Chapter 3: The Beginning, or the End?

January 10-12, 2020:

Wow, what a journey! Tonight, I find myself sitting in a chic, beautifully decorated apartment in the center of Chiang Mai, Thailand. Somewhere between 35-48 hours ago (damn time change), I was a nervous wreck, packing my belongings into two small bags planning to spend 30+ hours in route alone across the world.

Let me back up for a minute. I'm a medical resident, specializing in internal medicine. In my PGY-3, or third and final year of a crazy, messy, extremely fulfilling residency I decided that spending five weeks in Thailand studying palliative medicine, oncology, and Thai Traditional/Complimentary Medicine (massage, acupuncture, etc) would be a good idea prior to starting my position as chief resident this spring. Medical residency seems to suck you in, consume you, and spit you out, a little used and wrinkled but hopefully wise, ready to start in an independent practice as an attending physician. Medically, I feel ready to take on this challenge. I've learned some skills, have some knowledge, and have a few tools to (hopefully) survive as a full-fledged attending physician. What better time than now, I figured, to spend 5 weeks exploring a world unknown?

I've done quite a bit of traveling before. I spent a summer studying art history in Florence, Italy in college (still one of the greatest highlights of my life) and took multiple independent trips throughout Europe and the United States following this. Asia, however, in its entirety is new to me as a solo traveler. Apart from frequently enjoying delicious Thai food dishes in my home state of Minnesota, Thailand itself felt entirely foreign before this flight. I had a number of global health electives to choose from but felt that Thailand would be the best fit. Over the past few months, I had grown increasingly interested in learning about and exploring the Buddhist faith. Filled with historical temples, I was excited that Thailand would offer a spiritual journey in addition to a medical one. Between delicious food options (coconut curries, spiced meats, fresh fruits, fried delicacies, oh my) there seems to be a vibrant and unique culture in Thailand that I felt could offer a new, diverse educational experience, a chance to learn complimentary medicine, meet friends from across the world, and explore my changing spirituality in greater depth.

Let me take a step further back. I told you earlier that I felt professionally ready to dive into my upcoming completion of medical residency and enter the world of attending practice. That much, at least, is true. It was everything else in my life, however, that had quite recently crumbled and crashed down around me. When I initially applied for this global health experience around 12 months ago, I was a married, tired, 28-year old woman with recently diagnosed clinical depression and a semi-unhealthy outlook on life. I drank too much wine, complained about most things, and generally didn’t take very good care of myself.

Depression hit fast and hit hard during the winter of my PGY-2 year. Around the holiday season of 2018, I found myself frequently unable and unwilling to get out of bed unless it was required for work (I’ve always been a reliable worker, sometimes to a fault). I remember lifting my shopping bags out of the car one day after a grocery run. I got the bags inside, set them down on the kitchen floor, and proceeded to fall into a crumpled, emotional heap beside the bag of melting frozen food. Too sad, too hopeless to move, I lay on the cold wood floor next to these disgusting, thawing groceries. I thought about death constantly those few weeks. Luckily, I didn’t go through with a wish of death, or I wouldn’t be here in my beautiful apartment in Chiang Mai writing this tell-all I hope you’re still finding interesting.

Life went on like this for a while, if you can call a continuous death wish “living.” I don’t remember one minute of the day I wasn’t thinking about dying, actively, for about three weeks of my life. Part of this abrupt entrance into depression, I thought, was likely brought on my significant life stressors at the time. In particular, my younger brother (whom I love more than life itself and am insanely blessed to have in my life) was preparing for his first deployment with the military. I was a mess thinking of this, worrying about his safety. That though, wasn’t the reason depression happened. Not even close. I do not believe even for one second that depression is “caused” by any one life trigger. I have seen too much mental illness in both myself and in my patients to believe this. An anticipated or feared life event might be able to mildly heighten underlying emotional stress, but depression and mental illness is complex chemical; it is a disease. I knew this. Incredibly fortunately, I looked at my own depressive symptoms from the perspective of a physician. I told myself that if my own patient came into clinic with these symptoms, I would diagnose her with depression, recommend therapy and an anti-depressant, and check in with her frequently to make sure the symptoms improved.

Recognizing this, thank god, I took myself to a doctor and asked for a prescription for sertraline. My doctor was kind, helpful, and full of praise that I brought myself in to see her. I owe her many thanks. Within two weeks of starting on anti-depressants, I was a new, familiar person. I still felt like “me” with the same personality, same interests, same passions, but the suicidal thoughts were gone, vanished. A weight was lifted, a veil removed. I felt free. I could go to work, the gym, get the groceries, see friends and not end up crumpled on the kitchen floor, sobbing uncontrollability, willing my life to end. With this emotional weight lifted, this new-found freedom from my own inner demons led me to take a greater interest in finding the daily joy in my life, a greater investment in my emotional well-being. I found the peace, the comfort in being an open, more vulnerable and loving person. I wanted to be open about my struggle with depression, to friends, to family, to patients. I wanted the stigma to end. If I could help one person feel the weight lifted off of their shoulders as I felt from mine, I would be at peace.

I don’t say any of this to scare you, but I do think it’s important to be honest and open about the challenges of mental health. Depression is real, people. It hits when you least expect it and it doesn’t always give you a warning. Therapy, medication, exercise, and supportive family and friends saved my life. Following this challenge, my outlook changed. Life seemed brighter. Life seemed lighter. Why postpone joy when any day could be your last? These thoughts actually initiated my search for a global health elective during my PGY-3 year as I searched for an elective that would bring not only a rich educational and medical experiences, but a unique opportunity to experience absolute joy.

Through the illness of depression, I found myself, but unfortunately was only able to find myself through the difficult process of losing my husband. We are wonderful friends and will be for life. We have been through heaven and hell together. My husband, J, is a brilliant, optimistic, peaceful man. Always content, rarely rattled, I was perpetually in awe of these qualities. I loved every year of our wonderful relationship; however, after my experience with depression I found myself struggling to relate emotionally to this fantastic, optimistic man. The emotional chasm had grown too vast, too deep. Neither of us could jump across to the either side without one of us falling in. My husband, J, and I had met at age 15. We married at age 23, one year into the start of my medical school journey. He was supportive in every aspect of my life and I owe him endless gratitude. Our love story was fulfilling, wonderful, and perfect in so many ways. The issue was, to find ourselves, we had to grow and change as people in directions that pulled us away from the bond that had once held us so tightly together.

Why I’m telling you all of this, of course, is it brings us back to now, to why I’m here, alone, in Thailand writing about an insanely challenging year in a stupid sparkly pink notebook. Although initially my husband was planning to meet me in Thailand during this month, these plans slowly disintegrated. This should have been my first sign that our story was falling apart. J and I didn’t fight. There was no drama, no cheating, no scandal. We were simply two people who grew up together, then grew apart. We separated formally one month before I hopped on the plane to start this journey in Thailand.

So here I find myself, sitting in a beautiful apartment in Chiang Mai. In remission from my depression but still experiencing a strange and complicated isolation of marital separation. At 29 years old, most of my friends are getting engaged, married, pregnant. Yet here I am, in Thailand, starting over.

(I read this journal entry today, now knowing what I know, and I find it all the more fascinating. We are smarter than we give ourselves credit for. Follow your instinct. Follow your passion. Find your joy.)

Fondly,

Courtney

© CB2020