The first time I smoke weed, I am a teenager standing in a droughted riverbed with other nervous, coughing high schoolers. The first time I do ketamine, I am nearing the end of my twenties sitting in an armchair in a sterile doctor’s office with my mother holding my hand. I clutch a notebook to my chest and fish around in my purse for a pen to write down my thoughts. I babble to the technician and my mother, trying to calm my nerves. I listen to the directions: Blow your nose first, then tip your head back and spray the ketamine into your nostril while inhaling sharply. Repeat in the other nostril. Follow with another dose in five minutes. When I finish the first dose, I wonder if I’m standing on the edge of something good, something that will calm my aching brain, or if this is another shot in the inky dark of a brain injury.
Three years ago, I hit my head on the steering wheel of my boyfriend’s car and was knocked unconscious. No one is sure how long I was out but according to the police report, the emergency medical technicians found me leaning into the street, throwing up and saying my head hurt. I didn’t know, or couldn’t tell them, where I lived even though the accident had happened right in front of my apartment building. (Inside, my boyfriend slept. He would later be woken by a call from the hospital.) All I could say was that my head hurt. Medical records state that I arrived at the hospital with no knowledge of the accident. The doctor observed that I was “hysterical and fixated on letting [my boyfriend] know where [I] was.” He went on to note my history of cancer and obsessive-compulsive disorder and that I was in distress and hyperventilating. He diagnosed me with a significant concussion and intracranial hemorrhage, the latter meaning my brain was bleeding.
I still don’t remember the accident. Anything that I’ve come to understand about it has come to me stained and secondhand through police reports and medical records and conjecture. But whatever happened changed my brain. I sustained a traumatic brain injury and it hasn’t gotten better in the timeframe I was assured it would. Instead, my life has shrunk: I stopped working outside of my house. I became hypervigilant and obsessive, sure that disaster was around each corner. I woke each morning with a pounding migraine, or a simmering pain that promised to later bloom into one. I became easily agitated and sensitive to everything — the fabric of my clothes, the feeling of a watch resting against my skin. And there was the depression, the bone-deep feeling that this would be my life forever.
And I think it might have been, if I hadn’t found my way to Kaizen Brain Center, a private neurocognitive clinic two hours south of Los Angeles, CA, where I live. My experience with hospitals is extensive — I’ve had migraines since I was a child, I was diagnosed with depression, anxiety, and obsessive-compulsive disorder in college, and then I went through cancer treatment in my early twenties. Then came the brain injury. All of this is to say I have seen many doctors — and I have been dismissed by many doctors. Once, a doctor told me that a combination of yoga and dumping my college boyfriend would calm my migraines. I was told my pain was psychosomatic so many times that I was ready to give up on finding an answer until my mom begged me to see one last specialist, who found the cancer growing on my thyroid. And when it was clear my concussion had bloomed into something bigger and longer-lasting, I was told there was no reason I should still be in pain. The unsaid words were clear to me: You are making this up.
That was all before I got to Kaizen, where I found doctors who understood and believed me and could explain what was happening inside my head. Yes, they said, it was normal to still be in pain a year later. Yes, my hair-trigger emotions were part of post-concussive syndrome. Yes, this was really happening. Yes, this was normal. No, I wasn’t making it up.
I say that my doctors at Kaizen are my “doctor soulmates” and it’s a joke but it’s also not. It can’t be overstated what their knowledge of concussions, traumatic brain injuries, and migraines did to quell my raw anxiety that my life was ruined. It was a balm, even before we began treatment. I have cried in their offices so many times, from the sheer relief of being believed and assured. It means the world to a patient like me, who has been dismissed to the point of barely believing herself.
That’s where I’m doing ketamine, at Kaizen. In 2019, the U.S. Food & Drug Administration approved Spravato (generic name: esketamine), a ketamine nasal spray, for treatment of depression in adults (and Ketamine infusions, lozenges, and shots can also be prescribed off-label for treatment-resistant depression, though the nasal spray is the only option FDA approved for depression). It can cost up to $300/treatment for nasal ketamine (and $1,000 or more for intravenous ketamine), but my insurance, which is covering the ketamine treatment, has approved me for four weeks of twice a week treatment then a few weeks of once a week treatment.
While stigma against it lingers (most of us know it as “special K”, a party drug), medical professionals are hopeful about its clinical uses for treatment-resistant depression. The drug has been most widely studied in patients with the former but may also benefit people with PTSD, OCD, bipolar depression, anxiety, and eating disorders. And now, some brain injuries are being treated with ketamine since many of the symptoms of brain injuries are the same as depression, PTSD, and anxiety.
Remember, brain injuries are notoriously difficult to treat because, like a mental illness, they can’t be quickly diagnosed the same way, say, a broken leg can. Scientists are still struggling to explain seemingly infinite connections and patterns of the brain. It is also not fully known exactly how ketamine works in the brain (as the science is still very new), but the logic behind ketamine as a treatment for TBI is this: When you sustain a concussion, inflammation of the brain (known as neuroinflammation) can occur. The concussed, inflamed brain produces an excess level of glutamate, a neurotransmitter that has a role in memory, sleep, and pain. That excess glutamate, Dr. Mohammed Ahmed, a neuropsychiatrist and the founder and director of Kaizen Brain Center and my doctor, says, leads to a “tsunami” in the brain, with brain fog, pain, hypervigilance, and depression among the fallout.
Spravato, the ketamine nasal spray, is thought to modulate these glutamate receptors. The idea is that ketamine will calm the inflammation of my brain, which will have a cascading effect on all the symptoms associated with neuroinflammation, like pain, fatigue, and depression. That neuroinflammation, Dr. Ahmed explains to me, is the driver of everything in my body from mood to anxiety to processing speed (the amount of time it takes you to process information) to cognitive endurance (how long you can sustain effortful thinking).
Before I do ketamine, I don’t know much about any of this and why it’s been prescribed to me. I refuse to fall down an internet rabbit-hole of prescribed-ketamine experiences, which are becoming more and more commonplace in the US. I don’t want to know how it felt for other people or whether it helped them or not. Partly, this is because I’m anxious enough about the treatment but partly it’s because I trust my doctors and I know my job is to be as open to the experience as possible. It feels like this is the only possible way ketamine could work for me: if I let it unfold without judgment or expectation.
When I spray the ketamine into my nostril, I look around, as if the change will be instant but all I feel is the chemical drip of the drug in my throat. The technician and my mom look at me, waiting. “I’m scared,” I say, childlike in my fear. My mom reaches for my hand and I begin the trip.
Being high on ketamine feels like drinking two martinis on an empty stomach. The world is lurching and if I close my eyes, I might throw up. My tongue is loose, eager to share the connections the drug is drawing in my brain. Everything — from the color of my shirt to the sunlight fighting its way through the closed blinds — is almost unbearably vivid. For the first 45 minutes of the trip, anything seems like a good idea to talk about. I tell my mom about my teenage weed habit. I tell her I always knew my almost-husband would one day be my husband. I tell her how deeply I missed her when she lived 8,000 miles away from me. She takes everything in.
When the tears come, I’m not sure why. I feel wrung out and exposed. There isn’t a light on in the room but it still feels too bright. I have the distinct, aching feeling of being the drunkest girl at a party. It is such a familiar feeling and I am so ashamed. I wonder if embarrassment is the basis of everything I feel about myself. I apologize to my mom and the technician and they assure me I have nothing to be sorry for. But I am sorry and I’m embarrassed and I want to go home. My mom tells me it’s okay, to let the tears out, to let what will come come.
I write in my notebook in loopy, scrawled half-cursive:
I’m so embarrassed of how much my body needs to survive.
I tap the pen on my notebook. It’s so hot in here, or is it just me? It’s just me but the heat is overwhelming. The technician points a fan at me and turns it on full blast and I feel some of the anxiety melt from my shoulders.
My mom asks if I’m okay. I tell her I need to say something. I know it will upset her so I warn her ahead of time. Let me finish, okay? Don’t say anything. She agrees. So I tell her what I’ve always suspected: that I’m not worthy of all the resources it takes to keep me alive. Why is it so important that I’m alive? Don’t she and my dad ever want to focus on the four healthy children they have? Don’t they think their genetics may have just mixed badly on this one? Why do we fight so hard to make life bearable for me? Doesn’t she ever want to give up — on me and my aching body and my sick brain? Does she ever think it’s not worth it?
She listens without saying anything, which I know is hard for her, because she hates when I talk like this. I lift my eyes to hers when I’m done and I’m stunned by their size and their color, which is the shade of the natural honey we buy on the side of the road in Kosove, where my family is from. I wonder how I ever look anyone in the eye.
“Never,” she says. “Not once. Not for a second. Never.” And something in me relaxes.
I’m not sure how long my ketamine treatment will last. For now, the plan is twice a week for a month but that can change. Medical protocols often change with the publication of new studies. But regardless of how long my ketamine treatment lasts, I’ll be writing about it here. I’ll touch on what it feels like to be on ketamine, how it’s changing my relationships and life, what it’s done for other patients, and what my hopes are for the future. Oh, I’ll also try to tell you if it works. Cross your fingers for me.