Sunday, December 30, 2012

biting my tongue

Another pier driven into my memory stems from a few months after encountering the heart-drum. After a lackluster summer internship in Seattle, I found myself faced with an awkward relocation. I spent a good thirty hours packing-up an apartment against the deadline of a flight departure time, flew to New York on a redeye, slept a slight handful of hours, and negotiated a convoluted sequence of transit legs (buses, a towncar, shuttles, and ultimately shotgun in a friend's car meandering deep into the Adirondacks). In the end, I found myself relaxing at last in a houseful of good friends, after about sixty hours of stress and anxiety with perhaps four hours of sleep.

The result was quite unexpected. I have some corroboration from psychiatrists and peers that my experience is not unique, but remains uncommon. As my adrenaline levels began to finally relax, and a massive adrenaline burn began to creep over me, the dopamine-regulated pathways in my fatigued CNS modulated their behavior in a curious fashion. For a period of perhaps half a day, my CNS ceased to respond to racemic amphetamine salts as therapeutic for ADD symptoms. Simply put, it responded, instead, as it might to methamphetamine. I found myself on a speed trip. Massive hyperfocus, extremely high energy, continuous social activity, and decreased impulse inhibition.

Although famished, I finished no more than a slice and a half of pizza in the course of a two hour meal, as I could not cease talking and engaging people. At one point I bit straight through my tongue while attempting without reservation to simultaneously eat, respond to a question, and initiate a new, separate conversation. After a brief pause to rinse my mouth, examine my tongue, and allow clotting to begin, I directly resumed conversation. Needless to say, I engendered a great deal of concern among my friends. The experience was quite unpleasant, especially in the immediate aftermath as it became increasingly clear to me that I had been acting well outside rational control. I was mortified. Yet I could not regain control. The evening wound to a close. Still I shifted and spoke and could not stop. I was steering, yet the accelerator was floored, the brakes gone.

In the end, I sat awake, downstairs in my pajamas in the dark, in a chilly cabin there in upstate New York. A couple of friends came downstairs to speak with me, to verify that I was well, that I'd calmed down. Later, another stopped and sat with me on her way upstairs from brushing her teeth and we talked quietly for a while of more calming things than my unhappy, unnerving state. Having been the last to arrive, the beds upstairs were all full, and I had the use of a small couch above a low bookshelf, and a pile of dusty blankets. We did our best to make it a comfortable pile. Then she went to bed and I lay there, wondering at myself, at my brain's ability to surprise and alarm. Sleep was hours in coming.

striking a drum

At the end of my second attempt at a junior year, I pulled, effectively, an "all-weeker" in order to complete a series of exams and the coding portion of a sizable independent research project (a distributed java-based webcrawler with a Swing-based GUI for network topology visualization, maybe a year and a half before such technology became part of standard open-source network analysis toolkits—yay me! I don't know where the code is, nowadays, though. Boo.) Near the very end of this period, during which I'd continued to medicate every four hours around the clock for about two and a half days, a well-meaning but misguided friend left a small bottle of "NoDoz" (like Vivarin™, a caffeine tablet) on my desk after seeing me in my groggy half-awake state.

Being a little short on lucidity, a couple hours later, I took one. Maybe 60 seconds after swallowing, the thought finished percolating-up that "oh, maybe I shouldn't take concentrated caffeine tablets with this much amphetamine already driving my CNS in high gear." This was, regrettably, followed by "Ugh … induce vomiting? No, I'm not in any mood for that! Guess I'll ride it out; it'll probably be no big deal."

My very own in vivo Kamikaze: No big deal.

Oh. Dear. God.

To those of you out there who've never experienced arrhythmias, palpitations, or any other pulse-related side-effects of dangerous overdoses of stimulant medication, I earnestly wish for your ignorance to continue indefinitely. You see, the circulatory system is a high-kinetic-energy organ group. The heart is an astonishingly powerful pump for being a soft, rubbery bulb of tissue. Every cycle it sends compression waves through the cardiovascular system—your pulse—whose intensity, even at the extremities, is not insignificant. We do not generally notice them with our haptic or tactile senses, as our nervous systems filter-out these repetitive, cyclic stimuli. In arrhythmia, however, this filter fails.

I have only my own subjective, anecdotal data, but for me the effect is not unlike the entire body suddenly becoming a soft percussion instrument. It is as if some awful, supernatural drum is beating in my flesh. And interspersed erraticly between the irregular, startling, soundless thuds are the uneasy beats of a hollow, silent non-sound. And with each hollow gap, each hole where a pulse should have been, my body fails a little. My strength ebbs, my balance vanishes; my muscles suddenly fail to support me. Stairwells become frightening obstacles. Breathing becomes an active labor. Mortality suddenly appears starkly-writ and immediate, heralded again and again by each unpredictable beat or skip in a rhythm I was not meant to feel. I grow ill, now, simply describing it.

My partner helped me down two flights of stairs and across a lawn to a large, shady archway. The mid-May sun in New Jersey was unforgiving, and the occasional pauses to regain strength seemed interminable. There, on the second step, half-sprawled on cool flagstones in the spring breeze, I rested for nearly an hour. Drinks were brought. My eyes were unmoored and floated between worlds; half their image was of a scattering of students abroad in the late morning light: seemingly-unreal, shadowless creatures of bright color, full of simple purpose, passing across the lawns, under the arch, up and down the broad steps. I may have spoken briefly with the image of a friend, once. The other half of my sight was filled with fog and memory. I relived taking each dose of stimulants, fifteen in all; I relived each struggle for focus, each piece of work done. All the while the death-drum stuttered itself out, receding, growing less frequent, and finally vanishing into a steady pulse. I slowly followed a path back to my tiny room and lay down by an open window, listening to birdsong and wind and the calls and laughter of those finished with their studies.

There is no moral, really. I never again chose to forego sleep a second night running, simply out of horror at the memory and recognition that it would do me no good. No happy ending, no tragedy, no further drama. I could not sleep until the night came, so full of stimulants as I was. My project was delivered. Emails were sent to various deans, acknowledging extensions, the everyday busywork of a struggling student. I may have been changed, suddenly and forevermore mortal, no longer an innocent. But I was still human, a student with disabilities and a great deal of hard work before her. I ate something. I slept. I finished the semester. I kept going.

The borders of me

My own particular ADHD presentation has been a significant impairment (and, of course, advantage) since early childhood. Like so many diagnoses that have landed later in my life, I can chart-out the onset of various tics and stimming practices, various odd mental states, from my earliest memories (I have reliable episodic memory from about 2½ years of age). All the same, my self-assembled coping mechanisms sufficed to get me (if only barely) through five excruciating semesters of a particularly challenging undergraduate program, at which point I spontaneously developed a panoply of seemingly arbitrary neuroses and sleep disorders. A year or so of research, experimentation, and reflection later, I settled on a stimulant treatment (Adderall, a mixture of R- and L-Amphetamine salts, and a SDRI (presently duloxetine HCl in subclinical dosage, but I've tried a few over the years) for cingulate gyrus issues) that made [mostly] everything just work again. That was over a decade ago, now.

Many things have changed in the intervening years. I take ever so much better care of myself, now, than I did then. I have a much more realistic and intimate understanding of my nervous system's capabilities and limitations, and how they degrade (both gracefully and otherwise) over time under persistent abuse. I know, now, how fundamental a healthy mind is to the maintenance of emotional wisdom and strength, and I am committed—for the sake of my self and my family—to protecting my mental health.

I have more insight, now, into certain traits that once seemed to be unusual offshoots of my existing diagnoses, if not outright inexplicable. It so happens that I am dissociation-prone. My emotional detachment and level mood stem from this rather than from a neurotransmitter-cycle mutation in the neurons of my limbic system. I am a survivor of childhood trauma, which likely led to my dissociative predilection. I am transgender, the neurological implications of which I am still unraveling. I am neurologically improbable in several other ways, with potential memory impairments having developed into unusually facile and encyclopedic mnemonic ability, dysfunction in episodic memory organization having produced a mind forever storytelling rather than a disoriented amnesiac. I have begun to complete entire sections of the puzzle, though it will likely never be done.

The time has come, I feel, to begin cataloging certain anecdotes that have become touchstones for me, that serve as markers and landmarks in my experience of daily variations in mental function. They are outliers, some strange, some horrible, some amusing. They are all a part of me.