Deeply disappointed in the previous day's lack of results, I begrudgingly went back to the hospital the next day for one last blood draw and MRI scan. This time at 8:00am. Traffic was tougher and more irritating at that hour but I expected that. This time I could drive myself.
Upon arrival, one of the assistants met me in the lobby and took me back to the MRI room. The other assistant was there with another patient from a different study. He was noticeably hesitant about having an MRI. He muttered something about "if" he can stay in there for an hour. I wanted to tell him it was a breeze and to just try and doze off but I chose to be silent.
Another nurse I had not met before arrived to take my blood. We went to the other side of the room out of view of the hesitant patient. While my blood was being taken, I could hear what sounded like goodbyes so apparently the poor guy was too spooked to proceed into the MRI tube so my place in line advanced to now.
It was now 24 hours since the administering of Ketamine and still no signs of improvement. I didn't sleep well the night before. I was taken aback by the absolute nothingness this drug displayed. Not even a lone side effect. Not what I expected. I was within the 72 hour window of possibly noticing a change so I latched onto that—loosely.
After the MRI, one more question and answer session. She said she was sorry there were no positive results. Of course there was no guarantee and there were disclaimers aplenty stating it would possibly not work at all. I asked her if I could participate in future Ketamine studies with the thought that maybe the dosage was too low, or too brief. She couldn't give me that info as she was not a doctor and had no way of knowing. I did hear that the doctors were approved to do a study of "serial" Ketamine infusions which means a series of multiple injections as opposed to the single one I experienced.
My fear that it wouldn't work came to fruition. Maybe it was a self fulfilling prophecy. Maybe I willed it away with my negative expectations or maybe the drug simply didn't fulfill its promise. I'll never know. Yet again, I shook someone's hand for the last time, thanked her for her time, told her it was nice meeting her as we parted in opposite directions.
I hadn't had breakfast or coffee yet so I thought I'd venture into the cafeteria to grab a bite. After purchasing my items I found an outside dining area adjacent to the cafeteria. The building's A/C gave me a chill so I found a table in a sunny spot. As I nursed my coffee, the realization of another failed treatment gripped me. I really didn't want my hopes too high for this one but I couldn't help it based on all the fuss around this "breakthrough." I simply couldn't believe that yet another medication couldn't make the slightest dent. At the very least I was hopeful to experience just a small taste of relief. Just a slight glimpse. A tiny morsel of happy. How could this possibly keep happening? I wanted to cry but I couldn't. I didn't want to go back home. I didn't want to stay there. I was lost in numbness.
I pondered the thought that I was possibly NOT clinically depressed, that there was NO chemical imbalance that was the cause. If there was a chemical problem, why wouldn't all the chemicals I've been prescribed change things for the better even remotely? Maybe this was just who I am. and what I've become. It's just the fiber I'm made of.
The weather was clear, warm and breezy. I did take note of what a beautiful day it was.
On the day of the infusion, my wife and I arose around 4:00am in order to get ready to make the trek to the hospital by 6. Luckily traffic wasn't too heavy at that hour so we arrived on time.
We met with one of the assistants who escorted us to an admittance office to fill out more paper work. After that, we made our way to a hospital room where we would spend most of the day. The room was very nice. Large and comfortable with a window overlooking the city from the 6th floor. A flatscreen TV faced the bed and broadcast serene landscape scenes accompanied by relaxing music.
We were introduced to the head nurse who would be one of three that would be overseeing the procedure. I was quickly weighed and asked to lie on the bed. Shortly thereafter, the other two nurses appeared with some equipment and the Ketamine dosage. It was in what looked like a large, transparent syringe minus the needle. I later learned it was called a barrel. The actual appearance of Ketamine could have been water, vodka, rubbing alcohol or any other number of unassuming, clear liquids. It would be diluted with saline which looked exactly the same. I'm not sure of the exact dosage.
The head nurse set up the central line where the drug would enter my system. The other nurses attached heart electrodes and a blood pressure collar so my vitals would be closely monitored.
Things began happening fast. The doctor I had the initial consult with popped in wearing a very official looking white lab coat. After I introduced him to my wife he began explaining what I was in for and made sure everything was correctly set up. The barrel was loaded onto the IV drip along with the saline. I later told my wife I felt as though I looked like a sick patient all wired in a hospital bed.
The drip was started as the nurses noted the time and recorded it in their paperwork. It would be about a 30-40 minute process. About 7-10 minutes in, I could start to feel its effects. At first a slight dizzy feeling like any other drug. As time went on it began to intensify. Things moved more slowly. I became disoriented. There was no euphoric feeling or mood lift. I was asked how I felt and I simply said I felt drugged. That was the best way to describe it. I could hear the music from the TV and intermittently saw colorful fields of wildflowers, waterfalls, mountain scapes, rivers and creeks on the screen. The relaxing music competed with the voices of everyone in the room. Sounds and images became compartmentalized. Music from the TV remote at my feet on the bed; the nurses at my left, the doctor at my right, my wife at far left. I strived to pay attention to what was being said. I didn't want to appear drunken or slurred. At one point I asked my wife how I sounded and she reassured me I sounded normal.
As the infusion continued I felt the need to catch my breath a few times. Things became dream-like although there was no euphoria or "high." I simply felt intoxicated, drugged. I had the realization that I was the center of attention as three nurses, a doctor and my wife all stood around the bed talking to each other and observing me but also felt slightly removed as if I was the observer. Two or three times the doctor quizzed me to check my overall mental alertness asking where are you? What day is it? Wiggle your toes. Wiggle your thumb, etc. Before the infusion ended, the doctor, satisfied with my "rock solid" vitals, said his goodbyes to everyone. I thanked him wondering if I'd see him again.
There were no feelings of joy or happiness. No overwhelming relief or hope. Slowly the initial effects began to wear off. I felt more coherent and lucid with just some residual dizziness. That was it. The infusion was complete. The show was over. Both the doctor and the paperwork stated that I could possibly feel the "peak" effects within 24-72 hours after the infusion. I rested my hopes on that.
Next, the assistant returned to check on me and ask follow up questions. These were questions I've answered before and would answer after every test. Unfortunately, I couldn't report any improvement.
From then on it was lots of waiting in the room as I was scheduled for a blood draw and another MRI later in the day. An hour or two after all the action, it was quiet in the room with the same zen-like music coming from the speaker. Disappointment settled in. There were so many reports and testimonials of people feeling relief within hours. After the initial "trip" into the K-hole, as its referred to, I returned to the exact same place I started. Not even the slightest side effect.
As mid day approached, my wife went downstairs to the cafeteria to bring back some lunch paid for by the study. I sat on a couch by the window gazing at the buildings and people below. I uttered a makeshift prayer pleading with God to please see that this medication kicks in within the next 24 hours. Please.
After a pleasant lunch it was time for the blood draw. A couple of hours later the MRI. I wasn't allowed to walk so a wheelchair was brought in. A precaution, though not needed. Ironically I felt fine enough to drive home if permitted—all effects of the drug were gone. My despondence progressed.
Both assistants returned and wheeled me to the MRI lab. I wondered what differences the trained eye would see in the before and after scans but figured I'd probably never know. The scan went smoothly and it was back to the room to wait a few more hours for one more scan for that day.
Another round of questioning. Same questions. Same answers.
Before the last MRI, the other doctor that was spearheading the study dropped by to introduce herself and check in. She was very nice and knowledgable. She reiterated the 24-72 hour "peak" effect time after I told her there was no remission. She then escorted us to the MRI room, this time sans the wheelchair.
Last MRI of the day goes smoothly. We're done for the day.