The Heath Ledger Paradox

Warning: This post has contents that may be hazardous to mental health.  It contains strong themes of suicide, suicidal behavior, and substance abuse.  Reader discretion is advised.

Have you ever had a moment where you heard the distinct and deafening sound of your own clock ticking down?

I have only heard this sound a handful of times. The first few times, it was difficult to distinguish from the other garble in my mind. But, the last time this occurred, the sound was unmistakable.

Tick.
Tock.

It happens when my physical state is badly threatened, but I’m not mentally aware. That is my defense mechanism that seems to be biologically programmed to protect me. It is what creates the Heath Ledger paradox.

And that’s what I experienced.

The Heath Ledger Paradox

Some things happen by accident

Personally, not proudly, I have attempted suicide between a half of a dozen and a dozen times in my life. I don’t really keep score; there is no tally anywhere. In fact, in total, I have only left a handful of notes behind. They don’t always correspond to the actual attempt, though.

I am not a violent woman. My method of choice was almost always centered around substances. My very first attempt landed me in a bathtub with a belly full of pills. It was an unintentional coincidence between Sylvia Plath’s and Virgina Woolf’s suicides. I know this to be truth, because I was only in my early teens at the time. I had yet to read about these authors. And despite these attempts, even some carefully orchestrated with blatant drug interactions, I never succeeded.

What was different about me that made me a survivor of my own wretched malice? Many a person has done these things accidentally! Marilyn Monroe, Michael Jackson, Elvis Presley, Janis Joplin, Jimi Hendrix, Bruce Lee, Brittany Murphy, and many others are examples in our modern culture of how accidental overdose happens.

I met a guy in college that I stayed friends with. Eventually, we ended up working together. He was dismissed for failure to attend, and we all suspected he had a drug problem. A few days later, he was found dead in his apartment from a multiple-drug interaction. The guy ended his own existence with his own carelessness. How could he do it by accident and I couldn’t possibly do it on purpose?

That’s the Health Ledger Paradox. It is easier to succeed when the mind is unaware.

Last night, I accidentally set my foot onto the other side of the fence for a moment.

I still have impacted wisdom teeth on both the bottom left and right sides. These wisdom teeth have risen up partially in the back, causing skin pockets to form. Occasionally, I will get something trapped back there and a small infection will form. If I treat it immediately with a rinse and keep the pain manageable, I can usually escape a trip to the doctor and an antibiotic.

I detest going to the doctor to hear the same thing repeatedly. Yes, I know I need to have those teeth out. Though, I now have dental insurance, I do not have the money for a serious co-pay there. I just had a major surgery a month and a half ago. I don’t have the time or energy to spend in recovery. And I always feel worse on the “cillan” antibiotics than I did with the infection. Other women will feel me here. I usually end up with a worse infection in the end.

I had some Vicodin remaining from my surgery. Admittedly, I hadn’t taken many. I had a problem where the Vicodin would cancel the Temazepam out. I would be up for hours, sleepless and still aching. I decided that my body needed rest more than I needed pain relief. I had to heal. Last evening seemed like a good time to take it. I don’t know how I let the situation with my teeth go from uncomfortable to agonizing. But, it happened more quickly than my mind could have processed. So, I took the Vicodin.

Bad choice.

I spent the rest of the night staring at the white porcelain bottom of a toilet bowl. At first, it was akin to other bad reactions I had to other narcotics. I do not respond well to Oxycontin or Percocet. And this was a similar episode. But, by the sixth hour, I knew there was something terribly wrong. My stomach had already emptied itself twice and was going for a third. This time, only water remained.

By the seventh hour, it became clear to me. I leaned forward and wretched. It felt like my stomach was turning itself inside out, in hopes to vacate an invader. I literally felt empty, as if I had evacuated every ounce of anything I’d eaten in the last 36 hours. And it dawned on me. My body was having a reaction – but why? I had taken Vicodin before with great success. I took it after my surgery and this didn’t happen.

I couldn’t muster the strength until the morning. I had only slept five hours out of fear that I’d never awaken again. I decided to refer to the almighty Medscape Mutli-Drug Interaction Checker. I thought I remembered doing this. Typically, I screen all new medications coming in. As I was trying to rattle my brain for all of my prescriptions, it occurred to me. I did do this, but I had forgotten a very important medication, Wellbutrin.

Significant – Monitor Closely

bupropion + hydrocodone

bupropion will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Significant – Monitor Closely.

lamotrigine + acetaminophen

lamotrigine decreases levels of acetaminophen by increasing metabolism. Minor or non-significant interaction. Enhanced metabolism incr levels of hepatotoxic metabolites.

That’s just the tip of the iceberg there. That’s among four additional interactions. Those are the most important though. That’s the reason I was hugging the toilet, wondering why my sedation was outrageous and my pain relief was minimal.

And I realized, I just set foot on the other side of The Heath Ledger Paradox. If it wasn’t for that mechanism, that beautiful inborn, DNA encoded device inside me, I would have been dead. Something in me told me not to take more medication when my pain relief was marginal. And that same thing kept me safe by alerting my body that there was a dangerous toxin that needed to be rejected from my stomach. There was still a tiny bit of knowledge encoded from some source that this was life-threatening.

Not everyone has that, and most people with it can bypass the safeties with enough of a loading dose. That’s the aim in a suicide – to get past the safety, just like a gun. Except, when most people knowingly stand on that ledge and look into the void, they turn back. The point with accidental overdose is that all of that is gone. It’s like playing with a gun without knowing if it’s loaded or if the safety is on.

That gun was loaded last night. Thank the powers that be in the universe that I have a safety.

Marginally Clear

Thanksgiving will hopefully be a day of thanks. It marks two weeks since the LEEP procedure. Since it falls on a holiday, my doctor’s office was kind enough to squeeze me in on Wednesday, Nov. 23. I’m sure the scheduling nurse I spoke with was aware that I’d have a Sword of Damocles hanging over my holiday table. It was kind of her to be so considerate. (Note to self: Be thankful for considerate, compassionate people).

The Healing Process

I was briefed after the surgery about care and restrictions. No worries – this is not going to get graphic. I’ll admit, it was not quite as I expected it. They likened it to a colposcopy with a biopsy. I know there is a huge difference between the two. One is a little snip and the other is more akin to taking a sizable section. Like trimming the hedges versus pruning a tree.

They under-exaggerate when they describe the more unpleasant parts of post-op care. I was in nearly constant, serious pain for the first four days. I would wake up in the morning in severe pain, because a full bladder likely pressed against the area. The more I moved, the more the pain increased.

Mothers will especially stand this next part. It is more akin to the physical sensations to about a week after labor and delivery. My bottom half was sore. It was pain like a T, across my hips through me, and into my back.

They don’t tell you the real story on a lot of it, although they are still defined within the parameters of “typical healing”. To sat the least, it was a lot more intense than I predicted.

The healing time takes longer than I predicted too. The doctors assured me that I’d be back on my feet, doing my daily activities in a few days. But, those activities are not to include any aerobic / strenuous activity. I haven’t been able to do any housework. No stairs, so I have to limit my use of them at home. It’s frustrating to leave something on a different floor.

I’m still not quite back to normal. I always feel like the doctors overreact when they give you restrictions. Possibly, it is because they know patients will not follow them to the letter. But, they weren’t kidding here. I’m moving better, but I am still in pain. I need extended time sitting. I’m tired.

The biggest thing they don’t tell you is the emotional rollercoaster that follows. I don’t know if it’s hormonal, but I have been completely out of whack. I described some of it in With This Pill. Manic Monday touched upon the subject in 2.5.

This is a conversation C.S. and I had on Friday.

I swear. A lot.

I thought I was on the cusp of a depressive episode. Mobility is difficult. It is irritating and frustrating to be at the mercy of others. I am a control freak. I like things done my way, and I like to be an active participant at all times. But right now, I feel like a useless invalid watching life pass as I’m bound immobile, as much as possible.

I feel useless. I can’t take charge of classes because I have to meet them in their classrooms. I must have children assist me in classes by passing out lyric sheets and retrieving items for me from across the room. I hate asking people for help. Then, I start to feel like an inconvenience, a burden, if you will.

Tomorrow’s Follow-up
I was under the impression that they were going to poke in there and assess my healing.  Then, they were going to report how much had to be excised, and what my chances of having more children is going to look like.  What they failed to mention is that tomorrow is also the delivery of the results from the sample they took.  What I thought was going to be a completely benign appointment turned malignant fast.

What the doctor is looking for is are Clear Margins.  Essentially, if the tissue they collected has both the cancerous cells and a margin surrounding it of healthy tissue, then we can be assured that all of the cancerous cells were excised.  However, if the margins are not clear, then cancerous cells still remain and pose a possible threat.

The course of action after that is typically to wait until the results from the follow up Pap smear come back.  If they are positive, then we visit colposcopy land to see how bad it is.  And, there is a possibility of yet another procedure.

You guessed it.  This poses a greater threat to my future pregnancies.  The more cervix that is removed, the higher the risk of miscarriage and pre-term labor.  I have a plan, but I need to get C.S. on board.  If the issue is forced, I want to make the Hail Mary pass in order to conceive another child before I would have another surgery.  We have two months to make a decision, because after that, it’s do or die.

I really do want another child, even if it’s not at a great time.  If I have to do it and take some risks, I’m willing to do that.  However, C.S. has not expressed a great deal of enthusiasm about another child.  I don’t want to come to blows over this.  But, if there is a serious disagreement, I know it’s going to turn into a serious problem.

One bridge at a time, Lulu.  One bridge at a time.

Taking the Bullet

I went to the dreaded LEEP surgery consultation, as first mentioned in Leep-Into-Cin – Part III, and more recently in  A Peach and A Catalyst.

Dodging Bullets
Honestly, I’ve been dodging this since I received word in May that my Pap came back bad again.  I put off the colposcopy until July, as I mentioned in All the Pretty Things.  The results of the colposcopy were among many things that triggered my breakdown in August, most noted in Meet Me in the Magnolia Tree.  I was informed at that point that I would need the surgery.  And I failed to go to both my August consultation and my September consultation.  I couldn’t face what I knew she was going to say to me.  I couldn’t hear that I may never be able to have more children.  And after the debacle from my last surgery, mentioned in Leep-Into-Cin – Part II, I couldn’t fathom the idea of having to go through another one.

The Reader’s Digest Version
It’s a lot of history to take in all at once.  I understand.  So, for those of you that really don’t have the time, or simply don’t want to sift through all of it, I will provide the abbreviated version.  I was diagnosed with HPV in August 2007 and had cervical dysplasia as a result.  At the time, I was in my early 20’s and the doctors all insisted that it would clear up on it’s own.  I got pregnant at the beginning of 2008 with T.D. and it only got worse.  In fact, so bad that I had to have the worst colposcopy of my life when I was 34 weeks pregnant.

Due to some insurance problems, I wasn’t able to get another colposcopy until May 2009, when it was discovered I had CIN-II and III in some places.  Essentially, I had the worst precancer before it became real cancer.  I had a very traumatic cryosurgery done in June 2009, and that was that.  For then.

Here we are, two years later.

My Worst Fears Realized / Speculated and More
From the moment I got the call, I’ve done my research.  I knew the words that were going to come out of her mouth.  And, I had face it alone.  C.S. and I decided that it would be better to save that 1/2 day off, in case I need it after the surgery.  Not that emotionally agree with the decision.  I see the logic.  But, I knew I’d need him there.  In a way, I am hurt that he doesn’t consider my health more important than his work.  I know he is only trying to make things stretch.  But, I feel like if he cared enough, he would have been there.

Like I already knew, I risk cervical stenosis, scarring of the cervix and cervical canal, that may make natural conception impossible.  I am at a higher risk for cervical incompetance, which may make carrying a child to term impossible.  I risk infection, hemmorage, etc.  But here’s what I didn’t know.  I risk damaging other organs in the vicinity, such as the vaginal walls, colon, bowel, etc.  And that made the whole ordeal so much worse.

All my doctor could say was, “The risks and complications are a possibilty.  I can tell you that these risks are small, but I can’t make any guarentees about what’s going to happen.”

On the subject of future children, “Cervical stenosis isn’t as much of a concern as cervical incompetance.  It depends on how much we have to remove.  We can only determine that when you’ve healed.  I’ll check at the 2 week follow-up and we’ll have a better idea then.”

My Aching Heart
I cannot get my mind away from the possibility that I will be incapable of having anymore children.  I wanted one, maybe two more if I feel my biological clock start to tick later on.  I cannot fathom the idea.  It breaks my heart to think about.  I may never have another child, ever again.  I could end up barren with the thoughts of the child that I could never have.  The child that would have been a sibling to T.D. and a child to C.S. and I.

Worse, is the possibilty of having multiple miscarriages.  I had one, and I know it was my fault.  I didn’t know I was pregnant until I miscarried at about 10-12 weeks.  I was drinking heavily at the time.  And that likely did it.  If that child had lived, he / she would be 9 in January.  It took me a long time to accept the truth about it.  But, I knew it wasn’t meant to be.  The day after I conceived, my boyfriend broke up with me.  I told him a year later about what happened.  His response was, “It was better this way.  I wouldn’t have left her (his girlfriend) anyway.  Now, we can all get on with our lives.”

It was cold-hearted, but he was right.  I was in no position to be a mother.  I was too young, with no college education, no income, and hardly a stable place to live.  The child would have had a deadbeat dad, and I would’ve been outcasted by my family.  This is not to mention that I was not yet diagnosed with bipolar disorder.  That baby has a better home in the life beyond.

Will I have to go through the unimaginable pain of losing a child?  Losing multiple children because my body just can’t do it?  I’m terrified at the idea.  I cry when I hear about it.  How could I even begin to handle that?

My doctor tried to be reassuring and said, “Most of my patients who have undergone one LEEP have gone on to have successful, complication free pregnancies.” Most.  Not all.  This is my second surgery.  I don’t know exactly what I will have left when all of this is said and done with.

The Worst Case Scenario of Them All
What if this LEEP doesn’t do it? What happens if the dysplasia grows back. I only have so much cervix. Do I have to face another LEEP? And if I do, that will destroy all hopes of another child. Beyond that, we’re looking at a hysterectomy. I’m too young to have my uterus removed. So what then? Hormone replacement therapy for the next 10 – 15 years? Or will I just have to bear early menopause?

That is honestly the worst of it all. Not being able to have children and having to go through menopause.

The Only Good News
The actual surgery isn’t nearly as bad as cryosurgery. I will have a cervical block, as well as IV sedation. Instead of being in the office, I will be at the hospital. The procedure is supposed to be painless, and afterward, I should sufffer no symptoms worse than a light menstration.

The after care is much like having a colposcopy, and heaven knows I’ve had enough of those.  Literally, I’ve had four or five.  With the last one, I wasn’t doing great the same day.  But, within a few days, I was back to my regular self.  I should be healed enough to resume normal activity within two weeks (like aerobic activity), with the exception that I’ll have a lifting restriction for a month.

The Plan
The date of the surgery – November 10th or 11th.  I have off on the 11th, so I tried to schedule it for then.  But, I can take the 10th off, if needed.  My doctor specializes in treatment for woman cancer.  I trust her and really like her.  She reminds me of the wonderful OB that delivered T.D., except she’s a little more forthcoming.  She’s the only doctor that has sent my specimens to an oncologist for review.  She is the only doctor that has been extremely proactive about this.  And she is the only doctor that hasn’t treated me like I’m a case, or I’m insane, or anything else.  She’s regarded me as a person every time.

I just want to get this all behind me.  I want to be able to deal with the aftermath as soon as I can.  And, I need to make the attempt to get pregnant as soon as I can afterward.  Because, if I have to face another LEEP or hysterectomy, I’ll be damned if I don’t at least try to have another baby before we come to that.