Postcard from The Abyss: Ahhh. That’s Much Better

Life is weird. Life with mental illness is a couple factors of ten weirder.

If you’re mentally okay, and you break your arm–and I hope you don’t break your arm. For gods’ sakes, I’m using this as a damned example. Stop being so literal-minded! 😉

Anyway, you feel the pain. You can reason out, “Golly. I think that in the process of _______________, I broke my arm.” You can go to your local emergency room. They can shoot x-rays of your bum arm, and a radiologist can show you the film, and say, “Yup! Right there is the fracture, almost all the way through your radius, and half way through your ulna.” Then an orthopædic surgeon will look at the film, and he’ll immediately start planning the best way to fix your broken arm–either with a cast, inserting wires, maybe surgery–all as he debates what color BMW M6 to order with what he’s fitna bill you. Over time, you can see the swelling go down, have the cast replaced after a few weeks, see the updated X-rays, showing your new bone growth. There’s progress, too, as you get the wires removed. You’ll get a new cast, once the swelling abates. Maybe, if you’re really healing quickly, a soft cast. Bottom line–barring osteoporosis, osteomyelitis, or some other skeletal malady–a broken arm is a broken arm. Some are far worse than others, but they’re broken arms, and fixing them is pretty routine.

When it’s your brain that has been injured–either physically or through some sort of psychic trauma–the treatment options are never quite so straightforward. I’m not talking about garden-variety depression, for which your GP can write you scrips for Prozac (an aside: who the fuck grows depression in his or her garden?? Try squash and pole beans, or maybe tomatoes. Sheesh!)

Part of the problem is that you have to try and see your progress through a broken brain. It’s difficult to analyze and assess how you’re doing if the six-pound goo loaf that analyzes and assesses is operating like a Yugo in need of a tune-up. Sometimes, you feel bad, but you can’t explain the badness. You know you’re sick, but you can’t explain the sickness. With the broken arm, it’s easy to pinpoint: here’s where it hurts; the x-rays bear that out, and treatment is simple.

What leads me circumlocutiously to where I am today. In April, or thereabouts (I have blocks of memory loss), my brain went kablooey. I went from functioning okay to not functioning at all. I was referred to a doctor who was recommended as, “The best psychiatrist in the business.” For once, this wasn’t hyperbole. He is awesome.

So, the first thing he did back in April was throw out the Prozac. “You are broken beyond Prozac. You’ve had the mental trauma equivalent of a major heart attack.”


This doctor–we’ll call him Dr. Borgia–inspires complete trust. In the past, I’ve been to psychiatrists who were complete turds. They wrote prescriptions for whatever the drug reps told them to, whether or not it was appropriate for me, as a patient. These psychiatrists will suffer greatly when my expatriate Vox friends and I take over the world. Oh, boy-howdy, will  they be punished.

Sorry. The Crayzee took over for a moment.

Dr Borgia listens carefully. He explains what he thinks is going on in my fucked-up brain, and when needed, he uses charts and pictures to illustrate his points. He asks questions, and when he sees that he’s asked me something I can’t answer easily–something that requires too much thinking from my broken thinker–he’ll rephrase until he gets the answer.

I’m a very curious patient. When I’m sick, I want to know everything about my illness, and I’ll read pages upon pages about any medications I’m prescribed. When I had the Fournier’s, I was researching every one of the antibiotics they were pumping into me 16 hours a day, and I grilled the Infectious Disease doc about what sorts of bacteria were holding this little orgy in my nardsack. One day, he came in smiling, and said “Peptostreptococcus! The latest cultures I ran found that Peptostreptococcus is your main bacterium. There are still anaerobics in there…” I immediately changed my Vox banner to a stained Peptostreptococcus slide.” (Lauri noticed the change, and commented, “Ooh! Buggies!!” (She has harrowing bacteria stories of her own, although to my knowledge, she’s never had anything eating away at her nardsack. Well, or a nardsack upon which the Peptostreptococcus could engage in dirty dancing and feasting, like a white trash wedding reception dance floor))

Seriously, every med Dr Borgia has put me on–and we’ve been through a bunch–has an excellent track record as a maximum efficacy med with few side-effects. His dosages haven’t always been conventional according to “the literature.” One medication, he started me at 45mg at bedtime each night. The various websites, FDA prescribing guidelines, etc, said that the normal starting dosage should be 15mg. I asked him today, “Isn’t the normal starting dosage 15mg? Why did you start me at 45mg?” I wasn’t questioning his judgment–if he’d started me on 90mg, I’d have trusted him and taken it as ordered–I was just curious.

“Tom, it’s because–as counterintuitive as it may sound–15mg is more sedating than 45mg. The way they researched and marketed this drug (mirtazapine (Remeron)) was wrong. They approached it from the wrong angle. This could have been a huge drug for them, and it never was, simply because they misunderstood how the medication reacted in a sick patient’s mind. 45mg was more therapeutic and had fewer side-effects than 15mg.”

First off, he got bonus points for using “counterintuitive.” His explanation made sense to me–the brain needed more of the chemical to be less sedating, even though that sounds backwards. This drug (mirtazapine) is also described on (my favorite source for “tell it like it really is” psych-med info (written by a Pharm D and an MD)) as being the psych-med equivalent of  “really good weed,” and that our brain should be “swimming in serotonin,” which is brain juice that makes you feel calm and content. Also, we’d sleep all day, and crave doughnuts by the dozen.

In me, it didn’t work (other than some increased ice cream consumption). I developed very un-Tom-like behavior. Like I’d go from zero to Dennis Hopper in “Blue Velvet” in the snap of a finger. An half empty soda bottle I’d taken out of the fridge fell onto the floor–I hadn’t set it all the way on the counter. I slammed the fridge door so hard that all my magnets fell off, then I threw the bottle completely across my apartment, like young Peyton Manning (I dented the wall, and just missed a lamp). The next day, somebody from my newly merged prescription insurance provider called me. She was reading from a script. Badly.

I work as a supervisor in a call center, where we have sometimes a thousand reps on the phones. I would have slain one of  my reps for being this bad. She explained that there’d been a merger. I informed her I was aware of this, since they’ve sent me about 15 different mailings announcing the merger. She then switched to a script informing me of the benefits in ordering a 90 day supply of my meds via mail-order. “You just got stabbyfeet meds refilled at your store, and your co-pay was $25. Through mail-order, you could have gotten–” I interrupted her. “I am aware that I could have gotten a 90 day supply via mail-order for that same $25, but A) I needed it NOW, and B) this thirty day supply will last me five months.” “But you could still save–” “I’M NOT INTERESTED.” “Okay, Mr. S. I see you just got a prescription for mirtazapine. Your co-pay was $17, but if you got a 90 day supply th–”

*tom goes from zero to pissed in .09 seconds*


(pause) “Well, Mr S, I need to tell you about how you can save–”


And I did.

Two things occurred to me. First off, hanging up on a cellphone is anticlimactic. I have to take the phone away from my ear, shake it to reactivate the display, then slide the red “end call” icon to the right. Lame.

Payphones were the best, followed by those old 1970’s indestructible Bakelite phones that weighed like 10lbs. THOSE could get your point across with a good receiver slam.

The second thing was this: I don’t get violently angry, bellow Mufasaically at some moronic rep, then hang up on her. Ever. I theater voice-project in an unfriendly tone when I’m speaking to automated answering systems, because they understand this better than my oversedated, slurring Cracker drawl, but I never snap on people that way.

Hand to God, though: that last bellowed sentence to the ignorant twatwaffle was echoing through my apartment for like ten minutes.

Today, I was having new tires put on the USS Nimitz, and I realized I couldn’t wait another week to see Dr. Borgia. What sealed it was this: I was sitting quietly outside, under an umbrella, and this lady was walking quickly in different circuitous routes as she talked on her cellphone. Around the time I wanted to shove the umbrella up her ass, I called Dr. Borgia’s office, asking if there was any way I could get in to see him today. Collette–who’s Mexican, which is counterintuitive for a “Collette”–said Dr. Borgia was completely booked. She heard something in my slurring ramble. “Is this urgent, Tom?”

“Yes, Collette. It really is.”

“Okay. Come in at 330, and we can probably squeeze you in somewhere. You might have to wait, but we’ll get you in.”

“Thank you, Collette.”

I got there at 325. At 335, Dr Borgia was taking me back to his office, which has expensive Salvador Dalí prints on the wall, and a leather sofa that doubtless cost more than my truck. I explained that my problems were twofold. First, this drug we started last week, which was supposed to enhance my sense of well-being had actually turned me into Russell Crowe on PCP, and second, that I otherwise had absolutely no spark inside me. I was all thick, dark gray fog. I wasn’t participating in life. Life was elsewhere. I was just a benign, gray cloud incapable of either a drizzle or a flurry. I explained that I was on four different meds that were supposed to be un-depressing me, but that each one of them had as primary side-effects “drowsiness, dizziness,” etc. “They may be working to heal my brain, but I’m so oblivious that I can’t tell. I HAVE to have some kind of spark, so that I can get out of bed and do things. Like, say, go to work, so that I can make money and not be fired for missing work because I’m too fogged-in to leave my bedroom. I need something that increases alertness, so that I can at least get my brain back to 75 or 80%, which would enable me to both shower AND work on the same day.”

First thing he did was grill me about the mirtazapine. “It really did that to you? And before we gave you that, you hadn’t had the rage issues since the Pristiq, right? When you scared your father?” “Right.”

“Okay. Stop the mirtazapine immediately. Your reaction is very unusual–I’ve used it with dozens of patients with only good effects–but we’ve established a good baseline with drug A three times a day, the rhombus pill once a day, and four 1mg Xanax a day, so it’s clear this drug reacted badly with your system. Let’s stay with drug A, the rhombus, and the Xanax.”

“I agree: I think we have something that’s working on the deep-down depression, but I need something to get me through the day. Four migs of Xanax in a day would knock most people out for a month, and I’m taking that every day.”

“I think you’re right. I would like to try adding a  stimulant, just to see if that can be a beacon through your fog, as you put it. It’s used regularly to assist with depression, and to counterbalance the sedating side-effects of anticonvulsants, which is what drug A is.”

He pulled out his pad. As he wrote the prescription, he gave me instructions on how to take the new med. “Day one, break one in half and take it, then take the other half four hours later. Day two, take a whole one, then another whole one four hours later. Day three, take one and a half first thing, then another one and a half in four hours. If you have any problems or reactions, call my service, and they will get your message to me day or night. Come back in one week, and we’ll see how you’re faring with that. We’ll probably titrate it up to 1.5 tabs three times a day, or maybe even two tabs three times a day. If it’s working–and I think it will help–you should feel some improvement pretty quickly.”

I took one in the Sarasota Walgreen’s parking lot at 727pm. When I hit the Sunshine Skyway around 805pm, I already felt like some of the weight had been lifted off of my shoulders. I sat up straighter; my mind felt like it was banging on at least eight of my twelve cylinders again, and I had to be careful to keep the USS Nimitz below 85mph.

During our five month doctor-patient relationship, I’ve left messages, and Dr Borgia has called me back on weekends, in the evenings, between patients–whenever I’ve needed him.

Tomorrow, I will wake up and take my new, little, baby-aspirin-orange-colored buddy, and head off to the therapist. I imagine it will be a more pleasant session than I’ve had in awhile. Next Thursday, I see Dr Borgia at 2pm, and the therapist at 3pm. Normally, this would seem daunting. Now, I feel like I can function. The new med is a pain-in-the-ass to get. It has to be a paper prescription, and there are no refills. They control this med tightly, as if it were an amphetamine. Well, that’s what Adderall really is, so it makes sense.

For so long, I’ve felt like I was caught up in that damned “Wizard of Oz” twister. I may not be over the rainbow, nor may I ever be, but at least I can see the rainbow, know what it is, understand how it’s made, name the colors (ROY G BIV), and most of all, see just how fucking beautiful a rainbow is after the past six months of  sepia-toned dust.

Beats the shit out of the sepia toned Kansas dust.

(And I don’t begrudge Dr Borgia his Metallic Black Sapphire Twin-Turbo V-8 BMW X6 X-Drive 50i one damned bit!)

This is a long and tedious post, and I’m sorry for that. I queried my “Films in 2012” category, and found that I’ve written 51 film reviews this year. There are five or ten films I’ve watched and not reviewed (yet, anyway), but 51 seems like a lot. To me, blogging is supposed to be about life, and how we live it, how we make fun of it, what makes us *snerk* and what makes us tear-up. Maybe I should set up a film review blog, so people who give a crap about my film opinions can go there. Here, in Dispatches from the Tom Zone, I like to blog about the quirky things–like my grocery store having a shelf of discounted Saint candles for just $2 each (vs $6 or $7 for non-saint candles). Discounted saints. I’m not Catholic, but it just seems oddly appropriate that I have discounted saint candles  burning next to my cucumber mint and cinnamon apple candles. To quote Kevin Costner in “Field of Dreams,” “Hey, I need all the good karma I can get right now.” (And if I ever form a band, it would be called “Discount Saints.”)

The film reviews were (and are) a way to exercise my brain. I love film, and I like analyzing them. Even when I was at my most mentally depleted, I could still review a movie. It’s what I’ve done so often–in school, for independent papers, blogging, etc–that it’s an automatic.

It was never meant to be a substitute for real bloggery, but it was really all I could write at the time.  Let me put this amphetamine-fueled 2900 word p.o.s. to bed, and we’ll wake up and face tomorrow head-on.

Thanks for being my friend, and for helping me through this effed the effing eff up last six months. It means a lot, and I’m grateful.

Not “BMW Z4 Roadsters for everybody” grateful, of course…but just thanks.

And in the name of काली the Destroyer, do NOT TELL ME HOW MUCH I CAN SAVE BY ORDERING PRESCRIPTIONS BY MAIL!! I’m not fixed enough for that argument again. Not quite yet. And you don’t want to hear the “Evil Boom Voice,” especially first thing in the morning.

Happy Thursday.



18 Responses to “Postcard from The Abyss: Ahhh. That’s Much Better”

  1. I always enjoy your movie reviews.
    But this one… well put. I haven’t been through what you have been through, but you sure make it easy to almost feel it.
    I really really really hope this new med does the job, getting you back to Tom!!!

    • Thanks for your help, Lauri.

      OH! Mom & Dad just adopted a used Golden Retriever from SW Fla Golden Retriever Rescue. She’s a pretty girl, lots of red in her (not quite Irish Setter red, but redder than yellow). She’s reasonably calm, quite smart, and obeys (at least she obeys my dad). She’s also a ginormous OX of a goldie: 90+ muscular pounds. My mom has bruises all up and down her arm from being walked. Anyway, she’s 3, named “Daisy,” and my mom is happy to have another dog in the house. Wind was apparently just too handsome and elegant for them, so they went with a dog. 😉

  2. “Now, I feel like I can function. ”

    I had such a grin when I read this. It’s about time you feel you can function.
    I love your film reviews, but yeah there have been a few too many for me to want to keep up with them this year. 😛

  3. It’s so amazing and rare to have a doctor as responsive as yours. That is a gift you’ve been given amongst all the yuck.

    • He seems to be the only one who knows what the hell’s going on in my brainz. lol What I like most (other than all the beautiful Dali prints), is that he’s’ not one of these jackass docs who insist on staying the course when a med has adverse effects. Twice, he told me to stop the offending med immediately. Once, I had to wean off of it. He trusted my word that the shit was doing bad things, and he sent it to the cornfield.

  4. If I ever make another friend down thataway with a broken brain, I will ask you for Dr. B’s number. I too have the backwards reactions and the gigantic doses and fetching the brand-new prescription every month, which means an extra trip even after all these years.

    But frankly, that call-center person NEEDED yelling at in the Evil Boom Voice, so hooray for the non-working med. Sometimes we have to take one for the team and you did there.

    • Yeah. I didn’t lose any sleep over it, nor do I plan to. I’ve Evil Boom Voiced my own reps for being morons, so I feel qualified to exercise Evil Boom force.

      One thing that impresses me about Dr B is all the post-doc residency programs he did at The Menninger Clinic. That’s one of the best psych places on earth. I know this, because that’s where they took Regan MacNeil in “The Exorcist.”

  5. Brown Suga' Says:

    May all the powers in the Universe bless Dr.B, he is a Rare One. Glad that you have him, and that you feel a little less foggy, thanks to his skills.

    And OMG. I swear, if you hadn’t yelled at the call-center person, I would have grabbed the phone from you and screamed at her for you. I am disappointed that she didn’t burst into tears on the phone before you hung up.
    (I kinda feel sorry for them, but hey, if you don’t know how to do your job without being annoying, that’s your problem. I have had calls from telemarketers who promptly hang up without a word when I tell them I’m not interested. Rude, yes, but way better than annoying.)

    • I wasn’t even wearing my Kali medallion when I Evil Boom Voiced her. And you’re right: Dr. B is a gem in a gravel field.

      Hope all is well.

  6. I should probably read everyone else’s comments to make sure I’m not repeating myself, but you know very damn well I’m not going to. So I’m sorry if any of this is repetition:

    The details you’ve posted are respectfully fascinating. I knew the movie stuff was therapy and to be honest, I skipped over the ones I haven’t seen.

    Please don’t forget that this is not a competition.

    Sidebar: I had this dream last night and you were in it. I was at a resort with my best friend and we both realized it was a horrible place to be (but for different reasons). I was so upset, you appeared in my room to pack all my stuff for me, but you packed just a few things. I kept crying about the stuff you weren’t packing, but you kept telling me it was just stuff I didn’t need. [And therefore wouldn’t pack for me.]

    Every day you wake up to live [in it] is a damn fine day. I’m sure as hell glad you are here.

    • The movie stuff was the equivalent of driving a sick car and being stopped in traffic. If you take your foot completely off the accelerator, the engine will sputter and be in danger of dying. I couldn’t focus enough to read (most of the time), but I could always find a movie to watch. Two hours for the movie, and another 30 minutes to an hour to crank out a review–this was me keeping my engine as un-sputtering as I could. Definitely therapy.

      Your dream was interesting, just because I’m horrible at packing. (Never traveling means this isn’t a real big skill I’ve developed) Still, in your dream–in my subconscious role as your packing assistant–God only knows what things I was telling you to leave behind, so you could get on with your journey.

      Oh, well. I just hope I was helpful, and remembered to have you take your passport and toothbrush.

  7. I think I might need a Dr. Borgia. I’m having a weird night again. Anxiety/depression issues suck. I have so much sympathy for people who (1) have it worse than I do or (2) have another invisible ailment.

    But I’m glad your amphetamines are working!

    I’m also happy to see a rambling blog post. Not that I don’t like your movie reviews, but I think blogs should be, at least mostly, about life… Which is why I need to write a real life post this weekend to interrupt my art nerdiness.

    • Your art-nerdiness is just fine, because you haven’t beaten everybody the fuck over the head with it, as I have done with my film essays. It’s not even that I don’t think I should write them. It’s the overwhelming percentage of my posts which are film reviews.

      I’m glad “Sacre Bleu” has inspired you to free your inner artperson.

      Oh, yeah. “The Penis.” (Mwahahahaha)

  8. Rambling blog posts are good because they let your friends know where you’ve been. Tom, I’m so sorry you’ve been going through this. There’s a tendency in US culture to assume mental illness isn’t as serious or as debilitating as a physical one. Some people even think it’s a character defect, though that’s like saying a person got cancer because she was lazy or lusted after younger men. 😀

    Dr. B probably enjoys the fact that you are an intelligent patient who is curious about his illness and is willing to work at fixing it. I’m glad he cares so much about you.

    • There’s a great scene in The West Wing’s “Bartlet for America” episode, where Leo McGarry is explaining alcoholism to his defense counsel. “You think this is a lack of willpower or intelligence? Do you know how many alcoholics are in Mensa?”

  9. There’s a great scene in The West Wing’s “Bartlet for America” episode, where Leo McGarry is explaining alcoholism to his defense counsel. “You think this is a lack of willpower or intelligence? Do you know how many alcoholics are in Mensa?”

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