Tuesday, November 19, 2013

Mental Minds

When I packed us all up for Disney World, I was very good about bringing only the bare minimum. I didn’t even bring my purse; instead, I took the essentials out of the worn little bag and hung it up in the closet. The essentials of my purse turned out to be just five things—my cell phone (obviously), my credit card (which is niftily attached to my cell phone), my license, my Chapstick, and my blue Dana-Farber card. I hid the last item in side pocket of my bag, embarrassed, even to myself, about the fact that I needed it with me.

My reasoning was ridiculous, I know. What if I find a lump while I'm there and the only way I can calm myself down is to go to the hospital and for some reason, at the hospital, they need that card? That was about as remote a possibility as me visiting the all-you-can-eat breakfast buffet less than three times, but still, it is possible, I thought.

The cancer card is a funny thing—both the literal one, tucked away in my carry-on bag, and the figurative one that far too many of us hold. Tonight, I will write about something the cancer card did for me.

I have dealt with anxiety for a long time. My anxiety has never been the kind of anxiety that I thought deserved any attention; it's not the kind that people aside from those closest to me would even know existed. It doesn't hold me back or hurt me physically. But still, it's been hard sometimes, and for some reason tonight, I feel a compulsion to write about it.

Thinking back to my earliest memories of feeling anxiety, a few things come to mind. To someone who doesn’t know this condition or illness or whatever it is, I’m sure these stories will sound beyond ridiculous. But to me, and maybe even others like me, they are very real.

One of my most anxious days of the year as a young elementary school kid was of the first day of summer camp. Feel free to laugh, but I'm not joking. My parents sent us to one of the most incredible day camps in the area, and there, the activities were countless. There was carpentry, Indian Lore, music, flag football, arts & crafts, ropes, gymnastics, boats, track & field, tennis, video, and too many other activities to even list. In fact, there were so many activities that every hour on the hour (except for the two hours a day that we all took swimming lessons or played at "free swim"), we each got to choose which activity we wanted to attend from a selection of three or four.

The first day of camp, the head counselors always held a clipboard with a fresh sheet of paper that laid out the “Choices.” The Choices were what we all called the grid of the activities that were available each hour of each day. For most kids, that paper was a chart of a whole bunch of fun stuff they could do that summer. For me, it was an agenda.

Some people may interpret this to mean that I didn't enjoy camp. That couldn't be further from the truth. I looked forward to camp so sincerely and I absolutely loved it. But intertwined with that anticipation and excitement was a feeling that I now understand to be anxiety. It was an overwhelming feeling of, How will I ever get everything done that I want to get done? What could a third grader possibly need to "get done" at summer camp, you may ask. Gosh, so many things!

First, I had plans to go to the Olympics for track & field and gymnastics so I needed to attend every session of either one of those (obviously that 45 minutes once a week with a camper's parent is where champions are born!). But what if one of those Olympic training sessions conflicted with arts & crafts...then when would I make my vase for my mother for Christmas? And I could never miss Indian Lore because that's when I would make the beaded necklace for my sister's birthday and I had to go to ropes to conquer the "spider web" and I had to go to tennis to practice for our family's summer tennis tournament. I could go on. In retrospect, this all sounds very amusing and, if you are spared a photo of how terribly nerdy I was, it may even sound cute. I assure you, however, that at the time, I was very serious about it. And I was not cute. 

Not that these constitute any big or interesting secrets, but I have never shared these memories with anyone. And in all honesty, neither of my parents ever put an ounce of pressure on me to achieve anything. Nevertheless, I was how I was, and since it was the only world I knew, it wasn't until decades later that I consciously entertained the thought that others didn’t feel the same way. Of course, my adorable little sister, the lighthearted one that every counselor wanted to take home with them, offered me plenty of evidence that I should chill out and have fun, but I was wired too differently to be able to chill out. Plus, I was having fun. As long as I was producing something, getting better, achieving ... that, to me, was fun.

Of course, there were some early memories of my anxiety that were, by no means, fun. Take, for instance, my first experience with a panic attack. I remember it as clear as day, although I had no idea what it was at the time. 

I was a sophomore in high school and like most others in my class, I attended the annual formal dance sometime in April, I think. We called it the “sophomore semi” and it came at a turbulent time in my social life, which is to say that it came before I was a good and strong enough person to know that Brianne was the friend I could rely on forever. I don't remember anything about the planning stages of that silly dance but I somehow ended up on a bus with upperclassmen who were smoking cigarettes in the back. 

I have always hated the smell of cigarette smoke but hating the smell was the least of my worries as the bus sat in the parking lot waiting to depart for the dance. All of the sudden, my claustrophobia met my anxiety and they went on a joyride in my brain. I felt like the smoke was suffocating me. I could barely breathe, my chest tightened, and I thought I was having a heart attack. I have absolutely no idea what I did physically in response to this mental monsoon. I just remember that afterwards, I was convinced that I had a serious heart condition. Little did I know, I had anxiety. 

Since those earlier years, my anxiety has come in waves. Sometimes it's almost non-existent and other times, it's particularly bad. For instance, when I was a teacher, my anxiety was largely in check. In my classroom, I was where I wanted to be and I never felt overwhelmed. Law school added some stress, though not in the I-need-to-do-well sort of way. I was oddly OK with not excelling there, probably because I started with no plans to leave education, and I never thought of myself as a law student or a lawyer. Ironically, this nonchalance was probably part of why I ended up doing well.

Ropes & Gray was a different story. For the most part, I didn't want to be there and despite how much I tried to fight it, I all-too-often fed off of, and contributed to, unstable energy. I generally didn't stress about "meeting my target" or dumb stuff like that. But I did stress about how I would fit in an assignment that needed six or eight of work on a Saturday, without missing any time with my kids. I worried about how I'd get to their school parties and how I'd keep my house clean and how I'd find time to go to the doctor if I needed to.

When I moved to a smaller firm, my anxiety leveled into an extremely comfortable place. Sure, I worried about terrorism and drunk drivers and cancer (doesn't everyone?), but generally, my mind was at ease. It has been a fantastic honeymoon for which, every day, I remain grateful. 

Still, anxiety is something that happens on the inside, sometimes without much regard to what's happening on the outside. If I had to describe what anxiety feels like for me, I would say that it feels like I'm trying to swim in the ocean during a very strong riptide. The waves are huge, or maybe they are small but they feel huge, and no matter how hard I try to swim out beyond the point where those waves break, I can't get there. It isn't so much frustrating, because being frustrated requires feeling some control over a situation -- some belief that, I could do it if only...

But the most real anxiety I have felt is more paralyzing than that. It's a feeling of, this is all just so big, so strong, so powerful, that I don't know how I will face it. And the funny thing is, that the thing that feels so big is usually, to a person on the shore, actually pretty small. 

Now don't get me wrong, I don't want an ounce of sympathy for these admissions. I don't feel sorry for myself or worry about what anyone will think of me (OK, maybe 2-3% of me worries about what people will think). Compared to others, I know that my anxiety is mild, and maybe that makes me freer to talk about it.

Or maybe, I feel freer because of that little blue card that I packed a few weeks ago for my family vacation. 

Truthfully, the cancer card gave me something for which I will always be grateful. It gave me the confidence to admit that I have things wrong with me -- both when it comes to cells in my boob that apparently wanted to kill me, and when it comes to wiring in my brain that made me stress out about wiping down the outside of my dishwasher (a whole other story)...

Cancer also gave me an excuse to say yes to anxiety medication. Sadly, I needed a physical disease as serious as cancer to admit that I needed some help with a mental condition. 

I hesitated to write that word, "mental" -- in fact, I deleted it, then added it back again. That, in itself, is so sad. Because I have learned a funny thing by having cancer -- our culture generally thinks of cancer patients as quite lovable. Unfortunately, I don't think our culture usually feels the same way about patients who suffer only from issues in their brains (unless it's brain cancer, of course). This is a very sad reality for people who suffer from serious mental illness. I know there's no use in comparing our situations, but I am certain that I have it so much easier as a cancer patient in our society than I would as a person with schizophrenia or depression, for instance. But why? A person wants to be schizophrenic or depressed about as much as I want to have cancer. And they're probably not going to have a whole community cook them dinner while they deal with their most difficult of times. 

But this isn't a blog about patients with serious mental illness. I know better than to write about something with which I have so little first hand experience. This is a blog about what I do know -- that even mild forms of anxiety can feel quite daunting. 

Enter the little peach pill. I take it every morning with my Tamoxifen and aside from one side effect that is beyond the scope of this blog (it's kind of R-rated), I have found no side effects of the Effexor. What I have found is that it has helped enormously with my anxiety. 

Of course, there is a great irony to all of this -- my anxiety is, in a way, better now that I had cancer. Let me explain. 

To me, fear and anxiety are not the same thing. Fear is more logical, more tangible; anxiety more inexplainable and impossible to grasp even when it's right in front of you. Fear is uncomfortable and scary, but it's anxiety that has, at times, made me feel like I'm drowning.

My medicine does not take away my fear of terrorists or drunk drivers or cancer, and truthfully, I don't want it to. If it did, I would feel less human and I would never want any medication to do that to me.

What my medicine does is it makes me believe that I can handle the waves. It doesn't make me think that I'm Diana Nyad or anything, so strong and so brave that I can swim beyond the point where the waves break. My little peach pill just makes me able to better focus on the wave in front of me and worry less about the ones that may come next. I know they are there, but I'm strangely OK with that. I no longer feel like I need to deal today with every obstacle of tomorrow. And in that way, it frees my mind up to be able to just be happier right now. 

Let me assure you that I am not a paid consultant of whichever pharmaceutical company makes Effexor (as a health care attorney who deals in the world of conflicts of interest, I feel a compulsion to say that). I'm just a regular person who never recognized anxiety for what is was until cancer handed me a few experiences, and a card that somehow made me feel like it was OK to admit that sometimes my brain wiring goes a little sparky. And I am very grateful for a little peach pill that calms those sparks down a bit; that helps me appreciate that summer camp, and life, shouldn't always feel like an agenda. 

The greatest irony in all of this is that I will forever thank my anxiety for helping to save my life. I believe that part of my funky brain led the healthy 32-year-old me to check for lumps in my breast and have a doctor take a look at the mass that I immediately found. And I'll trade a crappy sophomore semi and some terrified plane rides for the rest of my life, thank you very much. 

I can't even explain the stream of consciousness that led me to start drafting this post in my head while I walked to the train after work today. But I will admit that the freedom I feel in spilling these thoughts and memories onto my screen is indescribably liberating. Which leads me to my last thought in what you may think was a throwback to those steroid-induced blogs of the past. Yes, Effexor helps, but if I had to choose between writing and my little peach pill, I'd choose writing any day of the week and twice on Tuesday. Because for me, nothing steadies my mental state like sitting down and writing about it. And fortunately, there isn't even a co-pay for that. 

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