This is the third installment in a three-part series about being prescribed ketamine treatment for a traumatic brain injury. You can read the second installment here.
A sentence I never thought I’d say, but have said many times in the last month: thank god for ketamine. And when I say thank god for ketamine, what I mean is: I am happy — not every second, not all the time, but as a baseline. I hear the hum of possibility around me and mostly, I turn my ear toward it. My worries are dulled, smoothed into pocket stones instead of knife points. I’m wearing jeans again, not as bothered by the sensation of denim against my skin. I think maybe everything will be fine. And I think that I’ll probably be fine even if everything isn’t.
This is where eight weeks of ketamine treatment, which was prescribed for treatment-resistant depression stemming from a traumatic brain injury, has gotten me — to a place of tentative, quiet hope. A place where I can look around in awe at the bounties of my life and there is only sometimes a voice in the back of my head that says you’re going to lose it all. Yes, I am still knocking on wood three times and sharply saying god forbid when anyone jokes about something bad happening. Yes, the wheels of my obsessive-compulsive disorder are still churning through the muck of my injured brain. Yes, I still cry more than anyone else I know. And yet – the hope! I open my hand and let it land softly, a butterfly I don’t want to scare away with any sudden movements.
But two things can be true at once. Here is the first thing: after two months of ketamine treatment, I got married to the love of my life, Alex, on a sun-drenched altar in our hometown of Tucson surrounded by cacti and the desert sky and everyone we love. Here is the second thing: my brain injury, the result of a car accident I can’t remember, was with me every moment of the day despite all the treatment it has been given and all the effort I have made toward the herculean task of healing my bleeding brain.
The night before the wedding, Alex’s parents hosted a beautiful rehearsal dinner. In their lantern-lit backyard, I held a glass of champagne and posed for a picture with my family and felt so lucky. Afterward, I went to a friend’s house to have a sleepover and it wasn’t long before I was grinding a Klonopin between my teeth and crying. What if my brain ruined my wedding day? What if I got a migraine? What if I was so over-stimulated I couldn’t function? What if the music was too loud for my sensitive skull? What if I was exhausted halfway through the day? What if I just wanted to disappear, but couldn’t because I was the center of the event? 30 minutes later, I was in a Lyft on my way to sneak back into Alex’s parents’ house, desperate for the balm of tucking myself in next to my almost husband.
I’ll say it again. Two things can be true at once. Here is the first thing: I spent the morning of my wedding with my sisters and mom and bridesmaids, listening to music and making TikToks we forgot to finish and getting my hair done and writing a letter to Alex and looking around in wonder at the life we had managed to build together. Here is the second thing: I spent the morning of my wedding carefully parceling out medication – uppers and downers and migraine abortives and migraine preventatives and over-the-counter painkillers and a $400 IV infusion that a nurse came to administer while I was getting my makeup done – to find the perfect combination that would allow me to forget about my injured brain for the day.
Spoiler alert: I didn’t find the perfect combination of medications. In between golden moments, I was aware of my pulsing temples and the nausea from all the medication and the mental image of an hourglass slowly tipping, my limited energy seeping away as the day and night went on. I ended the night crying in my mom’s lap as the pain and anxiety overtook me and she calmly took the clips out of my hair while telling me how well I had done. And still – it was the best day of my life. My nieces and nephews were the ring bearers and flower girls and they told me I looked beautiful. My mom and dad walked me down the aisle and when I told them to keep talking to me or else I’d throw up, my dad chatted the whole way down, making jokes and comparing marriage to skydiving. Afterward, I danced with my sisters as an Albanian drum thrummed its beat, inviting everyone to join us. And they did.
Post-ketamine, I am a different version of myself. It’s not that I’m back to who I was before my brain injury, but it’s almost like the volume has been turned down on my anxiety, depression, and hypervigilance. The idea behind ketamine as a treatment for the symptoms of a traumatic brain injury is that a concussed brain is an inflamed brain and an inflamed brain produces an excess level of glutamate. Glutamate is a critical neurotransmitter that plays a role in learning, memory, sleep, and pain. An excess of glutamate in the brain can lead to exactly what I’ve been feeling since I hit my head on that steering wheel: brain fog, pain, hypervigilance, and depression. Ketamine is thought to calm the inflammation of the brain. And if ketamine soothes the inflammation in my brain, my glutamate receptors should produce less of the neurotransmitter. And if that happens, I should be calmer, in less pain, less sure that danger is lurking around every corner, and more able to accept the idea that my life might be worth something after all.
Without ketamine, I would not have been able to enjoy my wedding as fully as I did. I wouldn’t have been capable of feeling the bliss that overwhelmed me. I wouldn’t have been able to stay awake as long or keep the pain at bay for so many hours or handle the constant stimulation. I would have danced less and smiled less and ducked away for more breaks. But even with ketamine, and every other treatment I have so desperately sought, it was not an untouched day. All the markers of my brain injury – the pain, the anxiety, the hypervigilance – were with me, as my sisters zipped my wedding dress and I tapped Alex on the shoulder for our first look and hugged my crying mother-in-law.
Together, my psychiatrist and I have decided that I will continue ketamine twice a week for at least another month before reassessing the treatment plan. It’s common for patients to taper their treatment to make the process of stopping smoother. We might also add in some intravenous ketamine (another off-label use of ketamine that is prescribed for treatment-resistent depression and traumatic brain injuries), which is more effective for chronic pain and can cause breakthroughs in treating my obsessive-compulsive disorder. I don’t know how long I’ll be doing ketamine, whether weekly or only for maintenance sessions when I feel my mental health slipping. But this is what I do know: it is a tool in my toolbox and I am lucky to have it.
Two things can be true at once. Here is the first thing: for me, there may be no such thing as an untouched day. My traumatic brain injury deeply altered the course of my life and continues to do so every day. I am not the person I was before the accident.
Here is the second thing: I have found a way to live anyway, bruised brain and all. There is a phrase in Albanian that I’ve always loved: shpresa le te vdes e fundit. It means “let hope die last.” I think I can do that now. I think I can hold on to hope. I think I can let it die last.