Extract from Singuratate (Solitude) - Mihai Eminescu

Mihai Eminescu is the best-known romanian poet... more details in the wiki.

...
Ah! De cate ori voit-am
Ca sa spanzur lira-n cui
Si un capat poeziei
Si pustiului sa pui;

Dar atuncea greieri soareci,
Cu usor-maruntul mers,
Readuc melancolia-mi,
Iara ea se face vers.
...
(March 1, 1878)

...
Oft I thought, the lyre forsaking
To depart and change my mood,
And to leave off writing verses
In this wasting solitude.

But then mice with tripping noises,
Chirping crickets bring and nurse
My old thoughts, my melancholy,
And this soon becomes a verse.
...
(Translated by Petre Grimm)

2 months - highs and lows

Paul Levy gave up his Blackberry two months ago... This was the first post I read on his blog. So what did I do these last two months?

• Started the blog and shared it with my close friends
• Emailed Paul to visit the blog
• Accepted his suggestion to post a link to my blog on his
• I got nuts when he posted the link and advertised it
• I got over it and lived with it
• I started commenting on Paul's and other blogs with a link to my blog - first I forced myself to do it, but now if I have something to say, I say it
• Paul added my blog as the first on his personal stories link and advertised it again - I was ok with it this time (I felt a bit uncomfortable, but definitely didn't have the strong reaction I had the first time)
• Saw my profile count increase every day and did not blink about it

...I wrote this last week. This week I was a bit down. I need to have constant approval and confirmation that I am not writing anything stupid. Two of my consistent approvers were gone and couldn't comment. As it happens, nobody chimed in with any comments. And on Paul's blog there were some really negative comments. Hey, if anyone posts comments like those on my blog, they're gone! I'm no CEO (other than in my house) and I won't publish c... Plus work was not as good as usual last week. I think part of what keeps me floating is the fact that I am so good at my job, and any issue becomes a big problem and drags me down.

It's pretty neat that I discovered this though... so if you guys are interested in reading new stuff, keep the positive comments coming. Having two readers that I can always get feedback from and an occasional comment will keep me going. It's amazing how everything changes meaning depending on my emotional status. I'm still not great, but at least I am on an ascending trend.

While I was reading to my kid this evening, I found a great poem that works so well with how I'm feeling about writing or not on the blog... I will post it separately along with the English translation...

Cognitive Behavior Therapy

I imagine that the first advice I will get will be to try Cognitive Behavior Therapy (CBT) because research proved that it is the most efficient for anxiety in general and social anxiety in particular. All my books on social anxiety are unanimous about this (mind you, I just read three or so).

So I dutifully looked for a CBT specialist. I found someone that teaches CBT at a large New York University... I was sure it's going to be a winner. I was wrong. Five sessions later he declared victory and I declared stupor at the idea that we actually resolved anything other than me buying a sandwich and asking for help in the bookstore. It was a great start that I did those things, but it definitely was only the start. He declared that maybe I have some issues with my conception about life and that maybe another kind of therapy is right for me... I just think another therapist was right for me. I think part of his indifference had to do with the ridiculous amount that my insurance company was reimbursing him, but if that was an issue, wasn't it more fair to say so rather than make me feel bad?

Before that I wanted to help with research. I felt it was my duty to help other understand this condition. I went to get screened at an Anxiety Institute, and they were ready to enroll me in a study. Unfortunately, the only study they were having involved using drugs (Paxil) and therapy vs. drugs alone (anyone guess where the funds for this research comes from?). The researcher doubted that my doctor would agree with that because I was planning a pregnancy. I didn't even try to find out my doctor's opinion - the idea that I would end up with six months of being drugged didn't sound compelling. Oh, yeah, I asked whether I can read self help books during that time LOL - the answer was: what a good question, I think not... I guess their study subjects didn't have this issue before.

I am sure there might be a CBT therapist out there that could help me, I heard of one in Phoenix, and others in St. Louis. It doesn't help that there seem to be a therapist at each street corner and they all can treat it and are busy all the time. Very difficult to find someone : look for the needle in the haystack.

That was my state of mind when I read: Health and Suffering in America - The Context and Content of Mental Health Care - Robert T. Fancher. It presents each therapy method with its advantages and disadvantages. CBT might be the latest trend, but it has issues as well. The book also describes how valuable research in mental health is excluded because it is not studied in a randomized double-blind manner. The conclusion of the book is that the therapist's personality and the way (s)he relates to the patient is more important than the method, and that likely a combination of methods would work better.

I cannot agree more with this. I have been in therapy for about 8 months with a new therapist and I see the light at the end of the tunnel. No, I saw the light months ago, now I see the walls of the tunnel :o) And I wouldn't change my therapist for the world.

If you read testimonials about this or the other method: tapes, self help books, meditation, CBT, etc., there are always people that succeeded with that particular method. I think we succeed when we are ready and ripe to succeed. The rest: "When the student is ready, the teacher will appear"

Blog housecleaning

I would like to specify that I welcome any opinion, comment or advice. Hey I am willing to try anything that sound at least a bit rational and I definitely welcome challenging ideas...

I enabled comments moderation. I noticed that I have no control over current comments, I wasn't even able to delete them when the owners requested it... so now they are moderated.

If you wish to leave a private comment, please specify that at the bottom of your text and I will not publish it. I reserve the right to delete any messages that I am uncomfortable with.

It worked

It worked! It worked! The babysitter came back... on time, called me at work, picked up the phone when I called, did lots of stuff around the house. And I talked to her too. She tried to tell me something and I interrupted. I realized afterwards and I was sorry about it... so two days later I asked her about it. I think she felt heard, it's never too late to be nice and acknowledge your mistakes.

I decided that I don't need a big discussion, just small things every day, just don't forget to communicate. And I will use the advice they give for dieting: if one day things are not going well, not everything is gone, just start over the day after.

I wish I had a God that I can pray to to give me power to keep this going, but I'm afraid I will have to go through this alone and carry all the burden LOL.

Good news on the SA front

Hey, I have good news for my cheerleading squad: I think that the blog is working, I am seeing progress! It's amazing. Thank you for the wonderful notes to all my old and new friends!

First you will need to bear with me and read about my theory on why it is working... In my last post I quoted a book: The Gift of Therapy - by Irvin Yalom, MD. If you ever consider going into therapy, read this book first. This is the way it is supposed to be like. My therapist recommended it and I could hardly put it down when I started reading it. It is a wonderful book that I strongly recommend. Did you ever feel that even when you have no idea about the details in a certain area of knowledge when someone knows their stuff it's all logical and you can understand it? This is one of those books.

One of the cool ideas in the book is that there is no need to start investigating deep into the patient's relationships because sooner or later any dysfunctional patterns will emerge in the patient-therapist relationship and can be explored "here and now". The feelings and events can then be analyzed in a lab-like environment.

I think that the blog helped me to further extend this idea. The virtual environment and off-line mode allowed me to breathe and reason between interactions. This helped me to analyze my feelings and gave me the opportunity to take my time in responding. Pretty much everything that happens to me in real life happened while interacting here, but it happened in slow motion: the overly emotional response, the fear of rejection and the need to run away, the pain of not getting any feedback almost as bad as getting feedback that could be interpreted as neutral or negative. I didn't have anything to lose though so I plunged into it and occasionally forced myself into doing more. I am going to take each of these issues separately and discuss them (it helps me clear my mind in the process) in the next week or so.

But today I had a real-life success. I am trying to talk to the babysitter for months and months. Short successful discussions always ended pretty bad. She's very shy and very scared of me. I am confused how can someone be scared of me, when I am scared of my own shadow... But it is not uncommon, I am a scary person. Anyway this girl is really nice: very good to the baby, keeps my house spotless, and tries to do what I ask her to do if she can hear me through her fear. She is however getting sick or missing days quite often and unexpected.

So I finally think that I got to talk to her and tried to express my feelings and tried to encourage to think about her needs. I left the discussion open-ended, but told her that we both need to get over our fear and anxiety and start communicating. I hope that I was gentle enough: we'll see if she makes it tomorrow.

Oh, yes, did anyone see the irony in here? I am talking to the CEO of one of the largest hospitals in Boston, but have trouble talking to the babysitter.

About openness

Quote from Gift of Therapy - Irvin D. Yalom, MD (Emeritus Professor of Psychiatry - Stanford University School of Medicine )

[In therapy] we try to help the public cell grow larger at the expense of the
other three [blind, secret, unconscious] and the secret self to shrink, as
patients, through the process of self-disclosure, share more of
themselves-at first to the therapist and then judiciously to other
appropriate figures in their lives.

If the mentally healthy human is an open human why is openness such a big deal? Of course it is a big deal, but it is something to be admired and praised rather than criticized and presented as the sensation du jour.

In a couple of newsletter I received, there was a title: "Paul Levy did it again". Big sensation, he posted the results of the central line infection rates for the last year for his hospital.

Why does it feel like so few people get it? It is better for a person to be open. A relationship is better when it's open, based on trust and mutual respect. Each of us carries the burden of family secrets that were never shared with us. Is anyone doubting that an open person or relationship is better?

So why not generalize this and accept that organizations that are open and transparent are more successful, that hospitals that publish their data will be trusted more. This feels so obvious to me that I don't even imagine how can anyone doubt it is a good idea.

Between two doctors that have the same knowledge, I would choose the one that is able to honestly accept that (s)he doesn't know when (s)he doesn't. On a flippant note, with preeclampsia this is a great selecting doctors test cause I would never go twice to a doctor that acts as if (s)he knows everything about it.

It feels though like so few people get it. In the organization I volunteer for I keep asking for better communication and more transparency and I get polite thank yous for expressing my opinion. It does make me feel like a freak...

I am so happy that Paul's hospital is having such great results and I have the proof that openness works and that I can keep thinking like this.

Personally, I started this blog in an attempt to open up and I never regretted it. None of my good friends went away, most of them are closer to me now. In addition I now communicate with more people and I find it much easier to talk. It also feels like now everyone knows the worst of me, so there's nothing else to lose. Openness works: for me, my family and my world.

What I would do now if I had my impossible dream

This post is an answer to Paul Levy's invitation to throw out ideas about what can be done to improve safety and quality in hospitals.

Maybe 10 years ago I attended a course in implementing the quality standards ISO 9000. It was a big surprise to me that the course did not seem to teach us methodologies, forms, etc., but was more about finding common sense solutions to enterprise functioning. The most important idea that I learned and kept haunting me ever since that course was: ask the people that do the work to tell you how can their work be easier, how can things work better: they know, just listen to them. It's that simple.

So my answer to Paul is that I have no clue what can they do better, but I know who does: their patients, nurses, doctors and other staff. If someone digs into this collective knowledge and interprets it intelligently, you can find out what you need to do.

I would send a smart analyst (no need of medical knowledge) in the trenches and talk to the patients in the waiting room: ask them what should be changed, what is good, what is bad. Ask the inpatients, ask the nurses, ask the doctors. Don't send a kid with a prewritten questionnaire or survey, the person that does this needs to know what question comes next, needs to know how to interpret the findings. The analyst needs to bought by what he's doing: understand it's importance and believe that he can make a difference.

I would first screen the people I interview by selecting the ones that are good patients, are literate, and that can give reliable feedback.

If you care about patient safety, I would send someone to gently talk to persons that had something bad happen to them. Talk to them even years after the fact. There are some of us that keep searching for answers and would know exactly what doctor/nurse did what mistake and how it can be avoided in the future. They would tell you what hurt them and what helped them heal.
____________

The other day I was reading a pharmacist blog. He was complaining about the old patient that was yelling at him about a problem with the voicemail system. I could understand how he just wanted to do his job - fill in prescriptions. And I felt guilty for all the silly little things, non-medical related that I was telling the nurses and doctors... they don't care about these things, they shouldn't care about these things, but there is nobody else that I see that cares... If I tell the receptionist, she is trained to be nice to me and mind her own business.

Maybe I am a dreamer, but in my ideal world I see an office manager being in the waiting room a lot asking what can be done to improve the patients experience. I think this non-medical oriented person that is empowered to resolve issues that she finds can ease both the patients lives and allow the nurses and doctors to do their job.

There are a lot of patient satisfaction surveys these days... I never found out that I can really give a good feedback in the rigid structure or that my comments had a positive effect on the institution. I personally was seen by more senior doctors and I was treated better because I complained, but that was it. Pretty much like what Paul is describing: if the board only sees green the Board is bored and loses interest. If the only survey result is that we are treating the most critical respondents better, it doesn't make us better overall.
_________

And my conclusion with a sigh: oh, how I'd love to be that analyst!

Monique

Monique left a wonderful message on my post Now I'm public. I think I know who Monique is. I think she survived breast cancer and wrote a funny book about it.

This got to me on two levels. The personal one is that she is saying that losing a baby is the most painful experience that a woman can have. It is very painful indeed, but beating cancer is not a walk in the park either. You get hit like that and then people admire you and say that they couldn't have the courage to go through that... courage? what courage? I didn't choose to have a dead baby or get cancer... Once you get it you either go through it or you don't. Did I try to make good out of it? I did, but I didn't feel brave or courageous.

When we were a month or two out of our ordeal, my husband's friend just got diagnosed with Hodgkin's lymphoma. I never met him before and you can imagine that I was quite anxious. We got along very well... we seemed to be in the same emotional spot: me after my baby's death and him after finding out that he had cancer. We visited him again a few months later... after a couple of series of chemotherapy he was much deepened in the pain and really hard to get to. That's when I realized that I am doing better: I was going back towards life. Cancer eventually beat him.

The other reason why finding Monique's story and book pleased me is that someone I work with is going through breast cancer right now. Breast cancer seems to get closer and closer: a good friend's mother, my own scare a few years back that got me reading about it, my mother's cancer found and resolved in a very early stage... I am not so close to this woman, but I admire her trying to keep working through this and I wanted to find something nice for her. I have problems expressing my feelings (duh), so I need a nice something. A funny book about going through cancer seems like the perfect something.

Thank you, Monique for writing the book and touching my life!

Anniversary blues

I am feeling a bit overwhelmed right now. I have a million things to write and I am too tired by the end of the day to do anything other than crawl into bed.

I just realized that our baby loss anniversary is now less than 10 days away. It is ironic that I got into the hospital on Valentine's day. Everybody is celebrating and we are mourning. I thought I'll have no problems with it this year, but I learned in time that we all say we are OK and then we realize that we should not have forgotten the anniversary.

I had 2 difficult interactions yesterday and they both ended up bitter-sweet, just as expected. Somebody got upset and someone else blew me off completely, but both of them were done gently enough that I realized it's outside circumstances that caused the responses, rather than rejecting me. But the roller coaster of emotions to go through this killed me and I was in tears by the end of the day.

I think the traffic on my blog decreased significantly and I am glad. Maybe in two weeks, when I'll be over this, I'll start inviting more people over. For now, I'll just be good to myself.

I found more blogs of socially anxious people and sent little messages: an email, a few comments. I never heard anything from them... I guess I must be the only one that feels comfortable in this environment.

Why all the preeclampsia talk on a social anxiety blog

I'd first like to thank everybody that sent comments. I wanted to email you all personally and thank you for your kind notes, but most of you logged on anonymously. I got one or more comments each day and they all kept my day going. Thank you so much! It means a lot to me.

So why all the talk about preeclampsia? Because I've trying to talk about this for a long time, and it always seems inappropriate, the wrong time, the wrong person, or there's always someone that knows better, is smarter or can talk better than I do. I'm taking the spotlight here... and maybe this will be a good rehearsal and some day I will be able to say these things to other people.

I will linger for a while on preeclampsia and see how it feels. I might move it later to their website in a more professional format.

And a disclaimer: any opinions expressed on this blog are my own and do not represent the view of the Preeclampsia Foundation.