Thursday, July 07, 2011

Living With A Chronic Disease

Ask a fourth year medical student to name as many chronic diseases as she can think of, and you'd better have a cup of coffee and some doodling paper at hand to keep you occupied. She'll start with the ones she sees every day: hypertension, diabetes, lupus, chronic kidney disease (it even has chronic in the name!). Maybe she'll start getting creative, reaching out into the diseases that are more exotic--that she's only seen once, in a specialized clinic, or read about while preparing for the boards: myasthenia gravis, Friedrich's ataxia, scleroderma, Lennox-Gestaut syndrome. She'll ramble on, thinking back, remembering all the rotations she's been through. There's a good chance, however, that when she finally falters and stops, there will be some significant holes--diseases that are incredibly common, but often forgotten. Depression, which 25% of the population of the US will struggle with at one time or another, and which is often a chronic condition (though of course there are some lucky folk--lucky being a relative term--who have one depressive episode and never have to deal with it again). Schizophrenia is rarely a here-today, gone-tomorrow affliction. Eating disorders are notoriously chronic. Of course, the chronic mental illness nearest (and paradoxically dearest) to my heart is bipolar disorder.

I've been struggling with depression since elementary school. I had a hypomanic (not quite as extreme as a manic episode, but with boundless energy, little need for sleep, lack of usual inhibition, and a general feeling that EVERYTHING IS SO F*CKING GREAT!!!) episode in high school, and another in college--and one that veered into true mania this year, after getting off mood stabilizers. I'm now back on them.
The highs have always been few and far between. The lows come much more often, and are much more extreme; at times I've been catatonically depressed, though much more often it's a general malaise, an extreme fatigue, a bleak certainty that nothing is worth doing and that I will fail at anything I attempt in any case. I wonder myself, from time to time, how I managed to get through college (and medical school--though of course I'm not done yet). Yet I know that, like anyone with a chronic illness, I've learned to adapt. I "make hay while the sun shines"--during breaks in the bleakness, I do as much as I can in terms of studying, cleaning, laundry and shopping. On good days, or during good periods, I work ahead, making preparations I hope will carry me through the darker days that inevitably come. When the black curtain drops over my life again, I ration my energy, willing myself through the day--at times pushing myself through the everyday tasks of clerk-and-studenthood requires the iron will and stamina of a marathoner. I force myself through eight or ten or twelve hours at the hospital then come home and collapse into bed, perhaps managing to read a few pages before exhaustion takes me.
The past few weeks have been rough, physically and emotionally. It is one of those dark times, though thankfully not the blackest I've ever seen. I'm portioning out what little energy I have. Adaptation has brought me a long way--I've managed like this for more than a decade now. Yet there's always the nagging doubt in the back of my mind that someday this won't be enough. I guess I can only be thankful that it seems to be enough for now.

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