Monday, April 30, 2007

Little Miss Meltdown

So the salient topic du jour over in my favorite corner of the cancer blogosphere this week is emotional meltdowns.

Raise your hand if it comes as a complete surprise to you that an otherwise sane, rational, intelligent cancer patient might occasionally lose it, might experience a sudden deflation or explosive detonation of her normal healthy coping mechanisms, launching her into a dramatic meltdown.

Hmm. Ok, the rest of us will wait here while those of you with your hands flailing around in the air like insane sea anemones stop smoking crack and take a big fat hit on the clue bong instead. When you're all ready, come on over: it's consciousness raising day here at the Ranch o' Defeated Tumors! Breaking news: Meltdowns happen!

As regular readers know, I am most definitely Not A Trouper. In fact, I am the official 2006-2007 poster child for the militant wing of the Do It To Julia! Do It To Julia, Not Me! Brigade. To the dismay of friends, family, medical personnel, and innocent bystanders, I am prone to occasional meltdowns.

So what exactly is a meltdown, you ask, and what are its triggers? Well, let's take a look at three random but typical examples from my very own extensive repertoire.

  1. Meltdown A: The day after I was diagnosed with aggressive stage IV lymphoma, the man I was in love with and engaged to marry went out dancing, without me, while I sat home alone reeling with terror and shock. He also decided this was as good a time as any to vent his feelings about every little thing I had ever done to irritate him, so he emailed me a long laundry list of my most annoying faults. We lived 90 miles apart, and the next day he sent me another cold aloof email saying he wouldn't have time to come visit me because he had tickets to a football game and he had agreed to help a friend move; surely, he insisted, I would understand.

    Oh hell yeah, I understood all right. I understood that just about everything and everybody on earth was more appealing to him that day than me and my newly diagnosed cancer. The emotional pain of this abrupt rejection and the loss of support from the one person I had been relying on most was too overwhelming to bear, and I had a complete and total meltdown that consisted of sobbing nonstop, obliterating my former blog, and refusing to speak to anyone for 48 hours.

  2. Meltdowns B-1, B-2, & B-3 all occurred in a single day, so I'm lumping them together here as one. Six days after my first chemo treatment, I came down with the most horribly intense migraine I have ever experienced. This was probably caused by low blood counts, or maybe by coming off of five days of Prednisone. But whatever, the blinding pounding stabbing eyeball-searing pain was so severe it was making me vomit, and neither Hydrocodone nor Phenergan offered any relief. To make matters worse, I had a routine appointment at the oncology clinic that morning, which entailed a four hour wait. Stressed to the max, I spent those four hours moaning in fetal position, packed into in a freezing cold waiting room full of coughing sniffling infectious sick people.

    When the oncology resident finally saw me, she decided that my heartbeat sounded hinky and I needed an echocardiogram. This meant I would have another four hour wait. I experienced meltdown B-1 at that moment, bursting into tears in the exam room, tearing my hair out (literally!) and screaming that NO NO NO, I would NOT wait four more hours, I was sick and I HAD to go home NOW. Somehow the poor panicked resident arranged to schedule an immediate emergency echo, and I was escorted to the cardiology department by two brusque burly nurses to prevent me from escaping Against Medical Advice. Because there was already a sticker on my chart announcing that I have a record of acting AMA.

    Anyway, the two young cardiography techs who performed the test resented that this emergency appointment was delaying their lunch hour, and they complained loudly right in front of me, grumbling about me as if I wasn't even there. "I'm starving!" said one of them to her co-worker. "Would you rather get pizza or a burrito?" She then ground the transducer right into the tender incision where a chemo port had recently been implanted in my chest wall. "Ow ow ow, that hurts!" I wailed, straining not to vomit. "Hold still," she admonished, shoving me back onto the table and still grinding away. The colleague replied, "I dunno, I feel like a burrito, but they'll be sold out if we don't hurry. I don't see why we have to do this echo on her in such a big hurry, since she just had one a month ago." "Yeah," said the other woman. "Hey look, is this kind of enlarged? Do you think we should call Dr. X?" Colleague: "Nah, don't bother, it looks ok. Let's wrap it up. What do you think about those fish tacos they had last week?" And to me: "Just wipe the lube off with your shirt." Meltdown B-2 happened at that point, and consisted of 3 hours spent weeping silent tears of bitter despair accompanied by a complete inability to speak.

    By the time I got home, the migraine was so bad I was vomiting nonstop, and I was also starting to have severe chest pains (which I later learned were probably from the mediastinal tumor disintegrating). I was curled up on the bed wishing I was dead when the phone rang. It was the hospital calling to say that my blood tests from that morning had come back alarmingly low: my neutrophil count was a terrifying 0.04 (the normal range is 1.5 to 8.0). I was in grave danger of dying of infection within 24 hours, they said, instructing me to rush back down to the emergency room at Our Lady of the Damned STAT.

    After spending 45 minutes filling out duplicate forms in a filthy crowded ER triage room full of more sick coughing infectious people, the nurse on duty decided that since I was neutropenic I should be waiting to see a doctor in isolation. He plopped me in a wheelchair and shoved me into a tiny windowless 6' x 6' cinderblock cell containing nothing except a fan for ventilation, a harsh flickering fluorescent light that was aggravating the migraine exponentially, and a wastebasket that was overflowing with used tissues and a bloody kotex. He locked the door and left me there for over an hour. Ok now, wait, wait, wait: can you see it coming? Yes! Yes, you can! Here it comes, right on schedule, meltdown number B-3! And what did it look like? No, don't even ask.

  3. Meltdown C: Ok, this one was a doozy. It was the day before Thanksgiving, and two days before my birthday, and I wasn't going to be able to celebrate either. I had just walked in the kitchen door, home from my third chemo treatment, and I was already starting to feel the ground slip out from under me as I descended into that hell known around here as The Big Ick. I had barely taken off my hat when the front doorbell rang. I opened the door and there stood a large menacing sheriff's deputy, serving me papers to inform me that one of my creditors was suing me.

    I was sick, I was weak, I was scared, I was alone, I was broke, the debts were mounting, the chemo was kicking my ass real bad, and when that frickin asshole deputy recoiled in disgust at the sight of my shiny bald head for a second before handing me the papers, I totally lost it. At least I managed to stagger back into the kitchen before I collapsed. I spent the next two hours huddled in a ball on the cold hard floor in a corner of the kitchen, clutching the papers and drooling, my teeth chattering violently as I teetered on and off the brink of clinical catatonia.


I'll tell you the truth: these meltdowns are painfully embarrassing. Even talking about them now, months later when I'm ostensibly sane again, is embarrassing. It's horrible and mortifying to be publicly overwhelmed and lose control. And it's difficult for the onlookers as well: people generally just don't know what to do, and the onslaught of unbearable emotion makes them extremely uncomfortable. I lost a few friends who just couldn't take the fallout from my inevitable meltdowns.

Sometimes people try to help, but their efforts to stop the deafening roar of misery end up creating distance and alienating the meltee. For example: "You should see a therapist," a concerned loved-one might advise. Or, "You should get a stronger prescription for antidepressants. You should take up meditation, or yoga, or pray louder." There are several problems with this approach.

For one thing, giving advice always puts the giver in a one-up position, as the wise one who Knows The Answer. It simultaneously puts the givee in a one-down position, as the dumb ignoramus who never thought of the obvious. When I was feeling lonely and adrift, this split always made me feel even lonelier, and it pissed me off as well. Also, this kind of advice pinpoints the problem squarely inside of me, rather than in the world outside. It says that I am the problem, I am the defective one, I am the one failing, I am the one who is not coping properly, who is broken and needs to be fixed. Whether there's any truth to it or not, I just never found this implication to be at all helpful or comforting in times of dire distress.

Another common response to a meltdown was for a concerned onlooker to try to silence my uproar (or end my silence) by trying to rope me into denial, minimizing the problem. "Oh, it's probably nothing!" they might chirp gaily, gazing past the swollen lymph nodes that had ballooned up overnight to the size of hens' eggs. Or, "A 104 degree fever's not so high! Six weeks isn't such a long time to wait for treatment! That enormous needle they're about to stab straight into your bone could be a lot longer! You're going to be fine, you've just got to quit being so negative."

I've bitched about the whole bootstraps-happyface attitude thing repeatedly, but let me sum it up here by saying this: It's tantamount to an American sitting in a nice safe suburban living room offering glib advice to somebody who's screaming and cowering in burning exploding Baghdad basement. "Don't you think you're overreacting just a bit?" the glib American says. "Sure, another bomb could fall on you any minute, or armed soldiers could rush in there in a blast of gunfire and wipe out your entire family. But you know what, a meteorite could also fall on me any minute, and I could die too. But you don't hear me screaming, do you? You just can't spend your whole life being upset and freaked out! Now get out there and enjoy every minute you have left with a positive attitude, and stop subjecting us to these annoying meltdowns."

Can you imagine how helpful this would be? Think about it. Sometimes a meltdown is the only sane response to a situation, and maybe just maybe, awful as it is, it deserves a little respect.

25 Comments:

Blogger Yankee T said...

I wish I had something to offer in the meltdown retrospective. Some word that would be right, some "fuck 'em all" that would help.
I love your writing.

6:11 PM  
Blogger Jeanne said...

Liz--this is so wonderful. So sad, bad, mad, wonderful. I'm sitting over here in Seattle (channeling Dr. Seuss, one of my all-time favorite writers) sniveling for how awful you felt when you were in the middle of these meltdowns, and so angry at the uncaring people who helped put you there.

I've added a link from my blog, so now we have all sorts of links going around in circles. The other women haven't weighed in yet, as far as I know.

http://www.assertivepatient.com/2007/04/cancer_bloggers.html

Jeanne

6:35 PM  
Blogger BunnyBubblette said...

Amen!

9:22 PM  
Blogger StyleyGeek said...

I totally get that offering advice or minimising the other person's problems are BAD ways to respond to meltdowns. So, as the daughter of someone who has just been diagnosed with cancer and who has just had her first (of, I suspect, many, completely justifiable) meltdowns, I have to ask: what IS a helpful way to respond? What do you wish people around you had said and done?

10:06 PM  
Blogger UrbanCowgirl said...

This is a brilliant post. Reading your blog is like a breath of truth amidst the stale aroma of false 'positivity' about life-threatening illness. The situations you describe defy imagination.

As someone who has watched a very good friend suffer life-threatening anorexia (meltdowns very definitely included), I found it quite difficult to know what to do. But I did resolve almost instantly that sentences beginning with 'You should' were a very bad idea.

I hope what I did was the right thing: I provided a shoulder to cry on, I talked less and listened more, and I made it clear that if she needed me, I'd be there. I think that's the only thing you can do, sometimes. What else can you say without sounding like a trite moron?

10:34 PM  
Blogger Christina Shaver said...

YAY!!!! THANK YOU for putting into words what I can't. Granted, our situations are very different -- mine not on the verge of life and death -- but I still can't stand it when people try to shut me up/make me feel better when I have major reactions to my hyper aggressive little hell raiser.

My favorite is when people espouse the "think about how lucky you are" response. "It could be worse." I'm all like, yeah, could be. I could be held captive and tortured by terrorists in the Middle East somewhere, but that's not the reality I'm dealing with here, folks.

Anyway, now I'm going on about me and this is about you. Back to you: I am pasting your post to my desk.

11:18 PM  
Blogger Jeanne said...

Liz--I just read this AGAIN. And I want an AMA sticker! I think we should get them and wear them as badges of honor. (I just fired my doctor today. Feels good.)

To Styleygeek--I'm happy to help you with this one if you like (so glad you asked). The first thing is let your mom cry and rage and scream and say whatever she has to say. Just be there. Don't try to make it better. Just be there. You can say really simple things that repeat her language, like if she says, "It sucks!", you can repeat that back to her.

Then, ask her what she needs. And then give it to her. If she wants to go to bed and eat cheerios, dish up the cheerios.

Don't make her feel bad for having meltdowns. They are part of having cancer. She will have more. Accept it and be supportive without ever minimizing what she is feeling.

That's my best advice. If you want to continue the conversation you can e-mail me at
jeanne.sather at gmail.com

Take care, this is tough,

Jeanne
The Assertive Cancer Patient
www.assertivepatient.com

11:20 PM  
Blogger Courtney said...

I'm so sorry to hear about the horrors that caused your meltdowns. It's totally true that melting down is sometimes the only right answer.

You've perfectly nailed the problems with advice; I've been trying for a long time to articulate those things and failing. I'd like to link to this post, if I may, as list of things emotionally competent people should understand.

1:19 AM  
Blogger Rachel said...

Dang, I almost had a meltdown reading these! What horrid situations even without feeling like crap, and then being ill on top of that...well, this makes me think that a machine gun should be issued upon diagnosis so's you can keep the idjits in line.

I've gotten thanked a few times for saying "damn, that sucks" upon hearing of Bad Things like cancer dx's. Seems simple and obvious, but I guess a lot of people prefer to try to be falsely optimistic (or pretend that the afflicted person is invisible). (Not that I should get a gold star or anything: I'm doing all my support remotely since I'm both squeamish and inarticulate in person. No one knows you're a wimp on the internet.)

10:28 AM  
Blogger H said...

Thanks for sharing this. Really. I am always happy to read the realities of living that you set forth on this blog. Screw rose colored glasses.

We'd all be in a better place if we had more realistic expectations about how this life works and the manner in which ALL of us go about getting through it. I don't trust or really like people who go through life with a smile tattooed on their faces.

http://www.undertheglassbell.com

2:15 PM  
Blogger saraarts said...

He locked you in that room for over an hour?

Oh, my. Oh, oh, my.

Pig bastard.

3:40 PM  
Blogger patrizia said...

Well said.

If you don't mind me presuming upon an admittedly slight Real World acquaintance here...

I think the thing about your meltdowns in particular, is that you are so self-contained and together the majority of the time. I think it scares people to see you other ways. --Patrizia

3:48 PM  
Blogger Carrie said...

Bravo! Excellent post.

For what it's worth, if your experiences aren't worthy of meltdowns, then I don't know what the hell is!

10:32 PM  
Blogger The Cat Herder said...

Those meltdowns sound entirely appropriate IMO.

Consider yourself hugged from the wilds of Berkeley.

11:02 PM  
Blogger Citygrrrrl said...

actually, what kept going through my mind as i read all this was torture.

the nytimes had an article on the existance of "chemo brain fog" now they need to run an article on post traumatic stress disorder for cancer survivors.

if it were me in your shoes, i would have responded the exact same way as my sister and i were raised to be very stoic. but it makes my heart hurt.

by the way, you look fabulous as a blonde.

7:40 AM  
Blogger Carla said...

Blown away! What is amazing to me is not that you had the meltdowns, but that in each situation you waited as long as you did before having them. Thanks for telling it the way it is, much more helpful than the sunshine and rainbows crowd.

8:32 AM  
Blogger big mama said...

Oh, Liz, I am sorry that you had these experiences. It is always amazing to me that when we're truly suffering, others will come along to smugly make us feel oh so much worse.

Thank you for the reminder that people - whether in the midst of cancer, a divorce, or a parenting or any other crisis - just need honest listening, not advice. I think in this culture we are raised to tackle problems head on, but in this approach there is very little room for standing in relation to another human being. So we treat the person as the problem, and we don't even see how completely wrong that is.

I'm glad you shared your meltdowns. Frankly, it isn't you who should be embarrassed by your meltdowns.

9:24 AM  
Blogger JoannaO said...

Dear Liz,
It makes my heart sore to read about pain you were in.When people's unkindness or thoughtlessness compounds our pain and fear, a meltdown may be a healthy reaction: letting it out rather than stuffing it in. I know how it feels (not the cancer part, but the meltdown part--a reaction to diagnosis of chronic illness and its symptoms). The thing that people did for me that was most helpful at the time was not to try to help, or minimize, or judge, but to just listen or give me a hug: to be witness to my pain and acknowledge that is was real. That's not too much to ask, but it's so hard to find. From those experiences, I've tried to remember, when I see someone else in distress, to try to simply to acknowledge that they are going through a hard time.

9:46 AM  
Blogger fine said...

This comment has been removed by the author.

12:58 PM  
Blogger Allegra said...

Hi Liz,

As the survivor of both ovarian and breast cancer and very familiar with meltdowns, with an ex who left on a fun fishing trip to Alaska the day after I had the hysterectomy, while leaving me alone at home in a new state with no friends or foes to come to help or hurt, nor to bring a glass a water if I needed one, I guess I understand your feelings a bit about your ex.

As for what to say or offer to anyone going through one? An ear and a hug or more. Listen and say nothing, holding hands can help much more than any advice ever could.

And for the so called "helpers" at the Hospital, people like them have a special place in Hell, first row center to relive what they made you go through. You can quote me.

Allegra

1:29 PM  
Blogger RC said...

I am deeply touched by your words. What a beautiful writer you are! (Your writings are beautiful, too, duhhh...)
I am reminded that it is in the sufferings of life that great art is sometimes born. Only in that compressing cauldron of pain can the spirit seek an outlet of expression that clarifies for onlookers the extraordinary beauty of the honesty of that spirit. Stripped naked of pretence it is the absolute pureness of the being as human.
Thank you for your words.
Thank you for sharing your suffering so eloquently.
Thank you.

2:11 PM  
Blogger Liz said...

i so agree. meltdowns are embarrassing. but yeah sometimes they are the sane response.

i wish i could transmit the proper response to your meltdowns by traveling in time and doing... It. whatever it would be. one, slapping those fuckers in the ER. two, putting you to bed and feeding you tea or hot whiskey and administering foot massages. Both would be proper responses to meltdowns. space for grief and rage. and basic comfort.

;-) and <3

- badgerbag

4:09 AM  
Blogger belledame222 said...

poster child for the militant wing of the Do It To Julia! Do It To Julia, Not Me! Brigade.

heh. right there with you, i'm afraid; and yet, you know what? i admire the hell out of you. always have done. for your honesty.

and fuckmehell, i've "melted down" for far FAR less; if i'd had encounters like you did at the public hospital, (entitled little snot that i am...)--i dunno, i'd probably be on the Evening News. that shit is so fucking appalling, and say, where the fuck is Michael Moore with that movie about our abysmal health care system he was supposed to be making? because i think he should be interviewing -you.-

as per ex-fiance: Not Helpful, no doubt, but i gotta say it:

You Betta Off.

what an epic dickhead douchebag.

SRSLY.

12:18 PM  
Blogger bint alshamsa said...

Liz, darling, I love you to pieces! It's often hard for me to post here because I take what happens with you so personally. I can really relate to this. I think all of us with cancer are entitled to a few meltdowns every now and then.

4:29 PM  
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11:22 AM  

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