Friday, September 30, 2016

Alexis the Unconquerable

I haven't mentioned something because even thinking about it and preparing for it has been stressful enough that sharing the details with anyone in writing or in any form has been more than I cared to do.  Now that the deed is history, however, I can probably gather the courage to recount the details of a recent and rather daunting task.  It involved serving as a guest lecturer for primarily first- and second-year students in "Practice of Medicine" and neuroscience courses.  The topic of my presentation was  my own experience with Post-Traumatic Stress Disorder and the events that, for me, precipitated the condition. Clerkship students currently in the psychiatry rotation were required to attend, and numerous psychiatry residents and some fellows were present, as well as faculty members and people whose identities were unknown to me. I spoke to a packed house in a large-ish auditorium-style lecture hall.  As someone who doesn't aspire to be the center of attention in most situations (if I'm the featured artist in a musical performance, I do expect that attention will be paid to me and would be affronted if were not given, but that's basically the lone exception), having everyone stare at me as I recount highly personal experiences is not exactly the stuff of which nightmares are made (the events about which i spoke are the ultimate fodder for nightmares), but it was still stress-inducing. To express it mildly,  I'm relieved to have the experience behind me.  In terms of class presentations of which I've been required to be a part, my expectations for the attention of the audience were based primarily on the premise that if I didn't have it, it would have meant either that I was doing a lousy job in my presentation or that the audience was disrespecting me, neither of which would have been acceptable. Still, for the most part, I'm far more comfortable with a background role or, even more so,  with being an attentive audience member than with being a presenter.

In one particular class presentation I was required to make in my pre-clerkship years, I dressed a bit [for me, anyway; I'm usually buttoned to my collarbone and otherwise well-covered] provocatively with the hope that I would at least have the attention of the males in the group. It worked. In this situation, I didn't feel that dressing in even a mildly sexualized manner would have been appropriate. I thought it would be more fitting for them to see a version of me that was closer to the person I was at fifteen, which was my age when both trauma-inducing events happened to me.  I didn't put my hair into French-braided pigtails tied with pink ribbons, but I wore a pale polo shirt with slacks, and I probably did not look eighteen, much less the nearly twenty-two years that I currently am.  I wanted my audience to get that what happened to this person who is youthful in appearance even today occurred a full six years ago; there was nothing sexualized about my appearance at that time that would have provoked the attack, if a sexualized appearance ever provokes an attack, which it most definitely does not. It was truly a crime of violence, in this case against a child. Not every female is a little girl at fifteen, but I was very much so.

One's medical history is detailed in one's application to medical school. The members of the selection panel who view the medical history are, for all intents and purposes,  bound by the same HIPAA regulations as would any medical personnel be. It is, nevertheless, considered significant by an applicant's interview panel and is likely discussed both among the panel members and with the applicant. Medical school is a rigorous process. Few individuals are likely to be allowed into a medical school program without major accommodations if they lack the strength and vitality to maintain the required workload. It isn't leaps and bounds less physically demanding than training to be an astronaut. 

My physical and sexual assault, as well as my experience of being trapped alone in a smoky home in a third-floor attic in a severely mobility-impaired state, and the subsequent PTSD that developed, as well as the treatment that followed, were addressed by the panel. No member of the panel was insensitive in asking questions.  I believe their collective intent was to ensure that no lingering issues related to the events would negatively impact me in performing my duties. Would I be uncomfortable in examining or treating a rape victim in an emergency room was a question I recall. I was able to honestly reassure the panel that, if anything, my experience would make me more qualified and effective than would be the average practitioner in such a situation and I would probably be the physician-in-training or intern  of choice to assign to that patient if the E.R. had the luxury of making such choices on a given day.  

The panel was also curious as to the nature of my treatment, and I was able to discuss it with them comfortably. I mentioned the name of my primary care provider during my inpatient stay and during the outpatient follow-up treatment. My psychiatrist was a graduate and resident of their institution. Most of them knew him personally. I was asked if it was acceptable to me for them to discuss my case and treatment with him. I replied that I had no reservations with their doing such, and offered to type and sign a waiver to that effect at the conclusion of the interview. This was all before the interview got really weird -- before they brought out musical instruments for me to play in order to ensure that I was not padding my application with skills I did not actually possess.

At one point during the interview, one of the panelists asked if I would be willing to serve as a guest lecturer concerning my own experiences as a sexual assault victim, a mental health patient,  and recovering PTSD patient. I told him that at that particular moment in time, such a task was more than I was capable of taking on, but that, given a few additional years to distance myself from the events that took place, I would consider it.  It's been a few additional years. I was asked, and I chose to oblige the person who asked.

I don't claim to be 100% recovered six years later; it's an ongoing process, though I'm well on my way to recovery, and I do intend to recover fully.  I don't have a precise timeline for the recovery process, but I can say that twenty years from now, I don't wish to still consider myself a sufferer of PTSD. Somewhere between now and then, I expect to have come to terms with what happened, although I may always be sensitive to the smell of smoke, and I may be cautious in terms of entering public restrooms for the rest of my life.  That's probably just who I am and will always be, though it won't necessarily mean I'm still suffering from PTSD.  If a young child with even a hint of intelligence touches a hot stove, he or she is not likely to repeat the mistake. If a person has ever been hit by a car, chances are that in the future,  the person will always look both ways more than once before crossing a street. If a person has been attacked by a Rottweiler, he or she will exercise caution around large dogs. It's a natural consequence or a sign of intelligence if the definition of intelligence is one's ability to adapt to his or her environment, but, at some point, not necessarily still PTSD.

If public speaking is difficult for me when the topic is one that is in no way sensitive to me to the extent that I'm willing to dress in borrowed zebra-print shorts and a clingy top to ensure the attention of at least part of the audience, a person can probably imagine the level of stress related to speaking to an even larger group about something that is intensely personal to me. What if, in virtually baring my soul to my peers, slight inferiors, and vast superiors, I were to see them yawning, looking at the clock, and fiddling with their cell phones? I'm not sure how well I could have dealt with the situation if such had been the case. I don't know if I would have burst into tears or if I would have walked out of the lecture hall with no explanation and without excusing myself. 

Fortunately, my worst-case scenario never came to fruition. I don't know if the underclassmen had been warned that their cell phones were not to be in sight and that they must be an attentive audience, or if I was simply seeing the humanity of everyone present, but it was as though almost everyone there -- especially the youngest audience members -- was on the edge of their seats from the moment I began to speak. My dad had learned from some unknown source -- I didn't tell him, nor did I even tell Matthew -- that I was to serve as a guest lecturer. He asked if he could attend, which was very kind of him, as he could have simply shown up unannounced. I assume he wanted to be there as a source of support to me rather than because he wanted to hear what I would say. I respectfully asked him not to come. His presence would have made the task even more daunting to me. I was then surprised to see my psychiatrist, otherwise known in previous blog postings as Chairman Mao, slip in the door and into one of the few remaining seats just after I had begun to speak. He held up a pre-made sign on a 12" by 18" paper. It read simply, "I'm here if you need me." He knows my story as well as I know it, and could have taken over for me at any time had I needed him to do so. If he had asked for permission to attend, I would have, as I did with my dad, respectfully declined his invitation. Seeing him, though, and knowing that he was available if I needed assistance bolstered my confidence.

I was told that my presentation, with a brief interval for questions at the conclusion, should  take an hour. From the first word I spoke until the final question had been answered (there were students whose questions I did not get to; four stayed to ask me privately afterward) I took exactly sixty minutes. I only began to lose composure when discussing the most painful and graphic aspects of the restroom attack, and the indignity of needing to be connected to a bladder catheter for eight days following the attack. Chairman Mao appeared prepared to rise from his seat, but I smiled at him through my tears and told him I was OK. I dabbed at my eyes with a tissue from a box someone had thoughtfully placed on the lectern, took a sip of water from the bottle left there for me, and continued.  It wasn't fun to talk about it, just as it isn't pleasant even to think about it, but it's possible that each time I tell the story, it has less power over me -- less of something to for me to hide, and less of something to fear in my mind when I hear myself speak the words aloud. 

Interestingly, this is in contrast to what I was told by a local practitioner before I began treatment at the inpatient facility. She said that talking about it other than to her in therapy sessions would only cause me to relive the incident repeatedly. Perhaps what she said is true in some instances and for some people, but it hasn't been the case for me. It's not as though I want to go on the lecture circuit and tell my story every day, or even to relive it in casual conversations among acquaintances, but sharing it at times when it has felt right to do so has been therapeutic for me. I'm very grateful to have been under the care of the particular local therapist only for the brief time that I saw her. 

I called attention to the presence of Chairman Mao, my true savior in all of this. Many family members wanted to help and did so in their own ways, but Chairman Mao was tho one who possessed the knowledge and skills to enable me to begin putting the traumatic events past me. I asked him to stand, and we all applauded him. He bears more responsibility than anyone else for my progress in overcoming the lingering trauma from a set of unfortunate events that happened a little too closely together for me to bounce back from them easily and  on my own.  It was at this point that I shared stories of the fun times we were allowed to have in the in-patient facility, many instigated by us, the patients, and not by his rather lame "activity director," but how he went along with anything that seemed harmless. I expressed that it was a relief to know that many of the patients were not significantly "crazier" than I was; they were merely young people with issues; many of them suffered from lingering effects of PTSD just as I did. I told the story once again of deliberately dislocating my arm to avoid a confrontation with him, and how successful my ploy was. I then had to demonstrate my ability to dislocate both of my arms at the elbow, then put them back into place myself. My audience was impressed. if medicine doesn't work for me, the circus might.There are probably other joints i could dislocated if I put any real effort into it.

I felt that I did what was expected of me by the professor who asked me to speak. He wanted equal emphasis upon the events themselves and the subsequent treatment. While my audience was wonderfully and respectfully attentive throughout the presentation, their questions focused far more on the events than upon the treatment. They were understandably interested in the primary attacker, in his sentence, and in his current whereabouts.  I suspect the professor was disappointed that their questions were not more focused on the treatment, but they're human, and they wanted to know whatever it was they wanted to know.

The professor asked if I would consider presenting again in the future.  I told him that I didn't want to do it again very soon, but if he were to ask me again in a year or so, I would seriously consider speaking again. Meanwhile, I'm $500.00 wealthier for my effort.  Our cohort, or those of us who are off-duty,  will be having a beach party this weekend. I'll be generous with provisions and libations.  

As for me, I feel that I've metaphorically thrown a gorilla from my back.  I don't know who among my peers and superiors knew of my past -- it wasn't a total secret -- but now it's all out in the open. Anyone around here with whom I work who didn't know already either does now or will soon.  I no longer really need to worry about it. I hope no one will treat me differently as a result of their newly acquired knowledge of me, but if they do, the effect will be temporary. I'll return to being Cutthroat Bitch soon enough.


  1. Well done. That took real courage. I hope it can now just be one of the threads in your tapestry of memories.

    1. It gets a little closer to that sort of thing every day. PTSD doesn't have to be a lifelong thing, at least not when it's as a result of a situations such as mine. For people who served in horrific combat situations or those who narrowly survived events such as the World Trade Center disaster or the Oklahoma bombing or the Sandy Hill shooting, I understand it's a whole different ball game. Maybe you don't entirely recover from such trauma. My situations, however, are things one can get past, which I fully intend to do.

  2. I'm sure your presentation was very useful. It takes guts to speak in public, especially about such traumatic events.

    1. I'm finding that, minus a few little quirks and some problems at night if I have to send the night alone in the condo, as well as the smell of smoke, I'm getting past all of this. Bad things have happened to everyone. It was just for me that two potentially dangerous things happened within months of each other when I was at an impressionable age, and one of them involved a penis and some rather graphic violence when that penis couldn''t manage to perform as its owner intended it to perform.

      My blog focuses more on the assualt, but I talked about the incident in my aunt's and uncle's home as well. Somehow, in explaining the greater story, the topic of Mormonism entered the discussion. I apologized to any Mormons who might be present and stated that it was not intended in any way an indictment against the LDS faith, but shared the part about how the family lost custody of their children for varying lengths of time depending upon the ages of children. I probably didn't HAVE to do this, but I went on to share that the prevailing attitude of the parents contributed to what appears to be permanent estrangement from their son (my mom and dad are legally adopting him by his own choosing even though he's 23 already). The whole incident with the smoke inhalation and with parts of the family pressuring me to perjure myself in front of a judge in order for the evil aunt and uncle to get their children back into their custody more quickly was appalling to my audience. It does nothing to reduce one's anxiety to know that over 80% of a side of my extended family essentially hated me (still does, but it matters less now) when I was the victim in the scenario. Families have the power to be a source of support or to do the reverse. It doesn't matter anymore. It's interesting enough to me that the ones I liked and who were kind to me even before it happened were the ones who stood by me after it went down. My judgement even as a kid was on the mark as far as those people were concerned. I tried to impress on my audience that it wasn't in any way a mass denouncement of the LDS church, but underscored how a blanket philosophy such as "families are forever" played over and over in the minds of adherents can lead to people behaving in ways that are contrary to common sense and even to right and wrong. I knew who at least a few of the Mormons present were, and they seemed to be following me. I would have said less about that aspect of it, but it came up in the "question and answer" segment, and I answered honestly in line with my own beliefs and conscience.

    2. One of the questioners asked if i had spoken with the victim of the infamous Stanford bicycle rapist. The thought had never occurred to me, or to anyone else, apparently. I think our situations are so dissimilar that I'm not sure any discussion between us would yield anything all that fruitful, though I would certainly do so if asked. I'm not meaning to be judgmental in saying that our circumstances were different. I hold the opinion that a woman (or man, for that matter) has every right to be as substance-impaired as he or she finds himself or herself, and that it in no way gives anyone else the right to do anything but to come to the person's assistance. (Obviously in the case of a drunk person who is belligerent rather than unconscious, it's a different ball of wax.) Furthermore, I'm not sure the level of her intoxication was entirely of her own doing. It seems as though evidence pointed to spiking of a drink. I'm not sure under what class of law-breaking it currently falls, but if it isn't already, it needs to be a Class A Felony. It would be a difficult crime to prove were it not for my generation's fondness for documenting almost everything with video footage using cell phones. It's not just the idea of the often-resulting taking advantage of someone in a sexual manner afterward that is the issue. Hardly anyone knows at a casual gathering much about anyone's medical history --- allergies or drug interactions in particular -- and the whole matter needs to be treated with more gravity than it currently is. And it's the responsibility of my generation to step up with their cell phones and what knowledge they possess regarding a given instance. Rarely does one mildly intoxicated person go to successful lengths to hide what he (or she) is doing when drinks are spiked; someone else usually sees it. We all need to step up and call each other on dangerous behavior.

      But then, many of these people are frat rats. I admit to a personal bias, but my experience has been that the average (not all of them obviously) member of the Greek system is lacking more so than is the average person in morals, conscience, and all matters related. Why can universities not see that so much more harm than good is done by the Greek system, and that it isn't necessary to the extent that it once might have been in college and university life generations ago. Associations can be formed without the long-standing exclusivity and, in general, debauchery of the Greek system.

      I've veered far from anything I talked about yesterday. Suffice it to say I have relatively little in common with her despite the situation of having been violated in some way, but I'd be more than happy to chat with the victim of the aforementioned case if anyone with any authority thought it was a good idea and if she had any desire to speak with me. It's unlikely ever to happen.