Dr M, pain specialist… upon meeting me for the first time, asked me how I was coping with the diagnosis of metastatic breast cancer. I told him it was difficult and upended my world. That I have been working on making my life less stressful. That I had sleepless nights to start with but sleeping better now. That I am ironically thankful that I aggressively saved for a house but hadn’t found one yet – it would be MORE stressful if I’d found my perfect bungalow and put all my savings down on it, to have a mortgage and financial pressure like I have now. That I want to be functional and work and cling to some sense of a normal life.
He puts in my record: "Adjustment disorder with mixed anxiety and depressed mood"
What the? Where do you get off on judging my reaction to this storm in my life as inappropriate? What else do you want me to do? And how can you claim a label for me when you didn’t know me pre-crisis and don’t know how astonishingly difficult this has been for an introvert and a highly-sensitive person to have to cope with as much information and extroversion overnight, like a light switch? Me, who doesn’t like western medicine’s emphasis on drugs and more drugs for the side effects of the first round? Me, who finds this whole scenario invasive and undignified and expensive and dehumanizing? Needle-phobic me?
| A question | An answer | An alternative |
| 1: Is it true? | Maybe. Perhaps he goes through a series of questions and reads body language and realizes that it has made me anxious | Perhaps perfectionist me expects that I can sidestep the adjustment period with “a deep enough keel” and he doesn’t have that assumption about me since he just met me |
| 2: Can you absolutely know that it's true? | I don’t know that he sees it as a bad thing, or that he thinks any less of me for having a disorder | Perhaps I should think more of me… and continue to be kind to myself in this adjustment period |
| 3: How do you react, what happens, when you believe that thought? | I want to rant at him and be rude, to cry and berate him for being insensitive | Perhaps all those reactions PROVE HIS POINT: one of the symptoms of the disorder is crying spells… LOL, DOH – that would be one of those “see….” Moments! |
| 4: Who would you be without the thought? | I could continue to believe he is a valuable partner in my overall care, since getting a handle on my pain levels on an ongoing basis is essential to my well-being | Willing to be kind to myself in this too… to explore what was meant by it, to continue to accept how complex this is, to give myself time (months if necessary) to embrace this new life I am living |
on the positive side, he *did* prescribe a better mix of medicines and i get an mri tomorrow to see if my neck is structurally sound... so, breathing (lol) think the alternative column interpretation is good enough for this evening.
Byron Katie would be proud! I like your alternative. Restated: What exactly is "adjustment disorder" and how can knowing about this label help me cope better and improve my situation?
ReplyDeleteNobody with your diagnosis says, "Oh cool! I'm so happy I get to spend time in clinics, and get infused with drugs, and live with pain, and get to know so many doctors and nurses and technicians whom I never would have met at any other time in my life." If there wasn't some "adjustment disorder", I think you would be really insane.
My wife has been going through her own version of adjustment disorder with the ordeal of her knee replacement. She was commenting last night about how differently this experience has been for her than she imagined it would be. Yet in all that she has experienced, she sees blessings. She has a whole new circle of friends with whom she relates in a completely different way. She spends time each week in the care center where she convalesced, visiting with the patients whom she came to know and love and who are still there. She knows how to bring comfort and hope to people who have, for the most part, been forgotten and desperately need someone to remember them and care about them. She gives them purpose, and the in process, she has found her own purpose.
May there be blessings for you in this challenge that you face. May you find purpose in something that seems so purposeless and find sense at times that seem so senseless.
I'm very confused and slightly offended when I first read his diagnosis, but inspired by your diagram! Great idea, when faced with such a conundrum; I love it! I do not wish to defend him, but will say this, coming from a medical standpoint: (first - a question - where did you see this 'diagnosis'? Usually they are a matter of medical record in the chart and patients rarely see them - not that it makes it any better, I'm just curious.) 1 - Practitioners are always 'forced' to put a 'diagnosis' or code on every medical chart note. These are often 'canned' or from a list, and quite often I cannot find one that is exactly what I would diagnose, so I choose the 'closest' or best option of what's available. So, this may have been the case. There is no way to give a diagnosis of "Normal" or "Perfectly well adjusted" in your case - because, well, there's no such thing as normal to begin with. And any person with cancer will be in some stage of grieving/mourning/etc. We are all in some stage at any given point, over any loss or challenge. So, when he says 'adjustment disorder', I'm wondering if he means "Having difficulty adjusting" as in, there are a lot of difficult adjustments you need to make (such as moving to a different state, switching jobs, etc) - rather than implying that you are somehow lacking the skills to adjust or are having a 'hard time' coping. 2 - Mixed anxiety and depression is actually considered "normal" in your case. As David said above, if you DIDN'T have some depression and/or anxiety over all this, THAT would be concerning. So, I don't think Dr. M was implying that you have a psychiatric illness as much as the fact that you are going through this process as is to be expected, given the diagnosis. Am I making any sense here? I truly am on 'your side' and not trying to defend him in any way, but am just trying to explain that, from his standpoint, the diagnosis could have meant something other than how it may sound point blank....(I'm terrible with words.) LOVE YOU!!! And, for the record, here is my diagnosis (for what it's worth):
ReplyDeletePatient is authentic. She has a perfect blend of realism and understanding of her diagnosis, mixed with a great attitude, optimism and hope for the future. Diagnosis: Awesome. :)
~Sarah