My sincere apologies for the amount of time that has passed since my last post. I had an interesting (from a scientific point of view, not personal) experience with the ketamine and was floundering for a while. About six weeks ago, I took my regularly scheduled dose and it plunged me into a very deep depression. It abated in 24 hours, and just to be sure it was the ketamine, I took my next scheduled dose 3 days later and the same thing happened. I stopped the ketamine and went back on my old SSRI, but the side effects were amplified to such an extent that it was unbearable and after two weeks, I went off meds altogether.
Getting to Know Myself, Part I
Once I had adjusted to life without depression and learned how to manage the new-to-me world of feelings, I noticed yet another gift ketamine had given me; I began to discover myself and recognize my specific personality traits. It was as if I was meeting myself for the first time. The particularly interesting thing about this phenomenon was that these personality traits that I became familiar with were all personality traits that had always been ascribed to me by others.
I have always been described as someone who is funny, quick witted with a keen sense of humor. Although I knew I had the ability to easily make others laugh, I always found this ironic because I never actually appreciated my humor, nor that of others. I was incapable of feeling happiness or the pleasure of a joke. Yet, my quick wit kept asserting itself, like a knee-jerk reaction that I neither controlled nor planned.
However, now I understand why my sense of humor continued to manifest itself, even in the darkest moments of my depression; it is an intrinsic part of my personality and while depression killed my feelings and my ability to appreciate myself, it could not eliminate my core self, all the individual traits that make Xoaquima uniquely Xoaquima. And now that I can actually appreciate humor, I am coming to understand the role it plays in my life. It brings me joy when things are going well, and it helps me cope when things are not going well.
Several weeks ago, after a week of excruciating and physically incapacitating pain in my lower back (all of my cervical and lumbar discs were injured in a plane crash nine years ago), my doctor sent me to get a new MRI. I stripped down to my underwear, put on a hospital gown, and lay down on the tray that the technician slid into the MRI machine. After white knuckling it through the first portion of the MRI (placing a plane crash survivor in an extremely narrow tube that bombards her with really loud, unfamiliar noises does not make for a pleasant emotional experience), the technician removed me from the tube, injected me with a contrast dye, and rolled me back in.
Within two minutes, my face was burning so badly I felt like I was on fire. I squeezed the panic button and told the technician I thought something was terribly wrong. He pulled me out of the tube, and as soon as I saw his face, I knew something was terribly wrong. He looked at me with pure panic in his eyes, while at the same time trying to maintain a calm demeanor and assuring me everything would be okay, so I didn’t freak out.
He helped me up off the table and admitted my face was bright red, but assured me I would be fine once I took some Benadryl. But I wasn’t fine. Despite the Benadryl, my whole body started to itch, I began to hyperventilate, and my body started shaking so hard my teeth were chattering. The technician could no longer conceal his panic, and confessed he was going to have to call the paramedics. “But I don’t have health insurance, you can’t call the paramedics,” I sputtered through my chattering teeth. As soon as the words were out of my mouth, I knew how ridiculous they sounded. The technician looked at me like I was crazy, a look I am very familiar with, and asserted that this was a nonnegotiable point – I needed emergency medical assistance
Once the paramedics were on the line, they told him to make me sit down before I collapsed and cracked my head. But I couldn’t sit. The excruciating pain in my lower back made sitting impossible. Then the call dropped and the technician couldn’t get a cell signal because of the interference from the MRI machine. He was running around the room in a panic, telling me to sit down and frantically trying to get the paramedics on the line. My inner comic began taking notes and reminded me that although I could not appreciate the comedy in this now, I would definitely appreciate it later. I lay down on the dirty linoleum floor and ordered the technician to go to the front room, away from me and the machine, and call the paramedics back.
Even in my state of extreme physical and emotional distress, the comic in me watched the scene play out and took frantic mental notes. I mean really, the whole thing was so crazy and ridiculous, you couldn’t make it up. In the moment, I was too scared to laugh, but I knew when I told the story later, I would laugh and my audience would laugh. Sometimes shit gets so crazy that if you don’t laugh, you’ll cry. And I’d always much rather laugh.
The tragicomedy continued once the paramedics arrived. They lifted me on a gurney, and all I could think was, “Really? They’re going to wheel me out into a busy street in my underwear? Please don’t let me see anyone I know.” Fortunately, the technician had calmed down once the paramedics arrived and had the foresight to retrieve my clothes and wallet for me, which he placed in a plastic grocery bag and set down on the gurney next to me.
The paramedics secured me in the ambulance and rushed me to the hospital. I was still shaking like I’d swallowed a hundred vibrators, and as soon as they wheeled me into the ER, everybody stopped what they were doing and turned to stare at me. A doctor ran over and shouted, “Oh my God! What is wrong with her?” This was not good. This was an ER in Miami, where they see gunshots, machete massacres and all other manner of horrors on a daily basis. But the comic in my head quipped, “I guess the ER is about the only place it’s not politically incorrect to walk up to someone and ask that question.”
A group of doctors and nurses swarmed around me, taking my vitals and asking me questions, which were hard to answer because my teeth were chattering so hard. Then someone shouted, “She’s tachycardic.” Suddenly I regretted being an avid fan of ER and Grey’s Anatomy because in those shows, that phrase is always followed by someone rushing to get the crash cart, the patient’s heart being shocked, and either a round of high fives when the patient is stabilized, or a grim-faced doctor eventually calling time of death. But in my case, none of those things happened. Everyone just wandered away and left me lying there next to the nurse’s station, so I figured tonight was not going to be the night I died.
Unfortunately, people who were there to visit sick family and friends were not so sure. They kept walking past me, pointing, and asking why nobody was doing anything for me. One guy was so freaked out by me, he kept shouting, “Why aren’t you helping her? She’s really sick!” The nurses kept assuring him that I was being looked after, so finally, exasperated, he took it upon himself to begin praying over me and tell me God would take care of me. I really just wanted to scream at the guy, “Leave me the fuck alone! Can’t you see I have enough to worry about without some total stranger praying over me! I don’t even believe in God, and if I did, I’d be convinced he hated me after everything I’ve been through in my life. And if there is a God, he has more important things to worry about than someone in a first world ER.” But I was too busy hyperventilating and shivering to deal with him, so my inner comic giggled and reminded me what a great character this guy was going to make for our story.
Apparently, he was driving everybody else crazy too because they discharged his girlfriend and gave me her room. After attaching leads all over my body and a pulse monitor on my finger, they connected them to the machine where all my vitals were displayed. Then they inserted an IV into my hand and started to prepare the drugs I needed. One of the nurses stared at the order the doctor had written. “Does this say 3 ccs? Isn’t it supposed to be 5 ccs?” Another nurse rolled her eyes and responded, “It’s 3 ccs.”
As the idiot nurse inserted the syringe into the vial and began to draw out the mystery drug, I sent out a silent plea that she not be the one to give me that injection. “I can’t tell,” she said, squinting at the syringe and the vial, “is this 2 ccs or 3 ccs?” The eye-rolling nurse walked over to her and practically snatched it out of her hands. “It’s 3. I’ll take it from here.” My inner comic was ecstatic that these people kept giving me more material to work with. This whole exchange took place right in front of me, as if I didn’t speak English and couldn’t understand a word they were saying. Law suit anyone?
The idiot nurse left the room and the eye-rolling nurse came back and informed me she was about to give me an intramuscular injection of epinephrine into my arm, which she followed with an injection of prednisone through my IV. Within half an hour, I was no longer trembling, me teeth weren’t chattering, and I began to feel human again. Nobody had come back to check on my yet, but the evil woman in charge of making sure I paid my bill must have had a sixth sense because she swooped in, plastered a fake smile on her face, and asked me for my name, address and phone number. Then she asked me for my driver’s license. I pointed to the plastic bag sitting next to me, tied in a nice neat knot, and told her it was in my wallet, which was in the bag. “Well, can you get it for me please,” she asked like I was an idiot.
I returned her fake smile and condescending tone as I pointed to the leads on my hands and the pulse monitor on my finger and stated the obvious. “I’m not really capable of using my hands at the moment.” I smirked and continued, “I’m going to need you to get it for me.” Her fake smile disappeared, and she gingerly reached out to the bag as if it was infected with tragedy cooties and if she actually touched it, her perfect life would instantly dissolve and suddenly she’d be the one lying in a hospital bed being treated like a subhuman. Once she had retrieved my wallet, she heaved a huge sigh of relief that she had survived such a traumatic ordeal, reattached the fake smile on her face, and practically sprinted out of the room. I couldn’t believe it; these people couldn’t have handed me a better script if I had asked for it.
Two hours later, the doctor informed me that I had had a severe allergic reaction to the active ingredient in the contrast dye, gadolinium, and discharged me. I was so relieved to be out of there, to be alive and to be stable, I decided to walk back to the MRI place, where my car was parked. I was covered in bloody bandages from all the various IVs that had been inserted and once I reached the busy main street, guys openly stared at me with a what-the-fuck-happened-to her look in their eyes. Women nervously averted their gaze, afraid to make eye contact, and gave me a wide berth. Some even crossed the street to get away from me. I felt like the first wave of the zombie apocalypse, and I smiled as my inner comic stated, what a great ending to one of the funniest, most fucked up stories of our already-extensive collection.
When I got home, I looked up gadolinium. Only .01% of people injected with it have such a severe reaction. “Of course,” I muttered, “I would be one of the .01%. If it’s rare, random and crazy, it happens to me. Refractory depression, plane crash, gadolinium reaction, what’s next?!” I don’t know what else the universe has in store for me, but I do know this. Thanks to ketamine, I’ll get through whatever comes my way. Although this was actually a very traumatic experience and stirred up a lot of difficult memories from my trip to the hospital after the plane crash, the ketamine has put me in a place where I can cope with these difficult moments and actually feel, process, and work through the feelings that are a natural result of emotional trauma. And now that I can actually appreciate my inner comic, her laughter helps balance out the tears.
Ketamine is like Christmas every day. It’s the gift that keeps on giving. The latest, unexpected present ketamine has left for me is my memory. As a child, my intelligence was the one constant in my life, the one positive thing I knew was an integral part of me. It was about the only thing I really knew of myself, outside of depression, the only part of me I could connect to because it had nothing to do with emotions and therefore was not suppressed by my depression. My intelligence didn’t make me feel special or superior because it wasn’t something I could take credit for; it was a gift genetically bestowed upon me at birth. Yet, it was very important to me; it was the only life preserver I could hold onto on the constantly-sinking ship of my life. However, eventually the damage a lifetime of depression did to my brain significantly impacted my level of intellectual function.
The most debilitating effect depression had on my intellect was its destruction of my short-term memory. Until the age of twenty, I had a photographic memory. By the time I was 34, my brain was unable to retain even the tiniest scrap of new information. I had to place all the essential items I needed when I left the house (keys, wallet, cell phone, sunglasses) on a table by the front door, so I would see them before I left and remember I had to take them with me. I then had to perform a ritual before actually walking out the door, where I patted my head and all my pockets to make sure the necessary items were present on my body, while repeating their names out loud, “Sunglasses, wallet, keys, phone.” My roommate said I resembled a mentally challenged baboon with obsessive compulsive disorder.
As an English professor, this short-term memory deficit proved especially challenging. Every semester, on the first day of class, I would have to stand before my students and provide them with a disclaimer, alerting them to the fact that even at the end of the semester, I still would not know any of their names. I also had to assure them that my long-term memory remained intact (which it did), so they understood that even if I couldn’t remember what I’d eaten for breakfast, I was fully capable of teaching them how to analyze literature, write an essay, and explain the difference between a dependent and an independent clause. When calling upon them, I would refer to them by an item of clothing they were wearing or a particularly distinctive hairstyle. “Red shirt, what do you think the red convertible is a metaphor for?” Or, “Mohawk girl, what relevance does Brent Staples’ 1988 essay have today?” Fortunately, my students were very understanding and found this more amusing than insulting. I cannot imagine the same would have been true if I worked in a corporate environment.
This erosion of my short-term memory so terrified me (I was convinced I would have full-blown Alzheimer’s by the time I reached middle age), that I finally had to resort to an old Narcotics Anonymous mantra and just accept it as something I could not change and let it go. I tried to convince myself it was amusing that I could watch a movie, then watch the same movie three weeks later and have no recollection of ever having seen it, completely surprised and shocked by an ending that my brain had already received and processed a few weeks earlier. However, this made watching regular television impossible. I could no longer watch shows where the story lines built upon the previous week’s episodes. I was relegated to watching Forensic Files, Unsolved Mysteries, Snapped, and Cold Case Files. Since all this happened post 911, I am sure the FBI or the CIA or the NSA has a file on me somewhere based on my odd television viewing habits.
Now, thanks to ketamine, maybe they’ll actually throw that file away. I don’t watch much television anymore since I started taking ketamine; I am too busy living life and trying to make up for all the years I lost. But when I do watch a program, I watch a serial show, one whose plot line builds upon each previous episode because now I actually remember what happened, not just the week before, but all the weeks before. I no longer stand by the front door, flapping my arms and mumbling to myself like a mentally challenged baboon with OCD, before I leave the house. And, most importantly, I know the first and last names of every single one of my students.
One of the many devastating effects of depression is that it can eradicate one’s ability to feel feelings. Most people associate it with anhedonia, the inability to feel pleasure, but in severe cases, depression can also mute anger, sadness, frustration, fear and any other emotion human beings have the capacity to feel. Before I started taking ketamine, I don’t remember the last time I actually really felt a feeling. While some may think not feeling sadness, anger or frustration might be a blessing, I can assure you it is not. My whole life I have felt like a zombie disguised as a human.
While I could mimic a smile and fake a laugh, no matter how hard I tried, it was virtually impossible for me to cry. Kat, my therapist, had spent the past two years trying to teach me to get in touch with my feelings. We were able to get to the point where I could identify what I should be feeling in a given situation, and I could even faintly detect the presence of a feeling in extreme circumstances, like a far-off tapping sound I could hear faintly echoing in the background. But I was never able to get any closer to experiencing emotion than that.
Now, in the second week of my ketamine treatment, feelings have rushed to the forefront of my consciousness and they are screaming at me, as if desperately anxious to be acknowledged after decades of suppression. The facade we’ve been chipping away at and had barely managed to splinter has been broken wide open by the ketamine and these amorphous, vague, ambiguous sensations that Kat had taught me to distinguish and title individually — anger, fear, sadness, happiness, joy, excitement, etcetera — have now become real, tangible entities called feelings and I finally understand what everyone else has been experiencing all along.
Even the simplest things, like reading a newspaper article or being unable to get my printer to work, evoke a flood of extreme and seemingly exaggerated feelings that are proving to be quite overwhelming. The amplitude of these feelings is akin to when your ear has been plugged up for a few days, and suddenly it pops and there is a rush of noise. It seems unbearably loud, but really it’s just normal, only you’ve been deaf from your plugged up ear, so now all the usual background noise, and even just the sound of air, which you normally don’t notice, is so very loud and you just want to clamp your hand over your ear and make it stop.
But I don’t want to make it stop. As overwhelming and disconcerting as it is, at the same time it is marvelous and miraculous because, for the first time since I can remember, I actually feel alive! The other day, I was reading the alumni magazine from my high school (an elite and extremely academically rigorous boarding school where I felt very antagonized and was utterly miserable), and I burst into tears. It was like the bubble of sadness regarding that experience that has loomed over me for the past twenty-five years finally broke, and I really felt the emotions, rather than just sensed they were there from the dark cloud hanging over my memories. I cried for a good fifteen minutes and even though I was sad, it felt so good to cry. It was such a tremendous release, every tear expunging one more fragment of my sadness, and when I was done, I felt so relieved that I smiled. Call me crazy, but crying is now one of my favorite experiences.
However, I must admit, anger and frustration are proving to be a difficult adjustment for me. Anger sends my heart racing faster than Usain Bolt and renders me completely incapable of rational thought, so that I am unable to articulate even the most basic argument. Suffice to say, this was not the best time for me to find out that the government has been unapologetically spying on me and the rest of the world. However, with time, at least anger subsides. Frustration, on the other hand, follows me around for hours like a creepy stalker I can’t get rid of. When I am unable to complete a task I set out to accomplish, like talk to an actual human being when I call my cell phone company’s customer service department, a person who can explain why I have no cell service the minute I walk into my house and then fix the problem, frustration makes me want to scream and smash my phone against the wall.
I feel like a toddler experiencing a whole new range of emotions for the first time, but without yet having the tools to navigate this world and manage these feelings that erupt out of nowhere. However, I am an adult, living in an adult world with adult responsibilities. There is no mommy to comfort me or explain how to handle these feelings. There is no corner to retreat to when it’s all just too much. But I do have my therapist, Kat. She has given me hundreds of pages of handouts on emotional regulation and mindfulness, which I have come to realize is the adult version of a time out. Thank goodness for Kat and mindfulness! Without them, I surely would be curled up in the corner of my living room, having succumbed to a total meltdown, stuck in a permanent temper tantrum, fists pounding and legs kicking while I screamed, “But why? It’s not fair! My constitutional rights are not supposed to be violated by my own government, my cell phone should work in my house and my printer should print when I tell it to!”
Yet, as overwhelming as all this is proving to be, I wouldn’t trade it for anything. Happiness and joy may be the best feelings in the world, but sadness, anger, frustration and all the others are just as important. Now that ketamine has restored me to the land of the living, I cannot fathom returning to my previous zombie state.
It hasn’t even been a week yet and so many things have changed. I’ve developed a routine for the days I have to take the ketamine. I tune my internet radio to an electronic, chill out station, turn off my phone, inhale my three puffs and ride out the ketamine cloud for half an hour, hazy and floaty, like a ballon lingering above a children’s party. After half an hour, I can engage my mind, but wait another half an hour before trying to actually move. Within two hours I am fully recovered, both mentally and physically, and am able to drive, teach, grade papers, or do whatever I have to do or want to do.
I have already noticed a significant improvement in my short-term memory and intellectual abilities. I beat my record of solving a moderate Sudoku by a minute, down from 4 and 1/2 minutes to 3 and 1/2 minutes. A new semester started this week and during my first-day introduction to the course, I did not lose track of my thoughts once during the hour and a half lecture. I was even able to go on several lengthy tangents without forgetting what my original point was and then seamlessly tie the tangents back to the original point. I even remember the title, author, and the names of the characters of the book I am currently reading — Dancer, by Colum McCann.
Before I started taking ketamine, my memory had been so ravaged by depression that I could not remember anything. Even while in the middle of reading a really interesting novel, I could not remember the title, author, or the names of any of the characters. Anything that I had to do, I had to write it down or I would completely forget, and I had to keep the things I needed every day, like my keys, wallet and sunglasses, right by the front door or I would leave the house without them. It became a running joke with those who know me because if they ever referenced a prior conversation, I would have no memory of that conversation and they would have to tell me the original story all over again. Even at the end of a semester, I could not remember a single one of my students’ names.
I am also now able to handle last-minute changes in plans without having a complete meltdown. I was so fragile before I started the ketamine, like an egg shell riddled with hairline fractures, the slightest jostle breaking it apart into dozens of tiny fragments. Any event that required me to leave the house or deviated from my daily routine had to be planned days in advance, so I could mentally prepare for it. If the event was rescheduled or cancelled, I went into a panic because I was unable to handle the disruption to my schedule.
On day four of my ketamine journey, I receive a phone call from my mother just after I have started a walk around my neighborhood. She is stuck at the airport and needs me to come pick her up immediately.
“No problem,” I say. “I’m on my way.”
It isn’t until I am in the car on the way to the airport that I realize it really isn’t a problem. My mind had easily switched gears and transitioned from my original plan to the new emergency plan without the slightest emotional distress. After battling rush-hour traffic for 45 minutes, my father calls me to say he is at the airport to pick up my mother and I don’t have to come. By that point, I am already at the airport, but again, I smoothly adapt, turn around, and drive home.
When I get home, I resume my previously-aborted walk, and it is as if I am seeing my neighborhood for the first time. Although I’ve walked through my neighborhood hundreds of times before (two dogs equals lots of walks), it’s as if this is the first time I.ve ever taken this walk. The brilliant, south Florida pastel colors of the houses jump out at me with their joyful beauty. Each different species of tropical foliage grabs my attention and makes me gasp in wonder and exclaim, “Oh, I’d love that in my garden.” The birds sing out to the late-afternoon sky, cats laze on porches and lawns, and dogs strain against the fences enclosing them. Within seven minutes, I have reached Biscayne Bay. Even though I have lived in this neighborhood for two and a half years, I had never realized how close to the bay I am. Boats bob lazily in the water, docked in front of a mixture of traditional Spanish-style houses and modern, glass and steel homes. The air smells of a combination of sea water and freshly cut grass, and I suddenly feel the excitement of a child at the beginning of summer vacation. “I love my neighborhood,” I gasp. “It’s so beautiful!”
And suddenly it hits me. I have spent my entire life living at the bottom of a murky, scum-covered lake, everything appearing muted and dull through all that darkness, every step forward taking tremendous effort as the muddy bottom sucked my feet into its mire, and now, suddenly, I am out of the lake, standing in the sunshine, walking effortlessly across the soft, grassy bank, and staring in awe at how bright all the colors are and sunny the sky is.
I wish I had somebody to share this moment with. I’ve spent so many years in self-imposed isolation, and now all I want to do is socialize. Before I started taking ketamine, I cringed at the thought of human interaction; it took so much energy to pretend I was not depressed and fake my way through social situations that it would take me days to recover. Now, I actually crave the presence of other human beings, and not just superficial, temporary social interactions, but real friendships. I feel like I am discovering myself for the first time, meeting and learning about the real me, not the husk of me who learned how to pretend so well, learned to mimic the facial expressions and movements of others so that I appeared as vibrant as them, like a foreigner fumbling her way through a conversation in a language she did not really understand.
My life is now a blank notebook waiting to be filled with experiences, feelings and words. And I’m so excited!
It is Mother’s Day and the nine-year anniversary of my plane crash. Normally this is an unusually difficult day for me, full of anger, sadness and frustration with my life. However, today I awake with so much excitement for the day ahead, so much energy and motivation that I am like a stranger to myself. I call my mother and sister, a new mother herself, eager to wish them a happy day and share my own newfound happiness with them. In the past, I only made phone calls when I absolutely had to because the act itself forced me to engage with another person, coupled with the effort I had to expend trying to sound upbeat and “normal,” so the person I was talking to would not feel uncomfortable.
After sharing in the joy and silliness of my fifteen-month-old niece’s antics, I go grocery shopping. I slowly peruse the whole store without my usual anxiety and desire to get home as quickly as possible. I smile at fellow shoppers as our carts pass and marvel at how wonderful it is to appreciate everything I see rather than rush through the aisles grabbing what I need as quickly as I can, my heart racing and my head swimming with fear the entire time. On the way home, I am already planning my activities for the rest of the day.
I spend the rest of the afternoon doing chores around the house, listening to music and singing out loud. This may sound trivial and mundane to most, but to me it is as wonderful and exciting as winning the lottery. I cannot remember the last time I enjoyed music, the last time I sang out loud, the last time I did anything because I wanted to, not because I absolutely had to. I do more in three hours than I am normally able to accomplish in a week because rather than being completely overwhelmed and emotionally exhausted by the smallest task, each chore I finish gives me a tremendous sense of accomplishment and pride. Depression had shut down the “reward center” of my brain, the part that releases endorphins when you accomplish a task, so you feel good about yourself and are motivated to complete more tasks. But now my reward center is alive and kicking and it is an absolutely beautiful feeling! If this lasts, I cannot even begin to imagine what I will be able to accomplish in my life…