Running lessons

I started running today. Lessons learned:

1. Running with chest congestion does not feel good.
2. 8 year olds run faster than me.

What I learned about electroconvulsive therapy

I got to observe electroconvulsive therapy yesterday. What I learned (not all of which is related to ECT itself)*:

1. It's not as "shocking" as you might expect. (Or, at least, it did not provide the drama I feared it might.)
2. The patients get lots of meds ahead of time, like about eight.
3. Some patients get IV caffeine because it makes the seizure stronger.
4. Just before the procedure, the patients get a sedative and a muscle relaxant.
5. The muscle relaxant ensures that the patient's seizure remains confined to their brain, so they don't flop all over the bed. The nurse anesthetist uses a muscle stimulator on the patient's arm; when the arm stops twitching in response to the stimulator, they know the muscle relaxant has kicked in.
6. The nurse anesthetist inserts a bite block after the patient's sedation has taken effect to protect their mouths.
7. The anesthesiologist manually ventilates the patient using a bag and mask attached to oxygen before, during, and after the procedure to "hyperoxygenate" them.
8. When the seizure starts, you see the patient's jaw suddenly clench. If the blood pressure cuff had inflated when the nurse anesthetist administered the muscle relaxant, you might see that hand twitch during the seizure because those muscles did not get the muscle relaxant.
9. They can place the electrodes in three configurations: both on the front of the forehead above each eye, one on each temple, or one on a temple and the other on top of the head.
10. When I asked how they knew where to place the electrodes, the technician answered, "Wherever the doctor orders."
11. When I asked how the doctor knows where to place them, I got silence, even from the doctor. [Hm.]
12. The anesthesiologist then jumped in and said, "They use whatever works." [This bit disturbed me a little. I know there exist many things in medicine that we don't understand - we simply know they work - but if I decided to allow someone to pour voltage through my head to make me have a seizure, I would want to know that they knew exactly where to put the damn electrodes. On the other hand, this therapy usually remains a last resort for patients; many of them have already demonstrated that they pose a danger to themselves or others.]
13. Manually ventilating a real person with a bag and mask takes a lot more work than ventilating a mannequin in CPR class. [Human heads are heavy!]
14. People "hiccup" when they start to come out of the sedation.
15. Some patients get wicked headaches after the treatment [go figure]. 
16. The FDA just recently approved IV acetaminophen. Countries in Europe have used it since 2002. 
17. Patients can have treatments as often as every other day. As they improve, they start spacing out the treatments. Some patients have had hundreds of individual treatments. [I didn't know a person could survive even ten, much less hundreds.]

Other notes, plus some commentary:

I mentioned in #12 that the patients getting ECT are at their last resort. Some of them have attempted suicide or have seriously thought about committing suicide. Others have seen their lives implode. They elect to get ECT after they have tried everything else, when medications, counseling, and other interventions have failed. They don't make this decision lightly.

Every ECT patient I saw looked absolutely normal. If we saw them walking down the street, we would never know they went in for regular ECT treatments. They looked like dads, grandmas, and college students.

If you don't know a lot about mental health issues, think of them this way: when someone has diabetes, their pancreas either does not produce any or enough insulin, or the body doesn't use insulin effectively. Mental illnesses work much the same, only the problem lies in the brain; the brain either does not produce enough of the hormones (for example, serotonin or dopamine) it needs to regulate moods, or the receptors for those hormones don't work right. Both diabetes and mental illness are physiological problems.

This reality highlights how very important it is to avoid assuming that someone is "normal" just because they look it. We never know the feelings or thoughts another person has unless they tell us. I've seen patients with depression who appeared outwardly gregarious and engaging; we wouldn't know that on the inside, they felt utterly hopeless - unless they told us. 

* Everything I've written here comes from what I observed or what I was told during the procedures. For more information, try these sites:

The Mayo Clinic

Mental Health America