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Looking Back

It’s been a long time since I last wrote. Lots of things have been on my mind this week.

One is all that went on at this time last year. Being unexpectedly hospitalized and subsequently taking a medical leave from school to enter treatment at the Eating Recovery Center in Denver. While I certainly wasn’t “fixed” during my time there, I do believe I made more progress (and more lasting progress) than in any previous treatment. Things are certainly not perfect. Far from it. My weight is lower than my treatment team would like it, I still engage in eating disordered behaviors on a fairly regular basis, I still struggle with being able to not exercise and be okay with it. But things are not nearly as bad as they have been in the past and I have more motivation to continue to fight this than before.

I’ve also been thinking a lot about Zephyr recently. Today would have been his sixth birthday. Not only does that bring back some tough memories, we also recently (as in this week) got another puppy. An Aussie puppy. I thought I was ready for another Aussie because I was beyond the stage where I still thought I could replace Zef. But I was not prepared for the fear that came with having another pup so similar to him. Whether he truly is similar or not is probably debatable because I view everything he does through a lens clouded by fear that Zero will turn out to be like Zef. I see his playing with Ziva as aggression and dominance against dogs instead of typical play. I see his struggles with being restrained as aggression against people instead of normal puppy behavior. While we are working extremely hard with him so that none of this does happen I probably should relax a little more. And I am scared because I don’t totally love him yet. I think my experience with Zef has made me more reserved in my dog love. I poured my whole heart and soul in to that dog. I felt so connected to him and he was my sole companion for many years of living alone. And the pain that came with putting down my best friend in the entire world was heart breaking. I don’t think my heart will ever recover from that. I didn’t love Ziva when we first got her, but I love her to death now. So I probably shouldn’t be surprised that I don’t totally love Zero yet; with time he will almost certainly grow on me as well.

I have more to write about, but enough for tonight.

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I’m here

How has it been so long since my last post? I started on at the end of July, but never finished it. But where to begin….

When I last posted I had just (like that day) put down my dog. Since then (like the day after) I wound up with another dog. Far sooner than M & I had intended, but as a veterinarian my mother has connections and hooked us up with a pretty cute sheltie puppy for a pretty good price. And that’s how we ended up with Ziva.

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Ziva at 4 months old

 

 

She’s a doll, she’s crazy, she’s sweet, she’s beautiful and she still isn’t fully potty trained (grumble grumble).

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Ziva at 9 months old

 

After a few months off I have returned to school part-time. I started last week with only ~2 hours/day. It’s all pretty much review for now. Actually in the entire 8 week class a solid 4 weeks is review of stuff I was still around for and passed exams on last year. So it seems a little pointless and somewhat boring, but I’ll probably be eating my words when January/February roll around. And hey, maybe I’ll honor this class.

Things are good with M. I’m hanging in there on the eating disorder front. Still seeing my therapist, not seeing my dietitian (not helpful, expensive, and was never a really good fit anyway), still seeing my psychiatrist (and still trying to figure out how I can ditch her because we are really really not a good fit).

I’m sure there’s a lot more to write, but a little bit is a lot better than nothing!

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God

This is why people believe in God. I want so badly to believe that there’s something on the other side of this life. That I’ll get another chance to see him loping towards me with a tennis ball in his mouth. Another chance to be the owner he really deserved. A chance to get answers about all of it.

My heart is broken right now. It feels like someone reached into my chest, grabbed a piece and won’t give it back. It went exactly as I’d imagined. I threw him some tennis balls and his frisbee for a few minutes when we got to the farm. My mom anesthetized him first. The anesthesia she used typically causes hallucinations and often they look terrifying but even Zef’s hallucinations were happy. First he rolled around on the floor like he was doing the happy dance he did when I gave him a bone, then he lay on his side and was running somewhere. For the actual euthanasia I cradled his head on the table and held his leg so my mom could find the vein like I had done for so many dogs so many times before. He took his last breath in my arms. That was the only time I was silent and without tears. And then I broke down again. And so did M. I don’t think he expected it to be as hard as it was.

I cried all day. I cried all evening. I woke up now in the middle of the night crying again. I’m sitting in the living room because M finally fell asleep and I don’t want to wake him up with my sobs. But even this feels wrong. Zef is supposed to come out from under the bed, give me that What-the-hell-are-you-doing-up-at-this-time-of-night look, and flop on the living room floor to sleep near me.

He showed me how to truly love every moment of life. He was my buddy when I lived in lonely apartments by myself. When I was depressed he would drop a tennis ball in my lap and give me that goofy grin of his and I would be motivated to finally move. He did so much for me and I just gave up on him.

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Home

I’ve been home for a week now and have hit every emotion from ecstasy to despair in that week.

I was so excited to be coming home and yet sad to be leaving everyone in Denver behind. And then so happy to be back in Iowa and see everyone there. Being home was more challenging than I expected. Life here isn’t structured and regimented like it was in treatment. I’m responsible for choosing and making my own meals. Our lives are hectic and chaotic and dinner might happen at 6 pm one day and 9:30 pm the next and who knows when lunch might be, if it happens at all.

And then today I made the hardest decision of my entire life. Zephyr (my dog) is the love of my life. I have loved him more than I ever thought possible to love any living thing. Up to about the age of 3 1/2 or 4 he was happy and loved all people and all dogs even if he was a spastic ball of energy. But then his personality started changing. He started becoming more aggressive to other dogs. I took him to classes and then had a trainer come work with us 1:1 at home, but it didn’t seem to help and his behavior has only gotten worse. He still goes up to people wanting to be petted and then will turn and out of the blue try to bite them. 6 months ago he bit M’s little sister. At that time I had my mom do a full medical evaluation and we started him on Prozac for aggression. She couldn’t find any medical issues. The only possible explanation is that about the time his personality changed I witnessed his first (rather long) seizure and he had another fairly long one again this spring. But his behavior has continued to get worse. He has bitten/tried to bite several friends who came to the house. He’s become a liability, I’m out of ideas for what to do for him, I’m afraid to walk him because I worry some person (or kid) will come up and try to pet him, and I don’t know that it’s much of a life not being able to be petted. So I decided to have him euthanized.

I’m so sad I can barely function right now. I feel terrible. He’s in the prime of his life and still seemingly healthy and I feel like a terrible person doing this. I feel so guilty. I feel like I failed him in some way. And I feel like I don’t deserve to own another dog.

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The past 2 days

Thursday Feb 20th

1:30 pm: appointment with my psychiatrist (Dr. H). I’m assuming that it will just be a regular appointment. I have been struggling and I have been considering more intensive treatment, but my psychiatrist visits are more of a formality and she doesn’t do much with me. My therapist and the counselor at the med school are the people I really talk with about this stuff.

1:45 pm: Dr. H wants me to go to the ER and get a “medical” evaluation. I am adamant that I will not do that. It’s not that I’m against being medically evaluated I just think it’s a waste of healthcare dollars to send me to the ER to do it. Why can’t I do outpatient tests and if they come back abnormal I’ll come back? I beg her to call my therapist, W, thinking he would side with me that I don’t need to go to the ER. I am wrong and he agrees with her. Shit. Apparently I am a little too adamant about not going, Dr. H sends off a page and suddenly there are 2 people at her door to escort me to the ER.

2 pm: ER. Awkward chief complaint: my psychiatrist wants me to be medically evaluated for an eating disorder? EKG, blood draws, hang out, chat with the on-call psychiatrist, wait for the test results to come back normal so I can leave. His response: “you don’t know then?” Clearly, I don’t know. Turns out Dr. H. got a legal hold and they are admitting me to one of the inpatient psych units. It is not the general eating disorder floor fortunately.

2-3 pm: ER. I frantically start calling and texting people. The staff physician on the admitting floor comes to talk to me. I am so fortunate that currently the staff physician is my favorite psychiatrist in the whole facility (Dr. F). He is down to earth, normal, listens to patients, and gets stuff down. He tells me that he has already arranged to work privately with me with absolutely no resident or medical student involvement. He then does all my admission stuff in the ER while we are waiting so once I get to the floor I should have things set. He asks me what he can do to help and lobbies to allow me to eat a vegetarian diet, remain off the strict eating disorder protocol, and have my laptop. He must be a good persuader because I am allowed these privileges–dependent upon my not abusing them.

4 pm: M is taking this surprising well. He is going to take care of my dog and bring me some stuff tonight. We are both pissed at Dr. H.

On the unit: Matt brings me stuff. Dr. F stops by to talk to me again. He says that W is already working with facilities to get me admitted to a different eating disorder treatment program as soon as possible. Basically I am here to stay “safe” until I can be admitted. I am a ball of anxiety and spend most of the evening pacing the hall. The staff here know nothing about the typical eating disorder protocol (basically zero movement) and while I am not on the protocol I know I probably shouldn’t be walking as much as I am and am terrified someone is going to call me out on it. They let me order a safe meal and pace the night away. I’m not sure if ordering a safe meal is abusing my privileges or not. If I didn’t order something safe I would very likely purge it so I err on the side of what I think I can eat and not purge and if someone gets angry then I will deal with it.

Friday Feb 21

I am awake half the night. Nothing unusual. This has been happening more frequently the past couple weeks. I fall asleep and an hour later I am wide awake for another 3-4 hours. I am pissed that they won’t let me hang out in the day room and color so I sit in my bed and read a magazine by the faint hall light until 3 am. I wake up at 5:50 when my alarm usually goes off. They won’t let me take a shower until 7:30 am. WTF.

A friend comes to visit, the medical school counselor comes to see me with forms to sign, the staff dr comes to see me, a medical school dean comes to see me. I pace the halls. Even with the safe meals I can’t seem to finish them but I am committed to not purging so I do what I can. I pace the halls some more. Dr. F comes back and drops the legal hold and lets me sign in voluntarily. M and my mother come to visit. Dr. F comes to talk to me briefly with them when they are there. It is somewhat awkward because while he doesn’t bring up purging (thank god) he brings up depressive symptoms and sleep that I haven’t really let on. Throughout the visit Matt gives me some strange looks. I choose to not elaborate on why I am here. Apparently my dad is angry too. Dinner is the hardest meal yet. I’m not sure how much I will be able to do on my own over the weekend. I guess I’ll tackle those meals when they come.

And here I am Friday night. It has been confirmed that I will be admitted to a treatment center in Denver the only question is when. So I am almost certainly stuck here for the weekend. My roommate wasn’t too bad yesterday but today she is driving me nuts. At least the staff basically ignores me.

I’m mad that W hasn’t come to see me. I’m thankful that Dr. H hasn’t come to see me because I’m not sure I could be civil.

I want to cry. I can’t cry. I alternate between wanting to sprint the halls and curl up in a ball in a dark corner. Neither of those is acceptable so I compromise by pacing the halls at a moderate speed.

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Schedules

A piece I wrote for my elective humanities class. The prompt was “Your greatest fear.”

 

The bus rattled along the dusty gravel road. The girl and her brother were the only ones left and they stood in the front seats chatting with the driver. The girl’s mind, however, was elsewhere. She quickly constructed a schedule in her head: one hour for the appointment, one hour for groceries, one hour for Walmart, one hour for driving, one hour for flex time between each activity. With the extra hour tacked on her mother should be getting home right about now. As soon as they rounded the first turn she began looking for signs. The garage door was closed, no clue there. Her anxiety rose slightly. They got off the bus and headed inside: the car wasn’t in the garage. Now her anxiety was through the roof. She ran through her schedule again, making sure she had the right times and had added them together correctly. 4:30 pm, her initial calculation was right. Her brother didn’t stay inside long and soon left the girl alone with the dog and her anxiety. She paced the living room, pulling the curtains wide open so she could see all the way down the road. What if she had to answer the phone call? Would her father be angry? Who, if anyone, would she tell at school? Fortunately, within minutes, a cloud of dust rose and the grey car appeared, alleviating her anxiety. The schedule, while not perfect, had been close.

That was how it began. Schedules, constructed so she didn’t have to have the anxiety all day, only a portion of it. Schedules for practicing long hours that would fill the time when she wouldn’t let herself to be anxious. Schedules for when her mother didn’t come home so she could finish everything before her father came in from chores.

Ten years later, new schedules had developed. She lived alone and no longer needed hasty calculations about when her mother should be home. Instead, they served as a security blanket for all the other unknowns in life. If she followed the schedules properly, everything would be okay. So she was following the schedule and dutifully cleaning the kitchen when a young man came through the door. He was early; this did not fit the schedule. She came around the corner. “What are you doing here? You said you weren’t coming until 6.”

“I thought I would surprise you, but apparently I was wrong.” He turned and walked back out the door. Leaving her alone, with the schedule.

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New Challenges

This week has brought the biggest challenges of med school.

First, I’ve been having terrible headaches every day for over a week now. I don’t have a health insurance number or card so the only place I can go right now is student health and with my school schedule I haven’t had any free time during the day to make an appointment. If I don’t take anything it gets so bad that I can’t think or concentrate. Excedrin takes it town to a tolerable level, but it still sucks to just have it in the background constantly.

Second, M. He’s spent a lot of time with me recently and I’m adjusting to that. But we had our first exam today. I was really nervous about it but I came through with a couple points to spare. M’s strength is biochem and he was expecting to do really really well on the first exam and got the lowest possible passing score. So he was pissed. And he is difficult to be around or talk to when he is like that. And he is convinced that if he can barely pass his “strong” subject then he is absolutely certain to fail everything else in med school.

Immediately after that I went to a physical exam skills session where I was to learn the “proper” technique for taking vitals. I’ve taken a lot of vitals so I know I can do it, but I know my technique is sloppy and I was really nervous about being evaluated. We were told that the standardized patients teaching us were very kind and only there to help. And somehow I would up with one that reamed me because I didn’t make small talk and I forgot to verbalize two results. And on top of that he chewed me out for being quiet and not smiling. Because of course, that is how you get a person to smile.

Fortunately my next physical exam skills session (15 min later) was what it was supposed to be. A very kind standardized patient that let us practice on him.

Only one more day though. Then a brief weekend to reset before it begins all over again.

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