Once upon a time there was a girl who had a depressive episode. It wasn’t the first time she’d experienced depression–in fact, she’d experienced it many times before. But this time was different than all the rest. Every other time, the depressive episode occurred in the autumn as the days were growing shorter. This time, the depressive episode occurred in the spring as the days were growing longer.

Because this time was so different than all the other times she’d had a depressive episode, this girl didn’t realize that was what she was experiencing. She just knew that something was wrong with her.

She went to the doctor and told him all about her symptoms: extreme fatigue that persisted regardless of how much sleep she was getting, unexplained bruising on her legs, very dry skin, itchy scalp, acute colds that came on suddenly almost every week and lasted for a day or two, and persistent chest pain.

She explained to the doctor that she’d experienced most of these symptoms before–but that they seemed extraordinarily severe this time around, and right as circumstances had changed in ways that should CORRECT the problems rather than worsening them.

She’d had dry skin before–a combination of allergic reaction and having to wash her hands constantly in her position in food service management. But just as she switched from the food service management position to a desk job, her skin grew worse.

She’d had colds before–well, actually, she has chronic allergies. But the allergies have been under great control for quite a while. And now suddenly, just as she left her hospital rotation (in which she was regularly exposed to sick people), she was experiencing multiple short-term colds.

She’d been tired before. But she hadn’t been tired at all while she was waking up at 4:30 to be at work by 6:30am–and now, just as she was switching to a more moderate 6:00 wake up call, she was exhausted.

She’d had chest pain before–and she’d attributed it to stress. After all, the chest pain was occurring while she was going to school full-time and working three different jobs and volunteering for a total of 70 hours a week of commitments at more than five different locations. Why would chest pain like that be occurring right as she was switching to a cushy 42 hour a week desk job with practically NO additional commitments?

The doctor listened to her complaints with half an ear and gave the girl some advice that stressed her out even more. But at least he agreed to run the blood tests she wanted.

Trouble is, her blood test results came back with “Within Normal Limits” written on almost every value. She wasn’t hypothyroid. She wasn’t anemic. She didn’t have mononucleosis. Her glucose was normal. The trail was dead. The girl had nowhere to turn. What was wrong with her?

Then one day, the girl was sitting at her computer, typing on Facebook that she was “sick and tired of being sick and tired” when a germ of an idea hit her. “You know, I used to feel that way all the time,” she thought.

She mulled on the idea on her way to work–so much so that she missed her usual turn and had to go the long way ’round. But the result of her musing was that she had a direction to investigate. When was the last time she’d had chest pain like that? It was right before she’d started taking antidepressants to treat Seasonal Affective Disorder (SAD). When was the last time she’d slept for days on end and still been exhausted? It was right before she’d started taking antidepressants for SAD. Ditto on always having “colds” and other unexplained symptoms.

After she got home, she took a depression self-assessment and discovered that she most likely was depressed–even more so then she had been during her SAD episodes. From there, everything began to fall into place. She hadn’t recognized it because the normal seasonal cues weren’t there, but many of the symptoms were there. She hadn’t thought of it because she was still taking the antidepressant for SAD. But it made sense. The onset of symptoms coincided with three medium stressors that combined to pack a big precipitating whomp: a car accident that totaled her car, a need to buy a new car placing her in financial stress, and a job change (from what she’d been doing for almost three years to something COMPLETELY different.) It made sense.

Since the girl was still taking an antidepressant, she didn’t want to run back to the doctor for more drugs. And she didn’t really want to do psychotherapy either. Her insurance would demand a certain provider for counseling–and she didn’t think they would be able to give her any help. If lies needed to be replaced, she would much rather make sure they were being replaced with truth–instead of being replaced with different (humanist) lies. She didn’t feel that the insured providers could provide truth. So instead, the girl embarked upon a self-treatment program.

The first step in her program was to begin writing down her symptoms. She wrote down when she went to sleep and when she woke up and when she ate and what she ate and when she had chest pain. She discovered some interesting things. Every time she looked at her planner, she experienced chest pain. Every time she looked at her checkbook, she experienced chest pain. Every time she thought about money or time constraints, she experienced chest pain. If someone else mentioned time or money, she experienced chest pain. She discovered her triggers–and started working on decreasing them.

Since her planner is integral to her relatively fast-paced life, she knew that she would have to train herself not to have chest pain every time she looked at her planner. So as her first step, she placed some personal limits. She allowed herself five “to-dos” per day–three of which were firmly set. While she could do more in a day, she could not plan on or insist on more than that. That meant she could have two additional things to work on each day. Period.

The girl’s doctor had encouraged her with some sleep hygiene suggestions, which she’d initially blown off. The girl was unhappy with the doctor for not taking her fatigue seriously. She thought the doctor was blaming her fatigue on her own habits (she still kind of thinks so.) But encouraged by her roommate who happens to be a PA student, the girl began to put some of the sleep hygiene habits into practice. Two of the three set items on the girl’s list were 1) turn off the computer by 8:30 pm and 2) turn off the light by 11 pm. Slowly but surely, she began to be able to wake up to her alarm again in the morning.

The third set item on the girl’s list was “word washing”. She knew that since depression often involves inaccurate perceptions of the world, she needed to have some way of seeing the world clearly. While she felt sure that the counselors insured under her plan would be unable to provide her with truth, she was even more sure that the Word of God could provide her with truth. So she set a goal of spending time in the Bible every day.

As the girl followed these few simple steps, she discovered some amazing things. She was able to identify when she was being anxious–and was encouraged to cast her cares on Christ. She was able to relax her expectations of herself and stop living in false guilt (over things like failing to update her blog regularly.) And now, the hope that once seemed dead is alive again.

At lunch today, my dad suggested that perhaps my file at the University Health Center is flagged “Pain in the [deleted]”. If it wasn’t before this afternoon, it probably is now.

After all, my real Doctor’s office (where I see my Physician Assistants) has a slightly nicer flag that probably means the same thing: “Do not schedule for appointments less than 30 minutes long.” I saw the flag once, a giant yellow banner at the top of my computerized information. It lets the scheduler (and the PA’s) know that I’m going to be an involved patient.

And I am an involved patient. I consider myself to be the head of my health care team–whatever the physician may think of himself. No one else knows my body, my mind, or my medical history as well as I do. No one else knows all the information (and unfortunately, too many doctors would prefer I not give them all the information.)

And since I’m the one who knows me the best, I deserve to be heard in the doctor’s office.

Unfortunately, that’s not the way doctors always see things. Too often, I see a physician’s eyes glaze over when I start detailing my past medical history and current diagnoses. Too often, I get brush-offs when I raise a question about something the doctor tells me.

I probably don’t have to be as upset as I am about today’s visit. After all, he’s going to run the blood work I wanted him to do. I would have been happy if he’d just run the blood work and said “Let’s wait for results before I tell you anything else.” So why should I be so upset that he did what I wanted and then gave me all sorts of “free” advice.

He was just being a University Health Center- type doctor, giving his patient what he thought she wanted to hear. “Let me give you some self-help ideas to deal with your ‘dandruff’, ‘sleep problems’, ‘heartburn’, and dry skin.” What he didn’t realize or bother to find out was that I already know how to handle dandruff, sleep problems, dry skin, and heartburn. I also already know that I don’t have sleep problems or heartburn–and highly doubt that I have dandruff.

I say I’m fatigued and tell him that I haven’t had a consistent sleep pattern “since this started”. So he tells me to establish a consistent sleep pattern. He gives me all sorts of advice to help me sleep better. What he didn’t bother to do was give any answers for the problem I was there for–extraordinary fatigue that is keeping me from being able to perform my daily activities (working a job, keeping up with the laundry, and washing the dishes) DESPITE getting 7-8 hours of sleep every night.

I tell him that I’m having chest pain–which I’ve had before. I tell him that the chest pain is a stress response–I know it’s not heart problems (because I had a complete heart work up last year and got a clean bill of heart health). I tell him that I’m worried because I don’t think I’m experiencing enough stress to warrant this extreme physiological stress response. So he tells me I have heartburn and gives me advice for managing heartburn.

I brought up the dry skin, mainly to make sure he knows I need to have my thyroid checked. I point out that the dry skin has worsened even as I quit the job that had me washing my hands with drying soap several times an hour. He tells me this winter’s been bad for skin and that I should wear gloves when I wash my dishes. (Yes, I know. But did you miss the part where I said I’m too tired to keep up with the dishes?)

I don’t know why I brought up the itchy scalp stuff. Probably because it hasn’t responded to dandruff shampoo–even though I was leaving the shampoo on for quite a while (10-15 minutes a pop). Probably because my two PA roommates think it’s psoriasis. Probably cause I wanted to make sure I didn’t miss anything that could be potentially useful in making a diagnosis of my REAL problem. But the doctor took it as a serious problem and paid no attention to my assertion that dandruff shampoo had no effect on the itchy stuff on my scalp. He insisted that I had dandruff–and that I ought to wash my hair with dandruff shampoo once a week for (get this) 15 minutes before rinsing it off. Imagine that!

I got what I wanted–an order for a complete blood work-up including TSH (thyroid stimulating hormone). I just wish I didn’t have to go through the frustration of THAT to get it.

I miss my health care team. I miss my PA’s who let me tell them my whole story before they break in with questions, who tell me what they’re thinking when they’re doing their differential diagnosis, who take my questions seriously. I miss the team that already knows my meds, and understands why I’m on them. I miss how they always ask me for any last questions before I leave. I miss how they know to hand me a copy of my charts and laboratory values before I leave so I can put them in my personal medical file. I miss my pharmacists too. I miss seeing the same person every time I go to the pharmacy. I miss being able to get my prescriptions filled while I do my grocery shopping. I miss the pharmacy’s willingness to answer every question I have.

I guess I miss my Blue Cross Blue Shield insurance. Yeah, I didn’t have “free” visits to a clinic like I do with student insurance–but at least I got to see my team. I might not have the flexible scheduling of on campus health care–but at least I had confidence that my health care providers were practicing evidence based medicine. So there were more hoops to jump through back then–but at least then I was the head of my health care team. Here, at the Health Center, I’m just another dumb student who needs to use more lotion.

Medicine Schmedicine. Nothing worth stressing about, right?