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What I Lost, What I Lose by Erica Dawson
At my third ECT procedure, Tamara, a nurse, brought me warm blankets thin as sheets and inserted the catheter in my vein. She pushed Zofran for nausea, Toradol for pain, placed the scopolamine patch, for motion sickness, behind my left ear. The nurse anesthetist pushed a dose of caffeine equaling roughly eight cups of coffee in a few swallows. Caffeine lengthens the duration of the grand mal seizure, which is therapeutically beneficial, apparently, in combating treatment-resistant bipolar depression. So far, I wasn’t seizing long enough.
I hadn’t had caffeine in months, for fear of it triggering mania. Here, in the hospital, the stimulant hit my blood and I started trembling so hard I got confused, in sheer panic, and thought they held the electrodes to my head, inducing the seizure while I was still awake.
My heart rate increased and as the beeping from the pulse monitor became more and more urgent, I became convinced I was in cardiac arrest, about to flat line, and I wasn’t mad at that. They laid the gurney all the way down. Someone pressed on my shoulders, trying to minimize the shaking.
I heard the doctor’s voice.
Somebody said propofol.
I woke up in the recovery room, disappointed, alive, still suicidal with a plan and intent, my voice cracking as I spoke to the nurse, asking for apple juice.
Since having electroconvulsive therapy, I can’t remember parts of the past and, often, can’t make new memories. While I remember some moments from the hospital like this, I played the piano my whole life and now can’t read music. I studied Shakespeare to get a PhD and, the other day, had to look up the name of the guy who tricked Othello into murdering Desdemona. I can’t read long form writing; I can’t remember what happened in the previous pages. I don’t watch TV shows with several characters or complicated plots that play out over more than one episode.
I spend a lot of time trying to goad my brain into recalling things I’ve lost and continued to lose on a daily basis. I look at photographs in my phone, ask people repetitive questions. I go down this road because, with a brain that oscillates between two extreme moods, I need the kind of stasis that comes from knowing where you’ve been or what you’ve done or what you can do.
The exquisite hippocampus at its best.
I can revisit having my head in Mom’s lap after ECT as she tried to massage the headaches out. I can remember rubbing my calves; it felt as if all 600 plus of my muscles hurt. I can go way back and tread through the grass of our old backyard, wrap my small hand around the swing set’s pole, lean back, and twirl.
But out of 46 years of memories, what I need to know most is exactly how and when, during ECT, I stopped remembering I wanted to die.
I’m not sure when I began considering ECT as an option to treat my bipolar depression. My doctor labeled me treatment-resistant a long time before. I tried all the meds. Mood stabilizers. Anticonvulsants. Antipsychotics. I underwent transcranial magnetic stimulation (TMS). Nothing helped with the suicidality. I attended two partial hospitalization programs where, essentially, you’re admitted during the day for intensive care, support groups, and medication management, but allowed to go home at night. Every evening before I left the first program, in the exit assessment, a nurse would ask me if I had thoughts of harming myself. Each time, I answered yes.
Placing the problems with the US healthcare system aside, I usually had the safety net of my mom at home. She flew from Maryland to Florida frequently, often for weeks at a time. She removed all sharp objects from the apartment, hid my medication, doling out only a single day’s pills. When she wasn’t in town, we’d FaceTime 24 hours straight and my medicine was kept at my best friend’s house. I checked in with my therapist every night, saw my psychiatrist once a week.
With all those measures in place, I was safer than I would have been had I been on my own. Safer, but still wanting to die. I would find a way, eventually, to make it happen. Overdose on Benadryl, perhaps. Walk to the beauty supply and buy those sharp little eyebrow-trimming scissors.
Already, I’d lost so much of myself to depression dulling my senses, replacing my personality with anhedonia.
I’d think about my family. Especially my six-year-old nephew and my dog. My brother and sister-in-law just had to explain to my nephew what happened to Pop Pop, my dad who passed away less than a year earlier. And my dog? If we were alone when I went through with it, she, after, would be alone and confused. What would happen to her if EMTs or the police, and not my mom or a friend, got to her first?
I hesitated.
Torn between guilt and my suicidal urge, I thought I at least had to consider what I deemed my last resort. Desperate for something other than the life I was living—not much more than insomnia or somnolence, being bed-bound or pacing, occasionally taking the dog outside or sitting on my best friend’s stoop—I made an appointment with a psychiatrist, Dr. Woodson, who performed ECT, to see if I was a good candidate.
He said I was.
I’m pretty sure no one truly knows how electroconvulsive therapy works, but people swear by it. Patients, doctors, scientists. Possibly, the seizure helps release neurotransmitters which alter brain chemistry, relieving symptoms of depression. Or, the seizure permanently changes neural pathways. Before my appointment with Dr. Woodson, I skimmed a memoir where the author described how their depression, after ECT, had completely disappeared.
I got most of my information from the ECT scenes in One Flew Over the Cuckoo’s Nest and Requiem for a Dream, where Jack Nicholson’s Randle and Ellen Burstyn’s Sara absorb the electricity and seize without general anesthesia. I knew enough to know the use of general anesthesia was standard now and had been since the 1960s. And I did know about the procedure’s potential problems, too.
But the side effects, Mom said.
Dr. Woodson clearly laid out what he called slight possibilities for memory loss and cognitive impairment. He said the memory loss usually was contained to the time during which you received the treatment. Those memories will likely come back, he assured me.
Slight. Usually. Likely.
Already, I’d lost so much of myself to depression dulling my senses, replacing my personality with anhedonia. Other than the desire to kill myself, I had no real desires, no strong opinions. I felt as if I had nothing to look forward to. I hardly had the energy to think. Impaired cognition wouldn’t be unfamiliar. At this point I couldn’t work. What started as an illness morphed into disability. Black, female, and disabled: a minority three times over which likely wouldn’t help me find any sense of autonomy amidst my ailing confidence. I thought: Could things really get much worse?
I’d already left the Erica I knew behind years ago when the severe depression settled in. Now I faced the hardest decision I’d ever make. Maybe lose even more of who I was but possibly have a chance at survival or, sooner than later, at my own hand, die.
I scheduled my first ECT treatment for Monday, April 4, 2022. I can’t remember the specific consent documents, but I’ve looked at several examples online, all basically the same. Confusion can result but generally clears in an hour. Retrograde memory loss sometimes goes back one, two, or more years. For a brief period, difficulty with aspects of learning and thinking, in addition to anterograde amnesia (making new memories) can happen. The risk of death is very low.
And there’s always something like this: Reports show some people have memory problems and cognitive impairment much more serious and long-lasting. Not enough research exists to predict which patients will have major debilitation.
I was sick but I was a competent adult. I could sign the consent form and I did.
Between April 2022 and January 2023, I had something like 26 bilateral treatments, an electrode on each temple. In the beginning, three times a week, then a tapering period, then once a month in the end. At my first procedure, which I remember well, I took a selfie, lying in the hospital bed, waiting for the doctor to arrive. My face pale, resigned. I had EKG leads peeking out from the neck hole of my hospital gown. Nurse Tamara left it untied in the back at the top to leave access to my whole chest. EEG sensors stuck to my forehead. A blood pressure cuff pressed into my right leg. I was third in line. Even when Dr. Woodson—whom Mom jokingly started calling Dr. Wood Head to try and make me laugh—arrived, with his ill-fitting too-short pants, I had to wait. The ECT room was just one large space with curtains separating small areas—privacy for patients during preparation and the actual procedure.
I was sick but I was a competent adult. I could sign the consent form and I did.
I heard voices. Some screams. Eventually I heard the machine. An insistent hum, starting, stopping. I knew approximately when someone’s seizure began and when it was done. When they wheeled the contraption into my area—the name Thymatron Systems on the front, a power switch, and a small screen labeled percent energy—I froze.
They never let me see the electrodes or the bite block.
As the treatments continued, I remembered things less and less, including the hospital visits. I depended on other people’s recollections. According to Mom, I threw up after every treatment then wanted ramen for dinner. She said we watched Bob’s Burgers each night and I never laughed but occasionally sighed, a deep breath buried then released from my chest as my antipsychotic kicked in and I slipped off to sleep. She and my friends said I became something more and more like catatonic; but, I still knew some things. Mom gave me mini tests. I’d pass. This is the kitchen. The flowers in that print are purple. That’s me and Dad when we were young. I didn’t do much, which wasn’t that different from the state I was in before ECT.
At some point, in mid-2022 I think, something changed. In my journal, I started writing about looking forward to my birthday and Christmas. I often wrote about being excited for my next ECT appointment and the quick 10 seconds of respite after they administered the anesthesia and before it kicked in. My handwriting got messier as time went on, all angles and sharp corners, barely legible. I practiced signing my name as if, one day, again, someone would hand me one of my books to sign.
If I knew the day the proverbial tide turned, when I stopped obsessing about and planning my death, I could celebrate it like a second birthday. Friends would bring white lilies representing renewal, restoration of the soul. My family would buy mylar balloons floating high with the words Thank You. We’d eat a round, two-layer vanilla cake with white buttercream icing. I’d open a tiny-hinged box holding one of those necklaces with a semicolon engraved in a charm, the suicide awareness symbol for hope and the continuation of life.
To myself, I’d boast, I’m stronger than my thoughts. I’d be cocky, pleased. The self-esteem boost I needed for years, even prior to the severe depression.
More important than my second birthday, if I knew how I forgot I wanted to die, I could forget again the next time suicidality took over my life. If it was simply that I was basically catatonic and couldn’t process much information, or if my hippocampus, under the stress of the seizures, failed, I easily could have ECT again. Insurance would pay.
A clinician told me once having any mental illness is traumatic. Maybe my forgetting was a trauma response. Perhaps I couldn’t bear the suicidal thoughts, my intent and plans, and so I froze—no longer feeling or remembering the urges. My mind simply shut down. Perhaps I could make that happen again and it would save me.
I don’t believe in remission. I can’t see a time when I won’t be at least a little depressed or a smidge bit manic, or both.
Unrealistic notions, I know. Who would put themselves through ECT again, risking even more damage? And, of course, you can’t manufacture a trauma response.
Still, maybe believing I could do these things and save myself—the way people have faith that prayer can save them from illness—could be enough to clutch in my darkest moments. Because these moments no doubt will happen again. Depression digs its way into my bones: the smallest stirrup in the ear, the bigness of the femur.
I have bipolar disorder, am almost always clinically depressed and chronically suicidal, though sometimes passively. I can smile and laugh. I often do. I can write essays sometimes, maybe even read them aloud; but, the bipolar disorder isn’t gone. I don’t believe in remission. I can’t see a time when I won’t be at least a little depressed or a smidge bit manic, or both, or sick as I was when I underwent ECT. I need something to keep me going.
I wake up most days, toss my meds down my throat, and think, How much longer am I supposed to live like this. I get ready for bed, toss my meds down my throat, and think, How much longer am I supposed to live like this.
Some clinicians say my ECT was a success because I’m still alive. Maybe my ECT was successful because I had a brief reprieve from myself and my pain. I can’t 100 percent decide. In so many ways—with my memory loss and, overall, a brain that doesn’t function the way it did—I don’t know anything for sure anymore. I had to leave my life in Florida and move home to live with Mom in Maryland (my home state) which, three years later, can still feel unfamiliar. My mind often goes blank. She tells me something. Within minutes I’ve lost it if I didn’t jot it down. My biggest touchstones, writing and reading, elude me for months at a time.
People say, likely trying to console me, we all live with uncertainty. We all forget. For show I nod, put on a grin. In my head I say, Don’t tell me how to know my body.
At some point each day, alone, I scrawl trees in my journal. A page of jagged trunks and crude limbs, leaves like misshapen hearts. Sometimes they’ve fallen to the bottom of the ruled notebook where the last line serves as grass. I squeeze in my full name underneath, draw, around it, black swirls of soil.
The post I Need to Know How I Forgot I Wanted to Die appeared first on Electric Literature.
