Thursday, December 1, 2022

Anesthesia

Eleanor at Whidbey General Hospital with bacterial pneumonia

(pre-helicopter ride to Seattle Children’s Hospital)


Facebook can be horrifying. 

 

Several years ago, a friend posted a cheery selfie from his sunny hospital bed after a surprise appendectomy. A day later, someone else posted the report to Facebook that our friend had died from complications after surgery.


Eleanor after hip surgery

In February, Eleanor had a sports injury that didn’t heal. In October, she had arthroscopic surgery to repair a labral tear in her hip. I sat in the waiting room, trying to read or write while my daughter was under general anesthesia. 


I am not a superstitious person. But I didn’t post a picture to Facebook until after it was all over.


Eleanor spitting up

My first paternal vigil was at Seattle Children’s Hospital in 2005. When Eleanor was a month old, her infant gastric reflux spiked. Whole bottles of formula ended up on her fathers, and she stopped being her happy self. Our pediatrician assured us this was perfectly normal. But it kept getting worse. Eventually we took her to the walk-in clinic. They immediately sent us across town to the emergency room at Seattle Children’s Hospital, where Eleanor was diagnosed with pyloric stenosis.

 

The pylorus muscle connects your stomach to your intestines. It’s the valve at the opposite end of the stomach from the esophagus. In something like one in a thousand babies, the pylorus closes completely a few weeks after birth. Anything you try to put into the stomach just comes back up. In the old days, infants with pyloric stenosis soon died. Fortunately, a century ago surgeons figured out how snip the pylorus and get things flowing again.

 

It took three days in the hospital before Eleanor was hydrated enough for surgery. When she was finally ready, the surgeon explained to us what was about to happen. Then he and Eleanor disappeared behind the ominous doors, and the rest of us went around to wait on the other side.


Eleanor before stomach surgery


My friend Michael is a distinguished anesthesiologist. I met him when we served together on the Seattle Men’s Chorus board. Although Michael isn’t a singer, he traveled with the chorus on our successful Rocky Mountain tour. So did one-year-old Eleanor. Over the years, Michael has given his Facebook thumbs-up to countless pictures of my daughter as she’s grown into a graceful and confident young woman.

 

Michael is an avid traveler with long legs and an aversion to flying coach. Although I’ve been immobilized by parenthood and disability, I’ve traveled vicariously as Michael and his husband Ron voyaged across the globe. Michael regularly posts pictures to Facebook showing his legs happily extended in First Class, or begrudgingly squeezed into an economy row. Last month we saw a picture of Michael’s legs comfortably resting on a British Airways flight to Barcelona. He and Ron were on their way to board a cruise ship for a trip around the world in celebration of their 42nd anniversary.

 

The next day, Facebook reported that Ron suddenly collapsed and couldn’t be revived. As Michael himself reported, “The sad news has already been mentioned, but I’m devastated to say that with no warning, the Husband suddenly collapsed and couldn’t be revived by the valiant efforts of the Spanish paramedics. I’m now dealing with the local medical examiner, the US consulate and at least one funeral home. A million thanks to those who have reached out already.”

 

Michael is a social creature with countless friends. Ron was quieter. I mostly knew him from references to “the Husband” in Michael’s Facebook posts. However, I know anyone living and traveling together with Michael for decades will see wondrous things. Ron had a wonderful life, then a sudden death in Barcelona.

 

Michael managed affairs in Spain then returned to Seattle – terribly alone, yet surrounded by friends. Michael’s next Facebook post said “I’m absolutely gobsmacked by the outpouring of support and affection from hundreds of friends and family.” 


Eleanor after stomach surgery

Last fall I sat in another waiting room while our next-door neighbor operated on Eleanor’s nose to correct a deviated septum. (Another sports injury, don't ask.) Afterwards I came back to sit with her as she emerged from anesthesia. I had to sit for a while – they wouldn’t let her leave the building until her blood pressure came down. The nurse spiked her IV drip with a couple of different hypertension medications, to no avail. So she gave Eleanor a hit of fentanyl. 

 

It was eye-opening. For me, not Eleanor – I watched as her eyeballs rolled back and her blood pressure immediately dropped. In the car afterwards, Eleanor said she hated how the fentanyl made her feel, and she never wants to try anything like it again. 


As a parent, I found nose surgery provides a wonderful “Just Say No” moment.


Eleanor before last year’s nose surgery 


At Eleanor’s recent hip surgery, I was invited to the pre-op area as the nurses got her ready. Her handsome surgeon stopped by, too focused on business for the kind of charming chit-chat we enjoyed during our introductory meeting a few weeks before. 

 

Before returning to the waiting room for another paternal vigil, I also met the anesthesiologist. His spiel was soothing, but a little too polished. He told us the odds of complications were one in 250,000, and said Eleanor was at less risk during surgery than during her car ride to the hospital.

 

Never tell me the odds. As I observe Michael grieve the sudden loss of The Husband after forty-two years together, I think of my sister-in-law in Canada, who sleeps on the couch across the living room from the hospital bed where my younger brother is confined by Stage IV spine cancer. And I watch my parents across town growing old together as they celebrate their 60th anniversary next year. 


I’ve been a failure with romance myself. By most measures I’ve been a failure with everything else. Instead, I’ve poured my heart into fatherhood. 

 

Wherever we find love, probability is not destiny. Life is fragile and precious, with no guarantees. And no day but today.


Eleanor before this year’s hip surgery


I recently read Pathological: The True Story of Six Misdiagnoses by Sarah Fay. The New York Times Book Review described the book as a “fiery manifesto of a memoir.” Like other critics of what has been called the “Mental Health Industrial Complex,” Fay challenges two dangerous aspects of modern psychological treatment. First, too much weight is given to the Diagnostic & Statistical Manual’s taxonomy of specific mental disorders. The DSM began as a helpful resource for practitioners. Unfortunately, its rigid categorizations can take on a life of their own, usually without the support of valid data. Rather than being seen as individuals, patients are reduced to labels and insurance codes. 


Second, market forces and Big Pharma have corrupted medicine. Pharmaceuticals became the default answer to every mental health question, causing numerous disasters including the opioid epidemic. In Fay’s case, her fifth psychiatrist prescribed Zoloft along with a new diagnosis. No one knows what powerful drugs like Zoloft and Prozac actually do to the human brain. For many individuals – including Fay and me – Zoloft offers magical relief to various debilitating symptoms. For other individuals in similar circumstances, the same drug may have no effect.

 

I was lucky. As I wrote in “Breaking the Glass,” I like to compare Zoloft to cartoon dynamite. The most alarming effect of amped-up stress had been on my temper around the kids. Every little mess was making me uncharacteristically angry. On medication, my fuse feels a few inches longer. Just enough to avoid explosions.

 

When Fay’s next psychiatrist gave her a new diagnosis, he insisted she end her reliance on Zoloft, because the drug was no longer indicated as part of standard treatment. Fay gradually tried reducing her dosage. But every time she approached zero she was wracked with horrifying withdrawal symptoms. She needed to stay on Zoloft to avoid side effects she never experienced before someone prescribed Zoloft for one of the six serious DSM diagnoses she received (none of which involved traumas or triggers). 

 

Eventually Fay took control of her own treatment: 

 

“I found the right combination and dosage of medications, which is like finding the slimmest of needles in the largest of haystacks at the end of a rainbow after winning the lottery.”


Eleanor after being airlifted to Seattle Children's Hospital

For years, I relied on the maximum dosage of 200 milligrams of Zoloft daily. A couple of years ago my amazing Bellingham physician Dr. Heuristic and I agreed it was time to taper down. I plateaued at 100 milligrams for a few months. Then I made it down to 25 milligrams. However, every time I considered letting go completely, some new life crisis erupted, and I would lose my nerve. 

 

This year began with the usual stress at home and in the world, plus crises and/or disasters in several of my ongoing legal matters. Nevertheless, I decided it was time to let go of Zoloft. Fortunately, unlike Fay, I didn’t experience withdrawal or side effects. 

 

In his classic treatise on trauma and its effects, The Body Keeps the Score, psychiatrist Bessel van der Kolk levels some of same criticisms at his profession that Fay addresses in Pathological. Dr. van der Kolk observes “people have always used drugs to deal with traumatic stress,” and recognizes pharmaceuticals are an essential treatment tool. Nevertheless, in the particular context of Post-Traumatic Stress Discorder and Complex PTSD,

 

Drugs cannot “cure” trauma: they can only dampen the expressions of a disturbed physiology. And they do not teach the lasting lessons of self-regulation. They can help to control feelings and behaviour, but always at a price – because they work by blocking the chemical systems that regulate engagement, motivation, pain, and pleasure.

 

Since my PTSD diagnosis, I’ve spent thousands of hours meditating. Through writing I’ve learned to think clearly. I’ve finished a broader and more substantial psychology and neurology reading list than most grad students. Bear and I walk six or seven miles every day. I had a 3.7 Wordle average in November. I spend as much time as possible in Vancouver with my chorus brothers or walking on the Stanley Park seawall. I’ve placed my family at the center of everything. 

 

After letting go of Zoloft, I was able to open myself up to tears of joy and sorrow. Of course, this also means that my emotions are more vulnerable to stress and triggers. I’m an unemployed disabled gay single dad who lives across the border from home. Every day I deal with triggering conduct by abusive lawyers. It should come as no surprise that even with the benefit of my shiny set of mental tools, my family has observed some fuse-shortened emotions lately.

 

I don't want to go back on Zoloft. So Bear and I are going for another walk.







Sunday, September 18, 2022

Something Rotten


At the end of July each year, my mother and her friend Carolyn spend a girls’ week at a condo in Vancouver’s West End. They watch the fireworks, shop on Granville Island, and walk along the seawall. They also attend the summer musicals at Malkin Bowl in Stanley Park, where the nonprofit Theatre Under the Stars has been producing shows since 1940. 

 

This year TUTS presented two shows in repertory. The first, We Will Rock You, is a British jukebox musical featuring the music of Queen, with a thin plot about a dystopia where music is forbidden. The second show, Something Rotten!, opened on Broadway in 2015. Brothers Nick and Nigel Bottom struggle to find success in an Elizabethan theatre scene dominated by William Shakespeare’s rock star status. Christian Borle won the Best Supporting Actor Tony for his portrayal of Shakespeare as a preening but insecure narcissist. 


Seattle Mens Chorus singing “A Musical” (2016)

Desperate to get an edge over his rival Shakespeare, Nick Bottom offers his life savings to a soothsayer in return for learning what kind of theatrical production is guaranteed to succeed in the future. The only oracle Nick can afford is Thomas Nostradamus, an undistinguished nephew of the famous French seer. Thomas’s predictions turn out to be accurate but slightly garbled. In Something Rotten!’s show-stopping production number, Thomas convinces Nick he can succeed by introducing the world’s first musical. 

 

In 2016, Seattle Men’s Chorus conductor Dennis Coleman retired after thirty-five years with the baton. That was also my first year in Vancouver Men’s Chorus. Instead of singing with SMC, I drove to Seattle with my daughter Eleanor to see the “Everything Broadway” show. Both of us were riveted by SMC’s performance of “A Musical.”


This summer when my mother mentioned she had tickets to Something Rotten!, Eleanor and I immediately played her the original cast recording of “A Musical,” including this classic excerpt:

 

THOMAS:       Some musicals have no talking at all....
All of the dialogue is sung
In a very dramatic fashion.

NICK:              Um, really?

THOMAS:       Yes, really.
And they often stay on one note for a very long time
So when they change to a different note, [finally changing pitch] you notice.
And its supposed to create a dramatic effect
But mostly you just sit there asking yourself
“Why aren
t they talking?”

NICK:              That sounds miserable.

THOMAS:       I believe it’s pronounced Misérable.

Songwriters: Wayne Kirkpatrick / Karey Kirkpatrick        

A Musical lyrics © WB Music Corp., Mad Mother Music


Sure enough, my mother and Carolyn loved Something Rotten. (Mom’s review of We Will Rock You: “It was loud.”) I got a ticket to Something Rotten for the last Wednesday of the summer. As I reported on Facebook, the show was delightful.


The key to surviving Facebook is to remember you’re not the target audience in Facebook’s business model – you’re the company’s productFacebook’s actual customers are paying advertisers. In a popular and apt metaphor, the rest of us are merely a herd of cattle on display. 

 

I’ve run the numbers, and I’m pretty happy with our bovine arrangement. As far as I can tell, the algorithm has never lured me into buying anything. Instead, Facebook serves as a convenient communication platform and auxiliary memory bank. After posting pictures of children, dogs, and travel for fourteen years, I can now rely on Facebook for daily reminders of happy times.

 

For example, according to Facebook I was at the Saint James Theatre seven years ago waiting to watch the original Broadway cast of Something Rotten!. As I wrote at the time, “Shakespeare has always been my idol.”


I’m lucky I have Facebook to remind me – because I don’t have any memory of being at the theatre in New York. In fact, other than the songs I heard on the original cast album, I didn’t remember anything about the show before I saw it again in Vancouver last month.



The last time I was in New York I was on my way to New Haven for my 25th year law school reunion. This was just a few weeks before my new Bellingham physician told me my weird recent symptoms added up to Post-Traumatic Stress Disorder and serious codependency. My disability diagnosis changed my life – but not as much as the abusive behaviour of my employers. 

 

PTSD is a disease of memory. As Bessel van der Kolk observes in The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, “traumatized people simultaneously remember too little and too much.” Sometimes trauma results in disassociation or repression, leaving no accessible memories at all. More often, trauma prevents key brain modules like the thalamus and hippocampus from integrating our experiences into “normal” memories. According to Dr. van der Kolk, “the imprints of traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces:  images, sounds, and physical sensations.”


When I realized I had no memory of seeing Something Rotten! on Broadway in October 2015 – even Christian Borle’s Tony-winning portrayal of my idol Will Shakespeare – I went back to my collection of Playbills to figure what else was missing. 

 

The only other show I saw on that trip was Fun Home, a musical based on lesbian cartoonist Alison Bechdel’s memoir about growing up in a repressed and dysfunctional home (she was raised in the family funeral home). While Bechdel was away at college, her father killed himself rather than come out of the closet. 


In contrast with Something Rotten, I remember seeing Fun Home on Broadway. I’ve also read Bechdel’s graphic memoir. But my memories of both are fragmentary.


Theatre Under the Stars

Early in his career, Sigmund Freud successfully treated hysteria patients who had PTSD-like symptoms. Freud reported his patients could not access traumatic memories because of the “severely paralyzing” effect of strong emotions like fright and shame. Freud concluded “the ultimate cause of hysteria is always the seduction of the child by an adult.” 

 

However, as Bessel van der Kolk observes, when “faced with his own evidence of an epidemic of abuse in the best families of Vienna – one, he noted, that would implicate his own father – he quickly began to retreat.” Freud shifted his emphasis from real-world childhood trauma to “unconscious wishes and fantasies” like Oedipus complexes and penis envy. A century later, the leading psychiatry textbook in 1974 stated that “incest is extremely rare,” while opining it probably “allows for a better adjustment to the external world,” leaving “the vast majority” of underaged victims “none the worse for wear.” 

 

Since then, we’ve learned PTSD is very real, and that its not just a soldier’s disease. Here is Dr. van der Kolk’s call to action in The Body Keeps the Score after four decades treating trauma victims:  “Child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.”

 

My childhood best friend Paul killed himself a few months after he was diagnosed with Borderline Personality Disorder. In a pioneering study by Dr. van der Kolk and his Harvard colleague Dr. Judith Herman, 81 percent of patients diagnosed with Borderline Personality Disorder also had histories of severe child abuse. On my way to see Something Rotten!, sitting in line at the Peace Arch border crossing, I read more details about the study in The Body Keeps the Score. And I remembered various odd things Paul said or did over the years. Suddenly I made the horrifying connection  my friend Paul likely endured abuse while we were in elementary school together.


Christian Borle and "Will Power" on Broadway

When I visited New York in October 2015, my PTSD diagnosis was still a few weeks away. But I was well on the way to rock bottom. Even after Theatre Under the Stars refreshed my recollection, I still can’t remember seeing Something Rotten!.

 

I can think of several explanations for the memory gap. The first is the general effect of my disability. As a wrote in “Better-ish,” although many of my fuzzy memories from that period finally snapped into place, others never did. Instead my brain concluded the simplest way to adjust my internal clock was to delete two years from the timeline. It was like switching to Daylight Savings Time. Or like when England converted from the Julian Calendar to the Gregorian Calendar, and eleven days were dropped from September 1752. Nevertheless, there’s a silver lining:  I remember half as much Donald Trump as everyone else.

 

Another possible explanation for erasing Something Rotten! is my obsessive relationship with Shakespeare. For example, the best class I took at Yale Law School was Hal Bloom’s graduate Shakespeare seminar. My bardolatry goes beyond ordinary English Major fervor. I was born exactly four hundred years after William Shakespeare. (To the day, after adjusting for the switch to Gregorian calendar). All my life, or at least from 1964 to 2015, I could easily compare myself to where Will was at a particular age:  having his three kids in Stratford during the ’80s, writing classics like Hamlet in the ’90s, retiring to the country in the aughts, and dealing with poor health in the teens. Shakespeare died in 1616, on what would have been his 52nd birthday. On that date four hundred years later, senior managing lawyers at the Attorney General’s Office realized the State’s employment lawyers and their investigator had broken the law and discriminated against me. Rather than correct their errors, they hastily terminated my employment and embarked on the triggering coverup that continues today. My life stalled at age 51. As my health and career unraveled in 2015-16, I felt more doomed that Will Shakespeare. Now it feels like the clock has started again.


But there’s a third explanation for my memory blocking out Something Rotten!. As I sat in Malkin Bowl last month, I recognized some of the characters and plot developments from listening to the original cast album. For example, during Act I, Will Shakespeare’s rock-star narcissism was predictably charming. I was also prepared to see Nick Bottom weave his soothsayer’s misleading fragments of prophecy into the fiasco of Omelette: The Musical. (It’s no Springtime for Hitler, but it’s no Hamlet, either.) What surprised me was Shakespeare’s pathetic efforts during Act II to re-ignite own creative fire. Eventually Will is so desperate he steals Nigel Bottom’s brilliant draft script of Hamlet. After Omelette: The Musical bombs, Shakespeare conspires with the authorities to banish Nick, Nigel, their wives, and the soothsayer to America in order to cover up his own plagiarism.

 

Why did my memory block out the entire show, including the fact I saw it on Broadway? Because Something Rotten! centers on writer’s block. And finding your own voice. Which turns out to be how I finally worked my way through complex PTSD over the last few years. I still dont remember anything from the first time I saw Something Rotten!. But I’m happy so many of the other rotten things from that time in my life are finally beginning to heal.


Daniel Curalli as Will at Theatre Under The Stars




Thursday, September 8, 2022

I'd Rather Be Sailing

S/V Stella Maris, Deception Pass - 2000


The last time I was at showtunes night in Canada, heres how our piano player Kerry O’Donovan introduced the song “I’d Rather Be Sailing”:

 

“This is one of Roger’s favourite songs. And in the show the song comes from, it’s sung by a character named Roger.”


S/V Reachfar, Elliott Bay - 2007

My recent blog essay “Roger, Roger” described two of the three characters from Broadway musicals who are named “Roger”:  (1) Roger Davis, the rocker bro half of Rent’s straight tragic couple; and (2) Roger DeBris, the fabulous gay auteur who directs and stars in the terrible musical at the center of Mel Brooks’ The Producers“Springtime for Hitler.” 

 

The third Broadway “Roger” is another gay supporting character. Roger Delli-Bovi is the romantic partner of the protagonist in A New Brain, the 1998 musical William Finn wrote with James Lapine. The show is loosely based on Finn’s own experience at age forty when he was rushed to the hospital for emergency brain surgery, almost died, and slowly recovered.

 

William Finn’s surrogate in A New Brain, Gordon Schwinn, is a frustrated songwriter. Gordon composes songs for children’s television host “Mr. Bungee,” but he’s blocked in his efforts to finish both Mr. Bungee’s frog songs and his own creative projects. Gordon’s long-suffering boyfriend Roger is the one who loves sailing more than anything else in the world. Roger arrives late to the hospital because he had to wait for wind on Long Island Sound.


Gordon hates sailing. Roger still loves Gordon.

 

In the most recent revival of A New Brain, Jonathan Groff played Gordon, not Roger. But here is a link to Groff singing “I’d Rather Be Sailing” on YouTube


S/V Reachfar, Admiralty Inlet - 2005

Once upon a time I had a sailboat, a convertible, and a beach house. Seventeen years later, I’m an unemployed disabled gay single dad with three teenagers, two dogs, and an ancient minivan.

 

As Bear and I walk along the Boardwalk, we admire the boats out on Bellingham Bay. I miss my sailboat. It was a beautiful thirty-seven-foot Jeanneau, which I named “Reachfar.” What gets lost in the telling is that I actually bought my boat while we were pregnant with Eleanor.


S/V Stella Maris, Sidney Spit BC - 1995

During the 1990s, one of my gay lawyer friends lived on his sailboat at Shilshole Marina in Seattle. Many of my happiest memories involved the times I spent with friends on S/V Stella Maris. We explored Manzanilla Bay, Lake Union, and the Hiram Chittenden locks. We introduced my roommate Geoff to his husband Mike at a party on Jim’s boat. Even after I moved to Chicago to be a gay rights lawyer with the ACLU, I would regularly return to Seattle and the water, like a homesick salmon.

 

For several years I joined Jim on his annual spring sailing trip from Seattle north to the San Juan and Gulf Islands. We would arrive in Victoria’s Inner Harbour in time to watch our more intense sailor buddies compete in the annual Swiftsure Yacht Race. After a fun weekend in Victoria fraternizing with friendly Canadians, our group would sail off to explore otherwise inaccessible gems like Sidney Spit and Wallace, Prevost, Sucia, and Patos Islands, before returning home to the drudgery of legal practice.


S/V Reachfar - Puget Sound, 2007




Sailing is naturally mellowing.  

For decades, I found every aspect of being a lawyer crushingly stressful, even before I was diagnosed with complex PTSD and codependency. Nevertheless, I could always escape my miserable life by surrounding myself with waves and forests. Sailing offered instant relief. Although I found a similar Zen on chartered sailboats in Belize, California, and Tahiti, I always felt particularly at home on the waters of the Pacific Northwest. 

 

Eventually I became convinced I needed a boat of my own to sustain the magic. So in 2005, I bought a used sailboat. In a rare twist, the economics of boat ownership made sense for me. When I moved back from Chicago, Id chosen to buy a weekend cabin on Whidbey Island rather than an overpriced condo in the city. Mooring a sailboat at Elliott Bay Marina as a crashpad turned out to be cheaper than renting an apartment in Seattle.

 

As the cliché goes, the two happiest days of a boat owner’s life are the day they buy the boat, and the day they sell it. By 2008, I recognized sailing was not going to be my priority for the foreseeable future. I was happy to find a willing buyer for S/V Reachfar, for two reasons. First, I discovered being in charge of my own boat diminished sailing’s relaxing effects. Being the captain was a buzz kill. Second, I needed a place in the city that would fit my growing family, rather than a lonely pied-à-mer.


One of the poetic epitaphs in Spoon River Anthology by Edgar Lee Masters (1915)

Eleanor was born at the end of June 2005. A few weeks after beginning the laborious adoption process, we got a telephone call out of the blue and learned the cousin of a friend of a friend was pregnant. They were looking for a gay couple to adopt the baby, and chose us. 


I bought my sailboat at the beginning of May 2005. All those years of sailing, research, and trips to the Boat Show intersected with the miraculous surprise of parenthood. In hindsight, I think I grasped at the familiar comfort of sailing rather than face the terror of desiring something completely beyond my control. After the ultrasound, I realized our birthmother was just as terrified about us walking away from the adoption as I was worried about her changing her mind. Fortunately, my partner and her boyfriend were able to calm both of us down.  

 

A month later, we were at the house on Whidbey Island when I got the call saying our birth mother had gone into labor. We caught the last ferry to the mainland and raced to the hospital in Puyallup. Everyone spent the night watching movies in the lovely birthing suite. Shortly before 9 am, the doctor and the baby arrived. 


I watched Eleanor being born. Then we walked out of the room with our daughter, and the world has never been the same.


Bear, Buster, and Schooner Zodiac


“I’d Rather Be Sailing” is the simplest of songs. Gordon’s lover Roger celebrates the joy of sun, wind, and waves. Then he lists some of the things that aren’t as good as sailing, like food, sex, and other people. However, as Roger sings to Gordon, what he loves best about going out sailing is afterwards he can “come home to you.” 

 

Near the end of A New Brain, Gordon and Roger reprise “I’d Rather Be Sailing” as a duet. Gordon will never be a sailor. Instead, he sings “I feel like I’m sailing – holding on for life.” With the right craft and crew, sailing offers the exhilaration of the second-greatest roller coaster in the world. 

 

Sailing [Vancouver, chorus, writing, Bear, whatever] could be the one thing in the world I love almost as much as my children. But the point is I love my children even more. That’s the kind of Roger I am.

S/V Reachfar, Port Townsend - 2006



Tuesday, September 6, 2022

Seasons of Bear


Bear is approaching peak foliage. I can tell from the sudden spike in gushing compliments as we walk along the trail. 

 

Although Bear’s glorious autumnal pelt will be on display for the next few weeks, we didn’t purposely aim to accent the fall leaves with his hairdo. As with every other necessity of life during these trying times, dog grooming appointments are hard to find. Bear and Buster are scheduled for haircuts in October. Until then an increasing proportion of enchanted strangers will swoon on the Boardwalk, and say things like “Your dog is so cute!” and “Aw, fluffy!”



I prefer Bear’s “little rascal” look in the weeks after his haircut. With short curls he looks and feels like a pied plush toy. He doesnt overheat on walks, or smell too much between baths. And without the wild bangs, its easier to see Bear’s charming face and his expressive one-blue-and-one-brown eyes. 



Before I was in charge, everyone just let the dogs’ hair grow. Eventually the tangles and mats get so bad there’s no alternative to getting a buzz cut. My son says when Bear is shaved he looks like a blotchy weasel.



If you wait long enough, Bear’s hair gets so long he looks like a Tina Turner wig. Or a tribble. 



Other than during his blotchy buzzcut phase, Bear is a handsome and well-proportioned canine specimen. (In contrast, Buster has stubby legs and the dead eyes of a serial killer.) Bear is more attractive than anyone I’ve ever dated, and obviously way out of my league.

 

Bear is also blessed with smarts and a charming personality. If a merchant offers him a treat once, we can never walk past that store again without trading cuddles for snacks. (In contrast, Buster is skittish and has zero recall – each treat at Village Books is an awkward surprise.) Bear has become the favorite of every barista, book clerk, and ice cream scooper in Fairhaven.



I know it’s time to schedule a haircut when folks start referring to Bear as “fluffy.” (Personally, I prefer the word “shaggy”; “fluffy” feels like poodle shaming.) 


But I recognize Bear is more universally attractive when his hair gets a little longer. He’s like the ideal dog produced by an algorithm – not too big for people who like small dogs, not too yappy for people who like big dogs, and with perfect hair for everyone. If Jennifer Aniston were a dog, she would look just like Bear.

 

So for the next few weeks I will overhear a lot of “oohs” and “ahs.” I will answer questions about Aussiedoodles. I will explain “heterochromia” is the word for having two different colored eyes. I will thank smiling strangers for their compliments, and let them cuddle with Bear. 


I won’t tell them I’m not a dog person myself. I’m a Bear person. Bears person.







Thursday, September 1, 2022

Relabeling


I met my best friend Paul in 1970 on the first day of Grade 1. Like my best friends in high school, college, and law school, Paul turned out to be gay. (Apparently I’m contagious.) 

 

Paul also turned out to be mentally ill. After struggling with depression, anxiety, and other challenges, Paul killed himself twenty years ago.



I thought of my friend Paul while reading the first chapter of Stephanie Foo’s recent memoir. A few months before he died, Paul told me he felt betrayed by his healthcare providers. While peeking at his medical charts, he discovered he had Borderline Personality Disorder, a bleak diagnosis that was even bleaker two decades ago. No one bothered to tell Paul, which made it even worse.

 

In What My Bones Know: A Memoir of Healing from Complex Trauma, Foo writes about growing up in San Jose with dysfunctional immigrant parents who subjected her to relentless physical and emotional abuse before abandoning her as a teenager. Foo escaped to college, found an effective therapist, and went on to a successful career in Bay Area public radio. Eventually Foo moved to New York to work as a producer at This American Life, the granddaddy of podcasts. 

 

Nevertheless, Foo found herself increasingly frustrated with challenges at work and in her relationships. At age thirty she was still seeing the same therapist, now via Zoom. Eventually she asked “Do you think Im bipolar?”

 

Samantha actually laughs. “You are not bipolar. I am sure of it.” she says. And that’s when she asks, “Do you want to know your diagnosis?”

I don’t yell, “Lady, I've been seeing you for a fucking decade, yes I want to know my goddamn diagnosis,” because Samantha taught me about appropriate communication. Thanks, Samantha. Instead, I say, “Yes. Of course.”

Something in her jaw becomes determined, and her gaze is direct. “You have complex PTSD from your childhood, and it manifests as persistent depression and anxiety. There’s no way someone with your background couldn’t have it,” she says.

“Oh. Yeah, PTSD.” Post-traumatic stress disorder. I had a crappy childhood, so I kinda figured that.

“Not just PTSD. Complex PTSD. The difference between regular PTSD and complex PTSD is that traditional PTSD is often associated with a moment of trauma. Sufferers of complex PTSD have undergone continual abuse-trauma that has occurred over a long period of time, over the course of years. Child abuse is a common cause of complex PTSD,” she says. Then her eyes drift to the corner of the screen. “Oh—we're out of time! Let’s continue this next week.”



We’ve recognized for millennia that wartime trauma causes a predictable constellation of physical and mental symptoms. In the 4000-year old Epic of Gilgamesh, the warrior-hero experiences intrusive memories and nightmares after witnessing the death of his best friend. Greek historian Herodotus described an Athenian soldier who was stricken with blindness in 490 B.C. when he observed the death of a comrade at the battle of Marathon. After the Civil War, veterans developed “soldier’s heart.” The term “shell shock” first appeared in The Lancet in February 1915, six months after World War I began. 

 

Seven years ago I moved to Bellingham to accept a position with the Washington Attorney General’s Office as general counsel to Western Washington University. My dream job became a nightmare when I began exhibiting strange new symptoms, including bizarre anxiety tics and skewed personal interactions. I was shocked when my new Bellingham physician, Dr. Heuristic, diagnosed me with PTSD and serious codependency. 

 

As I told a friend who developed PTSD after serving as an Army Ranger medic in Afghanistan, I was sheepish about sharing the same DSM-5 category with someone like him. He told me not to be concerned, and that soldiers feel lucky they get so many folks’ respect. They worry instead about the many women and children who are scarred by the impact of earlier domestic abuse and do not have access to the help they need.

 

Or as Stephanie Foo writes:

 

It is a great, sexist irony that in our society, PTSD is generally considered a male condition. It is the warrior's disease, a blight of the mind that must be earned by time in battle, in some dangerous overseas desert or jungle. But the real statistics suggest the opposite: Women are more than twice as likely to have PTSD than men. Ten percent of women are expected to suffer from PTSD in their lifetimes, as opposed to just 4 percent of men. But even after #Me Too, a global movement to recognize the legitimacy of women's trauma, treatment for this trauma remains a half-assed endeavor, an afterthought in the shadow of the glory of war. And it has always been this way.



Actually, it usually has been even worse. 

 

Bessel van der Kolk is one of the world’s leading experts in trauma and its treatment. In his classic book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Dr. van der Kolk describes how both sides in World War I mistreated their traumatized soldiers. Depending on the whims of individual doctors, British servicemen originally would either get a diagnosis of “shell shock,” which entitled them to treatment and a disability pension, or “neurasthenia,” which got them nothing. Then in June 1917, the British General Staff issued an order stating “In no circumstances whatever will the expression ‘shell shock’ be used verbally or recorded in any regimental or other casualty report, or any hospital or other medical document.” According to Dr. van der Kolk, “The Germans were even more punitive and treated shell shock as a character defect, which they managed with a variety of painful treatments, including electroshock.” 

 

During World War II, my grandfather’s generation benefited from more humane leadership and more effective psychiatric treatments. They also had the benefit of fighting and winning a “good war,” followed by the GI Bill and fifty years of peace and prosperity. Meanwhile, individuals and society mostly repressed the lingering impact of wartime trauma. 

 

In contrast, Vietnam was a “bad” war in every way, which likely amplified its traumatic impact on American veterans. When Dr. van der Kolk began his medical career with the Veterans Administration during the 1970s, he was struck by the fact that all his psychiatric patients were “young, recently discharged Vietnam veterans,” even though the VA hospital was filled with aging WWII vets who were all being treated for purely “medical” complaints:  “My sense was that neither the doctors nor their patients wanted to revisit the war.”

 

In a sign of the times, the term “Post-Traumatic Stress Disorder” was coined in 1978. The diagnosis was added to the DSM-III in 1980, with criteria that continue to reflect its status as an event-based disorder.



Dr. van der Kolk is the founder of the Trauma Research Foundation and the National Child Traumatic Stress Network. Although his work began with Vietnam veterans, he quickly recognized trauma also affects other vulnerable populations. In particular, “child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.”

As the Department of Veteran’s Affairs recognizes, “Many traumatic events (e.g., car accidents, natural disasters, etc.) are of time-limited duration. However, in some cases people experience chronic trauma that continues or repeats for months or years at a time.” In 1988, Dr. Judith Herman proposed a new diagnosis of “complex PTSD.” In addition to the symptoms associated with classic PTSD, complex PTSD includes: 

  • Behavioral difficulties (e.g. impulsivity, aggressiveness, sexual acting out, alcohol/drug misuse and self-destructive behavior) 
  • Emotional difficulties (e.g. affect lability, rage, depression and panic) 
  • Cognitive difficulties (e.g. dissociation and pathological changes in personal identity) 
  • Interpersonal difficulties (e.g. chaotic personal relationships) 
  • Somatization (resulting in many visits to medical practitioners) 

Rather than a single traumatic event, complex PTSD is a consequence of ongoing trauma that occurs over an extended period, such as childhood abuse and neglect, domestic violence, and religious trauma. Because these types of experiences tend to involve betrayals by an individual’s most trusted authority figures, the resulting symptoms focus on impaired interpersonal relationships. Although the DSM-5 does not include diagnoses for complex PTSD or codependency, complex PTSD is already recognized by the Department of Veterans’ Affairs, the World Health Organization, and the British National Health Service.

 

Here is Stephanie Foo's reaction when she ended the Zoom call with her therapist and found the VA webpage after googling complex PTSD”:

 

It is not so much a medical document as it is a biography of my life: The difficulty regulating my emotions. The tendency to overshare and trust the wrong people. The dismal self-loathing. The trouble I have maintaining relationships. The unhealthy relationship with my abuser. The tendency to be aggressive but unable to tolerate aggression from others. It’s all true. It’s all me. The more I read, the more every aspect of my personhood is reduced to deep diagnostic flaws. I hadn’t understood how far the disease had spread. How complete its takeover of my identity was. The things I want. The things I love. The way I speak. My passions, my fears, my zits, my eating habits, the amount of whiskey I drink, the way I listen, and the things I see. Everything—everything, all of it—is infected. My trauma is literally pumping through my blood, driving every decision in my brain.

 

It is this totality that leaves me frantic with grief. For years I’ve labored to build myself a new life, something very different from how I was raised. But now, all of a sudden, every conflict I’ve encountered, every loss, every failure and foible in my life, can be traced back to its root: me. I am far from normal. I am the common denominator in the tragedies of my life. I am a textbook case of mental illness. Well, this explains it all, I think. Of course I’ve been having trouble concentrating on my work. Of course so many people I've loved have left. Of course I was wrong to think I could walk into fancy institutions full of well-bred, well-educated people and succeed. Because the person with C-PTSD, the person who is painted here on the internet, is broken.         



Stephanie Foo’s bleak epiphany comes near the beginning of her story, which is subtitled “A Memoir of Healing from Complex Trauma.” Eventually she recognized her disability had clouded her vision, and learned that healing is “the opposite of the ambiguous dread: fullness.

 

I am full of anger, pain, peace, love, of horrible shards and exquisite beauty, and the lifelong challenge will be to balance all of those things, while keeping them in the circle. Healing is never final. It is never perfection. But along with the losses are the triumphs. I accept the lifelong battle and its limitations now. Even though I must always carry the weight of grief on my back, I have become strong.

 

Foo’s “inner narrative” finally changed “from a hateful whip-bearing tyrant to a chill(er) surfer dude. Like love and bankruptcy, it happened slowly, then all at once.”

 

In many ways my journey through complex trauma and PTSD parallels Foo’s. Both of us escaped from our abusive origins by joining demanding professions – journalism and law – that turned out to be toxic. Yet we both found healing through writing, with the support of true friends and expert healthcare providers. 

 

Nevertheless, my experience with complex PTSD differs from Foo’s in important respects. Like so many other trauma victims, Foo’s symptoms are rooted in the pattern of abuse she suffered at the hands of her own family. I am an outlier because I was betrayed by a different kind of trusted authority figure – the Mormon priesthood leaders who told me homosexuality was a spiritual disease that could be “cured,” and who continue to deny the humanity and existence of LGBT individuals today. Fortunately, in contrast with most people who struggle with complex PTSD symptoms, I had and have the support of the best family in the world. But I also had the traumatic overlay of coming out of the closet at the height of the AIDS epidemic, when silence and rage both equaled death.

 

In contrast with Stephanie Foo, no one ever told me “There's no way someone could come from your background and not have complex PTSD.” Who can predict something like that? As every personal or global disaster demonstrates, individual responses to trauma will vary. What I do know is there’s no way someone could come through all this and not be a trauma survivor. If they weren’t survivors, they wouldn't have made it through – as so many of my tribe can attest. Those of us who remain.



My friend Paul’s anger at his healthcare providers probably contributed to his suicidal distress. Stephanie Foo reacted to her belatedly revealed diagnosis not only with rage, but also with resolve:

 

After I started realizing the magnitude of what having C-PTSD meant, I was livid at Samantha for not telling me about it sooner. This should not have been a secret, I thought. My diagnosis should have been a critical part of the conversation about my mental health this entire time.

 

So Foo fired her longtime therapist and began treatment with a New York psychiatrist who is one of the world’s experts in complex PTSD.

 

Why don’t I complain about my doctor’s original label for my disability seven years ago? Because he got it right. As I’ve reported from the beginning, after hearing about my symptoms and my background, Dr. Heuristic diagnosed me with “PTSD and serious codependency.” In addition to referring me to a therapist who specialized in treating PTSD, he also directed me to read Facing Codependency by Pia Mellody, and to attend weekly meetings sponsored by Codependents Anonymous (“CODA”). Because of my doctor’s experience with the recovery community, he recognized I would benefit from CODA’s group therapy model.

 

As the term is used by CODA, “codependency” refers to a pattern of deeply rooted compulsive behaviors that interfere with individuals’ ability to sustain healthy relationships, maintain functional boundaries, and express their reality appropriately. These are the same symptoms that distinguish complex PTSD from the “classic” PTSD diagnosis in the DSM. At the beginning of each CODA meeting, everyone recites the words “Many of us were raised in families where addictions existed - some of us were not.” I’m one of the “some of us.” It turns out being gay among the Mormons can be more harmful than growing up in a saloon.


Paul and Roger in Grade 4


Labels are not the patient. 

 

This year I’ve been reading through all of Oliver Sacks’ books. Dr. Sacks, a distinguished neurologist who died in 2015, was an extraordinary observer of the great diversity in human thinking. Most recently I finished his classic The Man Who Mistook His Wife for a Hat, a fascinating collection of case studies. In the introduction, Dr. Sacks writes that when he was a young medical student 

 

it was the patients I saw, their predicaments and their stories, that gripped my imagination, and these experiences imprinted themselves upon me indelibly. Lectures and textbooks, abstracted from living experience, left almost no impression. I was, however, strongly drawn to the case histories that abounded in the nineteenth-century medical literature-rich, detailed descriptions of patients with neurological or psychiatric problems. It is only by accumulating case histories of people with similar syndromes, comparing and contrasting them, that one can more fully understand the mechanisms involved and their resonances for an individual life….  With the rise of neuroscience and all its wonders, it is even more important now to preserve the personal narrative, to see every patient as a unique being with his own history and strategies for adapting and surviving. 

 

Since moving to Bellingham, my family has been blessed with exceptional caregivers. In particular, my physician has guided my recovery with insight and compassion. He immediately figured out my weird symptoms added up to Post-Traumatic Stress Disorder and codependency. He correctly diagnosed my tennis elbow and plantar fasciitis. He’s much nicer than Dr. House, the abrasive but insightful head of TV’s fictional “Department of Diagnostic Medicine.” He doesn’t laugh at my jokes about suing people for malpractice, but doctors never do. 

 

I originally gave my doctor his nickname because a “heuristic” is a simple procedure that our brains use to find quick answers to difficult questions. An expert’s various heuristics add up to an effective algorithm. Eventually I figured out my doctor’s heuristic for me. Whenever I show up with some new complaint, he will generally select from a repertoire of three standard responses:

  1. It's just another typical PTSD symptom.
  2. It’s a common side effect of my medications.
  3. It’s what happens when we get older. (He calls these “barnacles.”)

Nevertheless, Dr. Heuristic isn’t trapped by diagnostic categories. He sees each patient as an individual. He’s the opposite of the lawyers that surround me, who are blinded by confirmation bias, and so in love with the sound of their own voices that they cannot hear my scratchy lament. Because my doctor pays attention, he can help his patients find the answers they need. Rather than “Dr. Heuristic,” perhaps a better label for my insightful physician would be “Dr. Epiphany.”