Chapter 7: The Choice

His words were devastating, but they turned out to be a profound gift.

Good Morning, Beautiful Human,

Hello. We love you.

The snow arrived in Vermont this week. It is absolutely stunning. There is just something remarkable about it. The brightness it brings. The clean slate it offers. The deep and true quiet it ushers in. And of course, the snowmersaults and snow smackerels of my one best bear.

I’ve been leaning hard into winter comforts as of late — chicken nuggets, massive mugs of cocoa, bubble baths, and slow, oh-so bundled walks with Waffle up the road where she, my beloved queen, decides the pace we take and the sniffs we savor.

I, myself, have been trying to savor every second I have with her. She turns eleven next week. I can hardly believe it. And oh, what a gift. Then again, the lives she’s lived, the odds she’s defied, and all the health challenges she’s survived these many years.

If you’re reading this on Friday morning and have a spare well wish to pass along, we’d so appreciate it. We’ll be at her oncologists doing recheck scans, and any love you can spare would be so deeply felt and cherished by us.

Of course, I know I can’t stop time or control what the scans show. All I can do is love her. All I can do is be grateful that I get to love her. Yes, all I can do is hold her paw, write from beside her in her snowbank while she is still here, and cherish every single moment of her sweetness, her sass, and her snuggles.

The other thing I can do, and goodness knows I need everything possible to distract myself when I weather these cancer recheck weeks, is write about her. Yes, the other thing I can do is share the story of how this one-in-a-billion bear saved my life.

So, this week, I continue with that story here. And this week, from us, in our snowbank, I send love.

My office this week. Yup, really.

My girl in the snow, mid blizzard :)

To read the story from the start, begin here:

With Love, and Wafflenugget

Where we last left off, Kate was preparing for the one appointment that could keep her out of a life in a locked psychiatric ward — Dr. Cortado (a pseudonym) had agreed to treat her as an outpatient. At the time she lived alone, battling OCD, contamination fears, hallucinations, stress-induced fecal incontinence, and a Bipolar Disorder diagnosis, and had spent days preparing for the appointment by practicing all the things she felt she couldn’t say to the doctor, rehearsing a sanitized version of her story, hoping for a miracle. — Amy, Kate’s Editor

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Chapter 7: The Choice

The appointment and all the incontinence accidents I had before, during, and after the therapy session passed in a complete dissociative blur. Though my later journal entries paint a clearer portrait of that first 90-minute appointment with Dr. C. — that I was surprised at how petite he was, frustrated at his deadpan demeanor, confused over his ability to be completely unemotional and relieved that I made it through the appointment without sharing The Unmentionables or getting poop on his leather chair — I didn’t journal about it afterwards. Instead, I just collapsed into bed. All I had was the energy to scribble this on a scrap piece of paper:

Doctor Cortado is terrifying.

TERRIFYING.

And

he is the only doctor I’ve ever met who can sit in my suffering with me and do absolutely nothing.

He doesn’t try to fix it.

He doesn’t try to take it away.

He’s just there.

In it.

With me.

But somehow, he is at complete ease.

I think he might be a sociopath or psychopath? I don’t remember which is which. Which is which?

It’s either that or this is it. This is the person who will save me because he’s not uncomfortable with my pain and because of that, he doesn’t want to lock me up to avoid it.

Well, at least not yet.

After scribbling those words, I slept until Friday. 41 hours of sleep. And it was still not enough. It was never enough. I was always exhausted to the bone. I was always burnt to an absolute crisp and ready to sleep for days. But, with my freedom on the line, I forced myself to bury it and made it to the next Dr. C. appointment, and the next.

The toll of our time together was notable. Telling my story took it out of me entirely. I was actually so exhausted from our sessions that I skipped work and barely ate over the course of those first two weeks. But I made it to my appointments. I made it to my appointments — for Maura, my parents, and that “future dinner party of friends” I had promised my dad I’d have someday.

The first four sessions passed in the same blur of incontinence, storytelling, Unmentionable rule-abiding, and an absolute lack of emotionality or even acknowledgement on Dr. C’s side of things.

He just listened and nodded. He just was present and emotionless. He was just there, with me. But finally, that changed on the fifth appointment when I finished sharing all I’d been through.

After ending my story with Maura being gone, Atlas (my previous therapist) actively dying of colon cancer, Atlas’s outburst that led to my suicide attempt, and the proclamation from the inpatient care team that my time as an independent adult was over, I knew I had some course correcting to do.

So, knowing the mention of my suicide attempt was a red flag all around, I ended the whole story by doubling down on my Unmentionables. I told him — repeatedly — that the only reason I had attempted suicide was that I believed it would solve my parents and Atlas’s heartbreak, that helping people feel less pain was all I ever wanted to do with my life, so it just made sense at the time.

Of course, knowing this was also a red flag, I went on to clarify that: I knew that my attempt was a mistake and a misinformed one. I didn’t want to die any longer. Thanks to Maura – I wanted to live so I could fight for people like me, for people like Maura who didn’t have the privileges I had, and that was why I was sitting there with him and telling him this entire insanely long story.

There was relief when I finished, a deep relief. And as I spoke that final truth — a truth I actually believed and a desire I truly felt in alignment with — a silence took hold.

The quiet lingered between us for a while. I didn’t know what to do. I fidgeted. I bounced my legs up and down. I tapped my toes on the inside of my shoes. I pinched my forearm to remind myself that I was real. You are real, Kate. You are real. And then finally, after a long, slow breath, he spoke, measured in every single way.

“Kate. Wow. Thank you for sharing this with me. What you have lived through is nothing short of hell. In many ways, you are more traumatized than a prisoner of war. Actually, you might be. You were never given an enemy except for yourself. Prisoners at least get that.

Additionally, you have worked tremendously hard throughout your life. It is quite remarkable how hard you’ve worked actually, and it is a testament to your strength.”

He paused after this, letting his words sink in. They didn’t, so I kept pinching myself trying to feel enough pain to know that this was real. This is real, Kate. This is real. Finally, he sighed once more and continued.

“But the truth is that you are still suffering and also very exhausted by it even if you try to pretend otherwise.

So now, now you have a choice to make.

Kate, You must choose if you want to work with me and work harder than you ever have in your life – And you, Kate, you have already worked very hard. Very, very hard and this will be harder.

Or, if you want to, you can go to that hospital in Western Massachusetts, where you can live in a locked ward and be safe, and maybe even comfortable, and rest, finally rest, but no longer live independently.”

My brain clicked on in that moment, and I couldn’t hide my confusion or anger. Wait! Wasn’t I there for him to keep me out of the ward? Why in God’s name would he say that?! What the actual hell is going on here?”

Reading my face before I could even utter a bewildered and angry response, he responded.

“Yes, I recognize this might seem odd when so many of your past doctors have not given you a choice in how you move through treatment, but I really mean it.

This is your choice, Kate, and you must take this choice very seriously because I will only work with you if you work the hardest you have ever worked in your life. I mean that. If you want to work with me, you must work even harder than you have already worked, and that will be notable.

So please, I’m going to ask you to take the weekend. Take the full weekend to think about it and decide if you can actually work even harder or if it is time for some well-deserved rest.”

I didn’t know what to say. I was entirely speechless. Speechless and furious and pinching myself over and over. What the actual fuck? Is this real? Isn’t this doctor supposed to help me live freely? What is even going on?

But before I could find my words or even untangle my emotions, he stood, signaling it was the end of the session. So, head bowed, I stood too. But before he ushered me out the door, he paused me. He gently held my shoulders, and finally, after I raised my eyes bravely to meet his, he earnestly said:

“And Kate, thank you — really — thank you for sharing your story. I support you fully in whatever you decide.”

The gentle nature of his words cut through my anger. He was being kind. He is being kind. And as I walked down the long brick hallway, having an accident as I went, I realized the full weight of this decision, the deep intensity of the work he alluded to, and the herculean effort he required from me to work with him.

After taking a bathroom shower and cleaning myself up, I slumped the whole way home. I was so tired. So damn tired. All I wanted was to feel better — to be better — to live better. It was everything I had worked for my whole life. But how on earth could I work any harder than I already was? How could I fight more when my hallucinations, my incontinence, my racing thoughts, my all-of-it depleted me past comprehension? When is it just over? Can it just be over?

I cried myself to sleep that night and slept for three days straight. The hopelessness and exhaustion of it all was just too much to bear, and it would take a full decade to realize that being afforded that choice and the time to process it — was a revolutionary gift.

For even though the choice felt like a no-brainer for me back then, this was the first time since I had entered the mental health care system that I was given sufficient time to find informed consent.

Yes, this was the first time a doctor had given me the time to process my decision in a place of safety where I had the best possible chance of deciding with intention, instead of reactivity. And though I only learned this a few months ago, that choice is where my true recovery began.

Yes, that choice was the true beginning of my re-entry into the world.

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It’s quite a ride sharing these chapters with you. I keep weeping as I write them. Some of my tears are tears I repressed. Others are tears of pure and utter relief that I survived — that I made it out alive. And then, undoubtedly, the last of my tears are about my beloved Waffle as I process anticipatory grief.

Writing this chapter, in particular, brought up a lot for me. My journal entries alone paint such a vivid picture of my confusion at this choice. Undoubtedly, some of that confusion was seeded in medication, psychosis, and exhaustion. But what stands out the most and what is the bigger truth in it all is that choices like that — choices made slowly, thoughtfully, and with plenty of time in safe spaces to process the repercussions of them — were incredibly rare in my experience in the mental health care system even though I lived some of the most privileged care in this country.

The harrowing truth is that this is the norm when it comes to serious mental illness treatment in this country. Medications can be selected in 15 minute sessions. Diagnoses can be given after an hour consultation. And 90-day holds can be disseminated in one single breath.

None of that is okay. None of it. It wasn’t okay back then, and it’s not okay now. Of course, I didn’t even know there was a different way to move through treatment back then — thus my extreme surprise at Dr C’s offering.

Truth be told, I didn’t even understand the mechanics of all of this until a few months ago. It’s why I’ve written pieces here about the Your Nervous System, Finding Safety, and how Feelings Aren’t What You Think, to shine a light on the fuller picture of what’s going on in us and between us when we navigate these high-stakes moments of recovery and healing.

I, of course, don’t presume to have the answers. I just know that informed consent is one of them, and the current system doesn’t afford it. It’s simply not built that way.

I’m rambling now. I know. I should absolutely go to bed, but before I do, let me just say this loud, clear and colorful: you deserve agency. You are worthy of making a truly informed choice about how you care for yourself. And, even though the system might make you feel like it’s the doctor’s or the nurse’s choice (spoiler: the system is built to make you feel as small as possible), it is your right to choose your treatment. It is entirely your right.

And hopefully, one day, together, we will build a way through this broken system (or reinvent it entirely) where informed consent and practices that empower it are the norm and not the exception, like I lived those many years ago with Dr. C.

Alrighty, bedtime for me now. Wishing you a weekend and sending so, so much love.

Kindly,

Kate