“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.” David Foster Wallace
Odd, I faced a lane of hurdles just to arrive at a starting line, my first ECT session. I got the inside lane by ignoring other patients reasoning that those who respond to ECT are not in psychiatric units. I heard the starter pistol fire. I leapt over my first hurdle when I said-sobbed “ECT” to my nurse. In full-stride, I cleared the next hurdle demanding that my attending physician begin treatment. The next hurdle was a family meeting where my wife, in her absence I assume another adult being of sound mind and with some genetic or legal connection to me would suffice, and I would watch an informative video. (The ECT video has not at the time of this publication been reviewed on IMDB. Neither is it available at your local Redbox. My hope is that it is destined for 3-D IMAX release only in select theaters.) The wife would have to be present to confirm afterwards that I had an understanding of what the video presented. For the record, some understanding meant, “I was conscious for the entirety of the video.” The film was an informative little documentary entitled, “Everything You Wanted to Know About Electroconvulsive Therapy But Didn’t Know to be Afraid to Ask.” The wife and I met on the unit as I was still inpatient. Baptist’s adult behavioral health unit is actually two units, though in my stays I never saw the other unit open except for folks watching the ECT DVD. The premiere comes and my regular nurse, the same one to whom I first said-sobbed my intent to undergo treatment, lets Summer and I into the empty unit. He fires up the dual VCR/DVD player combo. There is an empty unit and a VCR/DVD player combo because “the adult behavioral health unit is not a revenue generating department of this hospital.” As the nurse is loading the DVD and selecting the correct feed on the TV, all I thought about was Nicholson in “One Flew Over the Cuckoo’s Nest” and Burstyn in “Requiem for a Dream.”
A soulless symphony of a title track plays interrupted by a narrator whose thick Southeastern-European accent was far from Don LaFontaine’s “in a world where.” Opening credits end revealing that the accent was booming from a doorframe-size Serb wearing standard-issue surgical scrubs and a long white lab coat. Enter Dr. G., whose actual name my tongue remains paralyzed to properly pronounce what with all those consecutive consonants. For the record, no one else ever called him anything but Dr. G. This day he was my ECT tour guide. Later he would administer the majority of my treatments. Dr. G. intoned, “While experts don’t know exactly how ECT works…” This was not an encouraging opening line. “Nonetheless, ECT is effective 90% of the time.” Better. (Some peer-reviewed studies suggest as low as 75% and how “effective” is operationalized varies. ECT’s success rate is still better than the suggested 60% effectiveness of antidepressants.) Dr. G. drones on listing all the salient points a prospective ECT patient and his wife would have to say they heard even if they didn’t fully understand it. More droning, then Dr. G. says something about potential amnesia being a common side-effect. Sir, you have my attention as potential amnesia does not sound common. Dr. G. was referencing retrograde amnesia, meaning I might not remember what happened right before my procedure. What I heard was, “You’ll wake up and not know who the hell you are?” He continues, “With any procedure…” Stop! Procedure is not nor will it ever be a comforting term. Continue. “With any procedure” becomes dramatically more threatening when the doctor adds “there is the potential for death.” Even more threatening is mentioning the possibility of “recall.” I knew what death meant. At least with death my fear of amnesia would matter far less. I figured if I couldn’t remember my name it’d likely be on my tombstone. Recall is the phenomenon of being paralyzed by the anesthesia while completely aware of all that is happening to you. Recall? Procedure, my ass!
Pan left, Dr. G. is joined on screen by an unnamed forgettable female patient some years my senior. She is nodding her head with the attention that I pay Summer when she shares at-length about the minutia that is occupational therapy. Like me, this patient looks like she is taking it all in when in reality she is hearing the Serbian equivalent of every adult speaking in a Charlie Brown cartoon. Fade to black, end scene. Fade in, she is in a hospital bed covered in a white blanket accented by EKG leads. There is a blood pressure cuff on her left leg. Her head is adorned with two probes connecting her to the nightmare-inducing shock machine. She is already sedated when Dr. G. shocks her. Far from my expectations of violent seizures and tongue-biting-off twitching, only her left arm raises slightly from her bed for the briefest of seconds. And that was it. Not exactly nightmare inducing as if I’d blinked, I’d missed it. Fade to black, end scene.
Fade in, she wakes up and is greeted by loved ones. I found it odd that instead of hugs the on-screen family only offered her high-fives. Transition to a tight close-up of Dr. G saying, “You’ll need to have this done every other day for several weeks for an undetermined amount of time.” Then adds “there may be potential maintenance ECT” and “some patients may need more frequent weekly treatments.” I don’t recall him saying those things as I had come to hate the word “undetermined.” Damn it. “Undetermined” is a special kind of hell as there is no countdown of “only X amount of treatments left to go.” Undetermined means no “we’re in the home stretch” or “this is your last lap.” Undetermined is the best description of the hell that is depression. Depression isn’t like an infection. There is no taking an antibiotic and count the remaining doses. Depression isn’t like cancer where diagnostics can suggest the nature, frequency, and duration of treatment. Undetermined is hell because it says run, but doesn’t tell you the distance to the finish line. After the closing credits, I agreed to treatment commemorating my decision by autographing a hand-cramping volume of necessarily redundant waivers and releases. I am set to begin ECT the following week. Other than this adding to my ever-lengthening hospital stay, I feel empowered at having exercised some agency in relation to my care.
The week passes, Monday comes. I’ve spent nearly a month watching other patients being taken down for ECT dreading the thought of joining their ranks. Inpatients go down later in the morning after all the outpatients have been treated. You’re NPO the night before so no food and only a few sips of water to take night and morning meds. No one is as thirsty as when the hour to begin NPO strikes. I could have gone all day with nary a sip of water, but when the clock struck 12am I was parched! I was also irritable, achy, and panicked as I had been taken off all my benzos and withdrawal was a bitch. The night before my first treatment I was taken off my Ambien and given a dose of trazadone that did not promote my dozing. Before I go down for treatment late that Monday morning, I watched others eat a breakfast that most mornings I didn’t want. Not only did being NPO make me parched, I was also peckish. Before patient transport arrived, I took my meds, sacrificed my unit-approved pajamas and slippers for the green gown of immodesty and an anti-dignity pair of grippy socks. I was then wheeled nearly a mile, literally, to the day hospital for my procedure. It is a drafty journey through long largely windowless hallways that connect the sequestered psychiatric unit to the rest of Baptist Hospital. Like the background in any Hanna-Barbera cartoon the dated carpet and forgettable white walls speckled with their corporate-approved art were like a Möbius strip. I never spoke much with the men who did my transport nor did they say much to me. I suffered the silence chanting to myself, “amnesia, paralysis, recall, and death.”
Of Eulogies, Cantatas, and Timbrels.
by Paul Singer
Drifting through long windowless hallways,
Recalling a soulless symphony.
No directions, cardinal or ordinal.
No north, east, or west,
South in theory only.
The lightning is deafening,
The darkness blinding.