Madness & Genius

There’s a thin line between madness and genius. Most people don’t readily see the demarcation, but believe enough in its existence. While a passionate few dedicate their lives to make the division universally, unequivocally apparent, a persistent few simply deny a difference.

On my end, however, I believe there is a difference, but a difference often tiny and subtle that only those who have eyes to see may see. The difference lies in the details one chooses to see and understand.

Few people are gifted with the ability to turn mundane and sometimes hostile discussions to inspiring ones.

Advertisements

The Shortest Semestral Break

So my friends in school had asked me, “What is a semestral break?”

A sudden coldness swept over me. I looked down and found a shard of ice, like a dagger, had pierced my chest.  My heart sustained a penetrating wound to the right ventricle.  I said I was fine but I knew I couldn’t forever conceal the skipping beats, the slowing rhythm, the increasing discomfort.  The evolution of symptoms has been rather slow relatively. Still, their constellation constitutes an emergency.  My hours are indeed numbered.  And I had done nothing but sleep, fooled into thinking that all those sleepless nights can be recovered.

Every now and then, there’s an unconventional idea that I struggle to silence. On most days I bury it under the folds of my brain, later to exhume and publicize by mouth or by hand. But tonight—just this night—I feel a sudden surge of courage to post a picture of this dreaded thing.

Here comes the sun, a most beautiful one
Off the sheets, into the road, on the run
If you think life’s given you enough shock
Tic toc, eight-oh-one, reads the bundy clock

In a smooth sweep of its hands, the short recess is ended.  The school uniform once again becomes a steady sight, a staple experience on the skin.

Life with Bipolar Disorder Type II & Clerkship

Like most patients with mental illnesses, I didn’t know I had something until a critical event occurs that would bring all pertinent signs and symptoms together to reveal the hidden picture.  I used to think that I was simply eccentric since high school:  my ideas often differed, sometimes significantly, from my peers; my concepts and standards usually had been non-congruent with the norms; days to weeks of inconsolable depression and unexplainable high-energy that are degrees more amplified than in peers; and so forth.

In August 2013, one of my consultant-facilitators in my PBL subgroup pointed out the striking incongruity between my Small Group Discussion performance and my exam scores.  He sat with me for over an hour, processing and counseling.  But he was the first person to have observed and suspected that I might just have had a mental condition worth attending to.  He was right.

In November 2014, weeks well into my Pediatrics rotation in Junior Clerkship, the increasing stresses ultimately brought me to the point where my body and mind simply would refuse to rise out of bed and keep going.  My sleep started to be prolonged dangerously.  I would have less time to read my lessons or prepare for exams.  I was constantly cramming and failing—a vicious cycle, which would augment my depression.  And then there had been extraordinary times when everyone would think that I studied medicine for the extracurricular opportunities in medical school.  Despite the packed schedules, I seemed to have time to carry out my responsibilities as an officer in the Student Council, accomplish my tasks as a member of the school publication Editorial Board, maintain an active status (as former officer) in the Advisory Council of my Greek organization, organize intra- and inter-campus events, review classes for the undergraduates, participate in regional and national medical student leadership and reformist activities; the incredible list goes on.  If I had not been a medical student, I probably would have scoffed at (and probably revolted against) the first suggestion of a possibility of a bipolar disorder.

My psychiatrist maintained me on valproic acid maximum dose for about 5 months when stability was achieved and my academic performance improved.  Titration was immediately begun on reaching those end points.  However, on further work up, imaging studies revealed an incidental bilateral Polycystic Ovary Disease (PCOS), prompting withdrawal of Depakote from my regimen and a shift to lithium.

Before the shift, my ability to concentrate and attention span had gradually lengthened.  However, I was increasingly detached from my creative side.  It would take me sometimes days to compose prose for a singular idea, in contrast to a few minutes to a few hours to write a full feature article with multiple subjects.  There had been many times when I would miss my “ups,” when it was easy to communicate and swivel between introversion and extroversion.  But definitely, the abolition of the prolonged “downs” and erratic fluctuations in moods within the day had been profoundly advantageous.

Consequently, the final half of Junior Clerkship had been smooth-sailing.  The next rocky ride was in June 2015, when I was maintained completely on a double dose of lithium and I had to hydrate more than usual to flush the salts off my system as quickly as is possible.  Moreover, my visits had been reduced to at least once annually if without problems.  I was already well into my third month in Senior Clerkship or Junior Internship when such needs just could not be reconciled with the duties and demands.  I lost compliance, consumed my stocks.  My psychiatrist frequently flies out of town; and when she’s here, my 36-hour shifts every other day just would not let me meet her.

To the date of this writing, I am already on my third month off of pharmaceutical or psychotherapy.  I am more familiar of my symptoms now and have improved control.  However, it is impossible to avoid recurrences of the mood fluctuations.  I fear the day when I would recede severely enough for normal activities to be impaired.

Note:  What you have read above had been composed during an asymptomatic period.  Compare with the train of thoughts below.


* * *  D  O  W  N * * *

It feels good to cry one’s heart out every once in a while.  But when it keeps crying out each day and night, at first in a drizzle and then in a burning torrential outpouring—there’s something likely amiss. Starting over seems like a cheerful option when there still remain shards of hope to crush and consume. But when there’s none, let the world mourn until the last gust of wind from the deadest of spaces within can be extracted auspiciously, irrevocably.

At the end of this unlit tunnel certainly is a world of unlimited paths. But as to the uncanny lurking in the darkness is an absolute uncertainty. I lost track counting how many blocks, detours, traps and other surprises we’ve uncovered so far. Certainly, there is that termination of the pathway. The variations of this journey remain with how long each pilgrim has been kept blind and vulnerable on the road.

Battling this disease during a protracted course of extreme physical, mental, emotional, psychological, psychiatric and spiritual stress is probably my most difficult test in life so far. Sometimes, we have limited choices to alter circumstances, limited influence over luck. This solitary adventure has been somehow more difficult than anticipated—perhaps longer for me. Still I look forward to the close of this chapter. Survival is an outcome of persistent choice; but the persistent scars are an outcome of chance and choice.

Despite everything, this, too, shall pass.

*  *  *  *  *


* * *  U  P * * *

First of three days in my Plastic & Reconstruction Surgery elective rotation felt like being in Donna Tartt’s The Secret History. The department has been a curious clique of seemingly detached individuals from a frequently misunderstood field.  The field is a huge world of its own with ill-defined borders encompassing many disciplines. What could be more humbling and inspiring than receiving life advice from the people who’ve finished five years of General Surgery, become fellows in a society, had once been chief residents in their own times?

It’s all about finesse and the details. Beautiful and awesome take time.  I feel at home with the atmosphere of organized thought, structured meetings, intellectual discussions—even for extra-curriculars and hobbies. And somebody has finally said it: do not neglect your hobbies; have a life outside work.

Of hobbies, I have much to choose but little to say:  I miss a life outside this graveyard.  Fortunately so, seven days in Orthopedics & Traumatology—and its eccentricity and dependence on a constant slow infusion of adrenalin—did uplift my spirit.To see is to believe: my first amputation was quite clean and a little dry. But today’s IMN was a bloodbath. For what looks like the “deadest” structure of the body, the bone is as alive as the heart.

To see is to believe: if I had to choose between a cut-down and an intra-osseous, I’d choose the latter.

Some accidents are nasty, some accidents are nice
That I came upon Orthopedics, I’d paid a high price
Exhausting days, exhilarating nights
But ultimately the choice was very wise

After a round-table discussion with residents, I’m more confused than ever: PGH or another university hospital?  For sure, I prefer to earn my lessons; ergo, bone-chilling endorsements and presentations.  This is coming from an introvert who had yet to grow out of social awkwardness.  The beauty of endorsements is this: an open mind continues to learn from either the good or the bad ones.  In so saying, I don’t mind being grilled during endorsements.  The hotter the iron, the deeper the burn, the harder it is to get rid of the new scars, or wisdom.

It has been a privilege to discuss my cases, to assist in operations, to tag along during rounds, to carry out doctors’ orders, etc. I feel luckier than ever to have spent my first two months of internship in the Department of Surgery (including Orthopedics & Traumatology)—here learning can be as visual as it can be, where details, finesse and determination are as important as fooling around just to get rid of the wear from long hours in the operating room.

To my seniors, the staff and my patients, thank you.

*  *  *  *  *

The Obsolete Need To Sleep

I don’t believe in claims of association between pasta, curses and crises. And so the longest sleep I’ve had in the past four weeks lasted two hours. Otherwise, the division between today and tomorrow often is indicated by a wink, a yawn or a weary sigh. A new day begins. The hours stretch on to the 36th or 40th, or onto the minute when the conjunctivae have been completely injected, and the innervation of the orbital apparatus slowed down in concession to the call of sleep. Exhausted has become a redundant fact made not very readily obvious to the naïve passersby because of the drive of necessity and outstanding resilience of the lowly forms.

And it is precisely because of this presumed resilience that Clerkship has been structured to be often unforgiving at times.  Deadlines cave in like massive walls.  As they draw closer, what scarce time to be spared must be stretched to fulfill the requirements needed to sail through the day.

Internship has only just begun, but this chapter has been dragging on for too long now. But thank you for asking randomly after my health, anonymous doctor (I’ve never met you before).  In that brief encounter, however singular, when you saw me steal some sleep in the elevator, with a half a hotdog consumed in one hand, a stack of documents in the other, you reminded me that all things will pass with time, like time, and in time.

“Shock”

When the body enters into a decompensated state of shock, time begins to shut down a life that has been thriving for some years—one process at a time slowly and slowly until the first organ finally succumbs to asphyxiation.

The exhaustion of reserves and resources—the critical point breached—and accumulation of toxic essences fuel up a fatal momentum of consumption of hope and life. Some hours prior to the patient’s departure, the evidence of his suffering has resonated within the walls of his chest, the thin membranes of the bowels. What once has been a steadfastly galloping heart enters the marsh that muffles the sound of hooves and horses. Then the light begins to recede from the apertures of the eyes as the pupils grow irreversibly. Soon, breaths turn into sighs, and then into silent vapors that dissipate into nothingness.

These events transpire so quickly that it is often hard to mark times with absolute accuracy and remember the exact succession. The color of his pain has given his lips a duskier shade, his skin a reticulated carpet of ruddy islets in a sea of pallor—into a complex omen often described as mottling. And the lifeless form that remained splayed on the bloodied bed has become another corpse to tag, tally, and transfer out of my care.

Shock is certainly a fitting term to describe the suddenness and congruity of these phenomena. No road has been more devastating than the spiraling steady path to a slow death. What remained of that vivacity is an empty glassy look, which reflected on my face and in my wrists and fingers as they write this short testimony.