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Ink Blots and No Propofol : The Ketamine Chronicles (Part 24)

Yesterday, I had another ketamine infusion for my treatment-resistant depression. We tried getting rid of the propofol for this infusion, which sounded interesting because it had the potential to help me remember more about the experience as well as make the after effects easier. I can’t say that I remember everything, but the infusion feels more real in my memory than it has in recent weeks.

Is It Working Yet?

Despite having done this numerous times, it’s still hard for me to discern when the ketamine takes effect. I kept checking in with myself, thinking, “Is it working yet? Are those blob shapes my usual closed-eye blobs, or something different?” But eventually, it became suddenly obvious that it was working. I started to feel like my nose had melted, leaving just the bare nasal bones exposed. This somehow reminded me of a seal closing its nostrils before diving underwater. I wondered if what I was feeling was close to what it feels like to be a seal. In hindsight, this makes no sense. Just having no nose is nothing at all like being a seal, but it seemed logical in the moment.

Colors, Ink Blots, and Numbers

The beginning of the infusion is the part that I remember the most completely. At first, the darkness behind my eyelids felt very normal and familiar. But soon, pale colors moved gently against the black, like lava lamp goop merging and bubbling off.

The colors eventually faded and were replaced by intricate black and white designs that reminded me of kaleidoscopes. They were incredibly detailed, and I don’t think I could ever recreate it. As they morphed, their intricacy faded and I was reminded of Rorschach ink blot tests. Somewhere in my brain, it occurred to me that that association was especially funny, given the context. What does it mean if you see shapes within shapes that you created yourself?

At some point, there were pages and pages of numbers that didn’t mean anything to me. They were mostly organized into columns and lists, and I tried to focus on interpreting them, but was unsuccessful. This is something that seems to happen repeatedly in my ketamine infusions – I see overwhelming quantities of numbers or letters that I can never quite decipher.

That’s about the extent of what I remember. The rest of the infusion seemed to consist of fairly mundane experiences and scenes, although they escape my memory.

Ketamine as a Dissociative Anesthetic

I’m glad that we tried it without propofol. I was a little worried that it would be too intense, but it turned out just fine. As usual, I felt far removed from the room around me. My body was in the chair but my mind was somewhere else. It’s sort of like there’s a tiny me inside my own brain, viewing images that create a highly convincing sensation of having my eyes open. To then test it by opening my real eyes is a bizarre feeling.

The rest of my day was dramatically different compared to days when we’d used propofol in conjunction with ketamine. With propofol, I often sleep for the rest of the day, broken with occasional small tasks like walking the dog or doing some laundry. I must metabolize it slowly, because when I wake up the next day, I have a lot of trouble piecing together the order of events or even what I did at all. It becomes clear that I was lot less sharp than I thought I was.

Without propofol, the disorientation and grogginess wear off more quickly. I’ll sleep for several hours, but then can function fairly well, if a little physically unbalanced. I vastly prefer to be as alert as possible. The sensation of not actually having made decisions with my full wits about me is unsettling.

I’m hoping that my old pattern of improvement two days after an infusion is consistent. The short series of infusions we did recently helped combat my symptoms, but there’s definitely room for improvement.

If you’d like to start at the beginning of the Ketamine Chronicles, click here.

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It’s Been a Whole Month: Birthday, Anxiety, and Ketamine

I can’t believe it’s been a month since I last posted here. I have some in-progress posts that are languishing in my drafts folder, but none of them feel complete enough to be posted. So, to try to break through the stall in my writing, this is a rambling update that will have to be good enough for me.

Look at me, fighting perfectionism one disjointed blog post at a time.

Ketamine

I haven’t written about my most recent ketamine infusions because the propofol makes it harder to find anything about them to share. I think that going into it with the expectation that I won’t remember much makes it harder to grasp whatever snippets do remain. Having the intention to write about an infusion helps me pay attention to my experience; without it, the whole appointment just disappears from my memory in the hours following an infusion.

When I began my treatment with ketamine infusions, I was fascinated by the endless imagery that each infusion created. Every appointment held new associations and interesting scenes. But lately, they all feel the same. Of course, this is okay. The dose of ketamine that I receive would probably be too intense without the propofol, and I suppose I’d rather not remember much than have a terrifying trip. Still, there was something helpful about having something of the experience to hold onto.

I have the sense that I’m more able to remember things when I’m more present in the real world – like how you remember your dreams when you awaken in the middle of them. I wonder if the degree to which you’re aware of your surroundings during a ketamine infusion impacts its efficacy, if at all. Because if it’s not at all, I’d totally ask my doctor to poke me every 15 minutes and ask me what I’m thinking about so that he can write down whatever absurd, hilarious things I say. Although, my level of zonk is usually such that I probably wouldn’t answer.

Birthday

My birthday happened this month, and it caused a lot of anxiety about the future. It’s frustrating to be hindered by my own brain. I commonly hold myself to unrealistic expectations and judge myself harshly for not meeting them. I wanted a different path than the one I’m on now, and I’m having a hard time letting go of that vision. Not that I can’t eventually end up in the same place, but I didn’t see it progressing along such a challenging path. But that’s life, right? I’ve been trying to re-frame my birthday as just another marker of survival. If I can’t get myself to be pleased with my progress in the last year, I can at least be neutral.

Anxiety

Anxiety and depression often go together, and I’ve noticed a pattern in my mental health where I alternate between the two. As I start to come out of depression, the anxiety kicks in and I feel horrified by all of the time I “wasted”. I think about how far behind my expectations I am, and then I get a frantic sense of urgency to kick it into high gear. Unfortunately, I’m also easily overwhelmed and the prospect of “catching up” to my expectations triggers an avalanche of worries and insecurities. Ultimately, whether it’s depression or anxiety that is most immediately at hand, the result is still a barrier to my forward movement.

This flexible connection between depression and anxiety is not black and white. I wouldn’t say that I move completely out of depression and into anxiety – the Venn diagram has more overlap than that. My position within it just shifts into the middle so that I’m simultaneously slow, tired, and occasionally hopeless while also filling up with anxiety saturated with heavy judgement. Fun times.

At least the anxiety pushes me to do more than I otherwise would. I would rather be motivated by the reward of doing the thing rather than the fear of not doing the thing, but I also prefer being motivated at all over not at all (if that makes sense). I’ve been trying to run again, and have been somewhat successful in the last couple of weeks. The wildfire smoke in Colorado has intermittently lifted and returned, so I don’t always get clear air, but I figure the benefit to my mental health probably outweighs the damage.

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This is kind of a rambling post, but again, I can’t seem to write anything in this context that seems worthy of posting. So, this will have to do. In other news, this is not my kitten, but look at how cute she is.

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Ketamine Assisted Psychotherapy 2: The Ketamine Chronicles (Part 23)

Compared to my first KAP session, the second one was wildly more entertaining for me, but much less productive in terms of the number of words coming out of my mouth. KAP stands for Ketamine Assisted Psychotherapy. The idea is to utilize ketamine’s ability to lower your mental barriers in order to more comfortably talk about difficult topics with your therapist. I know that I was very nervous for my first session and likely fought the ketamine in an effort to stay in control, but I didn’t expect my slightly more relaxed approach this time to produce such a dramatic difference. I think I remember that there was a slight dose change from last time to this time, but I don’t think it was enough to really impact my experience. But, in a bewildering turn of events, being more relaxed actually led to me saying less. Rather than unleashing a flood of thoughts and feelings, I found myself being washed away by images and colors. My ability to imagine images certainly made my conversation with my therapist more bizarre, and most of the time, quite disjointed.

We started out by talking about bridges. I had tried to create a metaphorical bridge that crossed into my protected mental fortress during a previous infusion, but got stuck with a drawbridge that lifted every time somebody tried to cross. This time, I saw a fraying rope bridge with missing wooden slats. It stretched across a dark chasm with no visible bottom. It was a long bridge with not enough tension, making it sag in the middle. Despite its frayed appearance, the connections to the edge of the cliff on either side were sturdy. It would be a harrowing journey to the other side, but you could do it. Thinking about this as a lucid person, it strikes me that the metaphor breaks down at some point. Clearly, I have a well-protected area of mental privacy. I don’t open up easily, and I don’t tend to rely on many people. But to picture a dry, brittle rope bridge stretching across a dark chasm implies that it would be frightening to attempt to cross it. It’s scary for me to allow people to cross the bridge, but I certainly hope the crossing isn’t scary for them. Perhaps the drawbridge was a better metaphor for me. In any case, I only come up with bridges that are difficult to cross.

I found it extremely hard to stay focused on the topic at hand during this infusion, sometimes pausing and saying things like “the blood pressure cuff makes me think of fish being squished.” (The cuff periodically tightened, which distracted me and produced a feeling of what I imagined felt like raw fish being rolled and squelched under pressure.) If an answer to a question didn’t immediately pop into my mind, I found myself floating away from it – the room and the people within receding into the distance. At times, I remembered that I was supposed to be answering something, but wasn’t at all sure of how much time had gone by since my therapist asked the question.  Is she still waiting for me to answer? Are we still on that topic or did we move on already? I don’t think I remember the question. It was chronologically confusing – seconds slipped by without my notice like water flowing over stones, and yet the small movements of my therapist and doctor in the room were auditory markers of real time. How much time passed between my last thought and this one? It’s too hard to think in words. Better to just float. I don’t usually try to hold onto the real world during ketamine infusions, and it proved to take a lot of effort.

I also don’t usually talk during my regular ketamine infusions, so it was interesting to discover just how hard it is to describe the images I see. I can write about them in detail after the fact, but in the moment, they just escape description. Take, for instance, when I said I was seeing “a bunch of…cleaning things.”

What I actually was seeing was more like a set of rectangular brushes that fit together into a grid. They were a very light pastel range of purples and blues. Why was I thinking about puzzle-piece bristle brushes during my ketamine infusion? I have absolutely no clue. Part of what made it hard to describe was that the image was so enthralling that pulling myself out of it to come up with words was difficult. But part of it was that I knew that what I was saying came across as completely bizarre. Trying to describe why such a mundane-sounding image was so pretty just kind of stumped me.

The random and nonsensical images that I was trying to describe reminded me of “Drinking Out Of Cups“, a video from the mid ’00s of Youtube (contains profanity). I tried my hardest to explain it, but seeing as it’s a video about nonsensical things, I had a hard time putting it into words while lost in my own nonsensical world. I think I slipped into fits of giggles halfway through and had to finish up with “I dunno, I’m not doing it justice, but it’s really funny.” Also, “outta” is a really hard word to say when you’re on a mixture of ketamine and propofol. Just in case you wondered.

At some point, vials of colorful sand spilled into a desert, creating clouds of blowing particles with swirls of color. I was seeing it from above, and the drifts and valleys the wind created were captivating. It was a beautiful but rather lonely landscape. A parrot with no feathers appeared in the foreground, and when I mentioned this, my therapist questioned me for clarification. “Yeah, like a…a plucked chicken” I answered.

“Aw, poor guy,” she said. To which I then said, “No, h-he seems ok, though.” Well. That’s a relief.

I wonder if, despite being more relaxed this time, I had a harder time engaging with therapy because I don’t know how to filter my mental experience. Last time, I may have been so nervous that I just locked everything down indiscriminately and tried to function as “normally” as possible. I was more open to KAP this time, which left me free to be distracted by anything and everything that entered my thoughts. It seemed to take enormous effort to hold on to the real world while holding the door open for therapy. I’m imagining a large wooden door to Ketamine Land, and within the door to Ketamine Land, a smaller door labeled “therapy”. I think I accidentally opened the big door to Ketamine Land and was bowled over by the peculiar sights within. I should have only opened the door-within-the-door and accessed the loosey-goosey-ness of Ketamine Land in a smaller, more manageable way. I’m not sure how to do that, but perhaps it takes practice.

 

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A Ghost Town: The Ketamine Chronicles (Part 22)

I woke up a couple of hours after going to bed following my most recent ketamine infusion. It was around 1 o’clock when I began my slumber, so when Stella woke me up, looking like she needed something, I automatically fed her dinner because it felt like I had been asleep for a long time. Then I wandered into the living room, where it dawned on me that bright sunlight was streaming in through the windows.

What day is it? Is it still daytime?

Perhaps I entered a different dimension where time passes more slowly. Or maybe I’m taller than the moon and my head is therefore circling the sun at a different rate. I went back to sleep, but apparently woke up periodically to accomplish my nightly routine. Wednesday’s cubby in my pill organizer is empty, and I vaguely remember flossing my teeth. Half of what I wrote here was already done, which surprised me when I opened my laptop this morning to write. My phone informs me that today is Thursday, although it feels like several days have passed since yesterday’s ketamine infusion.

I usually go about three weeks between appointments, but my depression has made a comeback. Similarly to how I first began getting ketamine infusions, we decided to do a short series of infusions in quick succession to try to reset things and boost my mood. In addition to the short series, we’re also trying another medicine that can enhance the effects of ketamine. Scopolamine is an anti-nausea drug that comes in the form of a patch that you place behind your ear. I can tell that it did something; the infusion itself felt more enveloping than usual, and for hours afterward, I had this weird sense that I could feel my blood traveling through my blood vessels. It almost felt like being squeezed – like the boundaries of my body were working harder to keep everything contained within my skin.

I talked to Dr. Grindle (whose name frequently autocorrects to Dr. Griddle, which I think is hilarious) about our plan of action at the beginning of the appointment. My previous infusion was my first experience with ketamine assisted psychotherapy (KAP). The goal of it was to help me bypass the frustrating barriers to talking that I run into in therapy by having a ketamine infusion and a therapy session at the same time. It was a fascinating experience, but also a little overwhelming, so I decided to just do a normal infusion yesterday. I’ll revisit KAP another time.

I don’t remember much from this infusion. The addition of all these other anti-nausea and sedating medications makes it hard to remember what I thought about and saw during the infusion. They also make me crash when I get home, which lets whatever memories I do have fade away before I have a chance to write it down. One part that I can vaguely recall came from a suggestion made by my therapist. After our KAP session last week, we marveled at how much I resisted talking about particular topics, even while zonked out on ketamine. This week, she suggested that I imagine building a bridge across the moat that protects my mental fortress. I have yet to figure out why some parts of my everyday life show up in ketamine infusions and some don’t. The image of a bridge over a moat certainly stuck, although probably not in the way that my therapist hoped it would.

Thinking about castles and fortresses created an odd merging of memories and imagination in my mind. At first, I found myself thinking about the ruins of castles on the Danube River in Germany and in the rolling hills in Wales. I imagined the people who lived in those castles milling about and going about their daily lives. Then, I seemed to combine that train of thought with memories I have of going to Caribou, an old silver-mining ghost town from the 1870s. It’s situated not far from where I grew up.

We used to go up there and explore the crumbling stone structures and look for currants and wild raspberry bushes. In my distorted ketamine haze, I saw people working in the half-built structures. All of the trappings of normal life were there; a large pot in the fireplace, a sturdy wooden table on the dirt floor, women in long, pioneer dresses and aprons bustling around in the four walls under the open sky.

At some point, the ruins were surrounded by a moat, and a figure stood on the opposite side. Remembering that I was trying to let the person cross the moat, I conjured up a drawbridge. Interestingly, simply creating the bridge was not enough. I couldn’t seem to keep the drawbridge down; it kept raising over the water, leaving the moat impassable again. It was somewhat frustrating – like those dreams where everything keeps going wrong, no matter how much you try to find a way around it. I suppose next time, I should build any bridge but a drawbridge.

I feel a little bit better. When I’m awake, I feel more motivated to get things done, and my immediate reaction to being faced with an opportunity or an obligation is not automatically “Ugh. No.” This is one of the more frustrating phases of depression for me. I feel capable of doing things, I sometimes even want to do things, but I’m so unbelievably tired that I waste hour after hour asleep. I’m starting to wonder if that’s a normal depression symptom plus side effects of the medicines I take, or something else entirely. All I know is that it makes me feel enormously lazy when I wake up 5:30am and am struggling to keep my eyes open only three hours later. It hasn’t always been that way; when I was first diagnosed with major depressive disorder, I didn’t feel the need to take a nap until mid-afternoon, and I could limit it to something more reasonable. I’m not sure what happened besides a worsening of my illness and the meds I take, or if those factors explain it all. Something to ponder.

 

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Ketamine Assisted Psychotherapy

Some people experience profound breakthroughs with ketamine assisted psychotherapy (KAP), in which a person engages in therapy while having a ketamine infusion. I’ve been getting IV

ketamine infusions for a while, now, but never really considered KAP an option for me. I’m comfortable with the arrangement of treatments I have now, and KAP has always intimidated me.

Cut to this week, when it seems a whirlwind swept through my plans for my upcoming ketamine infusion. Here’s what happened:

I’m in a rut. Again. My previous infusion didn’t seem to have a large effect on my mood, so discussions began to circulate about how to adjust things. My doctor suggested a ketamine assisted psychotherapy session and directed me to the release form that would allow him to talk to my therapist.

At this point, my alarm bells were going off, urging me to slow the KAP train down, but alas, here we are. My therapist had a conversation with my doctor, in which it sounds like they agreed that I am, indeed, in a rut. My therapist got some information about what ketamine assisted psychotherapy entails and then brought her thoughts to me at our regular session.

For context: One problem that I consistently run into during therapy is the brick wall between my mouth and certain emotional topics. Sometimes I can plow through it, but sometimes, I just shut down and the words don’t come out. There’s no fixing it until I go home and, often, write down what was happening on the other side of the brick wall.

Ketamine assisted psychotherapy is effective partly because the dissociative state that ketamine puts you in can make you less inhibited. It lets you separate yourself from your emotions. A therapist can then help you through topics that might otherwise be too difficult to talk about. The conclusion that everyone reached upon discussion of KAP was something like “Well gee, KAP would probably improve that problem where Gen makes like a mollusk and clams up.” (It’s likely that that particular wording only happened in my own brain.)

I’ve decided to give it a try. Despite constantly feeling like I don’t do enough, I do recognize that I work hard at improving my mental health. Beyond keeping up with the everyday tasks that seem to pile up to colossal proportions in my depressed mind, I also routinely push myself to leave my comfort zone. And yet, I continue to slog through quicksand. I sometimes feel like I “should” be able to heal myself with the tools I already have at my disposal, and if I can’t, it’s because I’m not working hard enough. This is garbage thinking. I’m allowed to add things to my treatment, and I’ll try something new if it seems like it could help me, even if it does sound scary.

My therapist asked me, “What’s the worst that can happen?” when I expressed my reluctance to do KAP. We decided that the worst is probably that I could embarrass myself or cry a lot, both of which I have already done in front of my therapist. Still, I know how I feel during a ketamine infusion, and that knowledge makes the idea of having a therapy session at the same time feel uniquely invasive. The sensation of talking while under the influence of ketamine is something I’ve written about before because it is just so bizarre. I’m always struck by how quickly thoughts go from my mind to coming out of my mouth; there’s no time to deliberate on whether or not you’ll say it. Again – this is part of the goal for me in this KAP experiment, but man, as a guarded person, the idea really provokes anxiety. Somehow, I’m also worried that I may not say anything. There is no way for me to enter into this with no worries other than to accept that there is no wrong way to do it.

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Just Float Away: The Ketamine Chronicles (Part 20)

Erin, the PA, tells me I have gorgeous veins. It’s just one of my many redeeming qualities. Prone to perfectionism and crippling indecision? Yes. But hey – at least I have great veins. Starting the IV for my ketamine infusions is always an easy process, which is nice. This time, we once again did a pretty robust dose of ketamine with some propofol to make it less intense. Erin got me set up while we chatted, and then Dr. G popped into the doorway, explained just how many anti-nausea drugs I got (technically four(?), if I remember correctly), and then stopped. “What are we NOT going to do a lot of this time?” He asked.

“[brief silence] Looking around!”

I got a figurative gold star for my answer. I promised Dr. G I’d keep my eyes closed, popped in my earbuds, and settled in.

The familiar floating sensation reminded me strongly of water, as usual. Behind my eyelids, the blackness rippled and flowed, hinting at some unseen current. Soon, minuscule red specks glittered against the dark, moving with the gentle waves and forming dynamic shapes. It seemed as if there were something beyond the darkness that I could nearly see, like I needed to travel through the black, quiet water to reach something.

I began to imagine that I was lying on a beach, submerged in shallow water, looking up at the sky through the water that lapped at the shore. The sand beneath me was gritty, but the water was clear and the sky was blue. It was peaceful. Soon, though, the movement of the water reminded me of my recent road trip vertigo and the anxiety it created, and the peacefulness was ruined. I wondered if it would even be possible to have a panic attack while mildly sedated, but decided that I should put effort into preventing one, regardless. After all, it would be rather counter-productive. Bobbing and rolling in the imaginary water did make me anxious, although part of it was at the thought that freaking out would be pretty embarrassing. In trying to resist the anxiety, I realized that I was only making myself more aware of the movement. I needed to not fight it – to just accept that I was not going to feel completely still.

Once I let myself float away, the infusion seemed to speed up, and large chunks of time just disappeared. I don’t remember anything except standing in a room in a family member’s house, recalling the details of my surroundings with what seemed to be incredible accuracy. I actually worried momentarily that I might be flouting Dr. Grindle’s orders by having my eyes open. He might confiscate my gold star. Except wait- my eyes were closed. And yet, the windows let bright sunlight in through the blinds. The ones on the right were broken three slats up. The wicker chair with the yellow cushions was angled just right in the corner. The dresser with a sand dollar and a starfish on top sat just how I remember it. That rug that years ago was closer to shag but is worn and aging now, laid on the floor. I took in the scene quietly. There was nothing happening; I was just absorbing the room’s contents.

It seems like the more I think about it now, the less I remember of how I got home. The infusion finished and Erin took the I.V. out. Then, Dr. G handed a bottle of apple juice to Erin, who offered it to me. I reached out and took it with my wacky inflatable car dealership arms and then decided to wait for my facial features to materialize before trying to drink it. Somehow, I got my shoes on and made it to the car with my mom, who politely stopped after every three or four steps down the parking garage stairs and turned slightly to make sure I was still on my feet.

I may have fed the dog twice that night. My memory of post-infusion actions is incomplete, and I don’t doubt for a second that Stella would take advantage of that. Maybe that’s why she begs for food in the evening after I’ve already fed her– because sometimes it works! This is why it’s important to not make any important decisions following a ketamine infusion. You might end up with a new boat or no house or, you know, a spoiled dog.

 

 

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Trying a Sleep Mask: The Ketamine Chronicles (Part 19)

While walking through the grocery store the other day, a cheap sleep mask caught my eye. My previous ketamine infusion, in which I was utterly entranced by a framed picture of what looked like a standoff between a wolf and a mountain goat but was really just a river and some rocks, piqued my interest in sleep mask-wearing. I grabbed the mask on a whim, intending to give it another try at my next infusion.

My first attempt to cover my eyes during a ketamine infusion was at my very first appointment. Not knowing what to expect and finding that I had never experienced anything like it, I was overwhelmed by the bizarre sensations. I remember the darkness behind the mask inducing a feeling of slow spinning, like turning a heavy stone on the end of a long, long string and then letting go. Soon, my head began to spin in one direction while my body spun in the other, and I took the mask off, preferring to keep my eyes open.

I hadn’t worn a sleep mask during an infusion again until yesterday. I brought my newly purchased satin mask, seemingly made for someone with no nose, and slipped it on just as the infusion started. My immediate reaction was “I don’t like this”. But, sensory processing disorder makes it hard for me to discern what exactly something feels like and if it’s to my liking or not. Therefore, my default is no new things ever. I decided to give the mask a few minutes, which I attempted to measure by the progression of songs on my playlist. By the time two or three songs had gone by, I had mostly forgotten about it.

At first, I was frustrated because nothing seemed to be coming to me. It was just dark. Gradually, subtle circles of purple and yellow faded in and out. I couldn’t tell if the ketamine was working yet or not, so I shifted my attention to my body and found that I was all stretched out. My feet were incredibly far away from my head, and the more I thought about it, the more I stretched. I got thinner and thinner, and I eventually was reminded of taking Flat Stanley home in elementary school. (Flat Stanley is a children’s book about a character who travels the world. As part of a literacy project, kids make paper Stanleys and keep a journal about his adventures, swap Stanleys with a partner via snail mail, then mail them back, often with photos of Stanley out and about.) I felt like Flat Stanley- like I had been rolled out with a rolling pin and then peeled back up. Briefly, I considered the strange photos that would result if somebody took me on their family vacation, this flattened-out woman waving in a gust of air, Little Timmy reaching up to hold my paper-thin hand while everyone says “cheese”.

Sometimes, the things I see in my ketamine infusions are bizarre or fantastic, and sometimes, they’re closer to real memories. After the Flat Stanley adventure, I enjoyed a slow-motion movie of my dog, Stella, running by me. We locked eyes as she rushed by, a moment captured in the dusty roll of fur on her shoulder and her tongue lolling out of the side of her open mouth. In slow motion, the prairie grasses waved lazily and Stella’s paws hung in midair, a snapshot of a great freedom gallop. I’ve seen such an image hundreds of times, yet my lucid memories never produce such a striking, detailed image as what I saw during my infusion.

My thoughts of Stella led me to a less pleasant memory. She killed a young rabbit the other day; I tried to stop her but was too slow. The weight of its still-warm body in my hands came back to me in my infusion. I looked at the delicate veins in its ears and a bit of fur stuck to one dark eye as I gently wrapped it in an old cotton t-shirt. Seeing it again during my ketamine infusion wasn’t disturbing, but it evoked some sadness and sense of wastefulness.

I only vaguely remember other images from this infusion- mostly measurement things like ticking numbers on a digital counter and tape measures stretching out. Overall, wearing the sleep mask made me much less concerned with time. I never have any idea how much time has passed, even when I try to keep track of how many songs have gone by. Usually, returning to the real world periodically reminds me that time exists, and I then wonder where I am in its course. But with the mask, I was just floating in darkness. I still don’t love the feeling of having my eyes covered, but it wasn’t as bad as I thought it might be. Occasionally, I considered taking it off but decided that lifting my arms would be too much effort. I did eventually sense that a good deal of time had passed, and I lifted a corner of the mask to peek out. Erin told me I had ten minutes left, so I leaned my head back and forgot all about time, once again.

I have not been doing well, lately. I tried to go off of one of my medications (with the OK from my prescriber), and it backfired tremendously. I’m back on it and hoping that things will return to how they were before I decided to go messing with my meds. Hopefully, this ketamine infusion will help me get back on track.

 

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The Wolf and the Goat: The Ketamine Chronicles (Part 18)

At this point, I’ve lost track of how many ketamine infusions I’ve had (they don’t line up exactly with the number of blog posts). My treatment-resistant depression has dug its heels in once again, and I’m wrestling for the millionth time with whether or not there is any chance of improvement for me (despite having experienced significant improvement that fell apart when the pandemic began. Clearly, it is possible). In a conversation with my therapist in which I explained my growing sense of hopelessness and how it makes me reluctant to keep going with ketamine infusions, she pointed out that I have said that ketamine makes a difference. It’s true. It’s tough to remember that the hopelessness is the depression talking. I can’t trust my assessment of the world when I’m getting all my info through the warped view of depression. At least, I think. Sometimes it’s all so confusing.

The Wolf and the Mountain Goat

The wolf had its mouth open, partway through devouring some kind of amorphous, green animal. Perhaps a giant frog? An algae-covered sloth? Try as I might, I couldn’t interpret the image correctly. But there, below the wolf’s fearsome jaws, was a pure white mountain goat kid. It stood perfectly still, watching the wolf eat its catch. That mountain goat should move, I thought. Directly below a hungry wolf definitely seemed like a risky place for a baby mountain goat. But nothing moved at all. The image was static. And then I remembered that I was not supposed to have my eyes open during my ketamine infusion, and I definitely was not supposed to be staring at the photo on the wall across from me. There is no wolf in that photo- nor is there a mountain goat. It’s a picture of a river flowing through rock formations with greenery on the shore. It was quite a trip.

framed photo of river flowing through canyon

framed photo of river flowing through canyon with shapes of wolf and mountain goat outlined in red

I can’t unsee it.

Ketamine Visions of Water

From the beginning, I could feel the warm air inside my mask. At some point, it started to feel like liquid, like I suddenly possessed the ability to breathe underwater. I’m fairly neutral when it comes to swimming in real life, and I don’t have any particular fascination with water. But ketamine always brings out these intense associations with bodies of liquid water and, occasionally, ice. Ripples and waves of all sorts, whales, jellyfish, cold rivers flowing downhill, being on a boat, icebergs; these are all images from previous infusions that stand out enough for me to remember them. Perhaps the physical sensations of unsteadiness trigger my brain’s water-related pathways. Except that I’m always decidedly stationary during ketamine infusions. In any case, I’d be interested to know if other people also see lots of water during their infusions.

This time, it was the ocean, or perhaps a very, very deep lake. My perspective was from beneath the surface, and I could see someone sinking slowly from the glowing blue into the inky blackness below. I was watching the person, but I also was the person. We were sinking through vast expanses of empty ocean, only water and light around us. It was striking but lonely, only the silhouette of a human form, gently falling through deep water. Slowly, the light receded above and I began to think that I didn’t want to be in darkness. It occurred to me that the person was drowning, and although I felt comfortable enough, that meant that I was also drowning. We were, after all, the same person. I didn’t know what was beneath us, and the unknown was somewhat unsettling. But everything was heavy, and the constant pull of the water was hard to resist. It was confusing; how was it possible that I was breathing the water that filled my mask? I must be drowning, but I felt fine, only incredibly heavy. Then I heard my own voice in my mind say forcefully, “open your eyes”, and suddenly, I was back in the room, looking at the wolf and the mountain goat once again.

Space and My Mental Map

Have you ever looked at a familiar room and felt like you’ve never seen it before? Like you just never really looked at the angles of the walls or the color of the furniture? I’ve noticed that my ketamine infusions often give me the sensation that a room has changed and space is distorted. When my eyes are closed, I feel as though everything is moving closer to me, but also over me. It’s like the weight of my body is folding space so that my surroundings move up and over me. Things feel much smaller, and I’m always momentarily surprised when I open my eyes, the space instantly expands, and I find myself in a bigger room than I expected. And every time, it’s as though I’m looking at a room that I’ve never really looked at before. By the time I’m semi-lucid and ready to set my legs in motion towards the hallway, the feeling has passed and the room is familiar again.

Some Thoughts on Masks

I don’t often relax in places that aren’t my own home. Even friends’ and family’s places give me that tense feeling of being a guest; I’m less familiar with my surroundings and therefore need to be alert and polite. It’s uncomfortable to imagine that someone might walk by and catch me making myself at home by taking a nap or, I don’t know, putting my feet up. I’ve obviously been forced to let that go to a very large degree for my ketamine infusions. But it’s gotten me thinking — this might be why I tend to open my eyes so much. My vulnerability alarm goes off when my eyes are closed anywhere that’s not my home. I guess it periodically yanks me out of whatever trip I’m on so that I can look around for a second. Maybe that also explains some of why I remember such vivid scenes. It’s like when you wake up in the middle of a dream and can recall it with perfect clarity, versus sleeping all the way through it, and then all you know in the morning is that Shrek was there.

That said, lots of people wear a sleep mask during their infusions and find that the darkness helps them immerse themselves in the experience. I have found that wearing a mask that covers my nose and mouth does make me feel oddly secure – like it’s hiding me from any eyes that may look in my direction. I wonder if a sleep mask would have the same effect, or, as I expect it might, just make me feel more vulnerable by preventing me from looking around occasionally. Who knows – I may try it someday.

(Imagining my entire face covered in masks makes me feel like the spider in that viral voice-over video: I cannot see you, you cannot see me…I am hidden.) 

 

 

The Day 2 Mystery: The Ketamine Chronicles (Part 17)

It’s been two days since my most recent ketamine infusion. Usually, I write these posts as soon as I’m able so as to not forget too much of the bizarre experience. This time, I found that I didn’t have much to say immediately following my infusion.

For transparency’s sake in my attempt to document my experience with ketamine, I’ll just say it. My mental health has been in decline over the last few weeks, to the point of struggling once again with self-harm, something I thought I had kicked over a year ago. The previous infusion seemed not to do much for me in terms of mood, but gave me more energy and motivation, a mismatch that left me restless and confused. I felt the drive to do something but had no desire to follow through. Perhaps this is what led me back to self-harm. Multiple stressors, not exercising as frequently, and a strange mix of motivation and hopelessness led me back to an old, unhealthy coping mechanism.

I had my most recent ketamine infusion on Friday. Like last time, it was relatively empty of bizarre images, at least that I can remember. At this point, my dose is pretty much at the upper limit of ketamine for my body, so Dr. G has been giving me propofol to make the experience less trippy. Last time, I stubbornly kept my eyes open for a lot of the infusion and seemed not to care about breathing. This time, I don’t think I could have opened my eyes if I’d tried. I remember chatting with Erin, the PA, while she got the I.V. set up. I know we talked about haircuts, but I’m not sure what else. The propofol hit me way before the ketamine did, and the last thing I remember is Dr. G taking an exaggerated deep breath and wagging his finger at me sternly before leaving me in Erin’s capable hands.

When I closed my eyes, the world disappeared above me as I sank down into peaceful nothingness. At some point, I remember feeling as though I were a passenger in a car on a highway, open road stretching ahead of me. We began to go a little too fast for my liking, but I was stuck– carried along by the seat beneath me. This is the only image I remember with clarity from this infusion. I also remember that, because I couldn’t feel my face, I was occasionally concerned that I may have taken my mask off. Laughable in hindsight that I thought I could have moved with enough coordination to do that.

Yesterday, the day after my infusion, I felt no different than I have for the past few weeks. Actually, I think I may have felt worse. But today, I awoke with a wonderful sense of relief from my symptoms. Whether this lasts remains to be seen, but it follows an interesting pattern. The day immediately following an infusion is often disappointing for me. I’ve learned to not put too much stock into whether or not an infusion has helped based on the day after. The second day, however, is usually when I notice the changes. I don’t know how common this is, but I think it’s interesting.

I have already put on my exercise clothes, anticipating a long run later in the day. I’m looking forward to today’s project of re-painting the grape arbors. I have mental plans to clean the kitchen and change my sheets, and maybe even vacuum. It’s great to feel better, but the previous few weeks have me apprehensive about this infusion; will it last? Will I need to adjust my medication or have more infusions to stabilize my depression?

We shall see. But for now, it’s nice to feel a bit better.

woman face with eyes closed against dark background

Close Your Eyes: The Ketamine Chronicles (Part 16)

“I think Stella is a bad influence” is a phrase I remember hearing Dr. G say during my latest ketamine infusion. Stella is my willful, independent dog who sometimes flat-out refuses to listen to me. In trying to piece together the events of my day, that phrase bounced around in my head without context. What had happened?

Apparently, I had refused to close my eyes. Dr. G repeatedly told me to shut them but dang it if that little glass dragonfly suspended from the ceiling wasn’t absolutely mesmerizing. I remember it glittering and moving gently while I stared. I closed my eyes eventually.

This infusion was different in a few ways. For one thing, it was a higher dose of ketamine paired with a sedative to make it less intense. I also am completely off of one of my mood-stabilizing medications, Lamictal, which can interfere with ketamine. Like last time, I took some Tagamet before my infusion to slow the metabolism of the ketamine and make it last longer. The sedative kept this infusion from being bizarre, or at least from me remembering any bizarre images I might have seen.

At first, I didn’t feel as deeply removed from the world around me as usual. This was deceptive, though, as I soon began to feel – as trippy as this sounds – like my being was shrinking into my body. Or perhaps like my body was expanding to create a shell around my consciousness. Things were happening in the room – sounds of typing and clicking, machines beeping, Dr. G telling me to take a deep breath (which I also did not listen to, apparently) – but they all seemed so far away as to be completely beyond my caring.

I opened my eyes periodically to see what was going on and usually got sucked into the computer monitor, which displayed a series of calming images of winter mountains. This is the danger of not wearing a sleep mask; when you’re hooked up to a ketamine infusion, EVERYTHING looks interesting and it’s incredibly tempting to let all of your automatic functions, like blinking and breathing, to be abandoned in favor of absorbing whatever magical thing you’re looking at. Nothing matters more than watching a snowy peak meld into a pine forest. Nothing.

It’s a strange experience to realize that you haven’t breathed in a while but not find that alarming at all. In fact, the longer I went without breathing, the harder it seemed to do. It’s sort of a heavy slowness that keeps me from breathing deeply. It has to be quite deliberate. I’ve had to be reminded to breathe during previous infusions, but a simple “hey, take a deep breath” always seems to break through my trance easily. This time, Dr. G repeatedly telling me to take a deep breath reminded me that breathing was a thing that people did, but I found myself reluctant to put in the effort. There wasn’t much that I cared about doing, and I remember thinking that I felt oddly cushioned against the ketamine.

Afterward, I tottered down the steps to the car and marveled at my mom’s apparent lightning reflexes as she drove us home. We stopped at the pharmacy and grocery store (a whole day of essential outings!) and I simply put my seat back and waited in the car while my mom went in. Unable to get comfortable, I flopped around until the car got too warm. I cracked the door open and leaned out a little to get some fresh air, resting my head against the door frame. I wonder what people in the parking lot thought. I was clearly not very with it and kept doing that embarrassing head-jerk that happens when you fall asleep sitting up.

When we got home, I crashed for several hours, then got up and walked the dog around the block. I didn’t think much about how I was acting until I passed a house and then noticed someone sitting on their porch. I had been walking a few steps, stopping for Stella to smell something, zoning out, then repeating all the way around the neighborhood. I have no idea how long I stood in front of that person’s porch with a blank look on my face, but it might have been much too long to look normal. Who knows- maybe they thought it was quarantine brain.