"It can"t be much worse than licking a battery." What it"s like to have ECT

I have had depression and anxiety, mainly depression, on and off since I was a teenager. After dealing with it for 10 years I had a particularly bad winter when I was working almost 24-hour shifts at work.

I went to visit my aunt overseas because I got a few weeks’ sick leave. I thought I’ll go, I’ll decompress, but while I was there I got sicker and sicker.

The GP there prescribed something called Lyrica [an anti-seizure medication also known as pregabalin]. I don’t know whether that had anything to do with it, but I went into a psychotic episode – I thought I was going to be deported, I had a lot of paranoia.

I suddenly started getting very, very anxious – and took an overdose. That landed me in hospital. I was a voluntary patient but I think I would have been forced if I wasn’t voluntary.

I was there for a really long time – a couple of months. I saw a lot of people come and leave and I wasn’t really able to do anything. They had an ECT [electroconvulsive therapy]clinic downstairs and the psychiatrist kept on suggesting it.

Eventually it came to the point where they had tried all these medications that weren’t working and I was an absolute nightmare – I was really difficult and I couldn’t do anything. After being really reluctant I finally gave in. I thought either I am going to die this way, or ECT might help. My aunt was like: “Well, we have tried everything else.”

They scheduled it super quick. We said yes on Friday and they scheduled it for Monday, then they did it three times a week for two weeks.

At first I was worried because of the image you get from the horror films of people being strapped up and electrocuted. Then I learned a little more about it, although I couldn’t do any reading on my own because I was so anxious – I couldn’t even cope with the phone. But I talked to my aunt who put it in really simple terms and talked about all the side-effects.

The thing that scared me the most was the memory loss. I went to an elite university and I really pride myself on my brain, so I was worried. Was this going to make me stupid? But I reached the point when I said: “Well, I don’t care if I am stupid. If I’m stupid and happy it’ll be fine.” So that is what made me go for it, even though I had a very bad perception of it.

The doctors talked me through the entire process. I had never been under general anaesthetic before and because I was anxious and paranoid about not being in control of my body, that was something I was really afraid of. I agreed to do it if my aunt could be in the room – but she wasn’t allowed in the room when they gave the electric shock because it is so traumatic for loved ones.

Before the ECT, they showed me the equipment and said: “The amount of electricity we are putting through your brain is enough to light a lightbulb for a second.” I was thinking: “How is that going to do anything? It can’t be much worse than licking a battery.”

After the first session all the nurses said: “You are so much calmer. I think this is really working. This is really good.” I thought: “I don’t know what you are talking about. I am still super-anxious and I hate my life.”

But looking back, the change happened almost immediately. After the first week I had hoped that I was going to leave the hospital and by the end of the sixth session, after two weeks, I was ready to get on with my life.

I had problems though – mainly short-term memory. I compensated for that by using a journal. Whatever my therapist advised, I’d write down and look over every day and try to do it. But I constantly found myself being told that I had already just told people something I had said. I had to monitor my medication very carefully. The memory issue went away in the course of the month. The benefit of ECT stayed for about six months and I needed to keep taking medication to prevent a relapse. But it didn’t work.

I was hospitalised again – this time in the UK.

I really wanted ECT. But they said the memory effects can be worse if you do it again and again and at that point I wasn’t psychotic. It is much harder to reach someone once they are psychotic because you can’t really rationalise with them, whereas I did what people told me to do, so that drastic measure of ECT wasn’t really necessary. But as soon as I mentioned ECT to any medical practitioner in the UK they said: “Oh my God, seriously?” The only semi-positive reaction I had from one of my GPs was: “Wow, how was that? I have never met anyone who had it.” He wasn’t judgmental, just really surprised and fascinated. In hindsight, I don’t think ECT was the right thing to do.

Sometime later I relapsed again. This time I had ECT on the NHS. They then diagnosed me as bipolar.

After I first had ECT I was really freaking out about whether I was going to tell people. But because of my short-term memory problems I was forgetting who I had told what and it was getting really stressful. It got to the point where I was anxious to meet people because I was wondering: “How much do they know? What do I say?” Which is why I put it up on Facebook, because that way everyone knows the same thing. But I am quite reluctant to tell people that I had psychosis. Because although mental health issues are more accepted and depression is quite common, psychosis is like really crazy. Taking medication is more accepted now, going to therapy is more accepted, but ECT … I think people think of One Flew Over the Cuckoo’s Nest.

There is definitely a lot of concrete evidence of ECT working. My aunt was absolutely floored by the results and she talked to the nurses and they said: “It is almost like a miracle but we see it every week.”

(*Name changed for confidentiality)

"It can"t be much worse than licking a battery." What it"s like to have ECT

Removing the battery: can a medical doctor make a decision how a patient must die? | Ranjana Srivastava

The pleasantries exchanged, she smooths her dress and positions herself in a a lot more relaxed spot in the hard chair. She nudges her walking frame away and untangles the oxygen tubing so that it doesn’t strain against her nostrils. She does all this in a silent, deliberate motion.

We had met only once prior to. That was when she found out that her nagging “winter cough” was really a signal of the lung cancer that had permeated her whole entire body. She said she had constantly acknowledged she would create cancer, from the day she declared to her mortified mothers and fathers that nothing at all would unyoke a modern girl from her cigarettes. Nevertheless, the diagnosis was not without its accompanying shock and sadness.

A former teacher, she had dissected the particulars of her diagnosis. Her husband, and fellow smoker, had succumbed to the same sickness. She was intent on staying away from what she imagined was his wretched encounter of chemotherapy. Shakily at times but with admirable equanimity, she informed me that she was going residence to Bristol the place her ancestors rested. So I am relatively stunned to see her return to see me.

Taking a shallow, unpleasant breath, she begins, “You thought I’d be gone by now.”

“Gone to Bristol, yes”, I reply, producing a mental note of her pallid skin and more bodyweight loss given that we met. “What happened?”

“I stored my cardiology appointment.”

Tears nicely up in her exhausted eyes. I slide a box of tissues along the desk. I know that a defibrillator had been inserted years ago following a cardiac arrest that she miraculously survived. I have a terrible sense of what’s coming.

“He mentioned that the battery is due for substitute. But given that I have a terminal illness, I might want to reconsider it.”

She seems at me and falters. “I mean, he was pretty but what he was truly saying is that given that I am going to die anyway, why complicate issues by fending off a cardiac arrest?”

Misplaced for phrases, I just wait.

“Modern medicine is all about choice”, she says, stifling a sob. “I can choose to die from lung cancer or a cardiac arrest.”

“I am sorry”, I lastly say. “You could have done with no the latest news.”

“I was reconciled to a slow but predictable decline from cancer, barring a crisis. But if my defibrillator runs out of battery, I could actually drop dead. It’s not the dying but the awful selection in amongst that upsets me.”

A defibrillator from 1994. Photograph: Rex Attribute

Slowly, we pick by way of her thoughts – ranging from extremely practical matters like finalising her will, to existential concerns about the nature of suffering. I grow to be aware that I am not fairly giving my patient the certainty or even solace she seeks. Her dilemma is so confronting that I really feel hampered by doubt and dread that a misspoken word or a careless expression could lead to a cascade of distress.

Cardiac arrest or lung cancer. Ought to we try to change the battery?

My heart sinks. I locate myself unequal to the monumental activity of assisting my patient navigate the most hard selection of her life. I feel back wistfully to my ethics fellowship, exactly where a team of doctors, ethicists and philosophers would have illuminated the numerous complexities and offered the treating clinician with advice.

The weightiest selections in medicine are not about which tests to purchase, or what medicines to prescribe they in fact get spot at the sharp intersection of medication and ethics. A lot of facets of daily health-related practice ultimately turn out to be schedule – involving pattern recognition, accumulated expertise and a healthier dose of conjecture.

Certainly, doctors need to master these aspects of the work in buy to treat patients efficiently. But alongside the program run of managing diabetes, administering antibiotics and repairing fractures, momentous choices unfold that do not comply with a tidy protocol.

The wife of a somnolent, demented man insists on a feeding tube, saying it is apparent that he can even now connect with his loved ones. In the absence of an sophisticated directive, whose selection is it to place or refuse the tube?

Who has the final say in turning off a cancer patient’s ventilator assistance? Who must grapple with the patient who sees nothing at all wrong with acquiring an illegally harvested kidney? Who in the long run decides whether to disable the pacemaker of a quadriplegic elderly man?

Anyone who has actually been involved in these charged choices understands that basically quoting the law, if there is a single, feels woefully inadequate. The procedure calls for the two head and heart. Extraordinary calls get manufactured in hospitals since anything “just feels right” to 1 doctor, or because the ramifications of a program of action are far from evident. These conditions can depart patients exposed to idiosyncratic, probably unethical practice – and result in doctors enduring qualms.

‘The weightiest decisions in medication are not about which exams to purchase.’ Photograph: flickr

The excellent and increasing ethical dilemmas of modern medication call for a different type of physician: one particular who can make rapid selections the place needed but who also possesses depth, sagacity and the ability to acknowledge when a case moves into a blurred ethical room. Regrettably, the latter is the things that ten-minute, corporate medication leaches out of us. Later, many realise they both never acquired the skill and judgment to make difficult calls, or lost it along the way.

From genome sequencing to gender choice, from cost of care to withdrawal of care, our healthcare dilemmas are mounting with the advent of new technologies. The role of a hospital clinical ethics committee can be invaluable for physicians and individuals searching for counsel.

But, in numerous areas, ethics committees are even now synonymous with study ethics that serve a vital, but limited, objective. Roughly twenty% of individuals enrol in clinical trials. The figure in cancer is less than 5%. Minorities, non-English speakers and the elderly are dismally represented.

A lot of more individuals than this encounter an ethical dilemma in the program of a prolonged illness. We all benefit from the insights of practicing clinicians, medical professionals and nurses, with robust ethics education, who see genuine-existence patients with real-daily life dilemmas. At times they form consensus, or help us value the flaws in our contemplating. Other instances they help us to see that it’s typical to really feel conflicted or dejected, but to remain the course.

Weeks later, I received a note from my patient in Bristol. She declined a new battery. “It wasn’t straightforward” she wrote, in her profoundly understated way, ahead of thanking me for listening. I can not think about the ordeal she went by way of before arriving at her selection.

Removing the battery: can a medical doctor make a decision how a patient must die? | Ranjana Srivastava