At 10:14 a.m. Saturday, Angela sent me the following email:
"I decided not to go away with Rob (her boyfriend) this weekend because I'm uncertain as to whether or not I can keep it together. Today, I am tearful, the feeling of sadness is overwhelming and often leads to suicidal thoughts.
"Maybe the ECT doesn't have the clout as yet to keep unwanted thoughts suppressed, and I sure as hell don't have the capacity to keep them at bay.
"I want it to be Monday so I can have another treatment. I want to know if the ECT is going to stick with me and work for me. My patience wears thin, my eyes tearful, and my heart has broken into millions of tiny pieces.
"I hate this!"
I called her as soon as I read her message. She sounded more buoyant than I had expected. Her sinking mood admittedly was caused by other problems in her life that have nothing whatsoever to do with her psychiatric condition and the trauma that's the root cause of her depression and suicidal ideation.
"Life's complicated," she said, referring to these problems that seem to her to be insurmountable right now with all that's happening to her – all the unknowns and anxieties about her new electroconvulsive therapy protocol.
She's concerned about her mother who isn't well and will be visiting her this weekend. Angela is terribly anxious about how her mother will react to her having ECT. She hasn't yet told her about it.
"And there's lots more," she added. "It's complicated."
She wanted to spend the weekend alone and I couldn't persuade her to meet me for lunch or to come and have dinner with Marty and me on Saturday night. She didn't seem open to company at all, insisting that she wanted to stay home, by herself, with her three cats – to watch the hockey game.
So, I signed off, reassuring her that I was here and at her beck and call if she wants to talk.
Meanwhile, to say I have ECT on my mind is an understatement.
But one in particular that came in Saturday disturbed me and not because of its angry tone. I didn't know what to make of it, despite my attempts at researching it.
I'm no scientist and ECT is a highly scientific, complex procedure with remarkable inconsistencies depending on widely specific variables.
I was so confused that on Saturday at 6:23 p.m., reluctantly, I wrote to my friend, psychiatrist Ron Pies of Tufts University, who is as committed to public education as I am. We are communicating often these days as I dig deeper into the contentious realm of ECT.
He has introduced me online to psychiatrist Max Fink, a leading U.S. authority on ECT, who generously agreed to answer my questions if I email them to him. On the thorny question of "involuntary" ECT, Ron also consulted leading forensic psychiatry expert Professor Daniel W. Shurman, the M.D. Anderson Foundation Endowed Professor of Health Law, Dedman School of Law at Southern Methodist University. In the weeks to come, I will be sharing this and other information I'm uncovering as Angela continues with her eight-week course of twice weekly ECT treatments. Depending on her response, this course could be extended to 12-weeks.
Time will tell.
In my Saturday night email to Ron, I admitted: "I don't know how to respond to this comment," referring to a writer named Ginger who sited a 2007 study by Columbia University psychologist Harold Sackeim. "I've found Harold Sackeim's paper, but I'm not sure he's using the most up-to-date ECT methodology nor am I sure why he's reversed his opinion.
"Everybody has a story," I wrote. "A different story. I think that there must be variation in quality of equipment and methodology in different hospitals. Differences between outcomes in bilateral versus unilateral. I can't become an expert in ECT. I'm reading as fast as I can, I'm not really adept at interpreting scientific research papers. Perhaps I've opened a Pandora's box with this series and now I'm in real trouble."
Ron responded at 12:10 a.m. on Sunday morning.
"Believe me, I sympathize. I waded through not only the 2007 paper by Dr. Sackeim's group, but also their 2008 follow-up study, which is of considerable importance, and which (I believe) clearly runs counter to the overblown claims by Linda Andre," of the The Committee for Truth in Psychiatry.
"Even with my training, I had trouble teasing out the clinical significance of many of these findings, as contrasted with the statistical significance. There is a big difference. The bottom line: it's like in real estate, but instead of "Location, location, location," the slogan is "Technique, technique, technique!"
"So much depends on using the newest and most "cognition-sparing" techniques. When you do so the results appear to be very good, without substantial cognitive loss in most individuals, and with substantial improvement in mood."
Ron signed off promising to find "a more definitive response" within a few days after getting "some consultation of my own."
Meanwhile, I found this TED.com talk by Sherwin Nuland on Electroshock Therapy. Nuland is an American surgeon, now retired, and prolific, award-winning author. He gave this stunning this talk in 2001 and it was first released in 2007. It's well worth 22 minutes of your time.
On Sunday morning, Angela and I spoke on the phone three or four times.
"I can't wait until Monday," she said anxiously and often. "I can't wait for my next treatment. I want it to kick in. It seems to take so long. I don't want to wait. I want to be cured now. "
She's also anxious because her current psychiatrist who is administering her ECT treatments is only going to continue for this week and next week, she'll have another doctor, a doctor she hasn't yet met. "I wish there was more consistency," she said.
I reminded her that the University Health Network is a teaching hospital and this is a standard practice in teaching hospitals. That wasn't what she wanted to hear.
Her despondency continued later Sunday evening. It was mild. She would giggle from time to time and joke with me, even though the word she tended to use to describe how she felt was "glum." When I asked her about her suicidal thoughts, she said she kept thinking, "What's the point of all this?"
I sent her the link to Nuland's talk and another 12-minute talk he gave in 2003 that was posted last month, On Hope. She said she'd have a look.
Yesterday morning, her third ECT treatment went without a hitch. When I called her at 9:45 a.m., she didn't answer the phone. At 10:43 a.m., she sent me the following note:
"Just checking in post ECT... Have a little confusion but nothing serious. I don't feel well today... suicidal thoughts and just glum. Wish this treatment will hurry up and work!!!
"Hope you're having a good day!"
We spoke a few hours later and her confusion was gone. She couldn't understand why she wasn't having three treatments a week, the way ECT is typically administered in the U.S. and in the U.K. She said she'd prefer that.
This morning, still "glum," she said a few hours ago. "I remember absolutely everything now and the suicidal thoughts are gone completely. No side effects. But why does this take so long to kick in."
Later today she'll be seeing her psychiatrist. I sense from what she says and even more, from some of her silences, that she doesn't realize just how much she needs this therapeutic support right now.
I suspect they'll have lots to discuss.