ask that he be taken to West Allis Memorial Hospital ( policy dictates patients be taken to the nearest hospital). However the paramedics discovered atrial fibrillation (fluttering heart beats) which alternately peaked and diminished and therefore paramedics informed me that they were headed to a critical cardiac unit at St. Luke’s Medical Center.

However, St. Luke’s didn’t have a bed open, so Rick was taken to Froedert Lutheran Medical Center. After tests and a CT scan the ER team began antibiotics to stave off a small area of pneumonia in his right lung.  Rick remained on the general medical floor until the results of an MRI showed he’d suffered a severe ischemic stroke (an obstruction within a blood vessel supplying blood to the brain) in the occipital lobe (at the rear of the skull and is responsible for vision). On Sunday afternoon he was transported to the Stroke Unit (one of just astroke2a few in the U.S.) where he was resting comfortably.

On Monday, June 18 Rick suffered a significant seizure which greatly diminished his short term memory and eliminated the peripheral vision on his right side.  I’ve visited and talked via telephone with him this past week.  The cadence of his speech has slowed, he’s practically immobile, he’s approaching clinical blindness, and finds difficulty in fundamental motor movements like holding a cup.  But as he told me earlier this week, “I ain’t going to be like this forever, you know!”

I’d like to ask that anyone reading this post to consider sending him a get well card.  I’m sure your sentiments would help replenish a hopeful spirit during difficult times.  For those of you who send cards, thank you; for those that haven’t, please reconsider.  Send your cards to:

Richard Didrickson
Froedert & Medical College of Wisconsin
5-NW Nursing Unit
9200 W. Wisconsin Avenue
Milwaukee, WI  53226