Nina Gaby

Essays, art, and healthcare


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Trump Has to Go. It’s Scientific.

I have spent six hours this morning in virtual conferencing with experts from The Harvard Psychopharmacology Master Class. I have fourteen hours to go this weekend. Usually the conference is held in the grand ballroom of the Fairmont Copley in Boston but this year I am in striped socks, hoody, a warm hat, lying on my toile fainting couch with no lines for the bathroom and no fancy lunch. I am writing from my own understanding of today’s information, and my decades of experience with these issues, not the interpretation of the presenters. No one mentioned our administration, no politics. Just to be clear on that.

 

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As I followed along on my screen today I correlated much of what I was hearing to the environment of our present world, considering how I can apply this research to examine how we move beyond all this intact. Or can we?

Dr. Charles Nemeroff, researcher, professor and consultant states in his presentation–“Interface of Medical and Psychiatric Disorders”: “Covid 19 is associated with a cytokine storm (cytokine is a category of peptide proteins associated with inflamation). There will be consequences.”As he continues it becomes apparent that he may not just be speaking to the immediate Corona illness, but to the interconnectedness of systems which we can extrapolate far beyond our own bodies. That is why I think of our survival and the Trump administration and its dangerous effect on that survival.

So these are nuggets from the research presented today about mental and physical health. I will simplify so we can make own extrapolations to why these dangerous times are are deeply exaggerated by our present administration, and administration that promotes hate and greed when simple kindness would go far to ameliorate the physiological responses I am about to describe. When action based on fact and not opinion would go far to ameliorate the world’s stress.

I cannot replicate any of the slides without permission so you will just have to take my word for it.

  1. Our mesolimbic reward circuitry is affected by stress. The limbic system is the walnut sized structure right behind our nose. It is considered the seat of emotional memory and houses the little light switch we call the amygdala, a peanut-sized structure which can modulate the experience of traumatic events. The mesolimbic dopamine system is the normal pathway for feeling good, but its circuitry is supremely sensitive to alterations brought on by trauma and stress. Poetic words such as “cascades” and “first and second messengers” and “de-arborization” and “connectomes” explain the transmission of chemicals–among them neurotransmitters and neurohormones– and also explain the new study of epigenetics. Basically “epigenetics” describes when events can actually influence gene expression (not sequencing) that leads to dysfunction of brain cells and their circuitry. This is DNA stuff.
  2. Alterations in circuitry affect neurotransmitters and hormones. Peptides which affect oxytocin and vasopressin (the attachment chemicals) can also be impaired. Receptors for these are present in the amygdala and affect bonding–between parents and children, between adults. Disruption changes this. Mammals lacking these peptides are at risk of
    attachment disorders as the presence in one mammal stimulates the system in another mammal. Think, “milk let down” in new mothers. Think, children in cages.
  3. Both physiological and psychological damage to these systems have long term implications that travel through generations. Through generations.
  4. The research shows inarguable effects on cancer and depression, as well as other psychiatric disorders. This is the schema:
  5. Increased environmental stress and/ or Adverse Childhood Events increase the inflammatory process (increases in cytokines and other stress chemicals) with increased risk of depression/heart disease/cancer.
  6. There is a proven bidirectional relationship between depression and medical illness. Autoimmune illness is also correlated with these events. Social connectedness has been proven to improve outcomes. I might suggest that concerns for one’s medical treatment and how to pay for pre-existing conditions might influence one’s mood state. The research shows an increase in suicide among certain demographics receiving diagnoses of certain illness.
  7. PTSD goes without saying. And this may also have a bi-directional schema. One must have been exposed to the stressor, and we now know there is a scientific basis for both developing or mediating the disorder. Understanding and providing support to the specific populations most deeply affected by violence and trauma would go far in healing the world. Homophobia, misogyny, racism, bullying, antisemitism, xenophobia has no place in the world we need to develop. (I am editorializing a tad here but the statistics don’t lie.)
  8. Most of the conference is about treatment, specifically medications, and other options. A couple items of interest: The odds of developing a psychotic disorder with high dose daily cannabis use is 3-4X greater. Use of cannabis in adolescence and pregnancy-a big NO. CBD has anectdotal therapeutic implications but metananlysis suggests data inadequate to recommend clinical use. I don’t even want to discuss ketamine. And what does this have to do with Trump? I don’t have the research on that, just opinions. But tomorrow’s another day.

 

 

 


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Liminal Spaces

 

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“Liminal Space” mixed media, Nina Gaby 2019

I am working with a student one day a week at the clinic. She is already a seasoned medical nurse practitioner who is now studying for her second certification in psychiatry and I mentor her on Thursdays. At first I was anxious, as while I know the psychopharmacology, in my practice I use a lot of intuition and experience. I match symptoms and medications (or maybe no medications) and try to “get” the person before I make recommendations. I’m not one to ponder long on the functionality of a receptor site in the brain or the half life of a molecule. I want to know what the patient wants out of this experience, what has worked in the past, and what their insurance (or the generosity of a pharmaceutical rep) might cover. And then it’s on to the next patient because it is always a busy day. Is this even going to begin to answer all a student’s questions?

So it is a great surprise to find that, at the end of the day, she and I can actually explore the “beingness” of our patients. That instead of rushing through my documentation alone in the now quiet office before jumping in the car to commute home, sometimes a little teary or anxious about all the stories I have heard that day, I can actually sit with a brilliant colleague and ponder the bigger questions. Some of them pretty existential in nature. As my Kundalini yoga teacher said to me yesterday, “You guys sit in the belly of the beast.” And as I like to think–we stand staring into the abyss, holding hands and containing what we can. Feeling honored by the process.

And then I go into the studio or sit down at my laptop and try to transform what I have learned from the process into something meaningful that reaches people through words or images. Art is a beautiful antidote, and here is a link to my latest published essay on Randon Billings Noble’s journal “After the Art”:

https://aftertheart.com/2019/03/19/certain-imperfection-revisiting-zetsu-no-8/

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Detail, “Zetsu #8” by Nishida Jun, Museum of Fine Arts, Boston-permanent collection

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For National Nurses Week, 2018: “On Legacy and Ego Integrity vs. Despair”

 

(2015 submission rejected by the American Journal of Nursing)

 

  1. Nursing school

It was May, 2015. I’d been trying to percolate some sort of blog entry that would bring my author’s platform up to date and also commemorate National Nurses Week, Mothers Day, and my upcoming 65th birthday. Is there a quatrofecta that lets me write a four for one?

 

In an essay a couple years ago, published in I Wasn’t Always Strong Like This: True Stories of Becoming a Nurse, I write about when I said goodbye to the relative freedoms of an artistic life and became a nurse: “At 34, I was the third oldest person in my Bachelor’s program, several of us ‘non-traditionals’ in a group of otherwise very bright and age appropriate young women. I was the wildest, with the most energy, and I looked nothing like a nursing student, whatever they were supposed to look like.

She’s an artist,” people would whisper. “She’s old.”1

 

My new friend Fran was ten days older.

 

We met the first day of nursing school in 1984. We were both the same age, with careers, entering nursing in our thirties as a means of achieving goals we otherwise might not. We were both interested in a myriad of health and social issues. Fran was to focus on patient education, and I switched gears from wanting to be a nurse midwife to settling on psychiatry and eventually becoming a specialist in addictions and a psychiatric nurse practitioner.  That very first day Fran told me Florence Nightingale wrote about nursing as an art.

 

Along the way I had a baby and Fran moved to Arizona.  Then I moved to Vermont.

 

We established a ritual to keep us connected. Every May, between our birthdays, we would exchange “Flo.” Flo is a little plastic nurse doll we named after Florence Nightingale,  the cake topper my mother put on our graduation cake in 1986. I made a special foam-lined box, “the official Flo transport system,”so she could travel safely between Arizona and Vermont.  This year, I would be getting her around Mothers’ Day. I miss my mother, and the ritual, of which I have very few, helps me feel connected to the best parts of her as well as to my friend.

 

2. Legacy

Fran planned. She had a year planner, a five year planner. I was lucky if I could plan the next five minutes. She gets to retire this year at age 65. I made impulsive life changes along the way; I will never be able to afford to retire.  Fran wins awards.

In the morning, when I called to congratulate her on her three newest awards, she tried to brush them off but I wouldn’t let her get away with it. “You got a freakin’ legacyaward,” I insisted. At our age the word legacy is fraught with meaning.

We overdosed on Erik Erikson in nursing school, feverishly memorizing his Stages of Psychosocial Development along with Maslow’s Hierarchy of Needs for exams. But who thought it would ever be us we were talking about?

 So here we are, leaving Generativity vs. Stagnation, the stage of middle adulthood, for our last phase: Ego integrity vs. Despair. Late adulthood. Age 65 through death.2

Cheery.

We are those people now wondering what our legacy will be.  At least I am. Fran got an award to define it.

What I didn’t tell her on the phone was that when I read the news of her awards I had been sitting at my desk for twelve hours trying to master a new electronic medical record system. Everyone else in the clinic had gone home. I put my exhausted head in my hands and sobbed.  No one’s going to give me a legacy award for spending my life feeding a hospital computer system, I cried. I can admit stuff like this now, old enough to know it is a universal thing, this is jealousy and despair. This is human messiness, and we nurses know about all that.

 

3. Mothers Day

What she did remind me was that I had had a child. She did not have, nor were having children ever in her plan. She reminded me that I was not factoring in the 25 years of pregnancy, bed rest, postpartum depression, motherhood. Would I have gotten a doctorate if I’d not had my daughter? Probably not. Written more essays? Made more money? Would my legacy feel any different? No. I’m a direct-care clinician, on the front lines. I help people. And now my daughter, in graduate school to become an end-of–life specialist will as well, help people. I am proud of her, I am proud of my friend. And yes, I am grieving my youth and worrying about the continued integrity of my ego. I will probably sob again before the month is over.

My Mothers Day card reads:

 “No one is useless in the world who lightens the burden for another.”

Charles Dickens3

1  Gaby, N. (2013). Careening Towards Reunion. In Lee Gutkind (Ed), I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse   Pittsburgh, P.A. : In Fact Books.

2 “Erikson’s stages of psychosocial development” Wikipedia.

3Dickens, C. (originally published in 1865, 2013).  Dr. Marigold.  On line publisher at OverDrive: A Word To The Wise.

 

 Addendum 2018: Fran got yet another award for which I congratulated her on yesterday, and I’ve quit and started several jobs since the original writing of this, and have finally settled in a medical clinic as their psychiatric provider and feel as though I’ve come home. As I sent the box with Flo carefully tucked inside to Arizona, I told the story to the postman and started to cry. He had a similar story of his own.

 

 

 

 

 

 


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More than the Sum of its Parts

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Book collage in process

Composite/collage. Synchronicity in text and image, transparency, translucency, opacity. How do we make it work?

In order to write in any sort of intimate way about mental health and addiction, I essentially make a hybrid of characteristics of an individual, spanning time, place, gender, symptoms. The point is to paint an accurate image of what without focusing on the who, on the why without the where. For obvious reasons, this allows me to shine a light on an issue without breaking confidentiality, and allows me to honor without alarm. I want the reader to understand what goes on for people in this world of addiction and psychiatric disturbance, within that understanding we might see impact or at least volition for change.

It’s a dilemma. CNF (creative non-fiction writers) will often say, if you can’t tell the whole truth than don’t bother writing about it. Others will find it good enough just to blur the lines. Others use permission contracts and footnotes. At conferences I’ve listened carefully to experts such as Lee Gutkind and Susan William Silverman, Dinty Moore and Jacquelyn Mitchard. My work has been picked apart by editors and lawyers. I don’t have an answer except that there are narratives that need to be told and images that need to be made.

I collage 3-D memoir from mixed media and think about whether transparency can truly exist. I work in porcelain and encaustic as well as words, all radiant in their translucency. I think about politics and the opacity that crushes us. I am proud of these stories I write about people I have been honored to know.

Here is my latest, a Monthly Muse contest winner from New Millennium Writings, “The Sum of its Parts.”

https://newmillenniumwritings.org/nina-gaby-sum-of-its-parts-musepaper-2018/


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Action plan. Writing about health care.

photo-66For today can I just write a blog about writing a blog? Of course I can. I’m the boss of me. Except that I started writing another piece today, one I realize could be considered controversial and should only see the light of day under deep pseudonym in the AARP magazine backpages–so I feel less the mistress of my own freedom than any thinly veiled braggadocio might suggest. That piece, the one you will likely not read, is about the atrocities of getting old in the changing workplaces of an ageist society where you are unappreciated as a still fierce force to be reckoned with. Instead the piece reads more like a Human Resource reportable incident than a blog post and do we really want to go there? If you do, message me discreetly.

So anyway, in the spirit of positivity, let’s talk about a new project instead. This March I attended the annual conference “Writing, Publishing, and Social Media for Healthcare Professionals” at Harvard. I admit it was daunting to spend time with two hundred medical experts and hearing their pitches for what could easily become the next medical blockbuster. We met with agents, editors and publicists and attended three days of lectures on such topics as “How to Get Your Message Out in Today’s Changing Media Environment,” “Narrative Writing in Healing: The Power of Stories,” and “Publishing is Changing the Way Medicine is Practiced.” Participants left the conference all charged up with action plans and brand new twitter accounts. I left geared up to do…something. During the workshops I made a pretend pitch to write a patient-centered handbook, titled something like So How Was Your Week?, which would explain, in a conversational Anne Lamott-y tone, what to expect from your psychiatric encounter. I practiced and pitched it and got good marks for my delivery to a panel of a dozen agents and editors and the aforementioned two hundred others. No agents swarmed me for a book deal, nor did I really want one. My handbook just didn’t have the punch of, say, revolutionary non-pharmacological ways to beat the common headache forever or how one surgeon brings the dead back to life or the slam dunk memoir potential of impoverished illegal immigrant cures blindness (maybe I embellished a bit here) What I really want to do anyway is find ways of talking about how we feel about doing health care, how do our stories matter in the schema of Obama-care and litigation and insurance insanity? I’ll never be an Oliver Sacks or Atul Gawande, I’m just a worker on the front lines. But what if stories like mine and those of my colleagues could shine a light on the complexities of today’s health care and create better communication with patients, families, colleagues, legislators? What if we could promote health care by making our process more transparent? What if we found words to support each other during this process? Working on the front lines can be a lonely and misunderstood endeavor. Our stories have great potential to heal and I want to talk about ways to do this.

So in the positive spirit of staying close to home and writing what you know, starting in May I’ll be working with the marketing and communication team at my local hospital to do some interviews and write some blogs and connect with my colleagues and patients to do the same. Stay tuned. In the meantime here are several collections with beautiful narrative, moving examples of the genre.

Shades of Blue: Writers on Depression, Suicide, and Feeling Blue edited by Amy Ferris, Seal Press 2015.

Mothering Through the Darkness: Women Open Up About the Postpartum Experience, edited by Jessica Smock and Stephanie Sprenger, She Writes Press 2015.

Same Time next Week: True Stories of Working Through Mental Illness, edited by Lee Gutkind, InFact Books, 2015.

 

 

 

 

 


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Blogger Block? Me?

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Valid excuses abound for my lack of follow through to my commitment of blogging twice a week to develop a presence. A “platform” as the new vernacular insists. How hard could that be for someone with boundless opinions on everything and insatiable energy for anything to do with the written word?

Yes me. Caught in a wash of the ennui that has always made me pity others. Me, of the “just do it” mentality. Legions of exhausted wordsmiths, I humbly join you. Hands folded, the laptop keyboard about as inviting as the treadmill in the corner that I am also avoiding. I can get mildly energized by the metaphor of laptop and treadmill, thinking I’m on to something, but it passes. I go get a yogurt, throw laundry in the washer. I have prepped for writing, I remind myself. I spent yesterday, a work day from home, writing up a pile of overdue psychiatric evaluations for my day job, got some discharge notes done, took a nap, and yes I will admit this to you, caught up on the Young and the Restless. All that so I could write today.

Or at least try to untangle the loop-de-loop that my anthology project has become. An interested agent needs me to include in my proposal some writers of household name stature before a publisher will even look at it. Household name writers don’t write on spec so I need a publisher. Generous women willing to help, waiting for more info. I wait for the universe to toss me some secret tool to unravel the loop or at least get more of my pleading emails answered.

I list all the reasons I can’t write today, all the reasons I am planning to go to a matinee with a friend instead. Why I spent last weekend eating fried seafood along the coast of Maine instead. A double sabotage, nothing pokes a hole in the energy reserve like overly oxidized trans fats. Actually I am doing a lot of stupid things to avoid how I feel about some really bad things that are going on, things I should be writing about. Like that my cat had to have her leg amputated this week. Like that a friend has been given two to seven days to live. Another friend has relapsed. Another friend’s dog died. A family member has had a serious exacerbation of a chronic illness. I’m worried about my daughter. I can’t keep up with the need for my services at work, and Obama-care isn’t helping with that. I cannot write about what’s important in mental health care right now because the state that I live in has an even broader interpretation of confidentiality laws than the feds. I have a sore throat. Headache for weeks. Cataracts. My house is a mess. Where does the list end, where does it cease to be valid? At any rate, I have to share the yogurt with the cat, it’s the only thing she’ll eat. And then I’ll post this, knowing you will understand.