I’m Baaack

I remember peeling off the cocoon of my bulky winter jacket one of the first times I came here.

Perching nervously on the edge of one of these same chairs.

Feeling completely vulnerable and exposed.

Wanting desperately for someone to mold me back together – yet not touch me.  Not look at me.  Not judge me.

For my weaknesses, my failures, my inability to just be.

It’s been awhile.  But I’m back.  And so are all the same feelings.

A Common Language

 

I’ve been thinking a lot about how to ensure that available mental health resources get into the hands of the women who need them. When and where resources are available, there seems to be a gap between the offering and the accessing. As always, I think back to when I first slid on the shoes of the women now making the postpartum trek.

Women of all socioeconomic, racial, and educational backgrounds share one extremely daunting obstacle when in need of such help: they must articulate their exact problem in order to get the help they need.

In a complex web of medical jargon, insurance restrictions and loopholes, and a frustratingly-absent physical presentation of symptoms (for the most part), it falls upon the sufferer to demand treatment for the condition that, no doubt, impairs the very confidence, decision-making skill set, and strength it takes to do so.

It’s an ironic catch-22. The doctor has the tools to ‘fix’ you, but you must lead her to the workshop. The doctor is the artist, but cannot pick up the paintbrush unless you led her to the canvas. The horse must determine the source of water before the doctor can lead it there.

There is no solution unless the patient gives the doctor information to determine the problem.

When I hinted that I felt like running away a few months postpartum, my midwife recommended I talk to a LISCW. This therapist helped me chip away at the enigma that dragged me down, but it was I who eventually had to request medication from my physician. When that dull cloud still hovered, I made the final call to increase dosage. More recently when I intimated to her that I still felt low sometimes, I apparently wasn’t descriptive enough because I was told the meds shouldn’t make me feel flat; there should be ups and downs.

How well my mental health situation is addressed directly correlates to how accurate I am in describing it. How empowering and crippling at the same time. If I do not share every pertinent detail in clearly descriptive language, I will not feel better. I will not get the meds, therapy, tests, information, etc. that I need to make anything resembling a full recovery.

Regardless of my level of medical literacy, the debilitating effects of depression and anxiety can keep me from adequately representing my plight. Regardless of the quality of care available to me, its benefits will not be afforded to me if I do not say just how much I need it. Nothing will be given to me unless I ask.

How do we on the receiving end of such conversations draw the stories out of the women who need help? How do we teach/speak the language to give them a voice? How do we release the language bubbling beneath their skin? In that wordless abyss is the bridge between therapeutic, wholistic maternal care and the women who need it.

word bubbles

 

Don’t Fear the (Ir)rational

As the sun rose hours after the baby’s birth, I was fading fast.  I had slept maybe two hours of the past 24 and didn’t have the strength to eat my breakfast.  The nurse suggested the baby go to the nursery, I drink a pitcher of water, eat, and sleep.  I did and woke up a short while later feeling a bit more human.  When my husband went to retrieve the baby and came back empty-handed, the feeling was short-lived.  “Where’s the baby?” I asked, panic creeping into my voice.

“Oh, her bracelets fell off, they’re just putting on some new ones,” he answered, easy-going as ever, which could’ve been an indication of my overreaction but went unheeded.  I went through every possible combination of events I could think of: were the bracelets in the bassinet, did the nurses take her out of the bassinet, were there any other babies in the nursery?  What I was really getting at was: how will we know this is our baby?  My husband, thinking with a rational mind, told me it was fine; they were giving her new bracelets to match ours and were checking the serial number on her Baby Lo-Jack, the nickname for the security device affixed to all babies in the hospital.  Still, I balked.

I worried for months, a year after.  I had moments of clarity: an expression on her face as she gazed up at me, identical to her oldest sister when she was an infant; her tiny hands patting me on the back as she wrapped me in a hug; shadows of family members in baby photos.  But always, when I allowed it to seep through, that dark thought,

‘Did I bring home the right baby?’

I was afraid that if I loved her too much someone would come to take her away from me.  The licensed social worker I had started seeing suggested I felt that way because things – the pregnancy, labor, delivery, and recovery – hadn’t gone according to my plans.

It wasn’t until we sped down the highway one day months later that the truth caught up with me.  As I saw the family resemblance written all over my baby’s face, I realized that I hadn’t thought she was mine because I still hadn’t accepted the fact that I was having a third child.  I hadn’t sanctioned it.  It hadn’t gone according to plan.  I was still grasping for some sort of control that I hadn’t felt since being plunged into the chaos of three children awash with my own anxiety.  Did I not see the resemblance because I didn’t want to see it?

Yes and no.  Or yes, but not totally.  It wasn’t my wounded psyche that was totally to blame.  As my therapist pointed out, irrational fears are another symptom of postpartum depression.  I more than filled that box on the survey.  It was a strange split, though.  Rationally, I knew she was mine and accepted her with the unconditional love of a mother.  In the stark predawn hours of loneliness or moments of love bordering on too intense, my irrational self would pull back, fraught with worry and dread.

My husband irresolutely assured me she was ours.  “What do I need to do to prove it to you?” he asked.  “Do you want to get blood tests done?”  “She’s ours, Jen, I know it.”  “I was right there beside you when she was born.”  To which I responded, sometimes verbally – and later as the argument wore out, silently – “But that was before she went to the nursery and lost her bracelets.”

I couldn’t shut off the stream of irrational thought and worry – even though I knew there were holes all over my argument.  I felt silly voicing my concerns, but wanted other people to tell me how much she looked like her sisters or me or my husband.  I needed validation that the ‘voices’ in my head were wrong.  I couldn’t defeat them myself.

And I didn’t.  With love and support from my husband, my fabulous social worker, lifestyle changes, the passage of time, and eventually medication, the irrational worry stopped.  It became definable, ‘boxable’, and I shut it away.  I don’t think it’ll come back, but I think I’ll always remember how real and frightening it was.

You Can Call Me Peri?

So I crack open this month’s issue of Family Circle, the latest installment from the gift subscription my mother-in-law gave me for Christmas, and see an article on menopause.  Ok, think it’s safe to skip that one.  But oddly compelled to read all printed matter that comes across my radar regardless of whether it pertains to or interests me, I scan the first page.  In speech bubbles strewn about the page are various questions, worries, and anecdotes from peri- and post-menopausal women.  More than half the bubbles could have been direct quotes from me!  And I am not very peri at all!

The article invites me to “read on to find out how to outwit, outplay and outlast the next chapter in your life.”  Thus begins a decade-by-decade breakdown on how to outwit this personified beast that threatens to overtake all women all over the world.  “In [my] 30s,” I can expect my fertility to decline.  Yes, knew that and no, that does not bother me in the least.  I should become my healthiest self as “what [I] do now impacts how early menopause starts, how intense the symptoms are and how they affect my body.”  Right about now, my dander is starting to get up – and it’s not just the lack of the third comma in the lists of three things that is doing it.  I need to “bust stress” as “mini-meltdowns will be happening.”  I should try tai chi or yoga or a “peaceful play list on [my] iPod” to “help alleviate menopausal related anxiety.”

It’s about now that I realize I’m fucked (and, no, I don’t mean the uncomfortable sex that I can look forward to in my 50s).

Either I’ve been perimenopausal since my prenatal visits for my third bambino or it’s gonna get a whole lot worse.  How does one who seems to be suffering from post-partum post-trauma prepare for a whole lot more of the same?

There is a sidebar by my decade entitled, “Get the #1 Test You Need Now.”  Apparently a baseline hormone panel (“an easy blood, saliva or urine test that determines [my] optimal hormone levels”) will assist my doctor in prescribing hormones “specific to [my] ideal range instead of the range of an average woman” when the time comes.  I actually laughed out loud when I read this, eliciting strange looks from my daughters.  My oldest asked what I was laughing at; how would I even begin to explain?  That, when it comes to Mommy, there is no such thing as ‘optimal hormone levels’?  That if the doctor prescribed me hormones based on the ‘range of an average woman’, the cocktail would be akin to a stiff drink of water?

While discussing “the (formerly) ‘silent passage’ is no longer taboo,” many women are still petrified by the thought of it.  Except maybe for my friend – who has such irregular periods, she was almost wishing for it.  But when I mentioned this to my mother-in-law, joking about it, she responded very seriously, “No, she doesn’t want it.”

So where does that leave me?  No, I don’t have hot flashes.  I haven’t gained mysterious pounds regardless of what I do or eat.  But mood swings, irritability, anxiety – all de rigueur already – and I’m only in my first decade, according to this handy little guide.

I’m starting to view women’s susceptibility to hormones as this insidious little secret that was only hinted at as my mother described my body’s cycles to me as I sat on the bathroom floor over two decades ago.  By no means was my mother light on the details; I understood my body’s workings in what, to a twelve year-old, was a revoltingly clear manner.  But I didn’t know how pervasive those pesky little hormones were.

Yes, I knew there’d be a few days of PMS.  Yes, I knew I’d be overly emotional during pregnancy.  Yes, I knew there’d be a few days of baby blues.  Then I noticed extra irritability that seemed to coincide with ovulation.  Then those damn hormones ganged up on me with crazy, heart-wrenching situations in my life to send me into a swirling storm of anxiety and depression.  Thankfully, my head broke water a while ago, but only with medication and therapy.  And I still struggle.

I’d like to say that an awareness helps me prepare for and deal with the effect hormones have on my life – just as the article touts the “18 Things Every Woman Should Know About Menopause.”  To a certain point, it does.  But when you know the beast is coming no matter what – and you can’t run and hide because life won’t allow it – what do you do?  Grin and bear it?  Pray to the gods that in your next life you come back with a penis?  I love yoga, but unless I take my strap and choke the hell out of the beast, it’s not gonna make it go away.  Maybe I can drown it out with the soothing sounds of my peaceful play list while I try to achieve optimal hormone levels.  Maybe instead of ‘silent passage’, it should be ‘silent scream’.

UPDATE May 2014: I spoke too soon on the hot flashes!  My past three menstrual cycles have been ushered in by a week of night sweats.  Good, clammy times!

 

 

No Salt in this Wound

There really is no point to a saltine – except for the salt, of course.

For some reason, as many other kids, I loved them when I was little.  I think it had more to do with trying to stand it upright in between my top and bottom teeth or shoving it in my mouth in one bite rather than any great gastronomic pleasure.  I didn’t return to them until I carried whole sleeves of them around with me during my bouts of morning sickness three times over.  That’s the telltale sign of a pregnancy, isn’t it?  The white, crinkly cellophane pulled open at the seam, the stack of perfectly pointed squares cascading out into the open, and hopefully, into your belly to quell the ravaging beast that threatens to ruin every waking moment – not just those in the morning.  A friend’s mother says that she hasn’t touched a saltine since her pregnancy over thirty years ago.  I can’t say I blame her.  It is not a pleasant connotation when that’s your last memory.

So, imagine my surprise, when I found myself chowing down on them as I rushed to an appointment in the car.  So light and insubstantial, I was flying through the sleeve with reckless abandon – actually just savoring the salt and waiting for some sort of gratification from the mush that the enriched flour had turned to in my mouth.  I had bought them for the kids, but running late and low on fuel, I needed a quick and easy – if not satisfying – snack.

After I’d downed a quarter of the sleeve, the sharp bite of the salt searing into my tongue, I realized what I was doing.  I was eating saltines!  After a miserable last pregnancy, I avoided at any costs anything that reminded me of those memories that made me shudder.  I gave away all my maternity clothes with great aplomb.  I threw out the sitz baths and lanolin left in the house.  A wicked pack rat, I even sorted through and shredded all paperwork from the hospital.  Saltines fell into this category.  I didn’t fling them out my window, a crazed cracker hail sending birds flying, I just didn’t even think of pulling a box off the grocery store shelf.

In one conversation with my therapist in that first year of recovery, I explained how I felt as if I were grieving a death.  I marked each familiar date, each holiday, each anniversary of some hard memory – noting it, like the rung of a ladder I had to climb to get up and out of this hole.  ‘Okay, I’ve made it past that one,’ I’d say.  I’d survive one set of negative memories at a time and start to wipe them away with new ones.

It wasn’t easy and I knew I wasn’t suffering the same grief as someone who had actually lost a loved one, but, as my therapist so astutely pointed out, I was suffering a loss – the death of my life as I had known it.  Things were totally – in some ways, irrevocably – different.  It was time to move forward with the positive and with this new knowledge and see what would happen.  Life certainly wasn’t over – it was just different.

As was the action of eating a saltine.  I wasn’t a kid crushing one into my mouth as I cavorted on the beach with my parents.  I wasn’t a desperately nauseous woman at the mercy of her upset stomach (and those damn hormones).  I was an adaptable survivor who could do simple tasks again without the crippling connotations once associated with them.

Saltines have never tasted so good.

The Next Step

“The journey of a thousand miles begins with a single step.”  – Lao Tzu

My first step was recognition.  Recognizing the fact that something was not right.  Then stepping through the door of my therapist, nearly two years ago to the day.  Accepting the fact that I suffered from postpartum depression.  Asking for help to make things right.

And with her help, I did begin to make things right.  I began to relish those Tuesday evenings when I would give Angela her nighttime feeding and hand her off to Daddy, kiss the other two on top of their heads, and head out the door.  In the waiting room, sometimes I’d get fifteen minutes to myself to collect my thoughts, jot down ideas in the notebook I’d all but deserted in the bottom of my bag, or – gasp – read a mindless magazine.  She even joked with me once about how early I’d arrived: “Need some quiet time?”  I told my mom that it was nice to just have someone to listen.  “How sad is it that I have to pay someone to do that?” I quipped.

But my mother completely understood.  I’d put her in the selfsame shoes thirty years earlier.  A mother, a woman, most times comes last on her list of obligations.  Doing laundry, changing diapers, wiping noses, reading stories, making lunches, making love – there is no time to even think about what would please you, let alone do it.  So an hour of sitting still and talking someone’s ear off about my problems – that was well worth the $35 co-pay.

And unlike other pursuits outside the home, say ladies’ night or a yoga class, there was no guilt attached to this.  I was not choosing time away from my children.  I had to do this or I would go out of my head.  I needed healing and she was my practitioner.  So for someone who was already feeling like a bad mother, this was the perfect escape.

In fact, I even called my car the escape vehicle.  When I had an appointment, I got to drive my sedan, not the RV-like vehicle that fit all the kids.  The car I used to commute in to work each day.  The first new car I ever owned.  The car that, when it sat idle in the driveway, represented all about my old way of life that was dead.

Then the most miraculous thing happened.  As I became a less stressed woman, I became a better mother.  And as I began to achieve some sort of equilibrium, I actually began to think about what would make me happy.  Let me rephrase that.  I began to formulate ways to make me happy.  Because as a depressed person, all I thought about was why I wasn’t happy.  Why was this happening to me?

I do not believe God is vengeful.  Or spiteful.  So even though I was by no means a saint, I figured there was no way He would wish something like postpartum on me.  And so I searched for a ray of light in the darkness.  I had a recurring thought.  There had to be some way to help other women realize that the horrible, terrible feelings of worthlessness that come with postpartum are not theirs to bear alone.

That thought led into a brainstorm that still has me swirling.  Its development has led to a change in course for my career, even my life’s calling.  And right alongside it has developed a better and stronger me.  Through it all, my therapist has been right beside me.

So on a January night not unlike the first that I walked through her door, I was heading to my therapist’s office.  And not unlike that first night, I was nervous.  In fact, I almost dreaded going.  Because, not unlike other things she’d waited patiently for me to figure out, I suspected this might be my last visit.  On some level, I’d known on my most recent visit that I was becoming strong enough to continue on my own, but like any human who is her own worst enemy, I ignored the niggling sensation of knowing and scheduled my next appointment.  In the back of my head, I heard my friend say that she’d stopped going to see her therapist regularly when they’d run out of things to talk about.  Not yet, I thought.

At the appointment, I updated her on all the items ticked off my to-do list and how I planned to accomplish the others.  I shared successes; the resolution of sticky situations I’d been dealing with.  As the clock wore down on our hour, it sounded very much like a debrief.  An after-report.  The niggling knowledge bubbled just below the surface.

“What do you want to do?” she asked at the end of the session.

I knew what she meant.  “I don’t think I need to schedule,” I said hesitantly.

“No, you don’t,” she agreed.  “But that doesn’t mean you can’t call whenever you need to come in.”

I knew she meant this, too.  But I couldn’t help feeling a little like the kid whose Dad says he’ll hang onto the bike seat, but lets go as soon as the pedals start spinning down the street for the first time without training wheels.

She was not deserting me.  She was giving me a more literal translation of Lao Tzu’s quote, “The journey of a thousand miles begins beneath one’s feet.”

She helped me find my feet again, but now it’s time I stood on my own.

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