Flying Over the Cuckoo’s Nest

because the hospital that my pdoc is affiliated with doesn’t have an ECT machine, he had to make arrangements for me to have it done at another hospital. fortunately, some of the pdocs with whom he shares his office have privileges at one that has the equipment. when we decided to go through with the procedure, the pdoc said i’d be admitted Friday or Saturday of that week once he set it up with the other hospital. his office called us Friday afternoon, and a couple of hours later, i was admitted to the emergency room.

i have no idea why i had to go through the ER, but during the 5+ hours Brian and i were there, they ran preliminary tests (the usual blood and piss stuff). over the weekend they took spinal X-rays, and someone came to my room to do an EKG. if anything was wrong with me physically, the ECT would be delayed, or possibly canceled. but everything checked out.

once we were led to the psychiatric ward, the social worker assigned to me inspected my clothing and other items. since it wasn’t my first time in a psych unit, i remembered not to pack toiletries in glass containers or clothes with drawstrings, and i wore soccer sandals. if you wear shoes with laces, the staff takes them away. walking around in laceless shoes totally sucks, i tell you. try it some time. i think you’ll agree.

i won’t describe the patients, staff, rooms, and our day-to-day activities since this post is about ECT. i will say that it was a nice, clean unit; the doctors and other staff treated us respectfully–like human beings; and the ward was split into two sections: geriatrics, detox patients, and the mentally ill on one side, and the mentally iller on the other. anyway, i can’t really remember most of the patients and staff with whom i interacted–just faces without names or names without faces.

ECT is a last resort for people whose depression/bipolar disorder is unresponsive to meds; for the severely, suicidally depressed and whose depression must be relieved quickly and immediately (maybe for the severely manic as well, but i’m not sure); for elderly patients whose bodies are too frail to withstand a bunch of meds; and for bipolar women (or with depression) planning to become pregnant and unable to take certain meds because of their effects on the fetus. i’ve read that the success rate is 80-90% and that temporary memory loss is, indeed, a side effect. of course i’m convinced this is it, and that i’ll never remember anything ever again. in my recent travels i’ve avoided places with big, huge parking lots. i mean, i had trouble remembering where i parked before the ECT. now i’m fucked.

typically, patients undergo ECT three times a week for six to 12 weeks. thank God i only had to do it for two weeks and as an outpatient the second week. on Monday morning, after not having eaten past midnight, they sat me in a wheelchair and rolled me down to the outpatient surgery unit. at least i think that was it. they did it in the exact same room when i had it inpatient and outpatient. well, whatever. all i know is it was on the third floor.

once there, i was transferred to a gurney. there were usually three or four in a row parked along the wall just outside the ECT room. the whole thing only takes about five minutes, so the doctor can just zap, zap, zap and everyone’s wheeled to recovery, which is where patients spend the most time during the entire process.

the no-food-after-midnight rule is because you’re put under general anesthesia, and they don’t want you puking when you wake up. the anesthesia is so you don’t feel any pain. they shock your brain, after all. in fact, a few days before i went into the hospital i had to stop taking Tegretol. aside from being a mood stabilizer, it also works as an anti-convulsant (sometimes given to epileptics), and since they want your brain to convulse, obviously they don’t want anything to get in the way.

while you’re parked in the hallway, they insert an IV through the back of your hand or the underside of your forearm. this explained the huge, dark bruises on my roommate’s inner arms. i got maybe one or two you could barely see. then again, i’m in my 30s and she’s probably in her 60s. it didn’t help that the phlebotomist or nurse or whoever had IV duty stabbed you with the damn needle. come on. i’ve had plenty of IVs, but this was the first time i was ever bruised.

when it’s finally your turn, they roll you into a teeny, tiny room that holds the equipment and has just enough room on either side of the gurney for the doctor, anesthesiologist, and nurse. electrodes are stuck to both your temples, and an oxygen mask is placed over your nose and mouth. (i never liked the smell of that canned air. it has an artificial scent to me. ) the anesthesiologist informs you that they’re about to inject the anesthetic. you’ll know when they do this because you can feel a slow burn flowing through your vein. that, combined with the fake-smelling oxygen, is an awful feeling. fortunately, it only lasts a few seconds because then you’re knocked out.

what comes next, obviously, i only know from what was explained to me. the doctor flips a switch? turns a knob? on the ECT machine, and about a volt of electrical current is passed through your brain. this causes a seizure, but because muscle relaxants are administered to you beforehand, your body isn’t flopping around on the gurney. from what i understand, the degree of twitching is a lot like dogs or cats in REM sleep.

i can’t remember being in the recovery room, though i think they give you something to eat and drink. i can’t even remember being brought back upstairs, except that you’re transported in a wheelchair. everything immediately after the ECT is a blank.

no one knows exactly how ECT works, but it does. however, it isn’t necessarily permanent. my pdoc told me that typically, once a patient undergoes ECT, they’re no longer given anti-depressant medication. instead, they have maintenance ECT, where they’re treated once a month or two. though i’m still not taking any mood stabilizers, i’m on Cymbalta and Wellbutrin. the pdoc is in the processing of discussing my case with the ECT pdoc to see if i’ll continue to be on meds, or if i’ll have maintenance ECT. i’ll find this out on my next appointment.

i don’t regret having the ECT done because it worked. no, i’m not all smiley and happy, i don’t love the entire world, and it’s really up to me if i’ll live happily ever after. however, just having energy to do stuff and not being too scared to go to the store or wherever by myself is such a great feeling. the ECT has changed my life.