At The Doorstep

Electroconvulsive therapy. I've been aware of it for years.
I know it's been around for decades.
I know it's the most successful treatment for depression—ever.

My current doctor as well as several other doctors, nurses, counselors and therapists from the past have recommended it. When I went for the TMS treatments, the doctor in charge was strongly selling "ECT" as the treatment of choice. He's been treating people for years with this method and has seen the results. The positive results. At least that's what he told me.

My longtime perception of this treatment has been one of a cautious procrastination. It's something that's always been waiting in the wings as a last resort. It's a point I'm heading towards but I'll never get to because there's bound to be something less extreme to pull me up and out. There's gotta be a pill; a vitamin; an herb; a therapy; a miracle. That's been my flawed thinking for years and years.

After each failed medication, my doctor brings it up again. Each time I recoil. I can't conceive of this. How can I possibly be here? At its doorstep. Only crazy people get shock therapy. Only people who are suicidal or a danger to others. That's not me. It's not time yet.

My doctor has recommended ECT to several of her other patients and many have reported profound recoveries. I asked if it would be possible to speak to any of them because I've read countless nightmarish accounts on the Internet of memory loss, slurred speech, further brain damage, etc. There are even several organizations established to ban ECT because it's perceived as barbaric and dangerous. I don't know what to think.

She gave me the number of a lady. I'll call her K. Middle-aged, married with children. I waited a while to phone her. I was waiting for "the right time" whatever the hell that was. The right time came when I was at a very low point. I can't even remember what triggered it. It's so hard to keep track of all the low points. I actually texted her first so as not to catch her at a bad time. She didn't know what to make of this strange text. After a few more text exchanges it became clear to her who I was. When we spoke on the phone she was so glad I had called. She had been anticipating hearing from me and was eager to chat. We began exchanging our stories. K had been through unimaginable hell for years. Bedridden for months on end, divorced, had a miscarriage, was committed to hospitals, endured years of unending medications, etc. She hit depths that I've never comprehended. I felt ridiculous describing my pity party. I have no business whining about my situation because it's a walk on the beach compared to others' torturous existences.

She became passionate about helping me. ECT saved her life and she knew it would save mine as well. There were no regrets and she would do it again. There were no memory loss issues or debilitating side effects. She only wished she had done it sooner in her life. As I remember she mentioned she had ten or so treatments. K repeatedly and adamantly urged me to go through with it. She was determined to see me through and felt it was a divine occurrence that I had contacted her. She was convinced God sent me to her so she could help someone else. I was appreciative at first if not slightly put off by the religious overtones she was touting. I thanked her promising I would keep her posted.

It was good to speak to a real person who had gone through this treatment. All the anonymous Internet testimonials are suspect. This was the real deal that could feasibly change my perception of this scary treatment.

A couple of months later I hit a rough patch involving my wife. I was riddled with guilt because of some careless things that I had done to her. I was pretty distraught and had nowhere to turn for solace. I then thought to call K because I knew she would relate on some level.

This conversation was different than the first. Right off the bat she said she knew I was going to call and knew something was wrong. Put off again, I played along. I basically cried on her shoulder and vented to a total stranger. This time the religious overtones that were sprinkled into the first conversation completely hijacked this one. She revealed that God was talking to her right at that moment. She wanted me to accept that Jesus was going to steer me in the right direction. I stopped her short and informed her I was Jewish and was not a believer. I also told her point blank that this sort of talk is a huge red flag for me. She replied that if I hadn't thought that of her she would have been very surprised. She gets that a lot apparently. She compromised by refraining from using the name Jesus and dismissed the religious differences because we "believe in the same god anyway." I wanted to lash out at such an ignorant remark but restrained myself because her intentions were sincere and she was genuinely trying to help. So again, I played along. I was too exasperated to squabble over religion. She asked if she could pray for me. I obliged feeling as though I had just driven a bus into a wall. She went on and on about casting demons from my soul and how "god" will cause a miracle for me. I just let her perform her faith healing session as long as she wanted. It really didn't matter anymore.

It was a long, tearful, disappointing conversation for me. I realized who and what she was, and— well, it figured—after all I was speaking to someone who was admittedly mentally unstable so it shouldn't have surprised me. Though ECT "saved her life," she attributed most of her recovery to a divine miracle and that's where we parted. I haven't called her since. Not because of the religious babble, but because there hasn't been anything to report regarding ECT. I haven't yet committed to a decision. If I do, I might contact her again. She'll tell me she knew that anyway.

Another ECT patient who I'll call J wasn't as talkative as K but he did highly recommend ECT. He's had dozens of treatments with no regrets. He did say he experienced temporary memory loss but it came back after a couple of weeks. When we discussed the meds we had each taken, he surprised me by saying he was currently on ELEVEN drugs. Even with the ECT treatments he has to be medicated with a huge antidepressant cocktail that he is resigned to for the rest of his life. I felt pathetic admitting I was on 2. So here again is another REAL individual who raves about ECT.

As I write this, it's a few days before the holidays of which... surprise... I loathe, so there's no way I can pursue ECT until after the first of the year. I have several more weeks to ponder this. I can't help but to feel it will be a mistake to go through with it. I fear it won't work or it will do irreversible damage that will only make things worse. If I choose to move forward with it, I'll have to figure out how to take some sort of medical leave from work and an explanation for it. I'll also have to find transportation because you're not allowed to drive after each treatment. But I don't want anyone to know. I don't know what to do. I need someone to decide for me.

Carrying On

Haven't posted in a while. Not much energy and not much to report.
It's been very dark and very sad. Heavy. Wish there was more to say.

Point Of No Return

My marriage is disintegrating.

Depression has taken my soul and in the process, my wife and children have lived with an empty shell of a man that knows no joy. It's reaching new depths that I never imagined. I live with immense guilt and regret for so many wasted years that are lost forever. I've strived to be a good father and husband under the relentless weight of depression. But I'm convinced now that I've failed. It may have reached the point of no return. I believe I have lost her. My heart is broken because I've broken my wife's heart. I've done selfish things over the years that have hurt her though I've never had that intent. One can say 'I'm sorry' only so many times. She has been robbed of a happy marriage that she so deserves.

It may be time to seek more intense treatment before
I lose my wife — or my life.

TNS (Final Post)

It was initially a two-month clinical trial with the option of an additional six. The first two months brought nothing but disappointment. Opting for the additional six didn't fare any better. I bailed out after five months which totals seven. There was no sense in going any further. It was clearly another failure for me while others in my group had various degrees of relief.

My last appointment with the facilitator seemed quicker this time. He saw once again that I had brought all the equipment back but it wasn't verbally noted by either of us. During the routine of questions and forms he repeated that I was allotted one more month and he hoped I would use it. After the formalities were done, he asked if I intended to continue. I replied, I think I'm done.

I was somber and lethargic. He did state a couple of positive things that had come from their study of me. All of the subjects including and especially me did not get any worse. Also, all treatments in no matter what form don't always work for everyone. If every single subject had benefitted, it might appear skewed. In other words, my treatment failure kept the trial grounded and less suspicious. Apparently the FDA is skeptical of tests and trials that are 100% positive. So, in a way I was the balance that kept it real.

We shook hands thanking each other and promising to keep in touch. I felt nothing but complete numbness as I made my way back to my vehicle and became traffic once again.

Pains, trains, and automobiles

At my workplace the administration decided to implement parking fees to the tune of $400 per year through payroll deduction. After working there for more than a decade with free parking I was less than enthusiastic upon hearing this news. It was optional, meaning if you didn't pay you couldn't park on the premises. The only way around this was to find a spot on the many side streets nearby. We were given a few week's notice before the fee went into effect so I had time to troll around the neighborhood to seek a precious "free" parking space.

I was actually successful in finding a couple of streets with forgiving stretches of fee free areas. Most other streets had 2-hour maximums. One such spot that I use the most when it's not taken already is literally half a block away; an easy 2 minute walk. That short jaunt has a pair of major train tracks that carry thundering commuter and freight trains all day long. Occasionally I'll get temporarily stranded waiting for a freight train that seems to stretch for miles.

I walk across the tracks on a daily basis to and from my vehicle. Along a rod iron fence that separates the sidewalk from the track area is a makeshift shrine to a young man that was in the wrong place at the wrong time. Friends and family cemented an ornate, white rod iron cross along the fence indicating the general area where the tragedy happened. It's surrounded by artificial flowers, candles, beer cans, rosaries, and even live plants growing from the ground. A laminated photo of the deceased hangs off the cross. He was hispanic, looked to be in his early 20s and was somehow killed there on September 11, 2010. Not a good day for many people. Today as I walked by it I noticed a handwritten sign that read "Happy Father's Day Mikey." I thought, my God, he was a dad. What the hell was he doing wandering around railroad tracks? Why wasn't he with his kid or kids? Most likely he was in a drunken stupor, either alone or partying with friends. Foolish waste.

From time to time when I take my daily stroll across the tracks, sometimes I'll stop and stare at the tracks themselves. My eyes follow the tracks to their vantage point, each side angling toward the other then meeting at the horizon. I'll have a momentary flash of hope that a train will come out of nowhere and instantly take me and my pain away. It wouldn't be suicide. It would be an "unfortunate accident." It will never happen but I can't seem to control disturbing thoughts like these. It's troublesome and just part of the game I have to play every day.

Choices

A miserable day today.

A miserable day because I chose it to be that way.
I chose to be complacent.
I chose to be lethargic.
I chose to be distant.
I chose to be sad.
I chose to be alone.

I don't understand why I choose these things.
Maybe deep down it's a familiar comfort level.
How can one be comfortable on a bed of nails?

I'm my own worst enemy.
Nobody's fault but mine.

TNS (post #6)

It was time for another follow up appointment. It's been a total of 5 months undergoing this experimental treatment. I have 3 to go if I wish. For the previous month's appointment I had decided I'd had enough. It wasn't working and I was tiring of the inconvenience it was to sleep with this thing. Fast forward to this appointment and the scenario repeated itself. I went with the intention of turning in all the equipment and saying goodbye.

The facilitator immediately knew upon seeing that I had packed everything up that I was going to opt out. He wasted no time asking me if that was the case and I replied yes. We proceeded through the protocol of the appointment and then he laid out the big picture. Again, with his wise words and what seemed a genuine concern for me, I reconsidered just like last month...sort of. This time I was given the option to keep the device if I chose to continue. If I chose not to then arrangements would be made for me to FedEx the device back to them to save me the drive.

I spoke to my wife about it, asking her what she would do in this situation. She said she would continue to the end and didn't understand why I was so eager to quit. It wasn't easy explaining that one.

So I begrudgingly decided to continue for at least another month. I've lost faith that this will ever work but I have nothing to lose and I'll never know if it would have worked if I quit now. By the end of the month, the futility of the treatment will have gotten stronger. Then the facilitator will make me aware of all the options I have, or lack thereof, and my perception will change. It's become an annoying cycle.

Pills, Pills, Pills

The doctors overseeing the clinical trial I'm involved in gave me the green light to change meds if I want. I shared that news with my psych doctor...reluctantly I may add. This meant there would be further tinkering and experimenting with new pills or combinations thereof which in turn means side effects. Side effects can range from a small annoyance to not being able to function at all.

Without boring the reader with drug names and dosages, she basically increased the dose of a med I'm already taking and then added yet another. The new one is supposed to increase my energy in the daytime. It acts like a stimulant but it's not a stimulant.

I am now taking FOUR drugs along with the TNS treatment. I also take a fish oil supplement because it's supposed to be good for the brain.

All simultaneously.

This is the most amount of treatments I've attempted at once yet I still slowly spiral downward.

In the past when a doctor would prescribe something new, I would ask questions and express my concern about side effects or withdrawal symptoms. I'd ask if it's ok to take with other meds or with alcohol, etc. This time I just silently took the script. If it would cause me to spontaneously explode, turn me to stone, or cause a massive seizure, I simply didn't care. If it works, great. If not, add it to the failure list.
I've become so jaded.

TNS (post #5)

It has been a total of 4 months now which includes the initial 8-week trial period. 4 months. It seems as though this treatment would have worked by now. At least that's my perspective. I've grown disenchanted with the routine of wearing this contraption to bed every night. I can't help but to think that the time I've invested at this point has been keeping me from trying something else. I've chosen to continue with the 6-month additional option but am now having second thoughts.

I recently visited the trial coordinator for the 4-month follow up. I had all but decided that I was done with this. I packed all the equipment and supplies to return them.

Each appointment is basically the same. Questionnaires to fill out, an interview with the same questions, weight and blood pressure check, and a visit and/or phone call from the chief psychiatrist running the show. None of the people involved in this treatment have ever pressured me to do anything. It's all been up to me. When the subject of continuing approached, I told him I was reluctantly going to quit. Of course, he asked why and we discussed it for a while. He then said something very sobering.

If I quit now, I'll never know. If I continue, at least there's a chance.

My wheels began to turn. Apparently most of the other subjects in my trial reported some sort of positive effect. I might have sunk in my chair upon hearing that. I've heard it so many times before with other treatments. He pointed out that I was the only one in the group who has had such a long and chronic case so that may have been the substantial reason. There are just simply too many unknowns this early on.

He had told me in a previous appointment that people who had elected to go with the VNS treatment which is a surgical implant in the chest that stimulates the Vagus nerve hadn't felt any benefit for up to 24 months in some cases. Though TNS and VNS are not the same, they are cousins in that they stimulate nerves that run into the brain with an electric current.

I'm only being allotted a total of 8 months for this treatment. At the halfway point, I began to think how petty it was to quit at only 4 months when others went the dramatic route with surgery and patiently waited 2 years for changes with another treatment. What started out as a reluctant decision to quit suddenly became a reluctant decision to continue. So now I enter my 5th month of TNS. I know deep down it will fail but I need to see it to the end or I'll never know.

Goodbye buddy

We found him at a golden retriever rescue organization. They called him "Townsend." Their naming process was much like how hurricanes are titled. They simply run through the alphabet coming up with an original name from whatever letter is next. We liked the name. It was unique but not silly or odd. So Townsend it was.

They told us he was approximately 5-years-old. A visit to the vet confirmed that. All that was known about him was he was a stray wandering the streets in a nearby town. He seemed happy and energetic. Good with kids and loved attention. As we loaded him in the SUV he began barking continuously. The lady at the rescue place said he always did that but had no clue why. He continued to do that for years. It was as if he was yelling, "C'mon! Let's go! Hurry! C'mon!" It became annoying after a while but he would calm down once we'd start moving.

He had other strange little quirks, much of them involved barking. Every time he saw someone riding a bicycle he'd bark and sometimes lunge at them. Same was true for motorcycles. Just hearing one set him off. He also barked incessantly when taken to dog parks or dog beaches. One morning we were asked to leave our local "pooch park" because a resident had complained about the noise. That was a first.

Though he was a golden retriever he was actually neither one. He was more red than gold and he was a crappy retriever. Most goldens love the water but he wanted nothing to do with our swimming pool. He wasn't fond of baths either.

Like most dogs he wanted only attention and food. His cold nose would always butt into most situations. I'd walk him to the school with my kids and wait around for the bell to ring. Children would gather round him just to touch or stroke his fur. They always asked many questions and told me about their doggies. He ate it up. His tail wagged. He couldn't get enough. He loved people.

As time progressed he began to gradually slow down. One day I looked at him and was struck by how old and small he appeared. It was like overnight. He must have been 10 or 11 by then. This slowing down process accelerated with each month and each year. His face became white. He would occasionally stumble. The stumbling morphed into tumbling. Frequently his legs would just give out under him and he would be sprawled with his chin on the ground. A visit to the vet revealed muscle atrophy in his hind quarters and most likely arthritis. We gave him pain meds but it didn't seem to make a difference.

By the age of approximately 12 and a half he had become a bag of bones. His red coat became a washed out brown. His face and head entirely white. He was shedding like mad. His eyes were sunken in. His head took on the look of a skull. Like death. His legs became weaker and weaker. He struggled to get up, limped around when he walked, and struggled to lay back down again. His vision and hearing were becoming a thing of the past. At times he would not eat and that worried us greatly. We thought that meant the end but somehow he rallied and began clearing his bowl every day again. As the months flew by his legs were barely functioning. He would slide on the tile floor as if ice skating. He'd fall but couldn't muster the strength to get back up. I tried getting him doggie boots with traction pads on the bottom but they just got filthy and fell off. He then began growling and barking when he was stranded. Sometimes at 4 in the morning. All he wanted to do was go from here to there but had no choice but to call for help.

Yesterday, March 3, 2011, he seemed the same at first. My wife gave him his meds with a spoonful of peanut butter (his favorite). He clumsily went outside to do his business, then came back in. My wife has to leave earlier than me so when I'm done getting myself ready it's my turn to feed him. He was extremely lethargic. As I've been doing for several months, I tried to pick him up to put him out again because he had taken to making messes in the house. I dinked around some more in my daily routine. I looked out back but didn't see him. My fear was the pool. One slip and that'd be it. I went out to look for him and found him around the corner lying on the cold wet cement. I picked him up and brought him back in and set him on a dry rug. He was very unresponsive. I picked him up again so he could eat but, like a baby fawn, the strength in his legs were non-existant. I put him back down and brought the food bowl to him. No reaction. I even tried to place his snout in the bowl but his head just sort of flopped in it like an unconscious drunk. I knew this was a large turn for the worse.

I had to go to work so I let him be. My oldest daughter was home that day so I left a note for her to try to get him to eat. She called me in the afternoon and told me he was still unresponsive. I suggested she try and move him off the rug in case of any accidents. Sure enough, later another phone call. He had in fact done his business on the floor and was just lying in it. She somehow managed to move him out to the back porch on a blanket. She called yet again to tell me he was whimpering and sometimes shaking. I thought maybe he was cold or hungry because he had no breakfast. She put the phone to his mouth so I could hear the noises he was making but I couldn't hear anything but a very faint breathing sound. I told her to just make him comfortable until I get home and evaluate the situation.

When I arrived home, she had brought him back in the house on a blanket in the corner. He was sound asleep. She said this was the calmest he'd been in a while. I knelt down and stroked his face—but barely a reaction. About 20 minutes later I heard whimpering. I went to him to find him shaking and crying out in pain. He was having a huge seizure. The shaking became convulsions. His head turned to me with his mouth wide open. I feared he might bite his tongue so I closed his snout. The convulsions were so violent I had to practically lay on top of him in an effort to calm him. My daughter ran over to help. Minutes seemed like hours. The seizures lasted a good 3-5 minutes. When it stopped he lied still, then began to howl. He was enduring agonizing pain. We didn't know what to do aside from trying to calm him. I tried giving him some water with a turkey baster. He actually swallowed a couple of times. He continued to whine and howl with pain. Then another seizure. I knew this was the end. There was already brain damage. My daughter and I began to cry as we, in futility, tried to stop his agony.

Again he was calm but disoriented. I gave him more water but he wouldn't take it this time. By now my wife and younger daughter had come home to discover this awful scene and had no choice but to become a part of it. They kneeled and stroked him as he wailed. It was the dinner hour and I had no idea what to do or where to get help. There was a vet clinic near my work. I called and they would be open for another 45 minutes. We all lifted him with blankets underneath to take him to my SUV. My oldest daughter had to go to work so she couldn't come with us. My wife told her to give him a kiss goodbye. At this point I was ready to explode with sorrow. I used what strength I had left to suppress it. I couldn't stop the tears but I was not about to ball like a baby now.

The drive was not too far but it seemed an eternity as we hit every red light. My youngest was riding in the back with him, sobbing and talking to him. He was shaking, howling, panting, etc. We could hear her repeatedly say, "I love you, I love you, it's OK." I prayed that he wouldn't die in her arms. When we finally arrived, two assistants came out with an animal stretcher with strap constraints and a blanket. We slowly moved him onto it as he panted and hissed with exhaustion. We carried him into an exam room and placed him on a table. The doctor came in a few minutes later to look him over. I knew what he would say. I asked if he could give him something to calm him. He obliged with an injection of Valium. Townsend's breathing slowed down almost immediately. The doctor told us the only options were to take him to a 24-hour pet hospital, pump him up with drugs, run tests and lab work to buy some time to see if he could be diagnosed and possibly saved. The other option, of course, euthanasia.

We knew if we were to follow option 1, it would cost hundreds if not thousands of dollars with no guarantee of anything. I knew his brain was damaged and he'd never be the same again. His quality of life had been bad enough for the last couple of years. There was no point. The doctor told us without running tests, they couldn't know the source of the seizing which could be caused from liver failure or kidney failure to a tumor or cancer among other things. My wife and I looked at each other both knowing there really was no option at all.

The veterinary assistant asked me to step outside and sign some papers. She informed me that if we were to euthanize him there might be muscle spasms, he might evacuate, or even give one last painful cry.

I literally signed his life away and went back to join them. I just wanted to end his suffering.

Townsend didn't spasm or yelp the moment his heart stopped. He went peacefully and quietly with what dignity he had left.

We decided to donate his body to the clinic so he might help someone else's pet in some indirect way.

When it was all over the three of us huddled outside the clinic door and cried our eyes out. I needed that release. I wanted to go off somewhere and sob by myself but that never happened.

It's the next day. March 4. Of course as I type this it's all very fresh in my mind. I feel a lump in my throat and my eyes welling up. We all thought he would just die peacefully in his sleep one night. I was so angry and shaken that he had to go through such agony. It was so unnecessary. He didn't deserve his last moments to be so torturous. I sit here and think how it might have been avoided if we had put him down earlier. Regrets. Empathy.

The worst of it all was witnessing the pain and sadness on my family's faces. Though we all knew this day was imminent, we were blindsided by its sudden cruelty. We never imagined.

Today I had the fleeting thought that the same hatch door of my SUV he climbed up in to enter our lives was the very same one that he exited to leave us.

I don't believe that animals have souls. I hope I'm wrong. My youngest daughter kept uttering that he's in heaven now. I do hope she's right.
Life is such a sad affair.

TNS (post #4)

Eight weeks.

Eight weeks sleeping with sticky electrodes adhered to my forehead and wires running down the inside of my shirt to a small, metal box.

Eight weeks of feeling the sensation of electrical current contracting the forehead muscles, at times to the point of discomfort. Ironically when looking in the mirror with everything attached, the current causes the inside end of my eyebrows to bow upward giving the appearance of marked worry and sadness.

The initial phase of the clinical trial is over.

No change.
No benefit.
Nothing.

I have the option now of continuing to use the device for up to six more months. I've agreed to do just that. The facilitator suggested I could be a "slow responder," or a "non responder." If I'm a slow responder then it's possible I'll have remission within the additional six months. If I don't continue then I'll never know.

There is another treatment that uses the same principle called VNS. Vagus (like Vegas) Nerve Stimulation. This involves the surgical implant of a device that has lead wires that wrap around the vagas nerve which runs down the neck. A completely different nerve, a completely different devise. The facilitator shared with me that he knows of subjects who have had the VNS implant but didn't have any remission until a year later.

A year.

This got me thinking that I need to be more patient and to see this through to the end as much as I can stand it. I am thoroughly disappointed that the first eight weeks failed....but, I've been here before...many, many times. I have nothing to lose by continuing. I don't know what else to do.