Day 358. Thanks, Dr. Katzow.

Well, it’s all over.

My psychiatrist divorced me the other day.  Dr. Katzow is the smartest, most insightful doctor, a terrible loss.  I had heard that he wasn’t feeling as well as he used to, so I might have foreseen this terrible day coming.  The thing is, he looks so good that I found denial an easy state to rest in. How ironic, in fact, that I would make the very mistake that bothers me so much when others make it about me!  When I hear someone say, “Oh Heidi, you don’t look sick; you couldn’t possibly feel bad,” it irks me something fierce.  I did the same thing to Dr. K., clearly a life lesson, that it isn’t that people don’t believe me as much as people don’t want me to be sick.

I saw Dr. Katzow for at least seven years that I can remember (that’s as far back as iCal goes), certainly through the worst of my health problems.  My allergist referred me to him because Dr. K is well-known as a specialist in treating mood disorders. All he does is psychopharmacology (and some intense therapy with “extremely involved” patients, as he termed them). However, my saying “all he does” makes it sound as though psychopharmacology is simple.  It isn’t.  It is endlessly complex.

Dr. K. has the most fantastic office on Washington Circle, in Washington, D.C., right across the circle from The George Washington University Hospital, to put it into perspective. His office is one of several medical practices in an otherwise residential building, so it has some unique characteristics, the coolest of which is a fireplace in Dr. K.’s office.

The office’s unique character reflects the doctor’s remarkable personality: Dr. K. has always seemed to me like an intellectual apothecary, with a mortar and pestle, grinding up precise doses and mixtures of drugs in a back room someplace in his office.  Of course, he doesn’t really mix up doses in the back office, but he knows every medication and its characteristics like it is a close family member. Thus, he can adjust doses so precisely that he can treat someone who is depressed, yet fiercely unable to sleep and somehow manically nasty.  He gives just enough medicine to raise the depressed mood and at the same time calm those manic, dysphoric feelings. He knows how a mood disorder whacks a person out. I am told. Not that I know anything about this. Other doctors, again, I am told, can’t figure out something so complex.  They hand out the Wellbutrin or the Prozac and send you on your way.

Dr. K. really does manage doses like an apothecary. For treating a complex situation, he sometimes is so precise that he instructs one to open up a capsule and dump out a quarter of the contents of the lowest available dose. The result of such tinkering is one’s genuine stability, as much as the extenuating circumstances of life allow.  He is similarly precise with his analytical skills. I have always been able to tell that he knows better than I do how well I am doing, and there is something unbelievably comforting in that, far better than medicine.

The real service Dr. K. has offered me, though, has been regular support and advice about the medical odyssey I am navigating.  More often than not I have come in and cried, telling him about the newest doctor who has misunderstood me, or the way the pain simply will not go away and that no one would believe me.  For quite some time, we explored  the possibility that anxiety and depression can cause chronic pain, for no reason anyone can explain.  In fact, I had finally decided that he was right (just before the aneurysm); he was the only doctor who presented that idea while still encouraging me to find out what was wrong with me because he didn’t think that there was any reason having pain from depression meant that I didn’t have some other disease. He probably is right. However, it is impossible now to decide whether the depression came first, or the pain and agony from headaches and neuropathy.

Just recently, while I was working on a chapter of my book called “Chasing a Diagnosis,” I tried to calculate the number of doctors I had to see before I finally got my diagnosis of VEDS.  I have seen doctors in 20 different specialties, and within those specialties, I have sometimes seen two or three different doctors each. That means, conservatively speaking, I have seen between 30 and 40 doctors during the time I have been Dr. K.’s patient.

He sometimes strongly supported my decision to stop seeing a certain doctor (and many of us know how psychiatrists are frustratingly opinion-less on nearly everything).  Other times, he would give me ideas of questions to ask, or medications I should ask the doctors to consider.  He was a fantastic consultant, and he led me down many of the right roads.

For this reason, he felt more like a family member than a doctor.  For this reason, he is not replaceable.

How am I to call my insurance company and ask for a mood disorder specialist/apothecary/expert in all the body systems/health care consultant/member of my family/and genuinely kind, avuncular man who I genuinely adore?

When Dr. Katzow stops practicing, there won’t be another like him.