Slip Sliding Sublimity

CW: Themes of and/or references to suicide and mental illness.

I like living life inside the edge. It’s wider than you think.If you really look at the point of a knife, the side of a ruler, or even the thinness of a human hair, you can see the middle where both sides meld. This in-between area can be dangerous. God knows that it’s easy to bleed profusely from a thin paper cut that stings like hell. Or it can be a zone that is completely protected, like in the eye of a storm. Once you grasp how to get there, it's easy to remain in this concentrated state where there are no external distractions and where solace is always guaranteed.

I've been in therapy since my sophomore year of college.Twenty years, off and on.Different therapists, different cities, different crises—­the overwhelmingness of moving from my strict upbringing in my parents' house to a campus with loose supervision and more risk-takers per dorm than in the entire population of my home town; the death of my sweetheart by a drunk driver; and now the cancer diagnosis of my six-year-old son. I've been labeled with several diagnoses, and I've swallowed a plethora of various medications, none of which were the magic bullet to permanently halt my reoccurring depression.

I picked this new therapist because of her expertise in grief and depression. Usually by the second or third session, I am asked politely if I'd be okay assisting the counselor by taking just a few paper and pencil tests to help them to help me. They never tell me the results but they "probe" for further details about one of the first questions on that universal two-hour personality test.Something about "do I let my dreams warn me."

Soon after that, my shrink will want to put me on antipsychotic medication. She willrealize that she needs to couch the request in fluff and feathers, selling me everything good about this "trial of medication" while minimizing the horrendous possible side effects like tremors, yellowing skin, even death. Her main purpose will be to eliminate my hallucinations and delusion.She'll tell me that once I'm dealing with reality, then we can work on the hard subjects of my disintegrating life.What she also knows, but we won't speak about too deeply, is the high risk that I will disappear if she removes my illusions that allow me to cope before I have a fool-proof replacement of something more than false hope. She has to give me something that will ignite and sustain my dwindling will to live.

Sublimity is the instance when something becomes something else—a caterpillar to a butterfly, night becomes day, reality blends to fantasy.The mind can involuntarily trip a switch and do this last feat by itself, like with schizophrenia, severe depression, torture and abuse. I've been crazy enough at times that my mind conjured up hallucinations and delusions. The first time this happened, it scared the bejesus out of me, but the doctor explained that it was the brain's protective safety jacket to keep me from facing what I perceived was dangerous in that moment.

Since then, I've mastered the voluntary transformation into a state of non-reality when I feel threatened, either from other's harm or more likely self-harm. I can enter this zone whenever I want and stay as long as I need. The difficulty is re-entering the "normal" world of shared reality, where I must function effectively enough to get by—eat, sleep, subsist.Sublimity is that tiny area between reality and fantasy where I retreat a growing amount of the time since my son's illness.

Most people, and surely most medical professionals, want to kill off hallucinations and delusions the second they're alerted that someone is experiencing them. Then there are others that actively search for this altered state as a form of recreation so that they can drop out of reality and drop into a mind-expanding drug state equivalent to a cheap vacation. In high school, a few years before my first psychotic break, I was fascinated by Carlos Castañeda and the Yogi way of life. I dabbled with my friends into psychedelics but found it too frightening because I had no control. I studied everything I could find about dream therapy, way beyond what Freud would have called productive. I learned that during those first one to seven minutes of twilight, when I'm drifting off to sleep, I could program my dreams. Now, I can do it at will, awake or asleep, whenever my life is circling the drain.

I've withheld my medical history from this therapist for fear that she'll get ahead of herself and slam me into a hospital.I denied that I'd ever been so sad that I wished life would stop or that I'd been hospitalized for psychiatric reasons.She may figure out my lies eventually, and realize this is a reoccurring, and therefore a more serious depression, but by then I hope to be through the worst of this current crisis.

I sleep soundly at night and dream my Walter Mitty dreams during the day because I'm not on those meds. I'm not strong enough to be in the "real" world to hear the full brunt of my child's cancer. My therapist is pretty good. Not the best I've had in the past, but she'll get me back on my feet before I blow my brains out, a real threat every time life gets this hard.I do like her. She's smart. I just hope she's smart enough to realize that she's not the primary one in charge of my therapy.

I'll be the "active participant" that she requires unless I get overwhelmed and shut down. If she's good, she'll back off a bit and give me time to absorb new information before delving deeper. But, if she gives me much more then I can handle, I'll follow the yellow arrows that my mind conjures up pointing to a shelter in my internal world until the danger passes.

The testing picked up my suicidal tendencies, of course, and she's doing a nice dance of keep a strong "therapeutic alliance" while asking questions that assess how high is my current suicide risk. She settles on insisting that I sign a "no-suicide contract." I take this contract seriously, because deep down I know I want to live and to get to the other side of this hell. If I refuse, she'll inform me of her duty to stop me from self-harm, pick up the phone and have a psychiatric emergency response team here within the hour. They will hold me against my will for 72 hours or longer with no regard that every second I'm away from my child deprives me of precious time to save him.So, like I've learned since my college days, I sign the contract knowing that I'll break it without a second thought if my child dies first.

My mind shifts as I Uber back to the hospital.I close my eyes and breathe while conjuring up a positive memory of his smile just before surgery a few days ago.We held hands as he was wheeled on the gurney to the operating room and until the anesthesia drip took full effect.I know without a doubt that this last memory is true even as disconnected images begin to slide across my mind until my head hurts and I close my eyes. When the Uber stops, there's fuzziness around the edges of things.I'm calm, realizing that my brain has shifted into an altered state for my own safety. I don't yet know why, but I force myself to trust.

I walk towards this blurry, somewhat familiar building before I sense that it is the hospital where I work. I'm eager to see how my favorite patient, my son, is recovering.Before I will actually examine him, I'll need to track down the charge nurse or the medical record for an overview of what tests have been run, and if any results are back from the ones I ordered earlier. The nursing notes are the most critical as they chart his vital signs—pulse, food intake and elimination, hours of sleep. I'm worried that his increased sleep is a sign that he's losing the fight.

Yesterday was uplifting when he woke clear-eyed and thirsty. The nursing staff were optimistic. The x-rays showed that I extracted the entire tumor that my surgical team initially thought was inoperable. I think we're through the worst of it. Although his rehab will take more energy than I can think about right now, at least we're moving in the right direction. I'll fight for his life as long as he does.

I concentrate on the rhythm of my sneakers as they squeak on the hospital's linoleum floor. One-two-three, one-two-three, one-two... The arrow on the floor changes from black to a bright yellow as the direction changes to the pediatric unit. There are now giant flowers on both sides of the walls that I assume are meant to be soothing.

I nod as a passing staff member in a white jacket comes into view. She greets me with, "Good morning, ma'am." I quickly correct her with, "Doctor," to which she smiles but doesn't rectify her greeting. Cheeky, I think. Why does she believe that we are familiar enough that she doesn't have to addresses me by my title?

The medical chart protrudes from inside a plexiglass holder attached just below the window in my son's door. I flip to the Procedures section while leaning against the wall and reread the surgery notes about the ping-pong sized tumor removed from his brainstem. The location was where basic life functions are controlled, including breathing, heartbeat, and blood pressure, upping the risk of death if any surgical mistakes had occurred. My medical colleagues concluded that it was inoperable because the normal brain tissue could not be separated from the tumor, but as the lead surgeon, I overrode them. And because I did, it saved his life.

I peek through the door window as I replace the chart in its holder. The bed is empty and neatly made with tight hospital corners. The flowers and balloons from me and the staff have been removed, or perhaps they are just not visible from my vantage point. Even his stuffed animals are gone, including the beloved and bedraggled scruffy elephant. My first step into the room confirms that it is, indeed, sterile and empty.

Suddenly, I'm terrified. Everything has sharp edges. I touch my heart as if I can stop the crushing and pounding with my shaking fingers. I need to vomit. I fight to remember the instructions to breathe, to understand that I am not dying. This is another panic attack and it will pass momentarily.I have to find where he's been transferred. Still sweating, I concentrate on the squelch of my functional shoes and retrace what feels like a thousand steps along the yellow arrows to the nursing station.

Days and nights blur and I lose track of mundane activities and the number of dead-ends. What remains clear, and linear, are my child's minute changes, his good hours and bad. My phone pings to remind me of my counseling appointment. I'm unable to answer my own question of am I ready for my next therapeutic step. No matter how good my therapist, or how strong the therapeutic bond, choosing reality before I'm prepared to handle it will be a guillotine's edge.

She greets me warmly with a brief hug. Not that I need one today, but sometimes I do.She seems to know when a clasp is needed, or when to hand me a Kleenex box before I even tear up. I know that physical comfort adds another layer of dependency that must be dissolved when the time approaches for my discharge from counseling. Better to never allow that physical crutch in the first place because when the patient gets needy, the line between ethics and friendship is sometimes crossed. An absolute professional no-no, but a gray zone every good therapy encounters nonetheless.

She asks how I am doing after commenting on my weight loss and unhealthy pallor. Which version should I tell her? We terminated our last session discussing my life before my child's surgery.How I coped as a single mother and what worked when I was so inconsolable that I failed to drag myself out of bed or forced myself to eat. She suggests strongly, again, that I need a support group since friends and family have disappeared because of my grueling neediness. I tell her that I called the number on the card she gave me and that I plan to attend a cancer support group one of these days soon. I can tell from the fleeting frown that she's not satisfied with my answer, but she lets it pass.

She asks if we can talk about the surgery. I explain that I'm not really ready, it's still such a raw issue. She retreats to a less emotional subject—if I've checked out the two gyms she gave me as a homework assignment. I lie that I stopped by both, but no one was there to give me information. She pulls her mouth to the side.I don't think she knows this tell happens just before she presses her point to me—not that she's ever used the word "non-compliant," but I know that's what she'll write in her progress notes after I leave today.

"Resistance to the little steps, like exercise and finding acquaintances, is something we need to get through in order to deal with the bigger problems in your life," she says. "We need to talk about your son." I nod and drift away. The words of agreement remain unspoken on my lips. I want to change the subject and to tell her how well I handled my panic attack, but she'll want to discuss all the details. So I don't start this conversation because I can't recall what happened after I saw the empty hospital bed. I'm fidgety and look at the clock. I stare at the edge of her eye and see peripheral movement behind her. A sort of swirling mist in the background that fades as she becomes all foreground. Her raised voice draws my attention to her lips reminding me that my "no-suicide contract" is still active.

She grants my request to schedule another appointment for tomorrow. She smiles.I know that she thinks this is a good sign. I explain that I'm remembering some painful moments that I need to look at more closely, but not when I'm alone. I leave with no intention of checking out a gym or engaging with people. I vaguely worry if she can help me carry this load without a hospitalization.

I am again greeted warmly the next day, this time accompanied by a tight hug that immediately sets me on edge. After I'm seated and decline a soft drink or water, she moves the Kleenex closer to my chair. She leans in until we've locked eyes and she says quietly, "I know you've been devastated by the loss of your son." I nod once and see behind her yellow arrows forming to show me an exit. My eyes are brimming and I reach for a tissue.

She touches the top of my hand to stop me from rising. "Stay in the moment with me," she smoothes. "It's time that we do this together."