Do I want to keep up?

Today, I went hiking with a group of students from my university, I didn’t know anyone else there. For the first two miles, I trudged along, following those in front of me. I was tired, I hadn’t eaten lunch, I wasn’t feeling great, and I didn’t really want to be there. It wasn’t a scenic or particularly interesting hike. I was kind of frustrated- the people in front of me were all friends and weren’t being welcoming to me, and I was annoyed that I was there. But I knew that we still had two more miles to walk, and I realized that I didn’t want to spend them frustrated.

            When we crossed yet another puddle, hopping between stones to avoid getting our boots wet, I found myself rushing ahead to keep up with the people in front of me. I didn’t want to get behind, I didn’t want them to think I was a slow hiker. But then I turned around and I saw the girl behind me. She was wearing sneakers, not boots, and she was much more careful about each step over the puddle. Once she got through it, I turned forward again and kept walking, eager to catch the group.

            But then I paused and thought about it. Did I really want to spend the next two miles trying to prove to the people in front of me that I could keep up? What if, instead, I turned to the person behind me and got to know her? Maybe she would be super interesting, and a new friend, but if not, at least I could stay with her when we crossed more puddles so she wouldn’t feel behind and alone.

            I ended up turning around, and getting to know the girl behind me. She was so nice, and I really appreciated hearing about her work and learning about other cool places she’s been. Instead of staying stuck in my head, I found myself laughing, smiling, connecting. Most likely, I won’t see her again. We work in different places, I didn’t get her phone number or even her last name. But that was never the point. Instead of just trying to keep up, I made an effort to connect with the people around me and support someone else when they were struggling.

            Honestly, I hope that I can do this more often in my life. It went from feeling like a complete waste of time to being one of the best parts of my week. Too often, I feel overwhelmed, I feel lonely, I feel like I can’t keep up with what I’m supposed to be doing. I hope that the next time I feel like that, instead of fighting to keep going, I hope that I pause and use it as an opportunity to connect with the people around me, especially those who might also be struggling. 

View from this hike

How I'm Preparing for an Appointment With A New Doctor

             I have white coat syndrome, so I get extremely anxious at doctor’s appointments. Often, this causes me to be completely silent or barely answer their questions, so I leave the appointment with no answers and even more frustrated with doctors.

            After moving to a new state, I’ve had a lot of appointments with new doctors. Most of them have not gone well, even though I prepared. Especially on days when I don’t feel well, it’s hard for me to talk to doctors, even if I’ve already outlined what I need to say to them.

            This time, I decided to go a step further. It was with a specialist who is known for treating one of my conditions, and I wanted to be prepared since I had waited months for the appointment. Instead of just writing notes about what to say on my phone, I would type up and print out notes for the doctor. This way, I can bring them to the appointment and read them, or if I am having trouble I can always give the doctor the paper.

            A few tips if you’re doing this:

·       Make sure it’s short. Doctors often have less than 15 minutes per appointment (often including time to make notes), so if you hand them a long piece of paper they won’t read it.

·       Use bullet points to keep it shorter and to emphasize the key points

·       Start with the most important concerns at the top

·       Use details, especially when describing how symptoms are interfering with your life.

·       Formatting matters- bold section titles, have a header with your name, the date, and your date of birth.

The template that I used for my appointment was:

1)    Letter- a short, one paragraph letter addressed to the doctor explaining that I have a lot of anxiety about doctors appointments and that I sometimes have trouble articulating my needs. I also listed my top 2 goals for the appointment and three questions I had for him.
2)    Bullet point list with seven sections to quickly summarize relevant health information. (See below)
3)    Reports from previous tests I’d had. These are copies from previous doctors of the full reports, included so they can be added to my file at this office.

My goal was to just hand him the bullet point list, but I also wrote the letter to have in case I had trouble explaining my reasons for writing a list. I wanted to make it clear that I wasn’t trying to waste his time, but that I was trying to use it as a way to get the most out of the appointment, even if I had trouble talking. I also included the reports from previous tests, and would give them to him if he asked for them.

The sections I included to summarize the relevant health information were:

1. Medical History relevant to current specialist- I included major diagnoses and date diagnosed, as well as notes about treatments I tried and if they were helpful
2. Current medications/supplements- include everything, even if it’s not prescription. Also record the dose and when you take it, or if you take it only as needed. It’s really important that this list is accurate so that if the doctor wants to prescribe something new, they can check that it doesn’t interfere with things you’re already taking.
3. Family relevant medical history- I have multiple family members with related conditions, so I included short notes listing those conditions so that the doctor is aware (since it changes some recommended ages for tests)
4. Symptoms- I listed each major symptom, started with the most problematic. For each symptom (a bullet point), I also included notes about how long it’s lasted, how much it interferes with my daily life, how frequently it’s a problem, how long it lasts, and anything I’ve noticed that helps or makes it worse.
5. Recent Relevant Tests- since I’ve moved around a lot, this doctor won’t have access to any of my previous medical records. I listed the tests ordered and any major results. At the end of the document, I attached the printed reports from the relevant tests so the doctor could read them if they wanted to see the full report. For this section, though, I made sure to just keep it a simple list so they could see what had already been done
6. Things I’ve tried- short list of treatments I had tried, what condition they were prescribed for, and how they worked.
7. Diet/Lifestyle- I briefly noted the foods I can not eat, as well as how often I exercise and what that looks like.

I hope this article is helpful for you. Most of the lists I found on the internet simply recommend ‘writing out your main concerns’, but I usually find that isn’t detailed enough to help a doctor. Hopefully, by reading this list, you can come up with a method that works well for you. 

What Happened When I Got Help for Depression in Graduate School

             I’ve struggled with my mental health in the past, but never to the sudden severity that I have over the last two months. Earlier this year, I moved to a new city and started a new graduate school program. But over the last few months, I’ve noticed myself becoming increasingly depressed, and recently was alarmed by some of the thoughts I was experiencing.

            Even though I was aware of the resources around me, I didn’t know how to get help. I didn’t want to talk to any of my friends or other people in the program about it. I didn’t even want to tell my family, because I didn’t want them to worry about me. It felt like too much effort to go to the counseling center, and I didn’t want to deal with answering a million questions.

            Even though I really didn’t want to talk about my symptoms, and was afraid of being known as ‘the person with depression’, there was a part of me that did want to talk about it. Everyday when my officemate asked how I was, there was a part of me that wanted to be honest. I even found myself a few times imagining what would happen if I told my advisor, since I knew he would be supportive.

            But as the symptoms got more severe and started to interfere with my everyday life and ability to do my work, I realized I needed to get help. I wanted to share the steps I did (and what happened when I did them) in case they’re helpful to other people.

            First, I went to the Health Center at my University. I also considered calling the Counseling Center, which directly addresses mental health. However, I decided to go to the Health Center for two reasons: I was concerned that there might be a physical component of the depression and wanted bloodwork done, and because I could schedule an appointment online which seemed easier than calling.

            When I went to the Health Center, they were very helpful and understanding. First, the nurse asked a lot of questions and made me do a standard depression assessment survey. Then, the doctor came in and asked more questions. She ordered the bloodwork that I wanted, but also told me that they were concerned and needed me to talk to people at the Counseling Center. So during the appointment, they had me talk to the Counseling Center (they also talked to them and shared their assessment and the answers from the assessment), and the counseling center scheduled an appointment for me later that day. Overall, I really appreciated the doctor that I saw. I felt like my concerns were taken seriously and that they were willing to explore different approaches.

            The Counseling Center appointment was also helpful. The Counseling Center at my university doesn’t do long-term individual counseling due to a lack of staff, so their primary role is to refer you to the appropriate services. They put me on the waiting list to see the psychiatrist on campus, and referred me to a list of local providers I could contact. We also discussed other things I could do in the meantime to support my mental health- prioritizing exercise, time outside, and spending time with friends.

            Overall, I was impressed with the response of the university. Previously, when I’d talked to doctors about depression, I found that they either dismissed my concerns or refused to help me. In all of these interactions, I felt listened to and that my concerns were being taken seriously. I also didn’t feel like I was forced into anything that I didn’t want, and I felt like I had options in next steps. The counselor I saw also followed up with me several times over the next few weeks to make sure that I was following up on the steps that we’d discussed.

            None of these steps solved my depression, but I didn’t expect them to. They did, however, help me take concrete steps to address the depression that I wasn’t capable of taking on my own at the time.

View from a recent hike 

The Question that Helps Me Make Decisions With Depression

             I recently did an intake session with a new therapist. Actually, two intake sessions a week apart because at the first one I responded “I don’t know” to every single question. I was overwhelmed and didn’t feel capable of answering. Luckily, she recognized that and we did the intake again the following week.

            That time, even though I still struggled to answer most of the questions, she asked me a question that’s been helpful ever since. When I responded “I don’t know,” many times, she decided she needed an answer to one of the questions. She said, “What would the answer be if you did know?”

            In the moment, I was frustrated by the question. I knew she was just asking the same question, hoping to make me actually think a little bit and answer. (I didn’t. I feel bad about it, I appreciate that she was trying to help, but I couldn’t.)

            But looking back now, I’m so grateful for the question, and I’ve used it myself since. I’ve been struggling to come up with some projects for work because my boss wants me to be “excited” by them. Which I find comical, the idea that I would be excited about work, when I haven’t felt excited about anything from my depression. But he doesn’t know that. This week, when I sat down to work on them, instead of asking myself what I found exciting, or even what might be interesting, I said to myself, “What if it was interesting? What would it look like then?” That way, instead of just having the annoying thoughts “I don’t care,” I could get my brain to actually think about the question. Maybe I didn’t find it interesting, but I could certainly brainstorm some questions that could be interesting.

            I’ve also found it helpful in getting myself to do tasks around my apartment. Sometimes, with depression, everything feels overwhelming and I don’t know where to start. Something like cleaning the kitchen just feels like too much, so I end up sitting on the floor not doing it. The other day, I was washing the dishes, and I really didn’t want to do it. I couldn’t get out of the mindset of “this is stupid. I don’t want to.” So I asked myself, “What if it was done? What if you had a clean kitchen?”

            I also have struggled with low appetite with depression, and find it hard to get myself to eat. I’ve been letting myself eat whatever’s easiest to make, but yesterday when I drove back from the grocery store I thought about how ‘unhealthy’ the food was that I’d been eating- I knew that it wasn’t food that would make me feel my best. I asked myself, “What would it look like if I ate like I wanted to eat? And if I ate like I cared about my body?” Just by asking those two questions, I realized that I needed more fruits and vegetables.

            This question certainly won’t solve everything. But it can be a good reminder that thoughts are just thoughts, and they aren’t always true. It can help me find answers that I know I know, I just can’t see right now under the depression.

The Hope in the Unknown

            It’s natural for people to think about the future. To wonder what will happen. To worry about it. When making decisions, we try to predict the future. We think about things that have happened in the past. We imagine what it would be like if that happened now. We imagine how it would feel. It can feel impossible to make a decision when you don’t know everything. It often seems like if only you knew what would happen, it would be so much easier.

            But I am so grateful that we don’t know what will happen in the future. It means life can surprise us. And sometimes, those surprises are truly awful. But sometimes, they are incredible, better than we could have ever imagined.

            I would’ve made most of the hardest decisions in my life differently if I’d known what would happen. I would’ve chosen the safer option, the one I thought would help me avoid pain.

            If I had known how sick I’d get in college, I never would’ve gone to school four hours away from my family. Two years later when I had to decide if I wanted to move across the country for graduate school, I was again worried about my health. But I chose to believe it could be okay, because by that time, it was. If I had known that I’d get sick again, I don’t think there’s any way I could’ve chosen to come to school anyway.

            It has been psychologically proven that people will do more to avoid being in pain than they will to pursue pleasure. And I know that’s exactly what I do. I am sure that if I knew how sick I’d get in graduate school, I wouldn’t have come. If I’d known how difficult it would be to get good medical care here, I wouldn’t have come. And yes, it’s been terrible. There have been hours, days, and weeks where I’ve wondered how I’ll survive. I’ve considered dropping out more than a few times-even though I love the program, sometimes I think I’m too sick to do it. If I knew how painful some of these times would be, I never would have been able to choose it.

            But I’m so glad I did. Because I came to graduate school here, I’ve gotten to work my dream job. I’ve gotten work in a whole new industry that didn’t exist where I’m from, alongside colleagues who are passionate about their work. And I’ve had fun: I’ve made incredible friends. I’ve gone on adventures to explore this new state. I’ve even seen the Northern Lights, one of my lifelong goals.

A first glimpse of the Northern Lights

            There’s a Nelson Mandela quote, “May your choices reflect your hopes, not your fears.” To me, that quote is everything. When we’re concerned about our pain, it’s so easy to be controlled by our fears. And sometimes, that is necessary. There are often things we legitimately can not do because we’re sick. But it can also be so easy to listen to that voice of fear when we don’t need to.

            I think one of the most incredible gifts we’re given as a species is that we don’t know what will happen next. We can worry about it, we can imagine different situations. But we don’t know until it happens. And while that can seem scary, I think it makes us incredibly lucky because it gives us the chance to choose hope instead of avoiding pain.

            The next time you’re trying to make a decision and find yourself wishing that you knew what would happen, try pausing. Remind yourself that you’ll never know what will happen. You could imagine a million scenarios and they could all be wrong. Instead, try to notice which choice you’re tempted to make to avoid pain, and which choice follows your hopes.

A Small Reminder that Keeps Me Going

Months ago, when I was complaining about how some of my symptoms were making it impossible for me to do my school work, my therapist reminded me, “This is only one moment.” At the time, I didn’t really get it.

            This week, that quote has been everything. When my symptoms get worse, it can be easy to panic. When I feel like I can’t eat, or I’m too sick to do anything, it can be really scary. I worry that I won’t be able to eat again. That I’ll just get sicker if I can’t eat. And in those moments, it often feels like those problems will last forever.

            When I have to lie in bed because I’m too sick to do my work, it’s easy for my thoughts to spiral. How will I ever finish this presentation if I’m too sick? How will I give this presentation? How will I ever do school work again? Will I need to drop out of school? But how can I even have a career? In those moments, it’s so easy to feel broken. It’s easy to feel incapable of doing anything, because often, I am.

            But what’s important is that I probably won’t feel that way forever. Maybe in that moment, my pain feels unimaginable, but it won’t feel that way forever. There may be times in the future that it will get worse, but there will also be times it will get better.

            This week has been a challenge for two reasons: my symptoms have been worse and I’ve been struggling to schedule doctors appointments. When my symptoms are so bad, it can be terrifying to imagine that I’d have to put up with them for even a few more hours.

            In the middle of that, when I called to schedule an appointment, I was told I could see the doctor in four months. Four months. I cried. I broke down completely. I had forced myself to call because I knew that I needed help. And yet, in that moment, it became clear that I wouldn’t get that help. At least not from that person.

Looking ahead at a calendar, dreading waiting months for an appointment

            In that moment, I absolutely did lose hope. I couldn’t imagine how I could possibly survive the next four months. I couldn’t even imagine surviving the next week. I couldn’t believe that I would still be alive four months from now if I were still dealing with these symptoms. I knew I would have to quit my job, that I would have to move away from my friends.

            But luckily, after I was able to calm down, I could remind myself that “this is only one moment.” Yes, I felt so crappy and incapable of anything that day. But there had been other days since getting sick that I was able to go to work, that I could eat food, that I could see friends. Most likely, in the future, I would be able to do those things again. And if I couldn’t, maybe something else would change.

            I still knew there was no way I could wait four months for an appointment. But I also knew that even if I didn’t have the energy to find another plan that day, maybe in the future I would. I knew that maybe another day, it would be possible to contact other doctors. I knew that even if the problem couldn’t be solved immediately, that didn’t mean it would last forever.

            Living with chronic illness can be hard. Symptoms are unpredictable, you never know how long they’ll last. And some you know will last forever. But we don’t know everything. We have to believe that it will get better. That even when it feels impossible to keep going, “this is only one moment.”

           

You Don't Have to Disclose Your Illness at Work

            For the past year and a half since I started graduate school, I’ve debated disclosing my chronic illnesses to my advisor. When I interviewed, I explained that I’d had a chronic illness in the past (since we discussed my leave of absence from college), but I didn’t say anything about current conditions. I planned to do it when I started the program, but then I started virtually so I told myself I’d do it when I met him in person. And once we met in person, I wanted to wait until the field season had started because I wanted him to see me as a person before he learned about my illnesses. I realize that this is a major privilege of having my invisible illnesses, that I can choose if/when to discuss them.

            Then, a few months ago, I started to become really sick again in a way that frequently interfered with my work. I stopped going to classes in person (luckily they all had a virtual option), and I found myself canceling meetings frequently and falling behind on work. When it first started, I assumed it was a virus or temporary illness, so I didn’t even consider telling my boss anything besides the fact that I “was sick”.

            However, after a few weeks I started to recognize symptoms that I’d had with previous illnesses, and some symptoms weren’t going away. I still don’t know what’s causing them, but at this point it’s most likely a combination of chronic illnesses I’ve dealt with before and possibly new conditions.

            During the summer, instead of taking classes I work full-time as a research assistant to my advisor. The first few weeks of this summer were hard- I found myself struggling through every work day, still calling in sick several days a week, and too sick to do anything on the weekends. Every time I told him that I was too sick to work I debated if I should tell him anything else or talk with him more about what was going on.

            I spent hours reading articles on The Mighty, blogs, and other websites about discussing chronic illnesses with your boss. Every article had a different suggestion: some said never ever disclose your diagnosis with your boss, and only talk generally about it when you need accommodations. Others advised being up front about your diagnosis and how it could affect your work in the future. Out of everything I read, there seemed to be two conclusions: 1) it depends on you, the specifics of your medical and work situations, and your relationship with your boss and 2) you legally don’t have to disclose anything, so you should only do it if you’re comfortable with it.

            Eventually, I decided that I would tell him some of what was going on, as an explanation for why I’ve missed so much work and to ask for more flexible hours in the future. I didn’t particularly care if he knew about my medical conditions, but it did feel sort of strange because he doesn’t know much about my personal life.

            The next day, when our plans for the day got cancelled, I asked if I could meet with him. When we sat down, he asked if we could talk about my health, and I said yes. When he asked how I was doing, I said okay. Even though I’d planned to, I didn’t say anything more specific, and he didn’t ask.

            Instead, he told me that I could take as much time off as I thought would be helpful. He said I could work half days, or take a few days or even a week off if that would help. And he explained that it was okay if we missed some of my research plans for the summer, that it didn’t matter compared to my health. Finally, he asked if there was anything else he could do to help me.

            I’m so grateful of his response. I’m grateful that he was so supportive of me. That even though I felt like I was asking a lot by asking to shorten my work day, he never made it feel like I was causing a problem.

            I was shocked that he could be so supportive and offer so many helpful suggestions even though I didn’t disclose my illness.

            In everything I read, it seemed like the only way to be supported by your employer was to disclose your illness. Even if you didn’t name your conditions, it seemed like you had to describe somewhat how it affects you and your work. And I’m sure that can be extremely helpful, especially if your boss is unsure how to support you. However, in this moment, I wasn’t ready to do that.

            In the future, I might decide to talk more about my health conditions with my boss. If symptoms change how they affect me at work, maybe that will be a conversation. Or maybe I’ll just decide that I would like to talk to him about it.

            But I now realize that the choice to disclose your illness should not affect how you’re treated and if you’re supported. You should not disclose it because you feel like you owe someone an explanation, or because you feel pressured into it.

            I’m glad I didn’t discuss it in more detail with him, because I clearly wasn’t ready. I thought I had to be ready, and I thought the fact that I had read about it, thought about how I’d bring it up, and planned what to say meant that I was ready. But it didn’t: I still felt uncomfortable about it, and I realized that it wasn’t just because I was nervous about having the conversation, it was because I was still sort of uncomfortable about how it would affect our relationship.

            I hope you find people who are as supportive as I did. If your boss isn’t, talk to Human Resources or find someone else at your work to help you. And I hope that if you decide to talk about your illness, you do it because you want to, not because you feel as if you owe anybody an explanation.