Dissociation in the Doctor’s Office: Complex PTSD & White Coat Syndrome

Yesterday, I had to have the kind of routine foot surgery that almost makes a zebra feel normal. I had an ingrown toenail that had to be partially cut out. As I lay here recovering from this minor foot surgery yesterday, I marveled at my lack of preparedness for its aftermath, wondering if the part of my brain that usually kicks into hyperactive planning and preparing for these things has somehow managed to shut down or malfunction by some twist of brain fog. I mean, why not? It’s taken just about every other cognitive skill from me at one point or another. I was just telling my husband that I can no longer be our cruise director (my cutesy way of saying “organizer of activities”) because it not only depresses me to see the sheer volume of things I would like to do but cannot going on about the greater Cincinnati area, but because it becomes a massive time suck because I’m just so damned slow at everything. It also has little payoff, frankly. My one day a week out of the house is usually spent on grocery shopping, running errands, and medical appointments.

No, this is something else and I realized yesterday, it feels an awful lot like the PTSD symptom of dissociation. Maybe I slipped into a bit of shock during the procedure yesterday. The doctor did question if I was okay, sitting quietly, staring at my foot the way I was as he slid a scalpel under my toe nail and began cutting away nail as the blood pored all around it, but I laughed and assured him it was nothing. It felt like nothing. I thought was I was having a hard time processing was the fact that I could actually have such a procedure without any pain whatsoever. The only thing that hurt was the injection of local anesthetic, and even that didn’t hurt as badly as he seemed to indicate it would. By the time I was through the first idea on a list of reasons why that might be, my toe was actually numb.

footquote

I had been concerned the lidocaine wouldn’t work. I have a long history of local anesthetic failures, from dentistry to kidney biopsies in which I have suffered on the table (or chair). But the doctor explained given the very nature of the toe, it’s almost impossible for it to not hit the nerve. We also figured my poor circulation in my lower half could actually pay off in this instance of so little tissue, along with all the fascia therapy I’ve done and he seemed to really dig my theory about myofascial dysfunction being a culprit in the mechanisms which prevent some zebras from benefiting from or reacting typically to anesthetic. Of course, resistance  local  anesthesia can also be genetic but in that case, it simply has no effect at all and I know I’m not in that group, as given a high  dose and enough time for it to move sluggishly through my tissues, it will do its job.

footBy the time my toe was numb, so were my emotions. I was preparing for a whole different experience. I was fascinated by my numb toe, I wanted to contemplate that, ruminate on the possibilities, but I didn’t really “feel” anything, physically or emotionally. I might as well have been someone else, a medical student maybe, watching the whole thing with analytical detachment, from having to hold down my own shaking leg to observing rivulets of blood pouring down my toes as he apologized to watching him mop up all that blood to reveal the canal of bloody meat he’d created in lieu of nail. It’s like I’d put on a ball gown to go to a ball game and didn’t understand why I couldn’t get comfortable with my surroundings.

What I realized later is that this numbness follows me to most of my doctors visits, whether I expect there to be physical pain or not. I’ve known for some time that I suffer from white coat syndrome as a result of all the years of disbelief and derision I’ve dealt with, North to mention the ones who carried out painful procedures despite my protests of pain because they didn’t believe local anesthetic resistance was a thing. This is the first time I’ve put together that what’s happening is dissociation.

It certainly makes sense. Given that I’ve suffered complex PTSD since childhood, I suspect I’m an expert at dissociation. It makes me really good in a crisis and shit at everything else. I’m so good at it, been doing it so long, I don’t even recognize what it is. I don’t even think my former therapists knew I did it because I’m so good at hiding it. In large part, it’s kept me safe and sane all these 46 years, this tendency to shut down and act as an observer, but it has no place in my medical care or my now safe and beautiful life.

Maybe that’s why I’m finally able to see my dissociation. I finally have a cadre of doctors who care and believe. I have real love and safety in my life and have for decades now, but I also had to stop muddying those waters by constant exposure to my toxic family. I also recently made the conscious decision to meet these issues head on. I am ready to face these truths. I fully believe all these things had to be necessary for these problems to come to light.

I suppose the next step is to figure out how not to dissociate every time I walk into a medical appointment. This is very important because when I dissociate, my memory fails to function correctly. I can neither supply doctors with sufficient answers to their questions because of poor recall than I can remember much of what they say after the fact. I have to rely on written instructions and notes and something always gets missed or lost in translation. Even if this weren’t a problem, the anxiety, sometimes full blown panic attacks that precedes these episodes are very hard on a person with multiple chronic illnesses that respond poorly to such hormonal fluctuations.

This is why it takes me days longer to recover from medical appointments even when they don’t happen to be physically taxing. Rarely can I ever walk away from a medical appointment without feeling  battled and bruised, even if nothing went wrong. It takes many appointments with the same practitioner before I can stop this cycle of panic attacks and dissociating. I was just getting there  with my PT therapist as our time together was coming to an end and I saw her 8 times over 3 months.

It also prevents me from making appointments to address situations that are quite necessary, such as with my gastroparesis, my MCAS, and even this stupid ingrown toenail. I fear going to a new practitioner so much that I will literally suffer for years with something that can be addressed in a single appointment.

It has apparently also begun to effect my ability to prepare for these things and the havoc they might create in their wake. I distinctly remember seeing flashes of what might be done to my toe in my mind weeks before my appointment. I’m not naïve about the ministrations required for ingrown nails. Instead of such visions prompting me to prepare, I took a thoroughly Scarlett O’Hara approach, so much so that tomorrow never came. It never entered my mind that removing part of my toenail would put me down for days, that I’d be taking foot baths for two weeks or that I even might have to curtail my workout routine. Mary Poppins (I was once called this by a former boss for my unfailing preparedness) sure as fuck fell down on the job this time.

The ironic thing is that for the first time in years, I had very little anxiety about this actual appointment. I didn’t even think about my white coat syndrome prior to my appointment. Was this because I was already in a dissociative state over the entire affair or has the run of good luck with practitioners and the hard work I’ve been doing to try to regain control over these neuroses started paying off? I suppose either or both are strong possibilities, but I haven’t come to any definitive conclusion.

All of this contemplation came about because of my desire to get on social media and whine about such an insignificant procedure and great appointment with an intelligent and knowledgeable doctor who introduced himself by his first name. Objectively I could see there was little to cry about. I deal with worse pain on any given afternoon. It was uncharacteristic. I’m not a fan of sharing every ache and pain online because it causes us to wallow and brings everyone else down. Don’t get me wrong. I’m highly sympathetic, I just feel like it does more harm than good, even if it might seem like a good way to bring awareness to invisible illnesses. But an ingrown toenail is common and not something which needs recognition, nor do I need or want pity, but I realized I was in fact feeling a bit traumatized over the experience,  which of course is laughable.

Laughable, at least until you realize it was traumatic precisely because I was triggered. Certainly the fact that it was a medical appointment was enough to do this, but I don’t think I really slipped into a dissociative state until the procedure began. It reminded me of all those times people have done things to me without actually being numbed, but I think it also touched on my childhood victimization, where I was forced to participate in my own torture in order to make it a little more bearable and safe. Holding my own leg down to prevent my shaking felt too much like holding onto the foot of the bed while my father beat me with a belt or taking my own clothes off for my rapist so he wouldn’t tear them from me.

I cry. I cry with the knowledge of just how neurotic I’ve become and how despite all the years I’ve spent getting to know the darkest, most destructive parts of myself to enable healing and growth, I am still blind to some of my own tricks. I cry because I berated and belittled my mother for being an expert ostrich with all things unpleasant while considering myself so brave for refusing to sugarcoat things, only to find that the old adage just might be right; we abhor in others the things we most dislike about ourselves. I cry because I realize no matter how old I get or how distant the trauma, I know I will always be a work in progress, forever chasing what looks like positive mental health. I cry because I have to release the safety of numbness and allow myself to embrace all the emotions that I have, be they good or bad, so that I can be a whole, healthy, functioning person. I cry because when I allow myself, I still feel pity for the little girl who endured so much before she even hit her 5th or 15th year.

Like all things in mental health, all I can do is find forgiveness in my heart for all of these imperfections and learn how to move forward, to do better. I’ll learn how to address the problem, and try to do better in the future. As I have been doing, so I will continue.

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6 thoughts on “Dissociation in the Doctor’s Office: Complex PTSD & White Coat Syndrome

  1. I had a near heart-attack – and it caused months of PTSD (very long story, on my blog in pieces), to the point where I have learned to do my version of the eye exercise that helps. When driving down the highway, if I start to feel anxious and panicky, I have something which has worked so far.

    I know that I was probably a good candidate to get medical PTSD because of the long-term illness/disability already straining my resources, but they sure did everything they possibly could have to make it happen.

    I hope you find a way to cope.

    And I’m still cruise director, so I get that. Except only partly, and only for the long vacation-type trips. Because someone has to and he is doing everything else, and will do most of the physical and mental stuff during. I like to be able to contribute – even if it costs me everything I have for months before.

    Liked by 1 person

    1. Thanks Alicia. I’m sorry to hear you struggle with it also. I’m finding it’s quite common among us spoonies, unfortunately and how could it not be with the gaslighting and other abuses we deal with regularly from the medical community. There are some great ones out tgere, but tgere are also a lot of jerks tgat woukd prefer to make you feel crazy than have to do their job.

      If we ever get to do a vacation again, I’m sure I’ll be the cruise director again. My husband just isn’t an organizer and I don’t “wing it” well, as I’m sure you don’t either. He definitely works hard and has less time, but I manage all the household affairs and finance and have even been managing most of the errands and grocery shopping for the last year or so, so I figure he can manage finding suitable places and events from time to time to save me a little grief. I’m the real adventurer. He’s more of a go along for the ride, but happy to stay home type, so it doesn’t depress him to see all we miss out on. Tomorrow afternoon, we’re going to see a play. Really looking forward to it!

      Like

    1. Thank you love. I try to let you know what’s going on inside this kooky melon as soon as I have an explanation myself 😂😂 Thanks for being such a great source of love and support and helping me in creating so much safe space to figure it all out. I couldn’t do it without you. 😚😚😚

      Liked by 1 person

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