I feel the concept of having “thin skin” is on the border of metaphor and simile.
I’ve been running a lot lately (not metaphorically, very actually) and the skin on the back of my ankles/heels is legitimately thin at present. Any time anything at all touches them — a sock, the sheets, my other foot — it hurts like crazy and even bandaids and copious amounts of neosporin (the kind with pain relief) isn’t helping. The only things that seems to help is toughing it out until the nerve endings go numb and from there, I’m good until I stop moving again.
Perhaps not an ideal strategy, but as with metaphorical thin skin, we can’t always (in fact, usually can’t) just stop whatever we’re doing for a good cry. Such is life.
This past week was like the for me, all over. Not just my heels. I just felt so raw and every little thing stung. Words in emails and off-the-cuff remarks, whether intended to be sharp or not, felt painful. And I struggled mightily to get through a couple of those days. Admittedly, in the dark before bed, at least one did end in tears. I couldn’t help them from coming.
By Thursday evening, I wasn’t sure I could handle one more (perceived) insult, and when Friday morning rolled around, only the promise of a weekend in eight hours got me out of bed. By 11:00 am, I was in the thick of self-pity when my weekly meeting with a close colleague came around.
It had been a stressful week, with work and otherwise, and I shared that with Tammy. In response, she shared with me the wisdom of another mutual friend. She said that long ago, when she said something similar, this friend would, without sympathy, look at her and ask, “And where exactly are you in your cycle?”
I had to laugh at myself then. I was feeling especially raw, but in reality, this past week wasn’t actually different than any other.
Sometimes I fall into this myth of mental health that if I’m doing ok, then everything should always feel ok. That true mental health is 100% happy 100% of the time.
Some weeks will be up and some weeks will be down. Sometimes I will feel raw and sometimes I will feel invincible. Good mental health, perhaps, is being able to feel both the ups and the downs and knowing that it’s all temporary. No one feeling lasts forever, nor does it exist in isolation.
In fact, in the absence of any down, would any up really feel as good? And to be able to feel sadness, grief, hurt and pain, only makes us human.
A few weeks ago, an email went out to everyone in my building at work with an important warning.
SUBJECT: Bear Near McMillian and Oak
MESSAGE: We were just informed that there is a bear near the corner of McMillian and Oak. Please refrain from walking near that area today as the city ordinance is trying to capture the bear and potential cubs.
Right. Avoid the corner with the bears, a block from our building. I smiled to myself — how is this my life? How did I end up in a corner of the world in which Betsy DeVos might actually have a point?
I didn’t feel unsafe, just avoided the area for a few days… limited my runs to the other side of McMillian.
Until a few days later when the Marshfield Police Department made an important announcement on Facebook.
The 1500 block of N Hume Ave… in the field about a block from our house. Runs re-routed once again. No letting Curls out alone after dark. Empty pizza boxes left in the garage until garbage day. Again, I did not feel particularly unsafe.
It’s interesting, though, that a real live bear, a hungry, just-woken-up-from-hibernation-only-to-find-its-not-really-Spring-yet-in-Wisconsin bear, really did not concern me. Bears are kind of a fact of life around here. And waking up hungry in early Spring is what bears do. It’s not terribly hard to avoid being its food. Avoid the general vicinity, don’t fill your outdoor bird feeders or garbage cans with tasty treats, and you’ll be fine.
It’s so simple… when it’s a real live bear.
But when it’s metaphorical? When the beast lives only in your mind? Then what? Then it seems far less simple.
The work email, the Facebook post, they reminded me of a walk with my aunt through a seedy area of Minneapolis back in October of 2015, shortly after I miscarried and she arranged a weekend getaway for us, saved my life.
We ventured out on foot from our lofty Airbnb in search of good food, unique shops, and a place to get a pedicure. We walked and walked and walked, ending up in a place that didn’t feel quite right. A dangerous neighborhood, perhaps. We certainly didn’t belong. We walked quickly, eyes straight ahead, and took a left into a safer neighborhood as quickly as possible.
We did stop for a pedicure, best described as unforgettable, right on the border between the two neighborhoods, safe and unsafe… and then walked on, leaving the dangerous space behind us in favor of Mexican food and more wine in the loft apartment. At some point along the way, maybe on the walk, perhaps over the wine, my aunt shared with me her own experiences with dangerous neighborhoods — dangerous neighborhoods of the mind.
I loved the metaphor. It was instantly familiar. Dark streets that suck you in, horrific thoughts lurking in shadowed doorways. Roads that lead to dead ends, that feel inescapable. Twists and turns in which a person can lose their way, lose their self.
How often have I ended up in a dark space like that? Unable to stop the thoughts, to prevent further escalation, to prevent the snowball from growing as it rolls down a very steep hill.
The mind as a city with unique neighborhoods, characterized by the nature of our thoughts. Yes.
I often spend time meandering carelessly through my mind, failing to use past experiences and mental maps to avoid the dangerous areas. I find myself in those places over and over again, let them suck me in, and get lost. Self-pity, body negativity, grief, jealousy — if I don’t turn back immediately, it can take a long while to get back to safety.
While I’ve always found comfort in metaphor, perhaps this would be a good time to find solution in reality. The neighborhoods in my mind, after all, can’t be all that different from the city of Marshfield. An unpredictable bear wandering the town on occasion — easily avoided, all things considered.
I can heed the warnings, the sightings of potential danger. I can keep the garbage inside until it’s safe to take it out, to get rid of it once and for all. And, if it’s not a bear, something more vaguely unsettling, I can call my aunt and ask her to walk beside me until I’m in a safe space again. A pedicure and bottle of wine to relax on the other side.
The age old question: which came first, the chicken or the egg?
A cause and effect deal.
Technically speaking, it was the egg. But I’m trying to make a point — so we’re going to focus on the long time philosophical conundrum for the sake of today’s discussion.
I struggle with a lot of different mental health concerns. Perfectionism came first and came early. I was young when my parents started a daily routine — hands on shoulders, looking me in the eye, “Rachel… relax” as I stepped out the door to school.
Binge eating came next. I don’t remember my first binge, but I do remember the first time I got caught. I was maybe 9 years old and had a jar of chocolate frosting and spoon tucked away in the filing cabinet I kept in my bedroom.
Legit depression took root in high school and it’s been off and on and off an on ever since. More consistently on than off the older I get. And always a bodily focus – dissatisfaction, disgust, hate.
Anxiety became a problem only very recently — panic attacks post-miscarriage. An entirely new phenomenon, though relatively easy to tamp down in the worst moments with medication and sometimes a well-timed phone call to the just-right person.
A veritable laundry list of interwoven mental health concerns.
Since I started seeing a therapist in college some 15+ years ago, I’ve spent a lot of time trying to unravel the knotted mess. The perfectionism obviously led to the binge eating — but did the depression contribute as well? Or was the depression a result? And while anxiety really became a problem only in the last two years, was there always some of it there? I mean, I’m definitely an introvert and social anxiety has been a constant since I was very young — how did that factor into all of it?
The age old question.
Which came first, the chicken or the egg?
Round and round and round… for years on end. Exhausting. And more importantly, stupid.
Who cares whether it was the chicken or the egg that came first when you’re sitting on a dozen that can hatch at any given time — running and pecking and clucking and so on?! No one. That should be the answer. And when did I realize that? Last week… maybe this weekend. Either way, it wasn’t soon enough.
I struggle with an embarrassingly long list of things. (Honestly, I’ve never felt so embarrassed before talking about these things one egg at a time — the whole carton on display at once? Yikes. Please don’t hate me.) But it doesn’t really matter why. Why doesn’t help. The only thing that matters is what I do, how I deal, the actions I take for the purpose of self care and mental health in the now.
Looking for a cause and solving the root problem is a great plan if you’re dealing with a plumbing issue. Or even trying to do some evolutionary mapping (a la chicken and egg). But it seems that lately, with respect to my mental health, getting stuck in that which-came-first, why-why-why mentality really prevents me from moving forward at all. I get stuck in a place that’s not solution-based, but problem-focused, and I can’t get out. In other areas of my life, I despise that attitude — in work, in personal relationships, when dealing with my physical health. Solutions are where its at. It’s time I took the same tack with my mental health. Enough with the why, the psychoanalysis, the which came first. Freud and the chickens can suck it. I’ve got eggs to deal with by the dozens and I don’t have time for the rest.
From an evolutionary perspective, monkeys are very nearly people. Our genomes know it. And so do our brains.
For as long as I’ve been crazy (always), I’ve thought of what the Buddhists and Evolutionary Psychologists call the “monkey mind” as my second track.
My second track is that source of unceasing, never ending criticism; second guesses; should, would, and could haves. It doesn’t matter how concentrated I am on something else, something completely unrelated. The second track is always running.
Maybe I’m working on a manuscript about a community-based underage drinking prevention program. Yet my second track is likely stuck on some other common refrain – “you’re fat, so fat, gross and ugly and disgusting, get it under control, fat fat fat.” It’s unstoppable. Distracting. Painful. Damaging.
I first came across the monkey concept when I read Thank God for Evolution by the Revered Michael Dowd, a once-upon-a-time strict evangelical and biblical literalist who fought vehemently against evolutionary principles, but later came to embrace and even promote evolution as part of what he calls the Great Story. Although Dowd’s discussion of the evolution of the human brain is somewhat simplistic and over-emphatic, he puts it into a really interesting perspective by diagramming it out using the different animals that have brains as evolved as the different sections of our own… including that monkey.
Several years later, Dr. C explained it to me in the more zen sense — the Buddhist monkey mind being responsible for the incessant chatter many, most, probably all, of us experience. For over 5 years, Dr. C and I have worked and worked and worked on strategies to calm the monkey… quiet down the second track.
We’ve tried modifying or replacing the message. We’ve tried mindfulness practices, dissociating/separating from the chatter. We’ve tried finding and addressing the root issues (the perfectionism, weight concerns, anxiety, and so on). We’ve tried and tried and tried.
But seriously. The monkey in my mind seems to be a bit more advanced. I honestly think it might have thumbs. And it’s using those thumbs to hang on for dear life — refuses to be ejected, refuses to be quieted, refuses to leave me be.
It exhausts me and after so many years of incessant trying and failing to put the second track, the thumb-y monkey, to rest, I’ve reached a point where maybe I’ll have to accept that this is just how I am.
I said so to my psychiatric nurse practitioner a week or two ago – she tends to disagree. I suspect Dr. C will as well. And I guess that’s the best I can do for now; trust in my team of professionals. That’s got to be better than giving into the monkey, no matter how highly evolved he is.
I’m not pregnant. Again. And I’m sad about it. Yesterday was pretty rough. Today I am sad, but my friend Marie made me smile (hugely and genuinely) and my sister has a ridiculously cute new hair color that I’m in love with and my friend Kristin liked the cookies I brought her and my husband and I are taking his parents out for dinner at a (central-Wisconsin-style) fancy place in Point tonight… and overall, I have a million and one reasons to be happy. So I’m not sinking. I’m not drowning. I am dealing.
And that’s a huge step for me. A yo-yo-er.
Next illustrative story…
One afternoon this week, at work, I got prank called by an endocrinologist. He put on a fake accent, called from another physician’s office, and pretended to be someone he was not and then laughed hysterically at himself as I got my footing back underneath me when he told me who he really was. I was literally taking notes for this “new” physician who wanted my help…
It was super weird. And super funny. We both cracked up.
And then we talked for a while for seriously about the importance of perspective when considering clinical data related to false-negative rates for thyroid biopsy in the context of nodules larger than 4 cm in size.
A far cry from the former formality of all my emails that began, “Dear Dr. So and So… lots of professional words… Thank you for your time, Me Me Me, PhD.” Followed by nearly incessant joking with my office mates (I needed an outlet!).
Tuesday’s conversation with the endocrinologist? That’s moderation. Funny. Serious. Everything in between.
Final illustrative story…
The weather this week has been absolutely lovely and sunny and cool and I’ve gone for several (incident free!) jogs. During one such jog this week, I took THREE puppy petting breaks. Three.
It was wonderful, but not the point.
The point is that I did NOT stop my RunKeeper (it’s my app for distance and time and I love it so much– I love making it map me while I mow the lawn, back and forth and back and forth, it’s hilarious) even once during a puppy petting or photo taking break. It just ran. The clock kept ticking while my feet stopped moving and it made my time slower… and yet. The time and the distance are not the point.
End illustrative stories… now, the point.
I have generally not tended to live my life that way. I’m usually at one end of the spectrum or the other– filled with hope or in complete and total despair. Too many jokes or too much seriousness. So much running that I crap my pants or no running at all for fear I’ll crap my pants. But this moderation thing, it’s so much better.
With respect to the big things, my mental health, my physical health, my work, these are places where yo-yo-ing from up to down, one end of the spectrum to the other, has never been good for me– yet it’s always been my default. That’s where I find moderation to be most key (key-est???), and where it’s often hardest (most hard???) to find.
Don’t get me wrong, living life on the end of yo-yo, with the ups and downs, fits and spurts, can be awesome for things like canning (pickle/tomato/apple marathon– ready go!) or sewing (it’s almost winter– time to go pick out some new fabric!!). Turning that yo-yo into a gently swaying, much more even keel, pendulum-style instrument is much more valuable in some arenas though. And I’m getting there.
I’m getting there with mental health. Yes, part of it is biochemical control (better living through chemistry) and part of it is therapy (with a therapist I didn’t want to like, but do), but honestly, most of it is time and experience and patience with myself…
I’ve spent over two years trying to start a family and every month so far has ended in sadness. Sadness coupled with a headache and cramps and discomfort that all seems so unfair. Life’s not fair though. That’s not part of the terms and conditions. Life is life and it’s weird and circuitous and out of our control for the most part. And that out of control thing is key when it comes to staying off the yo-yo. I can’t be in despair when I have no control. I know that I’m doing everything that I can do, and that’s literally all that I can do (short of illegal things like stealing babies or black-mailing my sister into sending me one of hers– chimps do that, you know, I read about it in National Geographic). I can be sad. I can be hopeful. I can be both simultaneously… a little more of one or the other at times is ok, but I don’t need to go all the way over the top in either direction.
I’m also getting there professionally. I know more people, I am more comfortable with more people, I am more comfortable with myself…
At work, I was nothing but a ball of nerves for about a year or so… especially around physicians. Turns out, I was basically just being a total Dorothy to the Great and Powerful Oz– it was just a man behind a curtain. Some physicians still seem to prefer the “Dear Dr. So and So” deal, but more often, they seem to prefer when I behave like myself– sometimes silly, sometimes serious. Exclamation points and winky faces and jokes in emails, book recommendations in both directions, hugs at Cattails when I see my most favorite residents, cookies and recipes and Valentine’s day gifts. All of that with good writing, prompt service (as much as possible), and a willingness to be as helpful as I can be. I’m good at my job, and (hopefully) likable and personable at the same time.
And finally, I’m getting there with my physical health…
I’ve been a runner since I was young– maybe sixth grade. My first 5K was maybe the Belleville Strawberry Festival or the Dexter-Ann Arbor Run with my friend Kelly and co. (Where “and co.” = Emily and Danielle and Christin, most likely, but I’m fuzzy on that, so we’re going to go with and co.)
My friend Kelly sent this super old photo on one throwback Thursday. I’m in love with us as baby runners. So cute.
Since then, I’ve always always always stressed over time and distance and intensity and frequency and when I couldn’t live up to my own expectations… I stopped. Stopped entirely. Most recently, I couldn’t run my favorite distance on my favorite route without have GI issues, so I stopped. Turns out, though, if I’m careful about what I eat, run at a comfortable pace without pushing myself too hard, and make planned loops with a quick escape route to my house every three-quarters of a mile or so, I can go pretty far/pretty long… and get this: I can even enjoy it!
And here’s something really crazy: by being patient with myself and super experimental, I have even learned to enjoy many vegetables! No, not onions. But lots of other vegetables… and that’s a big deal. I don’t have to force myself to eat an iceberg lettuce-based salad drenched in ranch dressing (yuck), but I looove pretty much any green preceded by “baby” or “mixed” with some chia seeds and an Asian-style dressing.
Patience and time, when it really matters. Yo-yo when it’s just for funsies. This is why, for me, I’ll take my thirties over my twenties any day. So much more time, experience, patience. It’s good.
Speaking of fun yo-yos… in sewing, yo-yos are these little dealies:
Growing up, my cousin Mary, me, my cousin Ashlee, and my sister Abby were all relatively close in age and we passed clothes, especially cute little dresses, down and down and down amongst the four of us. In their infinite wisdom, my mom and Auntie Pam kept all those little dresses thinking they’d be great for making quilts some day. My mom spent last summer making all those little dresses into yo-yos (even the velvet and corduroy ones! dang!) and then turned those yo-yos into four quilts– one for each of us.
Look at how amazing this quilt is:
It’s so ridiculously and unbelievably beautiful and meaningful and I love it so much. My mom is incredible. This is the kind of thing that makes me continue to hope for that family– so that someday I can do something like this for my sister’s girls and their cousins, my kids. My someday babies 🙂
My sister-in-law Kayla, Sister Athletic Trainer, is an absolute genius at puzzles.
I don’t mean that Kayla likes puzzles, although I suspect she does. I mean that she is literally a puzzle genius. She can walk by a table holding a 12,000 piece puzzle entitled “sky on a cloudy day” and find at least 6 pairs of matching pieces before I can even figure out which way to orient the picture on the box.
I am not being facetious.
Maybe Kayla has just had a lot of practice. She has spent three of our last 11 week long cottage vacations doing puzzles as she recovered from major knee surgery (as good as she is at puzzles, she’s not exactly awesome at keeping her own ligaments from tearing). Maybe it’s a gift from God or something. (Drop Dead Gorgeous reference… anyone?) I don’t know. But she’s real good.
At the moment, I feel like I’m staring at a complicated and beautiful puzzle and all that I have left is one particularly challenging bush or patch of sky or something. Once I get a couple pieces in place, the whole dang thing is going to fall together, but I can’t figure out where to start and I am le frustrated! (The “le” is intentional– I’m pretending that the word frustrated is French.)
Here’s what’s up:
In my job (like my real J-O-B) I work as a scientific research writer, which basically means that I help clinicians and scientists to write grants and manuscripts (and yes, sometimes even eulogies and other speeches and such) about whatever scientific endeavor they favor at the moment. I’ve worked on tons of different things. It’s awesome, really, because as much as I dig STDs, 6 years of nothing but gonorrhea and chlamydia got to be a little bit much. I’m not that into it. In my current job, I get to learn about new and interesting things all the time– oncology, genetics, bioinformatics, cerebral palsy, Alzheimer’s disease, chronic kidney disease, pancreas divisum, diabetes, neuroprostheses, patient navigation, and the list goes on. It’s awesome… like being in school minus the grades plus a real salary. Life is good.
Because I really love science and because nerdiness is my life, not just my job, I get quite invested in the things I do. And it’s all that much easier to get sucked in when I work with really passionate investigators… and so many of these investigators, just wow. These clinicians see a problem in their practice and come to us to either study the problem or solve the problem, and it’s inspiring. I have three projects swirling around in the back of my mind all the time right now. And there’s something about them that’s similar, they are related, they are somehow the answer to one another’s problems, but I can’t figure it out. That’s my puzzle. And it’s becoming my obsession. How can I make these things work together for the good of patients? I won’t know until I can fill in the sky!
Not long ago, I worked with a pediatric nephrologist and learned about Bardet-Biedl syndrome (BBS)– a rare genetic disorder that results in cilia malfunction and many consequent symptoms affecting nearly every organ system in the body. Because the disease is so rare, finding care for these kids, especially coordinated care with specialists who truly understand the disease, has always been a major problem for BBS families. Recognizing that challenge, Dr. Haws started The Treatment Center for BBS at the Marshfield Clinic to provide coordinated, comprehensive care for patients around the country… and even around the world. It is the only BBS clinic in North America and has already served 16 individuals from 14 different families in its 3 clinics to date. I helped Dr. Haws capture survey results from providers and families that participated in the clinics and the comments from the grateful families were overwhelming. I was particularly struck by the woman who blogs here at 71toes.com (polydactyly is a common symptom of BBS and her family of 7 was no exception– how clever!) as she documented her family’s participation in the clinic. So cool!
Coordinated care for kids with special medical needs… it’s a thing that’s done well for many kids at Marshfield Clinic. But what about kids in the foster care system?
I have also spent a lot of time working closely with the medical director of the Marshfield Child Advocacy Center. She is totally committed to creating a Foster Care Medical Home (FCMH) for kids in the foster care system in Central Wisconsin. Medical homes are a really effective and interesting way to make sure that healthcare needs are met in a timely, consistent, and patient-centered manner and it’s something Marshfield Clinic has really embraced in recent years resulting in huge cost savings as well as huge reductions in the need for emergency care and hospital readmissions. We don’t have one for kids in the foster care system, though, and they likely really need it. At the moment, I’m working with Dr. Iniguez to complete an American Academy of Pediatrics planning grant for the FCMH and we just completed our third of four focus groups with foster care providers and past participants. Holy… wow! These families. I mean, I was into it before, I thought it was a great idea… now? I’m smitten! I want this to succeed, to help these families, so very, very badly! I am committed. But how? Where do we find the funding? Whose going to coordinate the care? Can it be like the BBS clinic?
And finally, behavioral health. I told you about my big fat $1.5 million HRSA grant? The one that kept me from blogging for over a week, right? What I didn’t tell you was this: due to a “misinterpretation” of the guidelines, the grant was triaged without being reviewed. WTF, right? I know, I’m furious, but trying to be cool about it… because the program is just way too important to let die now. Yes, it was a big mistake. No, I was not at fault (thank goodness, right?!). But dang, do I ever feel responsible… disappointed… dejected even. It was unpleasant news for everyone involved. And now we’re looking for another way. Another way to bring behavioral health services to patients in the primary care setting who desperately need them, but cannot get them due to the provider shortages we face in our area. How does this fit in? Well, you know who else desperately needs behavioral health services but can’t get them? Kids in the foster care system. These kids benefit tremendously from the notion of trauma-informed care… care that keeps in mind, always, that these kids have been through a really stressful, really awful situation and that those traumas subconsciously inform their every single action.
So, in conclusion, I feel like there’s something there… an invisible thread weaving its way through these projects and constantly tickling the back of my mind. It alerts me to the fact that there’s something in common, some answer that I’m overlooking, some person who needs to be contacted or informed or something. I just can’t find what that something is at the moment. I am missing a vital piece of the puzzle– I’ve got to find my special purpose! (The Jerk, yes?)
Two winters ago, my husband’s grandfather set up a card table in the living room and worked on a puzzle all winter to keep himself occupied while it was so cold. He did a bigillion piece puzzle or something and it had a lot of sky in it. Lots and lots of plain, blue pieces spread out on the table. And when he got to the very end? One was missing.
There was one piece of sky that was blank.
And it stayed blank for a while.
Until one day, Ed, my grandfather-in-law, bent down to put his shoe on and found a puzzle piece in it. It was in his shoe! Right there! All along! He snapped it in and the puzzle was complete.
I’ll find the piece. I’ll make the connection. We’ll make the foster kids a medical home and extend behavioral services to the population that needs it.