Wednesday, March 10 at 4:45 p.m. The phone rings.
"What do you think of the idea of me trying bilateral?" Angela asked.
Her psychiatrist in charge of her current course of Electroconvulsive Therapy had raised the issue in a telephone conversation earlier that day.
WE DISCUSSED MAKING THE SWITCH
For about 15 minutes we discussed her concerns about making the switch, much in the way we had when she called and asked me, "What do you think of ECT?" back in early January.
Angela explained that her doctor had made the suggestion because was she might progress more quickly with bilateral versus unilateral ECT. She has had 12 unilateral ECT treatments over the last six and a half weeks.
"I'm definitely going for the extra four weeks," she said, referring to the option she was given when she first discussed her treatment course and the study on memory loss in which she's involved. "But I'm worried about changing things mid-stream."
Ultimately, I suggested she speak to her outpatient psychiatrist, who knows more about her psychiatric history and about the differences between unilateral and bilateral ECT than I do.
She agreed and signed off.
In the meantime, I started nosing around the Internet for a good, reliable distinction between the two variations on ECT administration, without much luck. Most sources were dated in the last century and not very reliable, as far as I could tell.
Within 10 minutes, Angela called again.
"I'm having my first bilateral ECT treatment tomorrow," she said. "I'm going to try it. I discussed it with my psychiatrist and she thinks is a good idea. If I find it's too hard on me, I can always go back to unilateral."
UNILATERAL VERSUS BILATERAL ECT
Wednesday, March 10, 5:41 p.m.
"I have a question for you. Angela has decided on her doctors' recommendations to try bilateral ECT. She's not progressing fast enough, I guess. She's going to have her first bilateral treatment tomorrow. I want to post about it on Friday. Although, I see an impressive improvement. It's not enough. She's in week seven and has decided to go for 12 weeks.
"If I could quote you and link to a good article that describes the pros and cons of bilateral versus unilateral ECT, something recent, in this century, that would be perfect. I've looked and I cannot find anything. Am I missing something? Is there something in the archives of Psychiatric Times that I cannot see? I'd rather quote you and link to an article on this ultra controversial subject, but I'm a little stumped."
At 8:07, Ron's email arrived:
"Given that these are very technical matters, I thought the comments from the Royal College of Psychiatrists, 2008, would be more helpful than a journal paper," he wrote. "I think this really summarizes the situation, as I understand it, quite well. It comes down to a trade-off between very high efficacy, significant cognitive side effects [bilateral ECT] and high efficacy, mild-to-moderate cognitive side effects [unilateral, non-dominant ECT]. There really is no “right” or “wrong” decision."
NO "RIGHT" OR "WRONG" DECISION
"In bilateral ECT, the electrical current is passed across the whole brain; in unilateral ECT, it is just passed across one side. Both of them cause a seizure in the whole of the brain. Although there is a lot of research being done, it's still not clear which type of ECT is 'best'.
"Bilateral ECT seems to work more quickly and effectively and it's probably the most widely used in Britain; however bilateral ECT seems to cause more side effects. Unilateral ECT has fewer side effects, but may not be as effective; unilateral ECT is also more difficult to do properly.
"Sometimes ECT clinics will start a course of treatment with bilateral ECT and switch to unilateral if the patient experiences side effects. Alternatively they may start with unilateral and switch to bilateral if recovery isn't happening. The choice of bilateral or unilateral ECT will depend on the needs and wishes of the patient, the opinion of their doctor and the skills of the ECT team."
(The boldface is Ron's – not mine.)
Thursday, March 11 at 4:05 p.m.
When I get home from Seneca, I pick up a voicemail message Angela left on my home phone at 1:13 p.m.
"Hi. It's me. Just checking in. Call me."
HER VOICE SOUNDED COMPLETELY DIFFERENT... NEW
It doesn't sound like her. At all. I barely recognize her voice, but from the log on my telephone screen, I know it is.
Instantly, I call her back.
"How are you?" I ask.
There's a liveliness in her voice I've never heard before. Ever. We met in 2006, on the phone. She called me when I was still working at The Toronto Sun. I knew nothing, then, of her psychiatric history or her depression.
"I feel good, but confused," she says.
I can't get over her tone. It's sharper. Stronger.
"Can you describe your confusion?"
"It's a little bit of confusion, like I can't remember everything I'm supposed to remember," she says.
"What do you mean?"
"Well... it like my thoughts are dull," she says. "I guess I'd call it mild confusion, but it's more pronounced than before."
She said she slept most of the afternoon, following her first bilateral ECT treatment at 7:15 a.m. that morning.
"I just got up," she said.
I couldn't believe the way she sounded.
"Maybe I'm spunky. The bilateral treatment was great!" she said. "There were three medical students with the psychiatrist and so she explained everything she was doing very carefully to them, and to me. She told them that I had been having unilateral and that now I'm having bilateral. And so far, I think I can handle it, so I'm going to continue with it."
Then she started chatting about how much money she had spent that day on new brakes and tires for her car.
"It needed to be done, so we finally got our act together and did it," she said.
TODAY, SHE'S COMING UP HERE AND WE'RE CELEBRATING!
This was the most proactive thing she had done in months. Two weeks ago, she couldn't get it together to get out of her apartment and go for a walk on a sunny day.
"Oh, and you know what? I had a good time with my anaesthesiologist today," she said. "When he gave me my drugs, he said, 'Have a good sleep.' And you know what I said to him?"
"No, Angela. Tell me."
"I said, 'Night, night!'"
She was laughing. Really laughing.
So, today we're celebrating. Right after she sees her psychiatrist this morning at 10 a.m. she's driving up here and we're going out for lunch.
And I can't wait to see her!