Tag medical advocacy

“27 8×10 color photographs with circles and arrows and a paragraph on the back of each one.”

Angel Ackerman 4 Comments

I have been writing this entry in my head for about two hours now, I even opened the phone app and literally started the file– the first keystrokes on the blank screen– in between doctor appointments. I feel a bit like the main character/Arlo Gunthrie in “Alice’s Restaurant.”

Which is a reference that probably only makes sense if you’re a Boomer or GenX like me.

In that song, the Arlo Gunthrie protagonist faces criminal charges of littering and the police department has submitted into evidence for the court case “27 eight-by-ten colour glossy photographs with circles
and arrows and a paragraph on the back of each one” only to have the judge enter the courtroom with a seeing-eye dog. (Then the joke: “it was a typical case of American
blind justice, and there wasn’t nothing he could do about it”)

If you need some more explanation… Here’s the whole song.

I woke up at 5 a.m., wide awake for two reasons. 1. My brain had flipped back on. Full force. 18 thoughts at the same time. But 65 minutes of deep sleep, even though I only slept six.

I tried to go back to sleep, I really did, but I ended up clamoring to my feet. And for some reason, I got dressed. Like really dressed. Fake satin and lace skirt, sweater, dress shirt, boots. Gained five pounds because they weighed me with my boots.

My blood pressure was high because I had two doctor appointments this morning, one of which I have been concerned about for more than a week.

I left a few minutes later than I would have preferred because I stopped to do some dishes, thought I left my phone behind, then circled back because I had had my phone the whole time. I made it almost to the office when I remembered my primary care practice had moved to a new building (luckily, more or less across the street from the old building) and when I arrived in the parking lot, I realized how big the new building was. And the signage wasn’t the best.

The inside of the building on the side that wasn’t the big physical therapy office seemed dark and unfinished, with about six self-service check-in kiosks right inside the door. So I walked around the building before heading in. And turns out those walls that looked merely framed out and not finished– that was actually decorative trim. Then I found the building directory and elevator (which took forever to go one floor) only to have it open into one of those massive waiting rooms with several practices feeding into it. Yup, definitely not the homey small feel I am used to.

And by the way, if I would have turned right and gone up the stairs, the waiting room was right there.

I finally arrive and the woman who checked me in is there for the day and needs a minute to figure things out, and a familiar face comes and helps her, then we all start talking about my hair, and before I know it, my shrink-by-proxy is wandering the waiting room looking for me.

She guides me back to her office, which is no longer a closet, and she fights with the light switch to try and lower the lights. I have confirmed that she is a MSW, and I notice she has a backpack with her name on it on a hook inside the door. [hang loose here guys– I have been interrupted from this post several times and it has tense shifts and all sorts of issues that I’m not fixing.)

Now, remember my “Alice’s Restaurant” reference? I had my Book of Kells reusable canvas tote filled with about 25 pages of spreadsheet data, a copy of my legal pad to-do list, and self-report ADHD surveys filled out blindly by Eva and I. As soon as I sat down, my MSW-shrink-by-proxy said, “I’ve talked to [primary care provider] and we believe you would benefit from an evaluation from a psychiatrist.”

Oh? The same one I wanted to see about 14 months ago?

Yes, that one.

I have been told and I knew from the beginning that the likelihood of this program helping me would be slight, and we thought it might be a way to get me further up the food chain. It did not. But that’s okay. I respected her for saying that she could not continue to experiment with medication to guess what I might tolerate and what might help.

I mentioned where my daughter receives her care for her ADHD, and my doctor’s staff made a recommendation on a physician there who might be a good fit.

So she didn’t look at my visual aids.

She sent me back into the waiting room where I intended to do my morning journaling.

A woman broke away from the medical assistant who had been sent into the waiting room to retrieve her.

“Excuse me,” she said. “I love your style. And the boots are great.”

“Thanks,” I said. “My business color is bright pink so these are my special event boots.”

“What business are you in?”

“I have a book publishing company, Parisian Phoenix.”

“I lived in Paris, and I worked in fashion for 15 years…”

Do I need to tell you that made my day?

I was about to head out to my car and grab business cards– because I had almost 45 minutes until my next appointment. But then, the medical assistant returned for me. My doctor was almost done with a patient and she thought he might get to me early. He did not.

I think she forgot it was working-with-residents day and that my doctor pretty much does everything over once the resident does it. I forgot that too. I sat in the exam room for more than 30 minutes, and then spent about 20 minutes with the resident. He opened with, “So what brings you in today?”

“I don’t know,” I answered. “Dr. Mathur has some concerns about my bloodwork and asked me to come in– I believe it was because of my low vitamin D and increasing A1C, but if you poke around in my chart, we can talk about anything you like.”

Short version: He wants me to watch my consumption of sugars/carbs, take vit. D and B12, and exercise. And he gave me all the standard advice. He asked if he could give me an exam. I said sure. He listened to my heart, looked at my knees (not sure why) and then gave me a neuro exam. Which I recognize at this point as I see a neurologist 1-2 times a year.

“Let’s see if you do this better than my neurologist did yesterday,” I said.

And he almost laughed.

He then left to “talk to Dr. [my doc]” and I didn’t see him again for more than 30 minutes. He returned with my doctor and suddenly my doctor and I are talking about veganism, my service dog, the macaroni and cheese at Chick-Fil-A, and the pizza at Spice Crust Pizzeria.

The resident smiles.

I explain to my doctor that it’s the Indian fusion pizzeria down the street. “They use what looks to be high-quality ingredients,” I add. “I bet he’ll agree.”

I gesture to the resident.

“It’s good,” he confirms.

Apparently, the resident is a “smart one,” according to my doctor, and he’s authored papers on vitamin deficiencies.

“You didn’t tell me that,” I said to the young doctor. I swear, he practically blushed.

Then we talked briefly of the medication debacle (Zoloft), and I told him why I had pursued this and the emotional regulation I experienced on Adderall.

But no one looked at my materials…

When I got home, I called the recommended psych practice and they require a good old paper referral. So once my doctor’s office faxes them that, I will get a call from them.

Over-firing

Angel Ackerman 3 Comments

I saw my neurologist/physiatrist yesterday. She’s a fabulous doctor and a dog lover. So at the end of my visit, I showed her the video of me working with South. She watched most of the video, paying attention to both of us.

She’s really excited and hopeful about the potential service dog placement.

She’s concerned about the recent changes in my movement and issues with my left leg and has recommended physical therapy, which I will do if I can do it before my deductible resets. I did, after all, hit my deductible for the second time this year.

She is okay with me taking up to 20 mg of baclofen 3-4 times a day. But she warned that experimenting with other medications for my mental health may impact my spasticity. Especially stimulants. I told her, anecdotally, the stimulants settle my brain enough that I don’t feel like I’m fighting my body all day. She expressed her doubt with a twist of her lips.

I understand the need for guidelines and best practices and the only value diagnoses often have is to put a label on something to render it necessary so insurance will pay for it. I am low on Vitamin D and have a history of anemia– I take iron fairly regularly so my ferritin is okay. My doctor followed-up with some vitamin B12 tests to make sure I don’t have an issue there– those were deemed medically unnecessary and I had to pay $500. As a small business owner who works several part-time jobs, that’s a significant amount of money to me.

There are so many things about trying to find relief for what bothers a person…And yes that sentence is deliberately ambiguous.

My daughter walked into the same office I am visiting today, at age 17, as one of her first visits to an adult family medicine practice. She asked for an ADHD diagnosis and medication and got a base dose of Adderall with no issue. Now, let me reiterate, that a true diagnoses of ADHD requires manifestation in childhood– and parent recollection counts. In my case, I have no such thing. My mother would probably shrug. My dad is dead. My biological father is also dead, and my mental health therapist thinks the ADHD comes from him. My grades were impeccable. I loved school. I talked a lot. ADHD was not a thing back then. I did not have a traditional doctor or routine medical care from around age 5 to 20.

My daughter, while her upbringing was much different, had an old school pediatrician who had patients my age. So emphasis on old. But he was good, and his office was about 400 steps from our house. That’s what I liked. We only had one car. Eva did, and still does, great in school. I would wager she has more intellect and capacity for greatness than I ever did– yeah, I’m implying that my kid is smarter than me and I think I’m pretty damn smart– but she’s got this streak in her… She calculates the end result she wants and the minimum effort it takes to get there. I am an all-in, competitive personality. She talks so much I don’t think she ever has a thought that doesn’t come out of her mouth. But, unlike my upbringing, which was a typical GenX “go outside and play” and adults did not really interact with children variety, I have encouraged her to speak her mind. I learned early on it was easier to hear her out and reason with her than enact arbitrary rules. She never stops moving, unless she’s asleep. And to get her to sleep as a baby, Darrell had to swaddle her so hard she couldn’t move or else her little limbs would slap herself awake.

But no one ever asked us if we thought she had ADHD.

Looking back, it makes a lot of sense. But when she was 17, no doctor really asked us. The school never said she might have it. Eva was a great student, and, while I was the traditional “teacher’s pet,” she became the kid who looked after the kids who had behavioral issues. The teacher would sit the disruptive kids next to her so she could help keep them in line. I wanted to impress the teacher, she wanted to help. Eva has always excelled at determining what has value to her and what doesn’t matter– the kid deleted all the invitations to high school and college honor societies– whereas I always reach for whatever achievements people tell me should be next.

But yet… we are the same.

I am 51 years and 5 months old. And about one month ago, I took a dose of Adderall that changed my perspective on the world so dramatically I get tears in my eyes right now typing this. THAT is what makes this journey exciting, frustrating and dangerous. If they offered me any drug that could make my brain do the things (or not do) like that… I would take it every day and probably pay a hefty price for it. It’s not about feeling “good,” it’s a chance to live my life without feeling constantly under threat.

And I’m so sick of doctors trying to say I’m depressed. I have close friends who have clinical depression, and a few peers with bipolar depression. I don’t see any of myself in that. I’ve said it before– I love everything about who I am and my life, and I recognize the good I do, what I have achieved, and (as my mental health therapist says) the value it what I have avoided. I have survived and thrived.

But sometimes, my brain tears me apart from inside my own head.

I carefully plot my time and my schedule to do the things I need and want to do. I choose commitments based on my personal values. But no matter how much I try to avoid it, I end up overscheduled, rushed and overwhelmed, and I happily but unwisely maintain an intense work schedule until my brain just stops (despite how much I love everything I do). I work, I work, and then one day I have no energy left and it feels like the soul has been sucked out of my body. No matter what I do my brain will not turn on.

I now believe, that’s BURN-OUT not depression.

And I do this over and over and over again. I have treated it like an emotion, like something inside me is wrong, and it’s just a different kind of tired. I never understood that until now.

At the arcade, when I was playing Mario Kart with the teens, I could play the game without tension, without feeling like my life was on the line, and I got a similar “rush” whether I won or lost. I enjoyed playing. I enjoyed trying. I enjoyed the camaraderie. I had never experienced that before.

There are a few special moments in my life when I experienced intense beauty, or better than usual sex, or a new level of emotion, when the world felt quiet and peaceful and warm, and I never realized until now that those instances of being truly in the moment don’t have to be that periodic. That…

Pause. 7:15 a.m. My alarm would have gone off now if I had slept more… and here I am now, crying. Typing this.

Yesterday, my daughter resumed her Adderall after the pharmacy did not have it in stock. Between her recent ear infection and the pharmacy issue, it had been about three weeks. So she split the pill with me. (Yes, this is a tangent, but bear with me. It’s pertinent, and this is the stuff that I will organize and edit when I write these things for real.) I experience some of those calm, beautiful moments throughout the day yesterday. Laughter with my friend, Nan, as we soaked in sun walking across the Staples parking lot, for example.

I went to work at the restaurant and learned I had a four-hour shift at the work center I like least and that hurts me most. No break. Just four hours of hell. I was very stressed about this before I clocked in. I even got a high heart rate notification from my watch. But I was also oddly resigned. Like we’d see how it goes. The first half an hour I was tense, but also steady. I said to the supervisor– the young one whose very energy increases my natural anxiety– “hey, I haven’t done a full shift in this work centers in six or seven months so I’m a little flustered.” And I communicated with her that I needed more supplies, and that I may need some help keeping ahead of what needed to be done.

Someone else asked if they could give me a hand– and we had had a special event that involved having children coming to get themselves ice cream at my station during the dinner rush– so perhaps that had me on edge, because I knew I had tp be on my best behavior and keep a tidy station… So I let them help, and this is someone who has energy closer to mine, though still he has the same frenetic tendencies the supervisor does, and it was fun. Because of the camaraderie. By the end of the night, I was having a good time by myself, and when I got behind, in the same way that often felt hopeless when I was unmedicated, I was able to listen to my rational brain and let go of the anxious thoughts. And I left my shift with good energy and minimal pain.

The emotional regulation piece of this is transformative.

I have always thought my brain was a hugely unreliable narrator. That I couldn’t trust it. I didn’t know when it was worthy of my trust. I now realize I have a highly logical and organized brain, but when it’s overfiring, and that’s the best way I can describe it, the thoughts fly faster than my poor little cells can file. Yes, I’m imagining neurons with little filing cabinets, and happy brain chemicals tossing balls of happy and calm around, and my poor little office workers being clumsy athletes.

This is where I would insert a shrug emoji if I were texting someone…

TO BE CONTINUED….

Well, Zoloft was a wild ride

Angel Ackerman Leave a comment

I took my first dose of generic Zoloft yesterday at 11 a.m. I know that’s late in the day to in start an SSRI, but it was a fairly quiet day and I knew I wouldn’t get to bed before midnight. I figured that would give me plenty of time to test how well I tolerated it.

And this weekend is the Easton Book Festival, and I have tabling events and a panel. So I need to have my wits, my strength, and my charm.

I took 50 mg and forgot to eat, so I got immediately nauseated. Knowing I had a long day ahead, I made what we call an “ooey gooy egg sandwich.” I fried some peppers and tomatoes from my garden in Irish butter, added two eggs and a big heap of nutritional yeast. Meanwhile, I toasted two slices of Eva’s homemade garlic-infused bread and put a slice of smoked gouda on each side and ran it under the broiler.

The nausea did not end. I managed to keep it under control by minimizing what I ate and what I drank. Because even liquid gave me trouble. And the diarrhea started fairly immediately. And occured every couple hours,

Mentally, I had less creative spark but not the fatigue that often accompanies the drug. I did feel calmer, but that changed later… I thought everything was manageable.

I went to bed around midnight as I expected. Woke up wide awake. And it was dark outside so I looked at my watch. I hoped it was around 5 a.m. so I had enough time to get some good sleep before the alarm went off. But it was 1:15 a.m. And I was more awake than I usually feel in the morning. I got 90 minutes of sleep. None of my normal techniques for falling back to sleep worked. At 1:50 a.m., I went to the bathroom. I didn’t really need to. But I thought the walk down the hall would show me how tired I really was and I would go back to my bedroom and get some sleep.

Didn’t happen. It scared me how awake I was. And for some reason, I decided to groom my pubic hair. That killed some time. And then I thought I’d go down to the kitchen, make some Valerian tea, and then while that steeps, file my toenails. I’d drink it and go back to bed.

At 2 a.m., I start the tea. Do some chores and my belly starts gurgling. Loudly. Uncomfortably. File my toenails. Drink my tea. Watch TV. The tea makes my nausea come back full force. I almost buy an Apple Watch series 12. Mine is a series 8.

I feel the tea relaxing me so I head back to bed at 3:30 a.m. I toss and turn, realize I have hurt my shoulder sometime, and play with the cat, and repeat. At 4:15, I give up. I go downstairs and get ready for the book festival. At 5 a.m., I get dressed.

By 8 a.m. we head to the book festival, while in the car I realized I have been wired since 1:15 a.m. and that I’m still wired. This is how I expected Adderall to feel.

And I still have diarrhea. And coffee makes me sick. But I’m also calm. Eva and I describe it as my emotions being forced into a bottle, corked and put under pressure, with a layer of calm on top not letting them through, My weakness is my ankles and knees is worse. I fell after the book festival. I have eaten a Gobbler bowl from Wawa and had about 10 ounces of liquid before 4 p.m.

At 3 p.m., I fought the urge to vomit and managed to succeed in not puking. At 4:15 p.m., I was not so lucky. I barely made it to the bathroom in time to find myself puking in the toilet. I had last eaten at 9 a.m. and I was violently heaving and croaking like a frog. When I stood up, I realized I had pissed myself.

I told Eva and M– no more. I refuse to take even one more dose. M told me he didn’t often weigh in on people’s drugs but that this one is poison and I obviously can’t tolerate it.

“Stop taking that shit,” he told me.

I looked up how long the half-life is of this damn drug– single dose can last two to three days!!! So I looked up how long the side effects last if I stay on the medication. It says in most cases they abate in two to four weeks. Weeks!!! Aw, hell no! I do not tolerate lack of sleep. I struggle enough with emotional regulation so if I also did not sleep for a month, I would have a psychotic episode.

Now, I will accept that part of this is on me. I did not think to tell my new shrink-by-proxy that I am a lightweight when it comes to medication (which is part of why I am troubled by my increasing use of baclofen. I have gone from 5 to sometimes 20 mg in a dose, and 3-4 doses in a day without relief). When they put me on a beta blocker after my incident of Afib, I could not get off the couch on the dose they gave me. They told me to cut the pill in half and I was fine. Same thing happened with the sodium channel blocker. (Neither of those are still in my medication routine, so while my life insurance company has deemed me uninsurable, my cardiologist has deemed me healthy.)

I see two options: I text my doctor in the morning something like “I tried the Zoloft over the weekend. One dose. Bad side effects. Stopped.” Or I could call my shrink-by-proxy and explain what happened. Either way: I am NOT participating in any more medication roulette until they give me either a true ADHD test or a trial dose of ADHD medication. If the medical establishment is willing to play with my well-being with these ridiculous experiments, they can at least try the medication I tried and tolerated well.

It’s now 6:30 p.m. I still haven’t eaten since 9 a.m. but I have had a glass of water and about 24 ounces of electrolyte water.

Meanwhile my spreadsheet is looking wild. Because I am tracking it all.

More assessments and more unmasking

Angel Ackerman Leave a comment

Today has already been a long day, and it’s not even noon. 11:49 a.m. but not noon.

I am holding and caressing my necklace pendant, trying to will myself to breathe and take a break. I have spent most of the day hungry and “driven by a motor” (if you do enough anxiety assessments, you recognize the language.)

I woke around seven, after getting to bed at midnight because I left the restaurant after 10 p.m. I came home, showered, reheated dinner and watched the latest episode of Doc. I went to bed, and before I drifted to sleep, I actually cuddled the cat who lives under my bed. I cuddled him for the first time, despite the fact that he has lived in my room for about five years.

I vaguely remember checking my sleep stats, weighing myself, going to the bathroom, weighing myself again, and getting dressed. I clearly remember how disappointed in myself I was for having a big fast food dinner last night and no fruits or vegetables at all yesterday and I was annoyed that I ate potato chips, because my weight stabilized after a weekend of bad eating and I probably would have hit a new low had I not eaten junk yesterday.

I came down, started laundry so my uniforms are clean for tonight and tomorrow, poured coffee, grabbed my water bottle– and had to scrub my water bottle and rinse all the dirty dishes in the sink– and then went to my desk to take my morning muscle relaxers, at double the high dose, because my movement is struggling and I’m in pain thanks to my shift at the restaurant last night. (But they gave me a floral crown.)

Working late and having an 8:30 a.m. medical appointment definitely interrupted my morning routine.

I worked on my journal pages for the morning while sitting in the doctor’s lobby. Now… what happened AT the appointment might best be summarized by my follow-up note for my long-time psychologist. Edited but presented here:

This poor woman. Her job is supposed to be to help medication management for patients who need to be monitored by a psychiatrist but are managed well enough that they don’t need heavy supervision. That sounds like a nice way to phrase it.

Last week they gave me TWO HOURS of assessments. And as I told you, I was fairly confident the psychiatrist would say I was bipolar or had GAD issues and recommend an SSRI.

He did not. So kudos to him. (His name is Dr. REDACTED by the way, which makes me happy because my dad went by that name.) He asked for deeper assessments.

So today we started with a different bipolar assessment meant to see if I have manic episodes– to which I replied, “I don’t have that kind of energy. If I did, the first thing I would do is clean my house.” 

After that one, we moved to OCD. And I can see why he asked for that one. NINE pages. (In the end I was disappointed– it wasn’t nearly as in-depth and laborious as she made it sound. There is not nearly enough standardized testing in adulthood.)

I literally said, “Great. I love paperwork. My friend is DC invites me down so we can do our taxes together.”

And she read me the first page of the Yale-Brown Assessment. Which tried my patience. I read it twice waiting for her to finish. Did I ever tell you I hate to be read to? 

The test had two columns– one for current, one for past– and the directions said to circle anything that was upsetting or disrupting to life. Well, according to the textbook definition of obsession and compulsion, nothing I do fits those categories. I absolutely know, understand and can deal with the reality that my routines do not matter or change outcomes. They are self-soothing behaviors that prevent my frustration, anger, and help me feel like my environment is under control. And I told her so. I told her that I want to be sure when I come home at the end of the day, I return to a place that I don’t need to worry about, a place where I am safe and calm. 

And she asked if I performed behaviors to achieve a goal, and I told her everything I do connects to a goal. “I am sitting here right now reminding myself that when I finish here, I get to have a cup of coffee from Panera.” 

She asked me to track my mood and my sleep– and I told her I have done both, but I periodically stop tracking mood because all it does it confirm that I worry about everything all the time and that upset me. That I last stopped probably about six months ago. And that I track my sleep every day, examine my sleep tracker every morning, and record notes every day in my journal. She asked me to take a piece of paper and make columns for mood | sleep | energy | confidence and I replied, “So, you want a spreadsheet? I have spreadsheets for everything.”

Now, I don’t know if you realize how this is going to go down. I’m going to spend the next hour working on a blog entry, then I will probably spent two hours designing a spreadsheet on Google sheets so it can be shared, that will hold the most precise data on these topics she has every seen.

And now, I am wondering if the next assessment I have to take will be to see if I am on the Autism spectrum, because numbers and spreadsheets and ABC order bring me great joy. On a scale like, in the absence of good sex, the next best high would be organizing research/data/objects. 

Oh, and I now refer to this practitioner as “shrink-by-proxy.”

And I gotta say, I respect this doctor for not jumping to the obvious conclusion. And I am now firmly in the land of medical-professionals-who-must-rule-out-all-the-things-that-I-know-are-not-the-problem” which I like better than the medical professional who assumes he just knows the answer because he’s an educated white man of a certain age.

I was not entirely accurate in my depiction of how the next almost three hours of my life would go. I came home, wrote a different blog entry completely, put my laundry in the dryer, took allergy medicine, told my daughter several stories, read someone’s comments about one of my stories, visited social media, and finally– again almost three hours after I got home– started this blog entry.

Some other thoughts from the session:

  • I will not eat or return to the run-of-the-mill activities until I design this spreadsheet.
  • I will add my pain levels to the spreadsheet and probably additional info as well because I deem it important.
  • I told them my biological siblings/father have shown evidence of ADHD
  • I explained the difference between my obession/compulsion and their criteria:
    • I follow rules rigidly, but I also break them if I know my behavior will not effect the outcome
    • My rules and routines do keep people safe (food safety, emergency preparedness) but I do not participate in them to the extent that it impacts my ability to live.
    • Keeping people safe/ maintaining a predictable environment comes from childhood trauma
    • Pattens/numbers bring me joy
    • I do not “hoard” but I will save certain items for a special occasion to the extent that they will spoil or get lost or broken– because of a scarcity mindset from insecurity caused by childhood trauma
    • I do not filter what I say or worry about what I say to the extent that I will pick “true” over “polite.”
  • Everything I do, I get done because I bribe myself with a reward when I reach the goal.

Things that didn’t come up but I wish they did:

  • I would bet money that I react to red dyes. Ask me about my childhood and my experience with Jungle Juice at the local pizzeria.
  • I have safe foods and food cycles. Same with music.
  • I have issues with sensory input and occasionally have meltdowns from overstimulation.
  • Does the world realize I have fictional characters existing in my head, telling me their story as I live my life. This alone may show how many things happen in my brain at one time.
  • I am fiercely protective of my spots: my spot on the couch, my parking spot in front of the house, where I put my possessions, how my food is organized while stored.
  • I drink my iced coffee out of old pickle jars.
  • I eat certain foods off certain dishes and with certain utensils.

I am currently very hungry but too busy to eat. My daughter has so far fed me a stale macaron and a mini cheesecake/pumpkin/coffeecake cupcake. I have had about 50 ounces of coffee and 25 ounces of water and peed at least four times since I got home. This is the precise behavior that has led to my “urge incontinence.” I thought I was getting older and therefore peeing myself when I finally realized that instead I drink insane amounts of caffeine in tandem with ridiculous amounts of water.

Off to make the coolest spreadsheet I have ever made.

Let’s talk about fidgeting (and diagnosis and disability)

Angel Ackerman Leave a comment

My daughter– the one diagnosed with ADHD and mild social anxiety– and I were discussing fidgeting. I told her that I have realized more and more that I fidget more than I ever realized.

“Mom,” she said. “You fidget more than I do.”

“I almost wish you could come with me to my appointment Thursday, because you and I have the same symptoms, but I really think they’re going to want to put me on an SSRI. Why do you get Adderall and I get an SSRI?”

“Because you are disabled.”

I must have given her a confused and shocked look.

“I am a white woman. You are a white woman with a disability. You are even further away from the standard white man. No one likes comorbidities they don’t understand.”

So, I’ve been thinking about fidgeting.

Whenever I wear jewelry, I constantly play with it. I resumed wearing my Celtic knot pendant before I traveled to Ireland in late March. I have been spinning it, touching it, and putting it in my mouth several times an hour.

When I wore a wedding ring, I spun it. And since I stopped wearing it, I rub my fingers where it used to be.

When I wear earrings, I turn them. When I had a nipple ring, I turned that, as long as people weren’t looking.

I run my fingers through my hair.

If I touch my nose or my eyebrows or my ears, I struggle to stop.

And I take notes, lots of notes. More often than not, I have a notebook and several pens in my hand. And I take photos. Of everything.

I don’t sit still well. Professionally. Personally. I excel at jobs that require sorting, organizing, finding and planning. I live life like a chess game– planning moves and tasks before they happen. Funny part is, I suck at chess. I can’t get the strategy planned out far enough ahead.

Am I Alice? The White Rabbit? Or the Mad Hatter? Or the Queen of Hearts?

Angel Ackerman Leave a comment

Who doesn’t love a good mystery?

Anyone who deals with serious medical issues has experienced a sense of Wonderland. Is your regular life Wonderland? Or is the medical system Wonderland? Who is Alice? Who is the White Rabbit leading Alice down the rabbit hole?

We all have a lifetime of experiences. Some good, some bad. Some of us got “good” bodies, some of us have bodies we hate. Some of us have learned to accept our bodies. Some of us work really hard to change our bodies.

Some of us want to understand. Some of us want only to survive.

All of those things are okay.

We all have Alice in Wonderland moments.

It’s been a couple of weeks since my daughter, who has ADHD, floated the idea that she inherited the ADHD from me. It’s been one week, almost to the minute, since I took 10 mg of extended-release Adderall to test her theory, at least to give us data on if the drug brought me up or down. And the answer was down, pointing toward something not neurotypical.

And as you will see later in this entry, one of the stumbling blocks to determining what exactly my brain needs– whether that is treatment for ADHD, anxiety, depression or nothing– is, as my daughter would put it, I mask so hard even I don’t see the problems.

I have always been extremely organized, and I forgot nothing. And yesterday, at my second doctor appointment of the day, the clinician got out the standard short ADHD screening and asked the questions related to inattention. I don’t have a problem there. But I am realizing more and more, I write everything down multiple times. I write in my journal, on my paper calendar, on post-it notes, on my electronic calendar, in this blog. I write down when I take my medicine. My blood pressure.

And this morning– I went to blow my nose. Allergies are hitting in full force and Eva has an ear infection. In the middle of blowing my nose, I put the tissue down so I could take a Zyrtec before I forgot. I do not remember if I took the Zyrtec. I did not log it in my phone. The cap is off my water bottle, but did I take the pill?

Could my “obsessive” habits, like checking my bank balance several times a day, be not a form of soothing my own anxiety but something I do to prevent myself from missing something?

And even right now, as I write this, Eva has interrupted me and the entire train of thought for what I was writing completely disappeared. I had to reread the whole paragraph and reconstruct what I was trying to say. Is that normal? I’m honestly asking. So before I get too much more ahead of myself, let’s talk about yesterday.

Yesterday, I met with my longtime mental health therapist. I wrote a quick entry yesterday about that visit, posted it, somehow managed with a same day appointment with the practice who handles my everyday care, realized that the post was worse than I thought it was, and so I took it down with the intent to do a better job with new information.

And here we are.

Some observations from that appointment with the therapist who started treating me for anxiety more than 15 years ago. (That seems crazy. It can’t be that long. It just can’t.)

  • My individual complexity may prevent a simple diagnosis/solution. My history of childhood trauma and neglect, my family history of addiction, substance abuse and domestic violence. My physical disability (to which he adds “never discussed nor treated). So my brain could be doing anything for any reason. I believe this is why I’ve developed many of the habits I have that are masking how I feel on the inside. Whether we attribute this to ADHD or anxiety, that is part of the mystery.
  • Even looking back, with my history of doing and achieving all the things and doing them pretty well, it would be difficult for a clinician to trace this back to my childhood. Childhood presentation is one of the required elements for an ADHD diagnosis. (But, again, I was dealing with a lot of things, things I didn’t understand… from my body and my environment.)
  • My therapist theorized that if I have ADHD, I may have inherited it from my biological father. And that was a lightbulb moment for me. The first time I met him, I was

(I picked up my phone while typing this. I have no idea why. Got lost scrolling Instagram. Put the phone down. Realized I was in the middle of the sentence. And don’t remember what I was saying. So I distracted myself?)

  • … impressed by the breadth of his creativity and the projects he undertook. But I also remember that he had decided to remodel the bathroom and had never finished the one wall. It was still primarily the framing. Functional. But no real wall on the inside of the room. And when he and my mother split up, he went with his dog and lived in a cave in the woods until it got cold. Then it built a shelter. And when he and his wife split up, he left in his pickup truck, with his dog and a duffel bag and moved to the midwest. Where he got a job at Russell Stover chocolates.
  • My therapist can provide a letter of support to my primary care provider, and he reminded me that it didn’t matter the diagnosis if we could find a treatment that could bring relief. (And my therapist and doctor know each other so that helps.)

Now, I know “euphoria” is one reason people who don’t have ADHD take Adderall. And I’ve taken other types of medication: Lexapro for work stress and then depression (which helped in that “take the edge off” kind of way); beta blockers to control my heart rate (which failed); and Ativan for panic attacks (great, as long as I just wanted to come down and not do anything for the rest of the day). When I took Adderall, it wasn’t euphoria– it was the sensation of being able to let go of the adrenaline, the sense of doom and the constant muscle tension and being able to effectively regulate my emotions because normally my emotions also stress me out because I can’t do anything to work through them. I could on Adderall. If anything, that is what I want. I want that.

I asked my therapist: What would you recommend as my next steps? Since I have not been able to get past the waitlist for a psychiatrist, should I make an appointment with my family doctor?

I went home and called the office.

(Right now I am sitting here, forcing myself to finish this because it’s important. I need to pee. I’m very hungry. It’s 9:22 a.m. and my daughter and I are leaving for Susaquehanna Service Dogs which is sooooo exciting and stressful and… but if I don’t do this now I will not do as good of a job if I do it later and I don’t want to forget a single detail because the details can mean the difference between finding answers and getting the run-around from the medical establishment. This is how my brain works.)

I was offered an appointment with my regular provider October 13 or I could see another doctor in a couple hours. I took the appointment in a couple hours. I knew nothing would get resolved quickly, but wanted to position myself “in the system” to get the process working. That’s the hardest part of the medical system. Positioning yourself to get access to physicians and presenting the case with evidence, not anecdotal experiences.

That was why I started with my therapist. While he’s the most expensive provider on my list of medical professionals, he was the most qualified to give an opinion. Offering his opinion, based on our experience of 15 years, will hopefully show this is a legitimate possibility and not just a drug-seeking behavior. I specifically work with this therapist because he is a Ph.D. psychologist– I wanted someone who could help me grow as a person, not just medicate my brain. I have done a lot of worth in those 15 years, but recent years have shown me how much I fight myself and that I could have a chance at actually slowing down and enjoying more of my life, not just frantically surviving it and celebrating sporadic moments. Because in my brain, nothing is ever safe, or enough, or helps me overcome the doubt and doom.

(Okay, I need to get up and pee now. I’ve had 10 ounces of coffee and like 24 ounces of water… Be right back.)

(Hi, me again, I stopped to look in my protein bar basket. I should eat something. My belly hurts I’m so hungry. I have these blueberry breakfast biscuits that taste nice but don’t have any real protein. I also have a cookie dough protein energy bar from Aldi that is high in protein but full of chemicals, sugar and preservatives… I can’t decide. I have them both on my desk. I really want a piece of toast, but then I need to find and decide on bread, wait for it to toast. I should make an egg sandwich, but that is a whole undertaking of cooking. I guess I’ll open the breakfast biscuits… The taste bad. They usually don’t taste bad. And they smell weird. Are they spoiled. “Best if used by August 2025.” Did I mention I tend not to eat food I like because I might want it more another day? And then I panic that it’s not the best day to eat it? And now I’m sad that I let them spoil. Like really said. But honestly– they were Dollar Tree biscuits. So now I feel bad that I feel bad. I don’t need to beat myself up that much.

Now, do I eat the protein bar? Because I do not want to eat now. I threw out the biscuits. But I put them in my office garbage can. And the dog often gets in that can. Maybe I should empty it. Yes, let me do that quick. BRB. Again.)

So the doctor. She’s a great doctor. I mention that my daughter, and I both use the practice and my daughter does have ADHD. I tell her that I know we won’t have answers today, and I don’t expect that but I would like to start investigating this. She listens attentively and we explore the classic short ADHD. I have the anxiety-laden portion of hyperactivity impulsivity but not much else– and I ask her– I probably do fidget, but I have a spastic muscle disorder that means my legs cannot move. So how do we know? And I have similar I don’t know answers to some of the other questions. The test is inconclusive. She mentions other SSRIs. And that Wellbrutin has shown to improve symptoms of ADHD that coexist with symptoms of depression but it makes anxiety worse. And then she adds, “so that would be a bad idea for you.” And she wonders if I should try other SSRIs.

Her plan becomes three-fold:

  1. Get the letter from my therapist.
  2. Book an appointment with my regular doctor ASAP because he’s a busy guy. (Did not expect that.)
  3. She gave me a referral for a behavioral health case manager. This professional should be reaching out to me to prepare my case for review by a psychiatrist. It sounds like she does the evaluation, makes notes and gives them to the doctor so I can get medication through primary care… or through that psychiatrist. It’s a program designed for people like me who don’t have dangerous behaviors or immediate needs. And reduces the waitlist problem. That people never get off the list.

(I don’t want to write this anymore. I am forcing myself to do it. Just so you know.)

I leave the office. Hear from Eva that she got antibiotics for her ear infection. I email my therapist but then decide a phone call is more expedient and professional, so I call. He leaves me a voicemail a little later that we will get the letter together. And then the funny part– my actual primary care doctor comes to the restaurant, drives up to me in the drive-through, and chuckles when I ask what name to put on his order. He knows nothing of what I have gone through this week, or maybe he does, but I don’t think the other doctor finished her notes yet.

And that’s where all that stands.

Now if you’ll excuse me, it’s cold this morning and I am debating making a can of Spaghetti-O’s for breakfast.

Do I need to put on clothes today?

Angel Ackerman Leave a comment

Tonight I have a long-for-me shift at the fast food restaurant. 4 p.m. to 10 p.m.

Tomorrow I have a very busy day– gynecologist appointment at 7:30 a.m., helping Nan with her stuff around 9:15 a.m., teaching in the afternoon.

Thursday, we are recording our radio program at WDVR. Then, selling chicken from 4 p.m. to 9 p.m.

So, today I wanted to send out our acceptance letters for the Greater Lehigh Valley Writers Group The Write Stuff conference, March 11-13, 2027 at the Homewood Suites by Hilton in Center Valley, Pa. And I almost sent one so far. It’s ten minutes from noon.

Did I do things? Yes. Were they important? Yes.

Just not what I intended.

One of the items I have needed to do is grab a few groceries. I have been very careful with my diet lately (which has led to a new number today, one I haven’t seen in more than a year if not since the pandemic when I started rapidly gaining weight). And my daughter made me get dressed and go to Aldi.

Why Aldi? I wanted chicken salad and shelled endamame.

They didn’t have chicken salad and only had whole edamame. I didn’t want whole. I also wanted a salad and all their greens and pre-bagged salad mixes looked past their prime. So I came home with baby carrots (which I don’t eat, and I was hoping to make carrot pickles but I didn’t get the vinegar…), plain greek yogurt (because the flavors have too much sugar, but I probably won’t eat the plain), half and half (but I did not get coffee), crab cakes, and cheese. And bologna. Cheap cheap bologna because despite my primarily vegan tendencies I just really needed a bologna and cheese sandwich.

And two boxes of protein bars since I didn’t buy much food.

I did not want to get dressed. Until later.

Yesterday, I had my annual physical with my primary care physician. It was the first appointment of the day, and he spent 45 minutes with me. I had told myself that I did not intend to bring anything up. That I wanted to get in and out, continue my own experiments into diet, exercise and sleep, and ask for follow-up bloodwork.

He went through my late June bloodwork I did for him and the mid-August bloodwork I did for the life insurance company, with me, and requested I do another A1C and some vitamin D and some stored Ferritin… He was surprised to see– that as I told him– my “bad” cholesterol and my weight change very quickly according to what I eat. It’s how I gained almost 15 pounds this winter and lost it since July.

I still think I am among a rare amount of people who really pay attention to their bodies and try to understand and improve. He also asked how long I’ve been off my blood pressure meds– and I said– “about a year,” and then I reminded him that my cardiologist knows, or at least I told her I would probably stop taking them.

“Your blood pressure is great,” he said.

“The pills didn’t help,” I replied. I was prescribed the beta blocker because of my single incidence of afib. I stayed on it because I hoped it would help my anxiety– specifically the way my heart will sometimes race for hours for no reason. But the medicine never stopped that. If anything (and I have yet to prove this, my evidence so far is purely anecdotal, it’s food. I think the right blend of high sodium and refined white carbohydrates makes my heart want to explode.)

And my blood pressure has maintained itself in a healthy zone the entire time I have been unmedicated.

But then my doctor found out, I have been having stress dreams, disrupted sleep routines and general poor sleep since incorporating more “easy food” and less of my “outside aisles of the grocery store” home cooking. And now he’s worried about sleep apnea, my tendency to display symptoms of mild clinical depression, and my inability to relax (or have fun). He offered me a temporary antidepressant, and I declined.

And then today I remembered… I have been on the waitlist for a psychiatrist appointment for almost a year. During my routine physicals last fall I talked with my entire care team (primary care, cardiologist, mental health therapist, and neurologist) about the prospect of trying a low dose of valium as a breakthrough medication.

According to my research, doctors often give valium to children with cerebral palsy to calm spasticity and help them sleep. I asked my team about it. No one has experience with that sort of thing so they referred me to psych. So I reminded my doctor of this is an email. I told him that on bad days I often take 60 mg of baclofen– so could we try a small dose of valium in a small amount of pills to see if I took 2 mg of valium instead of all the baclofen if that would calm my muscles, alleviate my twitching hamstring, settle my heart, reduce my spasticity, and allow me to (1) stretch everything, (2) sleep better and therefore (3) recover better.

Remember– my leg muscles are unable to relax. I can’t even describe what it feels like. Sometimes it feels like my calves are so tight they burn. Sometimes my thighs feel like bricks. So if my doctor thinks I might benefit from a little something… this might be the something.

And on my one tangent for today: I have been binge-watching Nurse Jackie. I never liked Jackie, found her repulsive as a person but the older I get the more I recognize the accuracy of the depiction of people in addiction. And my daughter brought up something vital to consider:

Is Nurse Jackie an unreliable narrator?

My daughter votes yes, because there’s no way that an addict taking as much shit as she does (especially as a nurse) could appear to have her shit together as well as she does.

Interesting thought.

I have reached the midpoint in the series, and I’ve never watched this much before. And she has entered rehab and thrown her husband out of the house. And I’m thinking about it.

Meanwhile, my daughter has been tracing ADHD and autism in her family tree. My daughter– from a young age– has been super keyed in to people’s minds, patterns and habits. And just like she’s freakishly good at seeing every ripple in a dog’s body language, she’s damn accurate with her psychiatric diagnoses. And she’s finishing her bachelor’s in psych at Lafayette, she’s also developed some ideas about medication (so I asked her to do one of her recent psychopharmacology assignments on valium). She’s wondering if I might have ADHD.

My response is typically that it doesn’t matter.

I have a disability. One that stems from lack of oxygen at birth. One known to affect GABA in the body.

I score fairly high on the ACE scale for childhood trauma.

My parents were alcoholics.

Did I inherit generational trauma? Probably. Do I exhibit everything from OCD to depression to anxiety? Yes. Because my brain never learned how to feel safe and/or let its guard down. I never relax. The last time I felt truly relaxed was during some good adult physical activities that I don’t get nearly enough of. And do you know how much I need to trust my partner to let that happen?

My daughter believes something interesting about this whole ADHD hypothesis. She basically said I have not allowed myself to fail enough to recognize the truth it what she’s said. AND that because of that no clinician could ever diagnose me.

Strange food for thought.

The Day the Garbage Trucks Swarmed

Angel Ackerman Leave a comment

My shift at the restaurant Thursday evening went much easier than Wednesday— though I couldn’t bend and reach the floor and I took a lot of Baclofen.

And my left hand strangely hurt last night in the fifth metatarsal, in the same spot where I broke my right hand what had to be a decade or more ago.

Today I slept until 8 a.m. when my Goffin’s cockatoo, Nala, screamed, probably concerned that I died in my sleep.

I stripped my bed, started laundry, drank some coffee and used household chores as my warmup for a home workout. (After clearing my business email and banking stuff.)

The scale showed another pound gone. Soon I might hit the ten-pound mark.

Nothing like 30 or 40 pound cat litter boxes to practice farmer’s carry. And five trips up and down the stairs gets the heart rate up.

I did a pretty solid shoulder workout today, 22 minutes of just weights— including push press, dumbbell row, shoulder lateral raise.

Did some more wash, handled some more email and spoke with one of the Parisian Phoenix authors about a presentation we have been invited to give at Hellertown Library.

I did the dishes, started cooking some chicken livers for the dog, and made myself a big salad with lots of carrots.

I went to Panera for a while to work on my background material for the stories I am writing for Armchair Lehigh Valley regarding the May 20 primary.

And I got my schedule from the restaurant— 4 days in a row and 22 hours. I messaged my boss on Slack to warn her that that may be a struggle for me. She hired me so quickly I never had a chance to tell her about my cerebral palsy. She hired me to work 10-12 hours a week in the dining room, so I didn’t think I would have to.

But here I am, working 20+ hours all over the place.

I wasn’t sure how to bring it up, and I feel it’s better to do these things in person, but at least on Slack there’s a paper trail.

It turned out to be a great conversation. One we will continue in person. As I suspected, she’s short-staffed and I can really use the money so I didn’t want to complain.

Eva picked me up and we stopped at Grocery Outlet. And as soon as we got home, three garbage trucks swarmed us and our house.

I made a vegetable lovers DiGiorno thin crust pizza and split it with Eva and watched some more of The Pitt. Then I came up to make my bed, clean litter boxes, feed the bird, and get the cats water before my shower.

Now it is almost 8 p.m. and I plan to read until I am sleepy.

Cardiology meds

Angel Ackerman Leave a comment

Last spring, I experienced two falls down the stairs in a two-week period that led to bodily injury. That led to a period of A-fib and 24-hours in the hospital.

The cardiologist on call at the hospital put me on beta blockers, metoprolol, and the dosage wiped me out and gave me orthostatic hypotension. I learned through working with a dietician that I am sensitive to salt and I drink enough water that I wash the sodium from my system.

My primary care physician dropped my medication dosage in half, but the orthostatic hypotension and occasional weird bouts of high heart rate did not go away.

I found a new cardiologist and got a second opinion. The new doctor thought the Apple Watch was enough protection against Afib and that I could stop taking the medication. Since I was losing my job a month later, I thought discontinuing a beta blocker would lead to an increase in blood pressure due to stress.

But now it’s a year later– and I’m not sure the pills do anything.

The physician assistant and I had a discussion about eliminating the med, and she wants the doctor’s opinion first. The question remains of what should this medication be doing. If it’s supposed to be helping my heart remain a steady pattern, then I need something extended release or a different class of medications. If it is really just an insurance policy against Afib, I suppose it is enough.

The physician assistant asked if I would be willing to wear a Zio heart monitor to make sure this was a smart move. Last time I wore a Zio, it showed some stuff, but not Afib. That cost me $600, and that was when I had “good” insurance and Medicaid. I have a high deductible plan right now with high coinsurance and no HSA, so I mentioned that I was saving my budget for more important tests– like the MRI I am paying for out of pocket. That bill was more than $2,000.

I haven’t heard back yet, but my point in mentioning this is that the pertinent question of the day was to ask what my medication is supposed to do, and if it is doing its job. It’s easy for a doctor to tell us that we should or need to take something without question its exact function.

Fifteen people who don’t matter & an advocacy story with an unhappy ending

Angel Ackerman Leave a comment

This week was hard. I thought it would be different.

So, last week 100 people got laid off. There was fanfare. We left at 9:30 a.m. with pay for eight hours. Supervisors, process leads and managers lined the walkways and wished everyone (even those returning to work on Monday) goodbye by name. There was hugging and frolicking, crying and laughing.

This week, because they laid off 100 people last week, we had to work every second of the 40-hour work week unless we took voluntary, unpaid time off Friday. And how much time depended on your department, whereas the week before everyone in the building left at the same time.

So a lot of people from support left after 9:30 a.m., returns left at 10:30, inbound left at 11:30, and QC left at 1:30. And leads and supervisors just disappeared throughout the day. One manager wished me well and said goodbye at 7 a.m. Which was rich, considering what happened at 6:30 a.m. But I will get to that.

There were only 15 of us laid off yesterday. I know numerically why 15 people are significant, but when 100 were let go the week before and then 15 each week for several weeks following, it really (in my mind) makes a statement of how impersonal and how meaningless each person is in the eyes of the company. Why not make it another large group? The psychology of realizing you are one of 15 people that the company picked to leave on this Friday, it’s awkward.

Because you’re singled out of a large group.

Now, imagine you’re me. I know I speak up when no one else will, and I know I have challenged the thought process of my leaders. I try to frame everything with logic, to explain why I’m challenging what I’m challenging, but in the end, some people don’t don’t like to reach beyond their comfort zone. And often they just don’t know what to do to fix it, or they feel helpless or they feel attacked.

Yesterday I reported to my assigned station, which has been changed over the course of the week because with the reduction in staffing we have new work patterns. And I told one process lead that I didn’t care where they put me for the week, as it’s only the last week and I don’t feel pressured to challenge my physical capabilities to meet metrics. Most people had stopped meeting their numbers on purpose.

So, on Friday morning, I reported to my table– which for the record, is a table I hated, but no one asked and I just sucked it up and did my job– and I noticed… No one else came near me.

It was my last day. And I think I might have been the only person in my little unit leaving that day (that didn’t take the day off) and now… I realize… there is no one else on either side of my line. I have no shipper, there’s no work for others. They moved everyone else and just left me there. This means all of my work will just sit on the empty line until someone moves it.

Probably because they know I have issues physically and struggle with table changes and more importantly, I have a big mouth.

I feel completely on display. I feel singled out. And at this time, other people are looking at me wondering why I am standing in the middle of a closed line. In the middle of a wide open space. Like there’s a big open field and I’m just standing there. By myself. On my very last day with the company.

And I’m thinking to myself, “See– even on your last day, you’re not part of this group. No one cares about you. You’ve seen how they treat their friends. You are an outsider and you always will be.”

My heart rate is 150/beats per minute. I’m starting to cry. I email my supervisor (although I know what needs to be done, and I will do it, but I want their to be a record, even if fleeting and electronic, a written record of the things that have happened to be because I have a disability).

I walk back to a process lead, and I said, while trying not to hyperventilate or scream or cry, “I know you probably think you’re being nice, and helpful, by not making me move, but do you have any idea how it feels to be isolated and on display on my last day here? I don’t care if it’s high or low, on the left or on the right, please find me a new table. Any table. With the group.”

And I told them– because now a group had assembled– that I would be back after I went to the restroom to collect myself.

I was told to pick any table available, and I said I would grab the first one I saw. And I did.

And that’s where I was when the boss walked up less than an hour later to say goodbye and said she hoped I felt better about everything about talking with everyone throughout the week. And I said no, I felt worse and I just wanted this day to be over. And that I didn’t blame any people, but that as we all know, every company has room for improvement and this is an area where changes should be made and I had hoped to advocate for that change. But I failed.

Or perhaps more accurately, I ran out of time.

This is why more people don’t speak up and advocate for themselves, because it’s hard. And it drains you more than you think. I only did it, at first, because my employers made changes that made me fear I would lose my job if I didn’t.

But I lost my job anyway.

Let’s return to the story about departure. Most people VTOed (accepted the voluntary time off without paid) except for those of us who knew this was our last paycheck and we needed every dime. And when we left– there were no supervisors, no leads, no managers. There was no fanfare. They just let us walk out the door.

Because the critical mass had left the week before.

And we were just a handful of random people that didn’t matter.