23w 6d (Imagination)

I've been having these strong escapist fantasies. Like, what if I could stop all my medication and get in my car with Zac and just drive until we ran out of money or gas. We could live in the car, maybe on a beach somewhere or in the mountains of Vermont. I'd get a job waiting tables and my fantasy hasn't quite figured out what Zac would do all day - maybe play with the dog. I admit there are gaps in my fantasy. It would just be us and no one would know where we were. We would just disappear off the map for a while.

I think a lot about getting off all my meds. I don't mean titrating down from them. I mean just one day stopping. Are they really helping? Do they allow me to get out of the house and go to the grocery store and take a shower every day? I guess the basic answer is yes. And I suppose to some psychiatrists that means that my medication management seems to be working. I can perform basic functions and tasks. The greatest failing of psychiatry is that it fails to medicate happiness. Oh, how it tries! I can take meds to make me feel numb, to make me feel less sad, to make me stop crying...but I've never once experienced a medication that made me happy. Although, I guess even that statement needs to come with a qualifier because amphetamines can make someone pretty darn euphoric, but it only lasts for a couple of days. But happy? True happiness? How many years of my life have I spent trying to find happiness? Is it an attitude, a state of being, a period of gratitute? Therapists say I should consider it a life long journey, my personal Iilad to find happiness, but I know few people that would suffer through years of unhappiness to find fleeting moments of happiness. Most of just make do. We find joy in small things until one day we can't anymore.

In my weak moments, I think about the brain I had at 21. I was in my senior year of college and had never taken anything stronger than birth control and I had beautifully clear, brilliant thought. It was free of self doubt, guilt, and recrimination., It was free of failure. It was my brain in the purest form, before all the medical intervention. Before the mood stabilizers and the mood stabilizer boosters and the anti depressants and the anti anxiety medications. Before all of that. When my mind just operated.

My mentor recently asked me why the doctors thought I was so depressed and I thought about it for a moment. Most depression diagnosis is self-reporting, "Have you had any thoughts of hurting yourself in the past two weeks? Do you have less joy and interest in activities and people than you used to have?" So - I think it's a valid question. My parents have asked me this question in a number of oblique ways. Usually they say, "I don't know whatever you say to those doctors, but you end up in the hospital and there is nothing we can do to help you." So, could I change my answers on these self reporting tests and change the diagnosis? Yes, the answer is a very real and possible "Yes". I could game the system. I could appear happy and maybe they wouldn't see the cracks behind the facade. That's what I do at work and to a large degree, I'm successful.

But, what if in my imagination, I don't to lie. What if I didn't go to anymore prenatal, high risk, psychiatric, optometrist, fetal appointments. What if I stopped putting the chemicals in my body? Wouldn't eventually, eventually, my brain return to the state it was when I was happy? Have I so altered my chemistry that I can't find happiness anymore if it hit me?

I just want to escape from what I feel trapped in. I want to stop being hurt by people that I thought cared about me. I want to stop showing doctors my scars and offering my brain up for their testing ground. I want to put a stop to it. My Mom was right. My brain isn't strong enough for this pregnancy.

23w 5d (Holidays)

I don't do well with holidays. I came home from Mongolia via Washington D.C. right after Thanksgiving and right before Christmas in 2003. It was the worst year ever. My depression was crushing and my disappointment and sense of failure was even more devastating. Every year since then, I try to create new memories, determined that this year will be the year that I embrace holidays. Then the holidays come and it's just so hard. Every year I fail at being merry and every year I'm not sure what is worse, the actual day or my expectations at how I think the day SHOULD go.

One of the problems is that my family is all in Pittsburgh or east of Seattle. In Houston, I have my parents and Zac. No cousins, no aunts, no extended family. And although KGII and I have known each other for almost three years, we've never spent a holiday together. We're both just so stubborn people. He invited me to his family's gathering in Austin this year (approximately four hours away) and I refused outright, on principle and practicality. I get sick a lot and I get up at 3am regularly. I also go to the hospital a lot and I didn't want to be four hours away from the maternal fetal hospital. I also didn't want to abandon my parents because without me and Zac, they would be alone. I invited KGII to my parents' house, but he said he got called away with his family's obligations.

When he got back from Austin last night , I asked him about our family, the family we are creating. In my parents' guest bedroom on Thursday night I had an incredible sadness come over me. Here I was, again, pregnant with another child and all my family was talking about was becoming a family of 5 next year (Mom, Dad, Zac, Me, and Baby Boy II), not a family of 6. There was no partner in the conversation. My family has an easier time imagining me single than imagining me bringing someone home to Thanksgiving dinner. I was pregnant with another man's child - another man that didn't want to build a family with me.

Most of the time, you know like 90% of the time, I'm fine with being single. I'm fine with saying that I tried very hard for a long time to find love and I just didn't find it. But sometimes, usually while alone in my parents' guest bedroom, I think about finding someone that will love me and my children. But I don't even believe it anymore. I don't believe in love. Which is why the holidays kill me. Everything on television and the radio is about connecting with your love during the holidays and sharing the joy. I try to be joyous for Zac, but sometimes it's just so hard. I want to curl up in a ball of self pity and holiday loathing and emerge again sometime in mid-January.

Did I mention that I'm blowing everything out of proportion and I'm so hormonal that I feel like I want to cry on a daily basis? Me, pregnant, and holidays just don't mix. I feel like I need to come with a disclaimer: contents under pressure and likely to explode with no provocation.

Damn, this is just a hard time of year. Being pregnant and alone just makes it harder.

23w 2d (HMO Avoidance)

Dear Large HMO,

Please don't read this post.

Sincerely,
B
_______________________________________________________________

Some of my favorite bloggers are blogging every day and it has inspired me to write more. I have no idea what happened to 22w of pregnancy. I'm not even sure how I've been off work since November 1st and today is the 20th. Where the hell did the time go?

I can tell you that in week 22 of my pregnancy, I had a complete mental breakdown. Part of it stemmed from a horrible ill-fated lunch that I went on with someone very close to me (sorry for the vagueness, it's necessary) and how it affected me. Part of it was feeling rejected and ignored by another person. The left-right punch combined with my new meds (anyone need a mood stabilizer booster? Cuz I've got a good one for you. Downside - it may cause a life threatening rash and may increase naseua in already sick pregnant women) lead to a night of histrionically sobbing on my couch. I took my night time drugs and couldn't fall asleep, what with all that sobbing at and. Then I woke up at 4am and turned on a DVR'd episode of "A Baby Story" (because I'm a masochist apparently) and then started sobbing again. I woke KGII up at 5:30am by climbing in his bed, still sobbing. KGII didn't want to leave me alone so I texted my Dad for pregnant sitting duty. He came over, very confused, at 7:30am. We went out to breakfast and then the grocery store. I only started crying twice with my Dad. Then I came home, canceled one of my many eye appointments, and crawled into bed. That was at 10am. Yeah, then I got out of bed at 10am to take my night meds and got back into bed. I fell asleep until 6am and then back asleep at 10am.

So that happened, which is going to make my next statement seem particularly ridiculous. Wait. Before I make that statement, let me tell you that my large HMO decided that my short term disability claim was a behavioral health claim instead of a medical claim. Suck on that for a moment. I'm in my second trimester and have been hospitalized four times for pain related to my pregnancy and my insurance company decided that I was more crazy than sick. I called and talked to the disability people and was like, "My medical health influences my mental health and then my mental health influences my behavioral health. It's Dante's 7th circle of Hell. You can't just evaluate one side of my health" to which they said, "Oh yeah. I'm pretty sure we can".

Ok, back to my statement: I'm not sure I'm sick enough to be off work. I have huge amounts of guilt and anxiety related to walking away from my job, especially since the insurance company hasn't approved my claim yet. I'm supposed to be in an intensive outpatient therapy program, but one wanted a 12 week commitment and the other has been full for two weeks and won't open up until after Thanksgiving. I see the Maternal and Fetal Psychiatrist every 2-4 weeks. I need to make an appointment to see my regular shrink. I started outpatient therapy and will start DBT group next week. But, I've been more depressed and mentally sicker in the past. When I left work, I thought I would continue to get physically sicker, with more hospitalizations and more bed rest. Instead, the opposite has happened. I am physically healthier since I've been off work. I had one of my best Ob-Gyn appointments at 21 weeks that I've had in easily 2 months. Sure, I still puke every morning. I still use Zofran like it's going out of style. I nap a lot and I go to a metric buttload of appointments.

But am I crazy enough to be off work for another 17 weeks? I'm not so sure.

21w 4d

I've always maintained that some people have friends and some people have blogs. Very few are able to combine those two factors of a life, unless they have online friends like I'm blessed to have.

I try to shower every day and get out of the house at least once, but I'm struggling to find free activities and I'm trying not to spend any money. I thought I had an intake appointment at an intensive outpatient therapy program tomorrow, but they moved it back a week because the program is full. So I have all these spaced out appointments for the next two weeks that leads to a series of other appointments every two weeks from here until birth.

My Dad has been retired for two years and he keeps telling me that it gets better: you can transition to being at home and find reasons to get out of bed every day. I have good days and not-so-good days. On the good days this feels relaxing and I feel productive. I clean and cook and manage to keep enough food in my stomach so I don't get sick. On the not-so-good-days, the anxiety I feel about walking away from my career is overwhelming. Rationally, I know there is a long history of women (and even men) that have taken medical leaves to take care of themselves and have gone back to their careers to be successful and fulfilled. These people probably weren't financial advisors. I've spent months building relationships with people and I just walked away. People in the office are covering for me and that helps ease the anxiety, but it also adds to the guilt because it just adds to their workload while I'm at home going to medical appointments.

What's been the most surprising about this pregnancy is how much pain and discomfort I have. I'm only in my second trimester and according to pregnancy books, I should be feeling great. Morning sickness to my back and cankles to look forward to. I have round ligament pain down low in my uterus and sharp, stabbing pain in my port. I'm supposed to see a neurologist soon regarding the day/week long headaches that I can't seem to get a handle on. I don't know. I just feel sick. Then I get sad. Then I don't want to leave my bed. Then I feel worse. It's just a cycle. Every day, I try and break the cycle. Every day, I try to drink water and eat a piece of fruit.

I don't have a pithy conclusion. I'm just struggling and I know that some days are better than others.

21w 2d (Medical Leave)

I'm on Day 5 of medical leave and I think I'm failing horribly at it. My one job in this world during the day (assuming the big one is at school and the dog and cats are self-sufficient) is to take care of myself and stay healthy and that's just a big task. I decided on Friday to stop taking Adderoll. I started taking it, I don't know, maybe four years ago when I was falling asleep while driving to work and then falling asleep at work and I maybe (just maybe) falling asleep while doing something productive human beings do - like raise their kids or get out of bed. My shrink told me it was a wee little dose, just 20 mg of amphetamine salt. Turns out others don't think that's such a small dose and assured me that Adderoll would surely start riddling my brains with holes.

Then I got pregnant and every, single, medical professional I talked to would start out the conversation on medication with something along the lines of, "Oh, but you've already started getting off Adderoll, right?" or my favorite presumptive question, "When did you stop taking Adderoll? I see it still listed on your chart." I would sigh and say that I hadn't stopped taking it because going to work without it made me tired, listless, and generally unfocused. I had to work. I had to make money. Hence, I took the Adderoll.

Then suddenly my world turned upside down and now my need to work has been trumped by my need to stay out of the hospital (which I failed on Sunday. Three day headache, hysterical crying, vomiting - four hour stay in the ER. The Emergency Doc took one look at me and decided that clearly I needed sleep - it was 4am - more than I needed to participate in an anatomy ultrasound. He prescribed IV Bendryl, which might as well be called "Look, I'm going to need you to go to sleep now and stop crying. You're scaring the homeless guy. Also, if you could stop vomiting, that would be great. We're running out of bags"). I stopped taking Adderoll the first day I didn't go into work and I remembered all the side effects of amphetamines. The primary one is euphoria. The secondary one is...I don't know...the ability to stay awake for more than 20 minutes at a time?

Suddenly I feel like those stories you hear about people retiring at age 70 and then dying three months later because they couldn't get out of bed. I bet they were taking Adderoll. I'm sad, apathetic, I don't want to take care of myself, and all I want to do is sleep, which I do in great, unproductive quantities. I just want to lie in bed and feel the baby move (20w 5d - that's how long it took before I finally felt this kid) and sleep.

I saw the Maternal Fetal Psychiatrist yesterday and she said something along the lines of, "Are you sure that Adderoll wasn't helping you manage your depression?" and I was like, "Um, I don't think so. I know it was inhibiting my ability to nap, but now that you mention it, I could use a little euphoria." She generally supports me getting off of it, but it's like jumping off a cliff. Also since I can't get within 20ft of a doctor without them prescribing me something, she prescribed two other depression meds. I haven't started them yet because of some problem at the pharmacy. That's something I'll have to figure out after my next nap. I did like that one of my drugs is folate for my brain. Apparently folate doesn't usually cross the body/brain barrier and she thinks my brain could use a little folate. That's sweet, right? I feel like that's up there with the theory that massive quantities of Vitamin C can cure depression. I have done every other synthetic, I might as well go all homeopathic now.

My main problem is that I don't want to feed myself three - or five - times a day. That seems like a lot of work. Then I don't eat and I get sick, which kind of defeats the purpose of being on medical leave. Short of keeping a refrigerator next to my bed, does anyone have any suggestions on creative ways to ingest food that I can work around my napping schedule?

20w 5d (Not that Kind of Hospitalization)

So I was hospitalized, but not for what you might be thinking. KGII and I went to my Ob Gyn appointment and on the way there, I started experience severe abdominal pain. Seriously, if someone told me that preterm labor felt like that, I would have understood. I had to take breaks walking into the doctor's office and breathe through my mouth. My Ob Gyn looked at me, felt around my uterus, and immediately sent me upstairs to the triage area of the hospital.

Everything hurt, but one spot in particular was hurting more than the others. It happens to be exactly where my appendix is. It also happens to be the exact spot that lap band port rests under my skin. Unfortunately, to rule out appendicitis, I had to fast for hours on end in case I needed surgery. They hooked me up to an IV of saline so I didn't die, but making a pregnant woman fast is just asking for nausea and morning sickness. They finally got me in for a CT scan. When I told my sister that (Aunt Jen, soon to be Dr. Jen) she immediately asked, "How did they shield the baby?" and I was like, "Um, they didn't". So yeah. I irradiated the baby after being pumped with contrast fluid in three different places (don't ask, you don't want to know, but I felt violated afterwards). Good news - I wasn't constipated when they finished that bullshit.

My scan came back and showed no inflammation and no fluid build up. The on call Ob Gyn called my bariatric surgeon and asked about symptoms of a gastric band port infection and it didn't look like I had that either. The pain had started receding in other areas of my uterus and just localized on the port. Finally, I was given some food and some pain medication. That was the best damn hospital food I've ever eaten after fasting allllllll day. The narcotics were nice as well.

The on call doc talked to my regular Ob Gyn and I was deemed "Not a physical pain complainer" ( !!!which made me laugh because I have been hospitalized three times in two weeks due to pain and/or inability to keep down liquids) and was told that since I was still in pain that they wanted to keep me overnight for observation. I was moved, finally, out of the triage room with the very uncomfortable gurney to the Woman's Suite with the Temperpedic mattress. So nice.

KGII got his futon cushions all ready and we settled down to sleep at 8:30pm after asking for my night medication at 8pm. You know - the medication I take every night to keep me sane and help me fall asleep. The medication that I'm addicted to and could no way fall asleep in a hospital without. I was told that the pharmacy didn't have my medication, but they were working on it.  The hospital I go to is brand new, state-of-the-art facility that is managed by a children's hospital. The children's hospital doesn't stock all the adult medication, particularly for depression and anxiety, particularly if it doesn't relate to labor or fetal care. At 11:30pm, I started begging them to just give me anything they had so I could fall asleep. I'm not proud, but I threw a hissy fit and asked to speak to the on-call doctor. I wanted to leave, so I could go home and take my medication, and fall asleep. She convinced me to stay since I didn't want to leave against medical advice and 20 minutes later my exact medication showed up.

The next morning, I felt fine. No more pain and I asked to speak to the Maternal Fetal Psychiatrist before I was discharged. She came into my room and we had a good talk. I had planned to go on medical leave in a couple of weeks, but after this recent hospitalization, both she and my Ob Gyn requested that I go on immediate leave. I went into work the next day and gave them the news. It was an incredibly stressful, overwhelming, and panicked day. I have one day on medical leave (Friday) under my belt and I can honestly say I have no idea what to do with myself besides go to medical appointments. That's not hard to do since I have So Many Appointments.

The Maternal Fetal Psychiatrist wants me to go to an Intensive Outpatient Program and I'm looking around for the right one. I've also started cooking and even cleaned a little on Friday. It was a big day. More to come.

20w 0d (Ante Partum)

It's very hard to tell the difference between depression and pregnancy hormones. Both can make you cry hysterically and both makes me not want to get out of bed for days on end. It's just something has changed recently. Ever since I started thinking about taking medical leave, I've realized how truly depressed I am.

I thought it was because I was so sick in my first trimester. I would go to work, come home, clutch my stomach, lie in bed, and go to sleep. Rinse and repeat. Then my first trimester turned into my second trimester and things got a little better, even as the nausea turned into morning vomit sessions. I'm 20 weeks and I still take Zofran on a regular basis. It's just...I don't get out of bed. I'm as close to being on bed rest as someone who holds down a full time job can be. When I get home from work, the first thing I do is get into bed (sometimes after taking a bath). I parent from bed, I eat in bed, I fall asleep insanely early in bed. If Zac wants to spend time with me, he comes into my bed room and I feel unbelievably guilty about that.

I've completely isolated myself from anyone who doesn't want to text with me from my bed. Even on days when I don't feel like complete crap, I stay in bed. KGII asks if I want to go out on a Friday or Saturday night and I can feel myself looking at him like he was just taken over by a band of roving aliens. I'd rather be eaten by cockroaches than to be outside of the house and get sick, especially if I'm sick and can't leave. It's created this kind of social anxiety. It's so much easier to stay in my nice, safe bed where I have cats for company and endless paper back novels to read.

I reached out for help today and the hard part about having my history is that you can never encounter just a little bit of help. The first two things that were suggested to me were partial or full hospitalization. Only when I balked at that did they talk about finding a therapist. The hardest part, for me, about starting with a new therapist is having to cover all the crap that came before. The previous hospitalizations and the times when I felt I didn't matter. It's so much crap that it keeps me from getting the help I need, plus I have an inherent distrust of strangers that ask a lot of questions. Bonding with therapists has been a definite issue within the past two years.

So I'm back in bed. This time my adopted (gassy) cat is here with me and I'm praying he doesn't start pooping under the bed again. I see my Ob Gyn and a Maternal Fetal Psychiatrist tomorrow. If you don't hear from me for a little while, just know that I lost the hospitalization debate and I'll be back soon. I've been sicker before and I've survived more. This is just a hard patch and eventually it will get better. That's what I tell myself when the crying jags start. It will get better. It just takes time.