by Tammy Richards
As I leaned back into the soft, adjustable recliner I realized that this was it. The potential of the next 45 minutes would either lead to triumph or defeat and if the result was defeat, I was certain I would die. The last 25 years were a compilation of all my successes and failures, and the results of a lifetime of self-doubt and struggle masked by a wicked sense of humor and relentless drive to be the best. But today the stakes were higher — I was exhausted, hopeless, and the pain was unbearable. I had to decide whether I was ready to give up the control I had so desperately clung to and embrace the willingness to let go of the why. I had to decide I wanted to live more than I wanted to be in control.
“This is just the initial dose, and then we’ll increase it from here throughout the first six infusions. Let us know if you are experiencing any nausea, and we can give you something for that. We can’t predict what you will see or experience, but if it becomes distressing, please let us know, and we can help with that as well. Are you ready to start?” the anesthesiologist looked at my masked face hesitantly, and I wondered to myself what the bottom half of his face looked like.
“Yes,” I replied nervously, “I never thought I’d be getting a “Special K” infusion at the age of 48 to try to manage my chronic, soul-sucking depression, but at this point, I’m willing to try anything because I’ve tried everything else. Let’s do it.” The doctor nodded and pushed the initial injection of ketamine into my arm and then started the IV drip.
“Do you feel anything?” he said.
“My hands and feet and lips feel weird,” I think I said, and then everything changed. My body felt warm, but disconnected and as I closed my eyes, the acoustic guitar music in the room became a touchpoint for my consciousness as what I started to see around me took on different shapes and colors, and my perception of time and space began to shift into a place I had never visited in my mind before. Maybe this was the answer I had been searching for — maybe things could change? Dare I hold out hope one more time?
Major depressive disorder has been an uninvited guest in my life since my late teens. While I wasn’t officially diagnosed until my late 20s, the eventual diagnosis explained so many things about the way I have always perceived the world. An entertainer at heart, my greatest hope was that people would like me. In my mind that meant I had to be exceptional, special, better.
In my childhood mind I remember every failure as a stain upon me until I was covered in darkness, disappointment and sadness. Throughout my quest to measure up, I had always fallen short, was never enough, but was somehow too much.
How I envied my younger sisters. They were prettier than I was, and they didn’t seem to care what other people thought of them. I watched them grow up and become confident, beautiful women with amazing children. They seemed so happy with who they were, and lived their lives authentically, while the shadows of impostor and fraud chased me like so many specters.
My first stay in the hospital was after my psychiatrist found out I had stockpiled enough medication to kill myself.
“You have two choices,” my psychiatrist said as I stared at the worn carpet in her office. Do psychiatrists ever change the decor in their offices, I wondered? I wished the plush pillows behind me would somehow suck me into the couch and port me to a place where I didn’t want to die every day, but I remained in the office.
“You can go into the hospital voluntarily, or I will commit you for your own safety,” she looked at me expecting an answer. I didn’t know what to say. All I could think of was the cost. The financial cost, the emotional cost, and the humiliation.
“I guess I will go voluntarily,” I said grudgingly, knowing that the worst was yet to come. Later that day, my husband of eight years dropped me off at the front entrance to the hospital ER
“See you later. I hope you feel better. I love you. I will visit later,” he signed to me before driving away and leaving me to either flee or go into the hospital on my own. My husband was Deaf, and he knew as well as I did that the hospital wouldn’t make communication with him accessible, and I was in no state to interpret for him, despite interpreting being my chosen profession. Just another kick in the teeth watching him struggle to understand what the actual fuck was going on with his wife.
After entering the ER, I was screened, searched for implements I might use to kill myself, and taken to the fifth floor psychiatric ward — a locked ward with patients whose diagnoses ranged from schizophrenia to mild depression and everything in between.
All around me patients in hospital robes and pajamas wandered talking to themselves, to people the rest of us couldn’t see, or sat looking vacantly at something they wished they could reach. I wondered what alternate realities they inhabited and if any of them were better than actual reality. I entered my room and climbed up on the windowsill looking out the window at the parking lot below. If only I could break the window, forever escape would be mine. Like a deep, pounding heartbeat I began to bang my head against the window, willing it to break and for me to plunge downward to freedom.
The next thing I remember is waking up rather groggy and feeling hungry. What had they given me? Images of nurses pulling me from the windowsill and a sharp prick of pain flashed through my mind as I pieced together that they must have tranquilized me like some kind of psychotic racehorse when I wouldn’t/couldn’t stop banging my head against the window.
What now?
It has been 22 years since that hospitalization. Since that time, I have divorced, re-married and now have two teen sons. Through all the medication changes, additional hospitalizations and ever so many treatments of electroshock therapy the depression has been lurking, ready to pounce at the sign of the tiniest crack or the most minor divot in my mental armor.
In 2017, that crack began to appear. Something visceral shifted and I could feel the descent into despair. How could this be happening to me again? What had I done wrong that had sent me back into the place where every day I woke up wishing I hadn’t?
By January 2020 I was back in the hospital. A week there and I felt that all I had done was reaffirmed that I couldn’t live this way anymore. I couldn’t stop thinking about my poor children. The day I checked myself into the hospital my 13-year-old-son was crying and hugging me,
“Honey, it’s ok. I will come back soon. I just need some help right now,” I tried to reassure him and hold back my own tears.
“Mom, I’m not crying about you leaving, I just don’t want to end up like you,” he replied, sobbing.
My heart cracked and broke into sharp shards of glass, too small to piece back together.
“You won’t, honey. You will be fine,” I replied, the guilt and shame overpowering now.
By June 2020, after months of the pandemic and barely being able to crawl out of bed each day, I knew it was only a matter of time before depression would kill me and reduce my family by one.
“I have done everything I can, Ryan. I don’t know what else to do at this point. I’ve been on too many medications to count, shocked my ever-aging brain dozens of times, and done so much therapy I’m surprised you haven’t sent me packing yet!” I complained to my long-time therapist and staunch supporter.
“Tammy, there is one thing that is somewhat new, but you could consider trying. It will take an extraordinary amount of willingness and bravery to try it, but I think you should consider it. There have been a number of very successful trials and studies, and they have shown this treatment can be effective in up to 70% of patients struggling with depression,” Ryan explained.
“What is this magical unicorn treatment that I haven’t yet tried?” I said, sarcastically.
“It’s called ketamine infusion therapy,” he explained.
“Wait, you want me to take Special K — like the party drug??” I was skeptical. Was my therapist seriously telling me I should consider taking a psychedelic drug to alleviate my depression? I was absolutely terrified by this prospect. I have serious control issues. I cannot stand to feel like I am out of control. The idea of taking a party drug, via IV infusion no less, sounded instinctively like a bad idea to me. Here I was at 48 years old, and I had never even been drunk or smoked a joint before! I hadn’t even partaken in THC-laced edibles, though all these things had been legal for years in Oregon.
What if I became so altered that I started doing or saying things I couldn’t remember? Visions of crazy, naked, trippin’ hippies running down the street came to mind. And dare I even have the slightest bit of hope that this treatment would help when so many others had failed in the past?
“What do you think?” Ryan asked as he stared at me through the video monitor as we continued our online session. It seemed like it had been an eternity since I had seen him in person. I secretly wondered if he still existed or if I was just talking to a therapist avatar of some sort that happened to look like Ryan.
“I am terrified. I don’t know if I can take the disappointment and feelings of failure if it doesn’t work for me. My capacity for hope is gone. I just can’t be disappointed again,” I explained.
“You don’t have to hope for anything,” Ryan reassured me, “I’ll hold that hope for you, but I need you to be on your own team, ok?”
Somehow having Ryan be my “hope proxy” was comforting. If this didn’t work, I wouldn’t have to have my own hope crushed, he could just hold it for me. I had to make a critical decision at this point: would my need for control outweigh my desire to live? Would I be able to choose willingness?
I decided that I would try the ketamine therapy. I had nothing left to lose by trying it, and everything to lose if I didn’t.
Ketamine infusion therapy is done in a six-infusion series over the course of two to three weeks. The dose is titrated up over the course of that time until the patient starts to experience clear dissociation which is the effect that the doctor is trying to achieve. All treatments are overseen by a nurse monitoring vital signs and a board-certified anesthesiologist who administers the infusion.
By the second infusion, I could feel a small shift in mood. I felt the boulder on my chest had decreased in size just a bit, and while I could still hear her, that horrible internal voice that railed against me, telling me that I was worthless, stupid, and vile, was more of a whisper instead of a shriek. And then, during the fourth infusion, things broke wide open.
A tiny crack appeared. It was slight but real, and with each failure, it grew until I poured out of it leaving myself empty and hollow.
I knew this feeling well. The innumerable fissures that I had carefully patched and spackled so as not to reveal the damage and breakage to anyone because I couldn’t let them see the imperfections and so much damage.
Sometimes the voices were so loud they overtook me in waves as rough and surly as any hurricane; screaming to me of my worthlessness and failure until all I heard was death and wished so hard it would take me. I cried as I believed the mind that tricked me, telling me lies so convincing that I couldn’t hear anything else because I KNEW it was right.
For years, I awoke, bitterly disappointed that I woke up at all. Wanting so desperately to end the screaming and hate and loathing that consumed me. But even when I tried to help it along, death wouldn’t come and teased me by saying I couldn’t even get that right.
But one day, I was so deep in the ocean that I couldn’t hear the screaming anymore and I floated upward seeing the light at the surface. I didn’t dare hope because hope was for suckers, and I had been fooled so many times before, but I pushed toward the surface as hard as I could until I broke through and was engulfed by the sun. I smiled, with genuine joy because the voices stayed quiet, and my mind didn’t tell me how stupid and worthless I was, and I could finally breathe, at least for now because something inside had popped.
The fissures and cracks had been made watertight again, and I felt myself inside myself again, not leaking out onto the floor and into the despair I usually occupied. There was finally space again.
It was after this fourth infusion that I began to allow in hope, and I made the choice to be willing to accept that I may never know why I experience such profound depression. I just do, and that explanation must be enough.
As Ryan has said to me many times, everyone struggles sometimes, it is learning how to struggle without suffering that is what we all need.
Tammy Richards lives in Portland, Oregon (a proud, life-long Oregonian) with her husband of 18 years and her two sons. She has served as a certified American Sign Language Interpreter for the past 31 years. When she is not writing or interpreting, she enjoys volunteering for access-related social justice causes (such as interpreting for inaccessible YouTube or Livestream content) and participating in endurance cycling events with her AIDS/LifeCycle team: Team Portland. She is an avid reader and is also a thriving child-taxi, driving her kids around to their various sporting activities (when we are not in lockdown). She has three mini-pigs: Zena, Zorro, and Zoey, who she adores. Tammy has trained Zena as a therapy pig, so she makes appearances in special needs classrooms and nursing homes where she visits, does tricks, teaches people about pet pigs, and gets lots of treats and belly rubs. Tammy’s memoir, “Toward Not Away: A Journey Through Depression to a Values-Driven Life” is currently in the works. You can follow her on Instagram @towardnotaway and on Facebook at @towardnotaway.
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