Thursday, May 3, 2012

Valedictorian

I saw this cartoon a couple days ago, in a copy of the New Yorker that was maybe a month old.  It's the perfect riposte to my normal, outlandish egotism.  I love it.

Wednesday, May 2, 2012

Meltdown

Early yesterday morning, Son 2 joined his class at the Train Station for an overnight school field trip. They will be back late this afternoon. So it was just the two of us (Wife and I) at home last night.

When I got home Wife was in bed. I puttered around to start making dinner, and she toddled out of the bedroom to tell me – with tears streaming down her face – to make dinner only for myself because she wasn’t going to eat. I asked what was going on, and she said she was hitting bottom in a depressive spiral. So I piloted her back to where she could sit down, and asked her about it.

What follows is probably jumbled, because I’ll type points as I think of them. But that mirrors the conversation, which meandered all around and did not follow a logical order. It’s just that I may not have things in quite the same (dis-)order she did.

She said that for a while now her psychiatrist has had her on a reduced dose of her anti-depressants; or another time she said he had taken her completely off of one antidepressant in order to put her on another. Maybe it’s both. She spent a lot of time talking about how he should never mess with her antidepressants, how she told him this, etc etc, … but he did. She also said that until very recently she had felt pretty much OK. And I would add from my side that yes, in retrospect I can now see that the last few days she has been more argumentative and less rational than normal … but as recently as two days ago (when she was being pretty argumentative and not very rational) I hadn’t put it together that this might be what was happening. But it all fits the pattern I have seen before. Anyway, she was plainly miserable last night.

She also complained a lot about one of our cats … he seems most bonded to Son 1, so I’ll call him Cat 1. (We have two cats, and the other is more closely bonded to Son 2. Call her Cat 2.) Cat 1 has been having trouble with vomiting and diarrhea (the vet hasn’t found anything), and lately we started buying moist cat food (because Cat 2 recently had gum surgery and can’t eat hard kibble for a month). Cat 1 is underweight at this point and it has been difficult to feed him: he will bully Cat 2 for this food but ignore that food and then we can’t tell what he will keep down. He also has a loud meow, and uses it to cry a lot more than Cat 2 does. Not to belabor the information about the cats, but to set the stage … Wife spent a lot of time also complaining about Cat 1: about how hard it is to feed him, and about how painful it is to listening to his wailing for hours on end, and about how she was on the verge of deciding to euthanize him just to get him to shut up (and also because maybe he’s in a lot of pain).

She also talked about suicidal ideation a lot, and this was related to another long series of complaints about how she can never get through to her psychiatrist’s office because his secretary never answers the phone (or something like that) and she really needed to tell him that she has been thinking a lot of suicidal thoughts. She was careful to add that she won’t go do anything about any of them, because she promised the boys she wouldn’t. (That was her only reason.) But then she began a different lament, about how Son 1 is away at school and “never thinks about her” and next year Son 2 will be “even farther out of [her] life” because he won’t have a cell phone at Durmstrang and so she won’t be in touch with him that way. The upshot of this line of self-pity seemed to be that after September even the boys wouldn’t care if she killed herself.

Wife’s voice takes on a normal monotone when she is complaining over and over about things, but last night her tone was different … more anguished and tearful. Very much the kind of tone she gets in a depressive spiral. As I say, it’s nothing new.

In and around all of this, I told her a couple of things. First, that she’s not going to kill herself. Second, that if she feels herself slipping this far down, it is crazy to stick on the low-medication regimen her doctor has prescribed when she knows what dosages can avoid it. Given the way she hoards medication, she already has in stock the meds she needs to come back up to the dose that has kept her stable for so long. So take them, and then call the doctor to let him know (after the fact) that she has overruled his prescription and put herself back on such-and-such a dosage. I’d never recommend that to an inexperienced patient, but Wife has done it before with her antidepressants, and every single time her psychiatrist has backed her up when he has gotten the information. So why wait and let herself slip into a state where she is fantasizing about suicide and killing the cat?? That’s just nuts. (But she has done it before. This isn’t the first time that I have had to push her into changing her dosage, even as she sits there in tears telling me exactly what dosage will make her feel better.)

She took her meds. I made her lie down to rest while I made dinner. Then she started fretting manically about our mortgage and about how we needed to refinance to bring the payment down because otherwise she could “never” save enough money to get even a little ahead to buy things she “needs” and and and and ….There was quite a lot here, all crammed into just a couple of minutes and all making only the loosest kind of sense. I told her rather firmly to stop talking (I had to say this more than once throughout this drama, because it was the only way I could get her to listen to my prescriptions for making things better.) and rest. She’d start up again and I’d remind her to stop talking and rest. Finally she lay down and I made dinner.

Halfway through dinner I ambled back to the bedroom and she was sitting up texting on her phone. I got stern again and told her to put down the phone, lie down, and rest. But I admit I worried a little. What if this was all an act, and she was playing a completely different part (who knows what?) behind my back? It didn’t look like an act, but I admit that sometimes with her looks can be deceiving. Nothing to do for it so I made dinner. She “wasn’t hungry” but I told her to eat. (She had had only a glass of milk for lunch, and even she agreed that the depression might well be WHY she didn’t feel hungry.) In the end she had two helpings of casserole, plus some salad. It should have stuck with her till this morning. Then she went to bed and fell asleep in not too long a time.

It turns out that her texting was all 100% consistent with what she told me. She had been contacting Boyfriends 6 and 7, plus one guy she says she sees purely non-sexually, wailing about how miserable she is feeling and about how the depressive spiral is getting worse and worse. A lot of the same things she said to me .. not at the same length (because she can talk faster than she can text) but at what is (for texting) a very ungainly length anyway. She also texted Son 1 to complain about Cat 1, and made a point of saying she wouldn’t euthanize him but boy was she frustrated! I had to shake my head at this. If she wants to complain to her (adult) boyfriends, that’s their lookout. But threatening Son 1 with something irrationally and cruelly destructive like that ....

I sent Son 1 an e-mail right away, to reassure him that the problem was not with Cat 1 but with Wife’s meds – and that she won’t harm the cat. This morning before I went to work I made her promise that she take a stable dose of medicines and not hurt the cat. And then I guess we play it by ear. Son 2 will be back tonight. I had better warn him (on the way home from the station) that Mom had a meltdown.