Chapter 7: Depression

One rainy morning last week, I lay snuggled in bed, rereading my earlier diary entries. It was the first time I'd gone back and read the whole diary, and as I read I wondered: Who was that woman?

All that energy and optimism, I thought, and now I can hardly get out of bed. Not to eat. Not to drink. Not even to take Robin to school. He sits in the living room, watching television and playing quietly. He brings his beloved stuffed rabbit to keep me company, and the toy and I lie curled together.

I lose track of time, waiting for the antidepressant and anti-anxiety drugs I've been taking to lift me out of the frightening depression I slid into about two weeks ago. I know it takes time for the medication to get into my system and take effect, but how much time? When I call my doctors and nurses, they are sympathetic, but they tell me there's not much more they can do for me. It's not the chemo, they say.

One morning, my toilet gets stopped up and I find myself completely overwhelmed. Calling for repair, paying the worker, getting the toilet to flush again--what once would have been a straightforward and simple task is now just too much. I look at the plugged toilet and I know something is seriously wrong with me.

Two days afterward, as early in the morning as I can without breaching all etiquette, I call my counselor at home. She listens to me, then tells me to call the psychiatrist I've seen once before at the University of Washington Medical Center. I get him on the phone, and try to describe what's happening to me. He tells me I should be admitted to the hospital--not for breast cancer, exactly. For depression.

Here, doctors will be better able to control the dosage of the drugs I'm taking--Paxil for depression and Ativan for anxiety. They'll also be able to give me more intense counseling. This way, they say, they'll be able to "pop" me out of the depression faster.

I call my mother, and she and her husband drive up from their home about an hour south of Seattle to stay with Akira and Robin. I enter the hospital on a rainy Thursday afternoon.

What Happened?
It's a little scary being here, but I feel like it's the right thing to do. Each afternoon, however, I tell my story over and over to a varying lineup of psychiatrists and social workers, all of whom have different ideas about what exactly is wrong.

Some think the anti-nausea drug I was using triggered my depression. Others say the drug probably had little, if anything, to do with it. One, a senior psychiatrist who brings with him a group of four followers, says I may be grieving for my lost breast.

Well, I tell him, I never thought of that. I'll think about it now. And I do. Still, it doesn't seem right to me. To me, the explanation that makes the most sense is I was overwhelmed. I think it may have started when I asked to take some time off from work. On the surface, I did it because my vision had become blurry. But in reality, I think I did it because I felt like I wasn't pulling my weight anymore.

Then came the holidays, when some of the people I rely on got so busy that I hated to call them to ask for help. When I did manage to summon my strength and call, I'd feel personally rebuffed if I got an answering machine instead of a friend.

Meanwhile, some of the friends I did reach didn't know how to deal with my depression. Not knowing what else to do, they pulled away. I got more and more isolated, and finally, a stopped-up toilet defeated me.

This Far Down?
Depression isn't unusual among cancer patients, the psychiatrists, social workers, and therapists tell me. Of course, not everyone who gets cancer has to be hospitalized for depression.

My editor tells me she called an expert to get some perspective on depression and breast cancer. Hester Hill, chief oncology social worker at Beth Israel Deaconess Medical Center in Boston, has worked with breast cancer patients for 20 years, and is a six-year breast cancer survivor herself. She says that in her experience, serious depression requiring medication and hospitalization is unusual for patients who are doing well in treatment, like me. But, she says, it's not unheard of. And, she says, almost everyone who has cancer suffers mild depression at some point.

"My experience is everybody has a psychological collapse and hits the skids at one time or another," says Hill. "It can be at diagnosis, or in the middle of treatment, or a year later."

The important thing, Hill says, is to get help. "Tell somebody," she says. Find a counselor who's experienced in helping women with breast cancer. Look for a support group. If you're lucky enough to have them, tell your good friends and family you need help.

I thought I could lift myself out of this low with the help of the drugs, my friends, my counselor, a new yoga class. I was wrong. So for now, I shuttle between my hospital room, sessions with psychiatrists and nurses, and self-help classes on how to cope. I get my scheduled chemo, which, ironically, doesn't worry me at all anymore.

Now, I feel better--not great; not nearly as energetic and optimistic as that woman who cheerfully wrote about shopping for a new boob a couple of weeks ago. But I feel well enough to force myself out of bed and into the world, even though it is the safe and regulated world of the hospital.

The doctors say I could be here anywhere from a few days up to a week. Right now, a week seems like an awfully long time.

@ Jeanne Sather 2006