Sorry for the radio silence. I've been having Adventures in Urgent Care this week, followed by Further Adventures In Insurance Paperwork.

I have what my ED discharge papers rather phlegmatically dub "anxiety disorder NOS". This means that I'm prone to freaking out over... well, not nothing, exactly, but usually either things for which I'm not responsible, or things for which I am responsible, but have already done everything I can to fix. The "NOS" is diagnostician-speak for "not otherwise specified", and it means that I quite clearly have something, which can be described in a patient file, but I don't hit all the checkboxes required for formal panic disorder or PTSD. Basically, once I've started spazzing out over something, there is a certain point past which I cannot physically stop spazzing out over it. I don't know how other people think of it, but it seems to me to be very much like the phenomenon of "kindling" as seen in seizure disorders, where storms of abnormal brain activity will keep sparking other abnormal brain activity in a positive feedback loop. It's unpleasant, I resent having it, and I avoid annoying everyone else with it to the point where I had to explicitly set myself a rule that I will only put up with a continual state of stupid, illogical panic for about two days before I march myself off to a doctor, and that only because I can't eat or sleep.

Anxiety and panic disorders are filed with other psychiatric things in the DSM-IV-R (or the ICD, internationally), but are considered to have legitimate physical sequelae, not that this stops me from apologizing to all and sundry when I do finally schlepp to the clinic. Which is why the friendly nurse doing check-in at the ED soothingly took my history, soothingly took my vital signs, and then soothingly wandered off to find me an EKG tech, because they don't like it when they take a heart rate reading from a healthy-looking adult sitting quietly in a chair and get numbers over 140.

I hate going to doctors for this. I hate going to doctors, period. Individual doctors are often quite pleasant people, but the process of going to the doctor has never been enjoyable or easy for me, and often was somewhere between unhelpful and traumatic, especially when my mother was in any way involved. Literally the only time I can recall not having to fight with her over any medical issue was the time I mentioned acne annoyed me. I had an appointment with our GP within a couple weeks, and within a couple more, had a referral to an out-of-network dermatologist, with not a peep out of her about the inconvenience or cost.

Attempts to get treatment have been a mixed bag. There's a sharp dividing line between how I'm treated by emergency department staff and how I'm treated by non-emergency medical personnel. The ED and urgent care people listen to me when I talk; the counselors and doctors in ordinary practice generally don't. It's frustrating because I've come to the realization that it has very little to do with me, and everything to do with other patients they see, over whom I have no control at all.

I learned not to lie pretty early on, as a kid. I would love to tell you this is because I was inherently a tiny respectable upstanding toddler-citizen, but really it's because I was observant. I had noticed that by the time adults got around to asking me questions, especially questions that suggested they thought I was doing something wrong, they'd already decided what the answer was, and whatever I said was an unnecessary formality. Making shit up would have been a waste of time and energy. Much later in life it occurred to me to wonder why they do this, and I eventually concluded that it's because they expect to be lied to. (Why they expect to be lied to is a toss-up -- either they've been lied to a lot in the past and have learned from experience, or they would personally lie in that situation and they're guessing from internal standards.) They're banking on their internal lie detector being better at detecting lies than other people are at making them up. They don't care what the other person is saying, they just want them to make some kind of evaluable noises and maybe twitch a time or two. This isn't actually a very accurate way to do it, but it's the way most people think it's done, and it's the way most people work.

Non-crisis mental health people see a lot of patients who lie. People go in seeking treatment for one or two symptoms and try frantically to keep their psychiatrist from noticing the rest -- or, better yet, try frantically to keep themselves from noticing the rest, because then they might have to do something about it. Clinicians who specialize in long-term therapy are used to having to sort of hammer on people to get them to admit to what they're really thinking. Essentially, they're suspicious of their clients, because they generally have to be in order to work out what's really going on. My experience has been that, on the whole, they are not particularly good at dealing with people who just tell them things straight out -- especially when that person is also medically knowledgable, does know what's going on inside their own head, and is really fucking tired of this particular merry-go-round.

They're really not good when the patient has already tried all of their suggested interventions, has only ever found one thing that has a 100% success rate, and that thing is Xanax. I was told at one point back in Arizona that I was probably setting off alarm bells because I knew what the ED had given me, how much, what it did, and how it worked. Well, fuck me. Apparently most people will just snork down whatever a doctor hands them, and if a different doctor asks what they're taking they just say 'some little purple pills'. If any of them had talked to me for more than two minutes, they'd realize I know a significant subset of everything to that level of detail, never mind having information about random chemicals I was meant to ingest, but only the psych eval people in the ED ever did.

Sympathetic people like to tell me that I shouldn't be so put out by having an anxiety disorder, that it's not really different from diabetes, which is largely true -- diabetics don't sit there and wish their pancreas broken, and I don't sit here and will my autonomic nervous system to go haywire. The problem here isn't so much the disorder, it's the way treatment is handled. Insulin and metformin are not Scheduled drugs. If I had a prescription for one of those, I could get the physician to fax renewals to the pharmacy, and I wouldn't have to go through the traditional Suspicion-Allaying Controlled Substances Ritual Apology Dance & ID Presentation to get the pharmacist to hand it over. And, although it's certainly not a good idea to take more insulin than you need, doing so isn't considered fun, and doesn't increase the chances that it will suddenly not work anymore when you do need it sometime in the future.

Emergency and urgent-care personnel, on the other hand -- well, they do get lied to about drugs a lot, I'm sure, but if you turn up with psych issues they figure you want help with your psych issues, and they're a lot more inclined to assume that if you're suicidal or want to be checked in, you'll say 'yes' to one or both of these things when they ask. If you say 'no' and are otherwise lucid, they don't stare at you suspiciously and pester you about it. I don't walk in and go OH GOD DRUGS PLEASE, but I do tell them the truth about what other doctors have done in the past, and so far every single one of them has ended with, "So, I'm thinking we'll give you some Xanax," because quick-onset PRN treatment of the physiological symptoms of acute disabling anxiety is what benzodiazepines are fucking for, and is exactly why they are still in the pharmacopaeia.

In any event, I've been Doing Grown-Up Things this week, most of them involving taking the train downtown to go sit and play more Ace Attorney games in a blandly-furnished waiting room until my name is called. This means A) my weekly batch of mail has been delayed, because God forbid the USPS be open at any point past normal business hours, and B) I have a lot of things in the queue waiting to be posted that I will get to finishing tonight or tomorrow.


  1. I hope things improve for you soon?

    1. They've already improved. Unlike in Arizona, when you turn up for medical treatment in Massachusetts, they prefer to hammer out the payment details while giving it to you. New Englanders consider it rather gauche to let other citizens languish in the streets. This might have something to do with maturity. The hospital I elected to present myself to has been a working institution for over a hundred years longer than Arizona has been an actual state.

      It's getting sorted. In the meantime people have been scheduling me follow-ups and handing me prescriptions and references under the assumption that everything will work out. Given how cordial they've been to me and how organized they are, it almost certainly will.


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