<meta>Still playing with ecto right now. I can’t figure out the timestamps and it’s kind of driving me nuts. Whatever. I’ll let Mephisto figure it out. But ecto is starting to grow on me. I may very well be shelling out $17.95.</meta>

It’s a Friday night, and I’m feeling extraordinarily anti-social. Part of it is the fact that I have to go to work at 7 a.m. tomorrow and don’t get to go home until something like 11 a.m. on Sunday. Kind of puts a damper on making plans. But, I don’t know. I’ve been really antisocial lately. I worry that this is grossly abnormal and a sign that I’m not well, mentally speaking.

Or maybe it’s how I’ve always been.

(Despite my distaste for “normalcy”, I find myself asking myself the question, “What is normal?”)

My thoughts are pretty damn scattered. While eating lunch today, I had an odd thought. I wonder, is my emotional stunting a permanent but self-limited disorder, or is it a chronic illness that will eventually lead to my death?

For some reason, I was thinking of one of my patients whom we diagnosed with gallbladder cancer. This is, invariably, fatal. Surgery is rarely successful, and no chemotherapy ever succeeds in wiping out the tumor. It is actually quite a miserable way to die, but you can probably go on for weeks to months.

I stopped to think of what being the primary care physician for someone with a death sentence is like. Here you are, telling your patient whom you may very well have known for years, knowing that he will die from this particular condition.

On one hand, everyone dies. To paraphrase Chuck Palahniuk (and Tyler Durden), extend the timeline far enough, and the probability of survival eventually drops to zero. And for internal medicine doctors, most of their patients will be older than them. So you know at some point it’s going to happen.

On the other hand, most of your patients aren’t going to die in weeks to months, either, in horrible discomfort. (One of the most unbearable symptoms of gallbladder cancer is actually the incuraable itching.)

But, as St. Andrew is supposed to have said, ”<p>Dum spiro, spero</p> .” While I breathe, I hope. If you’re alive, that’s something.

(Immediately, the question that pops into my mind is: is it enough to just be alive? I think of all the folks we’ve hooked up to ventilators, and just left there to literally rot for years on end, because their families still hope for recovery.)

But back to my ruminations: permanent but self-limited, or progressive and intractable?

And example of the former would be someone who was in a horrible car wreck, crushing their legs, and requiring amputation. This person will be permanently disabled but he/she is otherwise healthy, and can continue to lead a fulfilling life, minus certain experiences that require having legs. I mean, with prosthetics, it’s possible that this person could actually walk at some point, but clearly it’s not a perfect substitute.

This is in contrast to the latter. I guess the most illustrative examples are chronic diseases that arise in childhood or young adulthood. Cystic fibrosis. Inflammatory bowel disease. Systemic lupus erythematosus. Any disease that requires organ transplant. None of these are necessarily fatal, but they can certainly progress to the point where complications can kill you. You won’t be able to live a “normal” life, but that doesn’t mean you have to be limited in any way. Statistically speaking, you will probably die earlier than if you didn’t have a disease, but it’s certainly not the sentence of impending death that a diagnosis of inoperable cancer is.

But, either way you look at it, you have to deal with the issue all your life, whether it’s the permanent-but-self-limited problem, or whether it’s the progressive/intractable problem. So maybe it doesn’t matter (except that if it’s the latter, I should probably seek some sort of treatment.)

It’s only in very recent times that depression has been regarded as an actual illness, similar to the diseases I mentioned above. Unless you’ve actually dealt with someone with depression, or are depressed yourself, I think it’s difficult to appreciate the difference between ordinary sadness and grief that we all experience, and the crippling mental illness that is depression.

I’m not sure how long I’ve lived with it—certainly at least since high school, though it’s possible that I’ve had problems with it even before then. But whatever the case, it never got so severe until four years ago, where I could no longer function as a human being. That’s the point I knew that I had seek help.

For the longest time in my life, I had this penchant for looking back. For wondering “what if?” and having to deal with the fact that whatever it was never came to be. This was the kind of thought that would typically send me into a downward spiral.

This far into the game we know as life, I find asking that question is a lot more pointless. I am who I am, and as I look back at the convoluted paths I’ve taken to get where I am, it’s hard to be willing to second-guess myself. I have, more or less, gotten to where I have intended to go. Whether or not this was a good idea in the first place, or whether my motivations for getting here were reasonable, are completely separate questions which may well need to be answered at some point, but, well, here I am.

The older I get, the less point there seems to be in asking “What if?”

The other realization with getting older is the fact that time is finite. Now, I could very well live for several more decades, or I might get hit by a bus tomorrow. No one ever knows. But for some reason, I’ve started thinking about the fact that no matter what, I will never have enough time to do everything that I want to do in my life.

I’m going to have to triage my goals. List my priorities. Recognize the aspirations that are probably never going to happen. Concentrate on the things that are possible.

Prioritizing things has never been my strong suit. That’s the awesome thing about being young. You never stop to think about the fact that this is all going to end someday.

Which comes down to the thing that I’ve been pondering lately: the increasing likelihood that I will be permanently alone and unloved.

If I were “normal”, this would not even be a consideration. I feel like most normal people have a much easier time with developing relationships (platonic or otherwise.) Falling in love is a quintessential part of being human.

Unfortunately, I feel like I’ve completely lost my ability to do this. To leave myself vulnerable. To be willing to give without counting the cost. Every interaction I have is guarded. Defense mechanisms and rationalizations abound.

Everything I do seems guaranteed to push people away from me.

It increasingly seems like some kind of chicken-and-egg problem. To be loved, you must give love. But it’s hard to love when you aren’t loved. More to the point, being depressed makes it hard to be loved, and to love. But not experiencing love probably contributes to depression.

I don’t know. Maybe the above is not true. Maybe if I can believe that this is all transient and I just need to get better, and that I’m not going to die from this (although severe depression really does seem to have a high mortality rate) Easier said than done.

But then again, I’ve never been the most patient person in the world, which is remarkable, considering what I’ve been through to get to where I am. But maybe that’s it. I’ve used up what little patience I have.

<p>Dum spiro, spero.</p> I really have to remember that more often.