For as long as I can remember, I’ve been making up excuses for missing work.  I used to think I was just lazy.  I can be a go-machine for several days, on top of every little detail of my job, and then I just have nothing.  I’m a heap of exhaustion and deflation.  This state lasts anywhere from a day to a week, and it’s in this state that I sometimes call in sick if I can afford to.  It’s also in this state that I delay taking care of my home and my body.  I stay in bed and escape into sleep, or the internet, or just stare at the ceiling, beating myself up internally the whole while with name-calling and feelings of guilt and shame.  

I’m finally on a medication that helps, and I don’t cycle between these extremes as much.  Now when I miss work it’s usually to come see Dr. Kim, but I still make up excuses, like telling Darren today that I was going to have a ‘procedure’.  My experience has been that mental health is not an acceptable reason to miss work, unless you are institutionalized, which is something I have so far avoided.  Knock on wood.

Dr. Kim is smart and kind.  I like her because she treats me as though I’m completely normal.  Her office is on the top floor of a medical complex in North Portland.  Sometimes, when we’re talking, she stares out the window at the sky for a really long time and I think she has forgotten I’m there.  But then she’ll turn her eyes back to me and they are like sharp rays of sun cutting through clouds, like she’s gathered all the energy from the sky and is shining it into me.  

“So,” says Dr. Kim, tapping her pen on paper in front of her.  “You think maybe the Lamictal isn’t working anymore?”

We are talking about my worsening depression.  It’s been four months.  I had thought it was just the seasons, as heading into winter always worsens my depression, but it’s not.  

“I don’t know,” I reply.  “Maybe I just need a higher dose?”

“Didn’t we try that?”  She flips through the papers in front of her.  “You got a rash when we went over 150.”

“Oh yeah.  But maybe we could try it again?  Maybe the rash was just a fluke?”

“Possibly.  What kinds of thoughts have you been having?”

“Well, I haven’t been thinking about killing myself, if that’s what you’re wondering.”

“That’s good,” she says.  She stares at me patiently.  I know from experience that she will quietly sit there for a long time.

“I guess I’ve been having a lot of thoughts of ‘What’s the point?’  Like, everything I do seems so meaningless.  I mean, not everything.  I love my family.  And hanging out with Binky is the best thing ever.  But my work, my job, my writing, dating, eating, cleaning…what’s it all for?”

Dr. Kim nods.  Nothing I’ve said so far seems to alarm her.  I want to be honest with Dr. Kim.  I want to be well, and I know she is here to help me.  But I also don’t want to be institutionalized.  I often find myself walking a thin line between telling her the truth of what goes on inside my head and reassuring her that I’m not going to kill myself.  

“These are normal thoughts, right?” I ask.

“Very normal,” she says.  “Most people want their lives to have meaning.  Where do you think that meaning can come from, for you?”

I close my eyes.  The amount of weight I give this question cannot be understated.  It seems to always be on my mind, spinning in the background of whatever I’m doing.  What’s the point?  What difference is this making?  Who are you to think you can change anything?  Everything is going to be the same tomorrow.  I know from experience that I have to be careful with these thoughts, because if I stop guarding them they can become sinister, psychotic mermaids pulling me into depths I don’t want to go.  You are meaningless.  You’re not doing anything with your life.  Your existence is a burden on the world.  Everyone would be better off if you were gone.  These are the thoughts that led me to my suicide attempt when I was seventeen, and subsequent suicidal ideations.  And yet, the lighter version of them feels important.  What IS the point?  I want there to be a point to my life.      

“Mar?”  Dr. Kim interrupts my thoughts.  

I open my eyes.  “My writing, I think.  I just feel like if I could really write, if I had the time and space for it, I feel like it’s what I’m supposed to be doing.”

Dr. Kim nods.  She doesn’t seem to be agreeing or disagreeing with me.  “What’s preventing you from writing?”

“Money!”  I laugh.  “I mean, I work so much.  Between the stationery job and the writing jobs I do for money, there just isn’t time left.  I’m so tired by the end of the day.  I try to carve out time, but I just can’t seem to stick to anything.”  I’m embarrassed by how I sound, so whiny and helpless.  Pathetic.  If you were a real writer you’d have written more by now.  

“So you think if you had enough money you could be a writer?”

“No.  It’s not that.  It’s time.  Money equals time.  I need time.  I’m stuck in this catch-22 where I have to work to have money, but I need time to write so I can create the work I really want to be doing.  I have to trade my time for money!  I need to make more money so I can work less, I think, and be able to write more.”

“I wonder if there is another source you can find meaning from,” says Dr. Kim.  Or she asks it, I’m not sure if it’s a question.  “Something that is outside of what you produce.  Something enduring.”

“Like god?”  I’m not sure what else she can be talking about.

“Maybe.  For some people that is their source of meaning.  But what if your life had meaning just because it existed?  What if you didn’t have to do anything to matter?  What if you just matter because you’re alive?”

I want to believe what she’s saying.  I desperately want to believe it.  But I can’t.  It’s too simple.  “That doesn’t make sense to me,” I say.  “What about all our great people?  What about Gandhi and Martin Luther King?  What if they just stayed home and were content to exist?  All of our great art and literature and achievements are because people wanted more.”

“Do you think you have to be like Gandhi or MLK?”

“No, of course not.  But I have to be something!  I can’t just work in a shop.”  My words hang in the air.  They feel so stupid, yet I know I believe them.

“Mar, you are something,” says Dr. Kim, leaning forward.  “Where you work, what you do, what you wear, none of those define you.”

I know Dr. Kim’s big objective is to keep me alive.  But I want more than to just be alive.  I don’t want to just be, to just exist.  “I know,” I say, and smile.

“Do you?” she asks.

No.  I don’t know that I matter just because I exist.  But I lack the words to argue the point I’m trying to make.  The thoughts keep spinning in the background, leading me to somewhere there are answers to these questions, real answers.  I just have to wait.  I need time.

“No,” I say, “of course I know none of those things define me.  I just want my life to matter.  I want it to be worth something to other people.  And to me.”  Uh-oh.  I’m getting close to the line.  I try to summon an expression of happiness on my face to back away.

Dr. Kim turns to her notes in front of her.  “There is a medication I’d like to try, if you’re up for it.  It’s called quetiapine, or Seroquel.  It’s an effective antidepressant for bipolar.  We could see how you feel on it, and maybe even take you off the Lamictal?”

My eyes widen.  Lamictal is the only thing we’ve found that makes me feel better, that keeps the hypomania at bay.  “Why would we get rid of the Lamictal?” I ask.

“It doesn’t seem to be as effective against your depression anymore.  We could certainly keep you on both, but quetiapine can be used as a mood stabilizer on its own.  If it works for you, we wouldn’t need to keep you on both.”

I nod slowly.  “That makes me nervous.  But I trust you.  If you think that’s the right thing, then let’s do it.  I don’t want to feel this way anymore.”

“Great.”  She goes over the dosage with me, how to wean off the one medication while titrating up on another.  Nothing new to me.  “How’s the gratitude journal?”

“Fine.  It’s hard.  I don’t really feel grateful for anything.  I mean, that’s not true.  I feel grateful for a lot, but it’s hard to think of five new things every day.”

“You can write the same five.  Just don’t lose sight of them.  How about exercise?  Sleep?  Nutrition?”

Yes, yes, yes.  We review the same things every appointment.  Even though my motivation for taking care of myself has been very low lately, I am still managing to do it.  Somewhat.

After the appointment I head downstairs to the pharmacy to fill my new prescription.  Waiting in line to take a number, the person in front of me is coughing.  I watch as they cough repeatedly into their hand and then touch the machine to take their number.  Liz would be so offended right now.  Cough into your elbow!  She would say, unafraid to reprimand them in public.  I make a grossed out face to their back as they walk away and then touch the ticket machine with my knuckle.  The person behind me hasn’t seen, and they touch the machine with their finger.  

The pharmacist reviews the quetiapine with me, and asks the same question I get asked every medical appointment for the past five years, ever since I got diagnosed with bipolar II disorder.  “Are you thinking about hurting yourself or others?”  I shake my head no and smile.  Then I take my little white bag and head to my car, with a heavy feeling in my heart and legs.  I don’t like switching medications.

I decide to swing by the store for flowers, for Liz and Binky.  My mind is replaying the conversation with Dr. Kim.  Could I really be happy if I worked in a shop for the rest of my life?  People all over the world do it, and do much less.  Are they happy?  Why do I need to be happy, anyway?  What is this fixation on happiness we have?  Is this what Dr. Kim meant when she said I could just be?  Just be…anything?  Is this what the buddhists mean?  But what if I give up striving for happiness, what then?  Will I just sink into a big blah blob state of ‘fine’?

I thumb through the flowers at the store.  All the ones I really like are so expensive.  Why did I come to the health food store?  The flowers are gorgeous, but ridiculously priced.  Should I get a cheap bundle of wax flowers?  Or a single beautiful lily?  Why am I being so spoiled?  What’s wrong with wax flowers?  Think about all the people in the world who can’t stop at some bourgeois store and buy beautiful flowers.  Six dollars is a fortune to most of the world.  My mind is starting to race.  I need to calm down.  I pick a beautiful stargazer lily, and then impulsively take another.  What the hell, Liz feeds me all the time.  I can spring for an extra flower.  

I have a great time at Liz’s.  We play charades, and I forgot how funny she can be.  While I’m there I get a text from David.  I’m sorry.  I overreacted today.  I think we should hang out again.  Maybe not talk about 5G?  Hope you’re having a good night.  I show Liz and she raises her eyebrows and makes an encouraging face.  I put my phone away, not sure yet what I want to say to him.

That night, I take out my gratitude journal and open it, determined to make a sincere entry.  I close my eyes.  If I’m not truly grateful for the things I have, then what am I?  Ungrateful?  I look around my room and try to cultivate feelings of gratitude for what I have.  I just feel that I have so little, and need so much.  But really, in the grand scheme of things, aren’t I so very fortunate?  For so many in this world, if they were plopped into my apartment, wouldn’t they be astounded that this is all mine?  Hot running water.  My own bathroom.  A bed, my own bed!  All my clothes.  Shelves and shelves of books.  Cupboards of dishes and food.  A refrigerator.  A car!  An iPhone.  Do I think I am owed any of this?  Why do I always compare myself to those who have more?  

My eyes still closed, I try to think of the person in the world who has the least.  I picture a tiny baby in Syria, born into war.  I imagine this baby will die within a couple of months, only ever knowing suffering.  It will never have a childhood, never have a chance to dream.  It’s entire life filled with fear, cold, hunger.  Do I think I am owed more than that baby?  I could have been that baby.  Instead, I was born here.  It hits me that everything I have, all my possessions, all my health, my life I’ve built, it’s all a gift.  I am not owed any of it.  Suddenly, gratitude fills me at the same time as immense grief.  I’ve been crying a lot lately, and so this cry isn’t unexpected, but it feels more imperative.  I think I am beginning to understand.  

I make a massive entry in my journal.  I suddenly feel grateful for everything, even my new medicine, which I take.  The pharmacist had warned me that it is sedating, but within twenty minutes I can’t keep my eyes open and I slip into a deep, tired sleep.    

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