Well-Dressed and Smiling

After He Said Cancer | A Memoir

I knew something was wrong when I awoke feeling exhausted despite sleeping for 14 hours. I hadn’t slept that long in a single stretch since I was working 100-hour weeks as a resident physician-in-training.

My excuse for being so tired was either my grief – an exhausting beast on its own – or the new anti-depressant that I started taking a month ago. I was betting it was the anti-depressant. This was my first experience taking an anti-depressant and I had high hopes that I would feel better. Unfortunately, my fog of grief was still thick and impenetrable. And I had become a zombie.

From my years in medicine, I knew that many people stopped taking anti-depressants due to side effects or the belief that the medication wasn’t helping. Often it was just a matter of changing the type of anti-depressant to find one that worked for a particular person.

Giving up on the idea that an anti-depressant would help me wasn’t an option. The lows were too frightening, and I could barely function. I reached for my cell phone to log into the patient portal to ask my primary care physician to try a different anti-depressant. Hopefully, the next drug I tried would help me climb out of this dark hole that I had fallen into.

My thoughts drifted to one of my patients. I was her obstetrician, and she had delivered a beautiful baby after a normal pregnancy. Her husband called my nurse about one month after the birth and sounded frightened, saying he thought she was depressed. This was enough to alarm my nurse and myself – so, we scheduled her to come in right away.

She was normally a very upbeat person with a big smile, who had sailed through her pregnancy. Professionally successful, she came to her appointments well dressed and spoke eloquently. Her husband was often by her side and was very kind and supportive. They would be loving parents, I thought. What a privilege it was to help them bring their baby into the world.

Perhaps it was the mental image of my well-dressed, smiling patient that made it so difficult when I entered the exam room. The color had drained out of her normally light brown complexion leaving a pale shell. Her hair was disheveled, and eyes fixed on something across the room. She didn’t acknowledge me. Most disturbing was the vacant and deeply sorrowful energy that she projected. Her husband sat next to her, quiet as a mouse, and helpless.

“When I wake up in the morning, I don’t want to get out of bed or go to Grace,” she said. Tears rolled down her cheeks, but otherwise her head and eyes were motionless, staring at the wall. Her husband put his arm around her waist and looked at me, eyes widening.

Postpartum depression, I thought. It was a classic presentation, especially the difficulty in bonding with the baby.

“Do you have any thoughts of hurting yourself or the baby?” I asked. Assessing her suicide risk and potential for harming the newborn was the first order of business for me as her physician.

“No,” she said. “I couldn’t do that.” Her shoulders slumped, and she put her head into her hands. The husband rubbed her back and looked at me.

Will she be alright, his eyes asked me.

I began asking her questions about her mood, sleep, energy, and ability to concentrate. These were some of the standard questions to evaluate a patient for depression and her answers indicated that she was deeply depressed.

Treating her with a course of anti-depressants could be lifesaving. Suicide was rare after childbirth, but it did happen. Every other year or so, there was a postpartum suicide in Washington State. I needed her husband to watch her mood closely and help report how she was doing. It would probably be a few weeks until the anti-depressants would work, and we might need to change to a different type of drug if she had side effects and couldn’t tolerate the first one that I prescribed. Supporting a patient with postpartum depression and caring for the child does indeed take a village.

I prescribed her a low-dose anti-depressant and saw her every week. I found that I didn’t even need to look at my patient to know how she was doing. Her husband’s long and solemn face told me everything I needed to know. She was still struggling to get out of bed. He took a month off work to become the primary caregiver for their infant, while keeping an eye on his wife.

We arranged for her to see a psychiatrist specializing in perinatal mood disorders. The psychiatrist agreed with me and recommended a faster increase in the dose of anti-depressant that I had prescribed. After one month, it was clear that her mood was improving, and she had started caring for her baby. When her husband smiled, I knew we were making progress.

After about a year and a half, she returned to my office. She was beautifully dressed, smiling, and excited to share that she wanted to become pregnant again. This time, we planned to actively prevent her from falling into postpartum depression. She would begin the low dose anti-depressant after giving birth. Her husband would help to ensure that she got at least a 3 ½ or 4-hour stretch of sleep at least once a night. She would see me more frequently and her husband would let me know if her mood became dark.

Thoughts of her recovery brought me hope, because the dark pit that she was in had been just as deep and black as mine.

I had finally arrived at the screen where I could type a message to my primary care physician.

Need to change anti-depressant, I wrote. Too sleepy on this one. I pushed send before proofreading or completing the sentences. Writing was tiring and my physician could figure out what I was trying to say.

It will get better, I thought. It has to.

*****************************************************************

If you would like to read other posts, here are a few:

1. How It Began. This story is the origins of my Substack and tells the story of the first moment when we learned of my husband’s breast cancer diagnosis. https://www.afterhesaidcancer.com/p/how-it-began

2. Absolute Harmony. Watching elephants in harmony with nature brings a new way of looking at my husband’s cancer. https://www.afterhesaidcancer.com/p/absolute-harmony

3. Extremes. The extremes of poverty give me perspective on my grief.

   https://www.afterhesaidcancer.com/p/extremes

4. Go Down Swinging. A boxing lesson leads to a new approach to fighting one’s demons.

   https://www.afterhesaidcancer.com/p/go-down-swinging

*********************************************************************************************************

Thank you for being one of my readers. I appreciate you very much! If you’d like to support my work you can do so by:

• Hearting this post, so that others are encouraged to read it

• Leaving a comment (I do my best to respond to each of them), which increases engagement and visibility of my posts

• Sharing this post by email or on social media

• Taking out a free or paid subscription to this Substack

• Leaving me a tip by buying me a coffee.