What progress feels like

I spent most of the time between Tuesday morning and Thursday night last week having what felt like one, very long panic attack. Of course I didn’t recognize it as a panic attack until it was over. I seem to have two flavors of panic attack but neither of them have the precise textbook presentation I learned in school; a feeling of impending doom or a fear of death, frequently physical symptom similar to a heart attack, etc. What I seem to get are a sense that everything in the world in general and my life in particular is broken and nothing will ever be able to fix it, or a sense that everyone in my life either hates me or is angry with me about something. The one under discussion was the former and I spammed several friends, family members, and my therapist with texts and emails about how it wasn’t fair how badly my life sucked and now we’re going to have World War III thanks to Putin.

The thing is, at the time I did not feel irrational and, in my defense, it really has been a few pretty rough years and the nature of my reaction wasn’t completely unjustified. The problem started when my (perfectly justified) dissatisfaction with the state of the world turned into an out of control semi barreling downhill with no breaks. On some level I knew something was wrong. I knew I didn’t feel like myself, I couldn’t think clearly. It felt like my brain just wasn’t working right.

At this point I would like to pause for a moment and talk about brain anatomy. In broad terms, the human brain can be divided into three sections, the brainstem, the limbic system, and the cortex.

what a brain might look like

Generally, the brainstem tells you that you’re hungry and need food, the limbic systems tells you to go find food, and the cortex decides whether you want Thai or Mexican. Or, more importantly, tells you that you can’t go look for food right now because other things are more important.

That inhibitory function of the cortex is the key. The brainstem starts shouting about how there’s a big problem here (whatever it might be, probably a saber-tooth tiger), the limbic system agrees that this is a big problem (whatever it is and we certainly can’t rule out the tiger theory) and we’d better do something about it right fucking now. It is at this point where the cortex is supposed to step in and remind everyone that saber-tooth tigers have been extinct for a really long time now and all that happened was some jerk cut us off in traffic.

Problems start because under enough stress, either intensity or duration, the limbic system kind of stops talking to the cortex. It decides that the big problem (whatever it is) is important enough that we have to deal with it and we don’t have time for the guys at headquarters to get back to us. This effectively removes the filter between thought and action which frequently results in people doing stupid things like spamming their friends with apocalyptic text messages.

Or punching a wall.

What I’m learning is it’s impossible to think yourself out of a panic attack because the thinking part of your brain is quite literally not at the controls anymore. Of course the goal would be to not have panic attacks in the first place which is why I’m also trying very hard to learn the warning signs so I can do something to change the situation before the lunatics take over the asylum as it were. Unfortunately I am really bad at recognizing the warning signs, partly because I’ve spent the overwhelming majority of my life not just ignoring them but desperately pretending they didn’t exist at all. Since nothing my limbic system could do would get the attention of my cortex to have it fix the problem, my limbic system decided it needed to turn things up to a point where they couldn’t be ignored anymore.

The point to all this is I will almost certainly have more panic attacks in the future and people may very well see me behaving somewhat erratically. Be assured that in a matter of hours, or a couple days at most, I’ll be fine so just strap in and hang on.

Hey… didn’t I have cancer?

Remember how I was going to start a blog to keep everyone up to date on how my cancer treatment was going? What ever happened with that?

I started the second round of BCG yesterday. I had completely forgotten about it until about 5 pm Monday evening so it was a nice surprise. As always the procedure went smoothly. Pretty much as soon as I got home, though, I was right back to the frequency and urgency with urination. It was like the treatment never stopped. I’m feeling a little fatigued today but there are plenty of non-cancer treatment related reasons for that as well.

The plan was for three more doses but that is going to get really complicated. After my second dose, I am going to be changing insurance and my current urologist won’t take my new insurance. Just out of morbid curiosity I asked the billing people at the clinic how much getting a dose would cost and the answer was somewhere on the order of $10,000. For one dose.

Yeah. I’m just going to finish this post later. Or not.

The benchmark for stupidity

Back in the early 2000s (by which I mean 2000-2001) I worked as a nurse in the emergency department at our local university hospital. Among the injuries we saw on a semi-regular basis were adult men (and it was always men) presenting with a fracture of either the fourth or fifth metacarpal bones (sometimes both) and no other injuries.

what the fourth and fifth metacarpal bones might look like

This particular injury is known as a boxer’s fracture and results from, as one might guess, punching a hard, unyielding surface such as a human skull or, much more frequently, a wall.

In my mind it did not get much dumber than punching a wall. You start off with a bunch of problems, something makes you lose your temper and you punch a wall. Now you have all the same problems you had originally plus a fractured hand (and it was almost always their dominant hand because that’s the one people tend to throw the first punch with) and a bill for an ER visit on top of it.

With that all said, this is how I spent my Thursday evening:

ulnar impaction syndrome is a degenerative joint disease similar to arthritis

I knew what I’d done as soon as I did it, although I did spend a couple of hours trying to pretend I didn’t.

So, as the man said, how did it come to this? The short(-ish) answer is that I am having an increasingly difficult time arguing that the PTSD-like symptoms that I’ve been having aren’t actually real1. The longer answer is that I really can’t point to anything specific. I’d been feeling off since the Tuesday of that week; more irritable, harder time concentrating, more than usual sleep disturbances, etc. and by Thursday afternoon I was moderately dysfunctional. I really can’t remember what I was doing right before. I was upstairs actively falling to pieces and went downstairs to try and get somewhere quiet. I went back to my office and then I was back out in the hall with a fractured hand.

I have to revise my opinion of at least some of the boxer’s fractures that came through the ER. This is, I think, a perfect example of that “toxic masculinity” you hear about these days. Men in America, certainly men around my age, were still acculturated into fairly traditional gender roles, especially when it comes to emotional intelligence. There comes a point where the only way one knows how to express and attempt to manage the intensity of emotions that one is experiencing is through violent rage because men have traditionally been actively discouraged from experiencing negative emotions in any other way.

I hope that others can maybe avoid these self-destructive patterns and learn a lesson from my experience.

And that lesson is: punch something softer than a wall.


1 This is not to say that my brain isn’t trying to tell me this is just an example of how serious I am about sloth and malingering; that I would go so far as to injure myself just so I could better fake mental health issues shows real dedication