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[In the early summer of 2013, I contracted a blood-born bacteria which required open-heart surgery. Since then, I have been writing about that season, using my personal experience as a setting to discuss the relationship between affliction and faith. The following is a potential chapter from these writings, if they should one day be put together into a book. This piece explores the subject of depression from a person who was writing about it in real time. Um, enjoy?]
I am depressed.
My doctors told me this might happen—a detail my wife recently reminded me of when she saw the dark clouds rolling in. She has seen this in me before; we both have. Still, even though being depressed is nothing new, this particular depression—because it is mine now—feels new. It always does.
My prior experience with this dark night of the soul tells me that, when unchecked, it has a tendency to become something untamable. And no matter how many times I’ve walked down this road, I still struggle to see it for what it is.
When a child hears a tapping on his bedroom window at night, until he turns on the light to see that it is only a branch blowing in the wind, it might was well be the knuckles a dragon come to carry him off to its lair where his bones will be licked clean.
I know from experience that when I leave the voices in the dark unnamed, they become monsters. Tap. Tap. Tap. They try to persuade me to climb into their bubbling cauldron on my own volition. So in an effort to overcome the darkness, I am going to turn on the light the only way I know how: I am going to describe what I see and hear and feel, and then I am going to look into what winds are blowing that cause the tapping that has me so troubled.
This is what my depression feels like. This is my monster.
My depression feels like anxiety. Worry and fear are never far from me. When I am alone, my thoughts gravitate toward my burdens. When I lay down to sleep, my mind drifts to unresolved fears I cannot seem to shake. I worry—not about my present health, but about my future. Am I supposed to return to the life I knew before this affliction hit? Can I? The world I know—my friends, my work, and my family—moves on while I sit in my recliner watching TV. The thought of climbing back into life feels overwhelming.
My depression also feels like grief over these seemingly wasted days. I lament that I spent my fortieth birthday and eighteenth anniversary in a hospital bed. It is the sort of sorrow I experience when I feel forgotten, which is a very unique sort of pain.
My depression feels like apathy. I do not care about things that once stirred me deeply. My desire to pastor people is all but gone. I don’t want to listen to peoples’ struggles—not because I don’t think theirs compare to mine, but because right now I honestly just don’t care. This disinterest scares me. Will my passion or empathy ever return? There are times when I cannot imagine they will, and that is a terrifying thought, which leads to another voice in the dark—futility.
Finally, my depression feels like futility. I cannot work. I cannot lift heavy objects. I cannot do anything that requires endurance or focus. I feel like I’m wasting precious days—and, as Annie Dillard said, “How we spend our days is, of course, how we spend our lives.” I cannot concentrate. I can’t hold a thought. I feel cooped up, deprived of sun and motion and warmth. I’m told exercise is great for keeping the depression at bay, but my best attempts at doing anything active reveal just how weakened I have become. This makes me irritable. My emotions are all over the map. Some days I cry easily. Other days I feel little if anything at all. This inability to reign myself in leads me to hopeless thinking.
So there they are—anxiety, grief, apathy, and futility. Anxiety raises questions about my future, grief casts a shadow over my past, and apathy and futility drape a fog over me in the present. These are my voices in the dark. These are the four-headed monster tapping on the window during the black night of my soul. He whispers his accusations into my ear, beckoning me to surrender hope.
“You’re letting people down. You’re selfish. You’ve lost your spark.”
No wonder I feel so lost.
There is no reasoning with the monster. Like the devil, he laces his lies with gilded threads of truth.
The truth is I am not yet recovered. I do depend on others to care for me. I wrestle with apathy, and sometimes it pins me to the mat. I have lost my spark. In my weakened state, this is where I am right now. This is all true.
In seasons like this, the straight truth is my best help. One truth my doctor told me early on was that this depression would probably find me after I had been home for a few weeks. And here it is, like a train pulling into the station right on time.
Now that I have named what I feel, I will describe what is actually happening to cause this tapping in the night. Why has this monster come to me now?
Depression is a common after-effect of heart surgery. One common trigger is the anesthesia, which alters a patient’s brain chemistry just enough to mix things up. Depression is also often triggered by post-surgery PTSD, or soreness and pain, or the extended neglect of care for one’s well-being (such as hygiene habits, exercise, or diet). It can also come as a side-effect of antibiotics and other medications that have been introduced into the blood stream.
I have experienced all of these triggers to one degree or another.
More medications course through my veins now than at any other time in my life. My nightstand is covered in pill bottles. Some of the pills help my body heal, but they also make me nauseous. For that, I take an anti-nausea medication which amps up my blood-pressure. For that I take a blood-pressure medication which causes dizziness. Lucky for me I’m taking that anti-nausea medication. Along with those, I take one pill to fight constipation and another to help me retain fluids when the anti-constipation medicine does its work.
And the painkillers. Oh, the blessed painkillers. I take a lot of oxycodone, as prescribed. Still, I get a few raised eyebrows when I tell people how much oxycodone I’m taking. I suspect I’m becoming chemically dependent on them because when the pill bottle gets low I feel anxious.
What wonders those little pills are—reliable servants constantly eyeing the role of master. At some point soon I will step down from the narcotics, but for now my doctor tells me I must keep taking them because I cannot afford to devote any of my physical resources to dealing with pain. All my energy needs to go toward healing.
Together, all these medicines combine like a cocktail numbing my system.
As for my soreness and pain, they are less intense than they were. But it still hurts when I try to perform some of the most basic activities, like lying down or sitting up again. Being unable to roll over without losing my breath is disheartening.
Then there’s the lingering effects of the anesthesia. One doctor told me it can take roughly one month per hour of being under sedation to finally come out of the haze. I am foggy headed all the time. Writing is one activity I can do to keep my mind sharp, but it is hard work—a frustrating exercise in false starts, heavy revision, losing my way, editing, and taking my time.
Between the cabin fever, the effects of my daily meds, the pain, the loneliness, and the narcotics, I have begun to lose my grip on certain things I know, on an intellectual and theological level, are true. When I pay attention to how I am feeling, I can almost see it happening.
This slide into sorrow has a name—depression.
If I am to see this depression for what it is, I need to remember what I have been through. My feelings come from somewhere. The scar down my breastbone and the puncture wound in my abdomen through which they fed the electrodes into my heart in case it should need to be shocked back into rhythm remind me that I have been through an ordeal. The reality is that I have been taken apart and reassembled. I am like a vase that has fallen and been glued back together; close inspection will reveal that I am not what I once was. I bear certain scars—inside and out.
My chest was opened up like a cabinet door and parts of me that were never meant to see the light of day were held in a surgeon’s hand. My heart was stopped for several hours as my blood passed through a machine. I experienced a stroke-like neurological event that left me temporarily paralyzed and confused. The physical trauma I have experienced is both unfamiliar and significant.
Beyond the physical trauma, there’s also the emotional weight. I have carried the burden of facing my mortality for the first time and preparing for my own death. I have considered the possibility of unimaginable loss for my wife and children. I have prayed in advance for the grief they and my parents and friends might have known.
All these factors together make up the soil from which the seed of my depression has sprung. So what am I to do? Keep going, though, to be honest, some of the time I don’t want to. One of the greatest lies the monster in the dark tells me is that I should neglect doing the things that I know on an objective level can only help—get good sleep, eat well, exercise, shower regularly, and nurture spiritual disciplines. I must avail myself of the means of grace that have been afforded to me—friendship, prayer, rehabilitation, Scripture, and time.
When I look objectively at the common symptoms people with depression tend to experience—change in appetite and sleep, irritability, hopeless thoughts, difficulty making decisions, and a general sense of apathy—I recognize that I own them all. The trick is to not let them own me.
This depression snuck up on me. It could easily have gone undetected because in almost every other health-related area, I am progressing nicely. My scars are healing and my pain is decreasing. My heart sounds strong through the stethoscope. My murmur is gone. But my mind and emotions are not recovering at the same pace as my body.
That simple fact is very difficult to observe. And since post-op depression doesn’t usually show itself until after the patient has returned home from the hospital, it can be difficult for family and friends, as well as the patients themselves, to understand what is happening.
Depression, when veiled by the good news of physical progress, hides beneath the skin out of earshot of the stethoscope, tapping on the window of my mind where only I can hear. It doesn’t take much for me to feel alone and afraid in the dark. But when I turn on the light, here is what I see. On one hand, my depression is common enough that my doctor told me to watch for it. There are a number of factors that contribute to it—some are named, others are more mysterious. My body has been medicated, taken apart, reassembled, broken, and put back together.
But on the other hand, depression is not new to me. It resides like a pox in my heart—dormant throughout much of my life, but able to be awakened nonetheless. And this reality is one I know I will live with long after my prescriptions run out and my body returns to normal and I go back to the routines of daily life.
Knowing my own tendency toward melancholy makes me regard this particular season of depression as a sort of a gift. This time around I feel like the monster is in a cage, like an old silverback gorilla at the zoo. I can observe him without too much fear.
This is a gift because I need to know this beast. I need to study his movements, watch what he responds to, and learn what calms him down because I know that unless the Lord chooses to remove this thorn from my side, I will continue to battle with seasons of depression. The time is coming when the monster and I will live together in the wild. He will lurk in the shadows and I will train my senses to anticipate his ambush before he pounces.
But there will come nights, no doubt, when I will hear the tapping and my soul will be gripped with fear. By the grace of God, I will use what I learn from this season of depression to feel my way around the room to the light, find the courage to flip the switch, and expose my depression under the light of truth. Sometimes that light will be enough to deliver me from fear.
But sometimes it won’t. Such is the nature of the beast.
God help me.
Russ Ramsey is the pastor of Christ Presbyterian Church Cool Springs in Nashville, Tennessee, where he lives with his wife and four children. He grew up in the fields of Indiana and studied at Taylor University and Covenant Theological Seminary (MDiv, ThM). Russ is the author of the Retelling the Story Series (IVP, 2018) and Struck: One Christian’s Reflections on Encountering Death (IVP, 2017).