October 18, 2013

sleepwalking through a dark night of the soul

     I stumble lamely out of bed.  The only light is the soft glow provided by the alarm clock.  3:30 am.  Didn't F. Scott Fitzgerald write:
Now the standard cure for one who is sunk is to consider those in actual destitution or physical suffering -- this is an all-weather beatitude for gloom in general and fairly salutary daytime advice for everyone. But at three o’clock in the morning, a forgotten package has the same tragic importance as a death sentence, and the cure doesn’t work -- and in a real dark night of the soul it is always three o’clock in the morning, day after day. At that hour the tendency is to refuse to face things as long as possible by retiring into an infantile dream.
As I stumble to the bathroom, I notice a throbbing pain in the great toe of my right foot.  I don't remember that pain being there when I went to bed.  Half asleep and half dreaming, I turn on the bathroom light and plop down onto the floor as standing requires to much effort in this condition.  I pull my sock off and through the crust of sleep and squinted eyes against the light, I observe that my toe is red and swollen, at least I think I do.  At the time, I probably couldn't have registered the correct number of fingers held up 3 inches from my face.  My mind quickly, well slowly actually, raced to conditions which cause the great toe to hurt.  Ah shit, I have gout?  Seriously? What else can go wrong?  My brain asks my brain, "how do you treat an acute flare of gout?"
     "Well, that's easy.  NSAIDs" my brain replied to my brain.
     "But didn't you already take some naproxen for your back and shoulder?"
     "Right you are, Brain.  What's the second thing you can add?  That drug you can add to the NSAID?" my brain puzzled over.
     "Colchicine or something like that.....we don't have any of that, do we?"
     "Now why in the hell would we have colchicine???  Please try to keep up," my brain said exasperated to my brain.
     "Wait...we have pred.  Prednisone can work, too!  When in doubt, give steroids!  That's what I learned from pharmacology."
      As I rustle through my cabinet under the sink looking for some prednisone, some part of me either shuts down this train of thought or another part wakes up a bit and says, "WARNING, DO NOT DIAGNOSE YOURSELF WHILE IN A HALF DREAM STATE!"
     "Ok," my brain replied already shutting back down, and I returned to a sleep state.
      I went back to bed.  In the morning, through the haziness of sleep, I began to remember what happened last night.  Holy Crap!  Did I try to treat myself for gout???  I look at my toe and see the big bruise on the toenail.  I had smashed it on a log during a bike mishap the day before.  That was the source of pain.  Not gout.  It reinforced to me that I absolutely need to go back and finish school before I hurt myself.  I have a deep need to finish that's not even explainable anymore.  At this point, it's my Mount Everest to climb because it's there.  That climb should start again January 1.  I qualify the "should" because at this point of my life, I have no control over what other hells can befall me.  My response is if not this January, then next June.  Come hell or high water, wait, those are already here.  Come hell, high water or zombies, I will finish.

(Of note, I've done even stranger things while sleepwalking.  Ask my wife.)


Steve Parker, M.D. said...

Good story.
You remind me of an aphorism from my training days: "No one should die without benefit of steroids."
I've noticed veterinarians love them, too.
But after you see some cases of steroid psychosis and avascular necrosis of the hip, you get cautious.


Isaac van Sligtenhorst said...

I've seen the steroid psychosis. Bizarre stuff but it was a pretty high dose of daily dex (inpatient chemo). Haven't seen the avascular necrosis and ain't looking forward to seeing it at some point down the road either.

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