Maybe this is a story
Maybe this is a poem
It starts where the last one ended—a new beginning
It continues, unafraid, without knowing
It’s been one year, one month, and eight days since I last published a post.
How to even start with what has happened in the meantime? As I sit down to write I feel compelled to offer an explanation for why this update has taken so long. After such a prolonged delay without word from me—a delay that, I know, left some people wondering, if not a little worried—I feel I should give a better answer than “a lot has happened.”
There are a few reasons for my absence, and I suppose the most obvious is that I’ve been busy. However, busyness is not the complete picture. It would be more accurate to say the greatest reason for my absence is that I’ve been focused. And perhaps the word “focus” is an understatement. It would be most accurate to say the greatest reason for my absence has been obsession—a soul-consuming obsession, a ravenous fire in the pit of my stomach, a blinding preoccupation with one thing, and one thing only—to recover.
I had beaten cancer, but I was a long way away from getting back the life I had before. My body was crippled with pain and fatigue; I had no job and no ability to earn money (a generous disability policy had supported me thus far, the payments for which would soon end since I was no longer on chemotherapy). I barely remembered anything I had learned during my seven and a half years of medical school and psychiatry residency—years spent studying my passion and vocation, years that were so inconveniently interrupted when I was diagnosed. I had survived, but felt light years away from putting the pieces of my life back together.
Are you surprised? Tales are written of great men who go out and fight battles and win wars and slay monsters, but what happens after? Men who slay monsters will tell you that slaying monsters is the hard part, but it’s not. The hard part is finding your way back home.
For three months I waited and planned. I went to Hawaii for my brother’s wedding, then Mexico for a college friend’s wedding. I loved these trips, but you must understand that simple things like walking through an airport and sitting up on a plane—what most people would consider the gentle lead up to a relaxing vacation—took up, for me, an inordinate amount of energy.
When I got back from Mexico I decided the first step would be to taper off pain medications, which I had been taking daily for the previous three years. I still had pain (a chronic effect of the chemotherapy), but I didn’t want to take pain pills forever, and as hard as it would be to stop now it would be harder to wait until later when I would hopefully have a job.
I took all of my bottles and counted up my remaining pills and wrote out an elaborate taper schedule. First one pill three times a day, then three quarters three times a day, then half four times a day, then half three times a day, then one quarter four times a day, then one quarter three times a day, then one quarter two times a day, then one quarter once a day. It took about two months.
For most of these two months I cocooned myself under the covers of my bed, imagining ways I could kill myself to end the torture. To distract myself I copied and then recopied my taper schedule in my daily planner (a planner that was largely empty except for the reminders to “take pill”). I soaked in epsom salt baths, I took vitamins, I popped a hundred other pills that were not opioids. On more than one occasion, I shit my pants. About two weeks after my last dose I no longer fantasized about committing suicide. As I started feeling better, that burning pit of desire rekindled in my belly, and as it grew I once again narrowed my focus onto the one and only goal that mattered.
At this point my primary problem was energy—not the average person’s perception of low energy like, “I’m kind of tired” or “I need a nap,” but the kind of crippling fatigue that resulted in days without showering and skipped meals because it took too much energy to walk to the fridge. At best, I could do one thing a day, such as running an errand or going to a doctor’s appointment. If I wanted to reach full recovery, this simply would not do.
So first I sought out information. I established that my symptoms were characteristic of the chronic pain syndrome known as Fibromyalgia, and so I read everything I could about Fibromyalgia. Fibromyalgia, I learned, is not so much a diagnosis in and of itself, but is more a final common endpoint to many potential insults (in my case, years of chemotherapy). The first four or five books I read on the subject weren’t any good, but then I found one that clicked, and so over the next week I read it once, then twice, then three times, then four, and then I read it however many times one needs to read something in order to be able to recite it by memory.
Now informed, I put myself on a fanatical regimen of supplements and vitamins, and armed with knowledge of a concept of energy conservation called “pacing” I created an elaborate point system to categorize how much of my limited energy each activity I did used up. Showering: 2 points. Eating: 1 point. Cleaning up after eating: 2 points. Talking: 3 points. Driving: 3 points. Anything outside the house: 3 points per hour.
I calculated I could expend no more than 20 points each day without becoming sick, so I fastidiously scheduled every hour of every day in my planner (finally, I had more things to fill in than “take pill”). I saved a few crucial points each day for weight lifting, and so week over week built my endurance to 22 points, then 24, then 26, then 28, then back down to 26 because I got greedy and tried to do too much, then back up to 28, then 30, then 32 points.
This took about three months.
After three months I could reliably engage in productive activity ten to fifteen hours a week. I know this doesn’t sound like much, but after years of doing not much more than lie in bed, I can tell you ten to fifteen hours a week is nothing to sneeze at. With ten to fifteen hours a week one may not be able to work full time, but one could, theoretically, finish the last few remaining requirements one had left in the final year of one’s psychiatry residency program and graduate. And yes, this is what I did. I finally graduated residency, and at the ceremony I got my diploma and it said UCLA Department of Psychiatry 2010-2017, and yes it took me seven years to finish a four-year residency program, but goddamnit I finished. I came, I saw, and I conquered.
So yes, I graduated, and yes, I was thrilled, but what was I going to do, sell my diploma for groceries? No, I needed money. And more than I needed money, I needed purpose. I needed a job. So I applied for part-time jobs, just ten to fifteen hours a week, because by this point I had enough energy points to work ten to fifteen hours a week AND shower and eat and talk every once in a while.
However, while applying for jobs, something magical happened. I met with a former attending of mine who is in private practice and I asked him for a letter of recommendation for a job and he said, Sure. And then he said, I’ll give you a letter of recommendation, but why don’t you come here instead? Why don’t you start a private practice and use my office (and you can pay me almost nothing for it) and I’ll send you patients (because I have a ton of connections and my practice is full)?
He said, You can do it part time, because when you work for yourself you’re in charge, and you can work when you want to work and rest when you need to rest and you can set it up however you goddamn want to and you’ll make a ton of goddamn money (he phrased it differently). And I said Yes, Yes, Yes, YES, YES.
So that’s how I got to where I am now. A few months ago I studied for and took my psychiatry board exam, and found I remembered much of what I feared I’d forgotten. A few weeks ago I turned 35—an age I wasn’t sure I’d ever reach. I have my own private practice, and I have a little office with a view of the ocean and I see patients and they tell me they suffer and I say, I know. I say, It will change, because I know it will. Time promises one thing—it moves forward. Somewhere along the way we will be changed, even if we don’t try.
You may wonder, Do I feel different now? Do I appreciate life more than I did before? Of course, the answer is Yes. How could I not be changed? How could I not appreciate what I have; how could I not be afraid of losing it again?
What amazes and thrills me, though, is that, sometimes, the answer is No. My life these days is so… ordinary. I go to work and see patients, I play tennis and ride my bike and balance my checkbook, I read books and write words and Google Game of Thrones fan theories. I plan my wedding for the Spring (I’m getting married). I get a cold and complain about it. Sometimes I feel tired and I forget why.
But how wonderful is it to be ordinary, to have the luxury of getting caught up in the petty concerns of everyday life like traffic and money and work? How wonderful is it to have a life so stable you are able to take it for granted? To be able to worry and hope and dream and plan for the future because you believe you will live to see it?
A few years ago I had a conversation with my oncologist, Dr. Eradat, when I was in the worst of my treatment and saw no end to it. I asked him if I would ever feel normal again. “Well,” he said. “It depends on what you mean by normal.”
(Not the most encouraging thing I’ve ever heard, but an honest answer).
So I clarified. “I mean, when will I not feel so… afraid?”
“Oh,” he said. “Afraid? That doesn’t go away. In twenty years you’ll have a cough and you’ll feel afraid. Your stomach will hurt and you’ll feel afraid. But you’ll need to live your life, anyway.”
There was a point when I had no fear left—when I had lost everything important to me and there was nothing left to lose. Now, I am afraid. I am afraid because I have a life I could not stand to lose; I have a life that, in all its imperfection, is worth the pain of living to keep.
All those years ago what I needed to know was not, Will I ever again be normal? It was, 1) Will I ever again be happy? and 2) If so, when? The answer was, 1) Yes, and 2) It won’t take as long as you think.
I struggled so much against this horrible thing that happened to me, trying to fight what simply had to be endured. In the end I did not need to do anything special to find my way home, because home is more than a place, it is a desire. It will consume you until you have no choice left but to find it; home will grab hold and pull you toward it with a force more powerful than gravity. I just had to be patient. I just had to wait.
I am here, and my feet are planted firmly on this earth. I am alive—I am so wildly alive. I feel each beat of my heart, I sense every sound, the melody of voices so distant you can barely hear them, the gentle hum of traffic outside my window. In the morning it smells of bitter coffee, in the evening of lavender soap. I see every brilliant ray of light, I feel the soft warmth on my skin. The sun glows down on me as if it comes from heaven.
Most of all, I am afraid. I feel that hiccup every time my heart skips a beat. The terror in my throat that chokes me. Every time I cough I feel it, every breath I take I feel it. But I will live my life, anyway.
Photo By Nigel Howe