20/02/2023
Really long post that would be better as a blog if I had a page up & running yet! But I don't & I need to get it out of me even if it is into an as yet empty void.
TL;DR my experience of a doctor appointment with my usually good doctor. I think he is still good and to his credit, he is open to information about autism. Or at least, I think he is.
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Note to my doctor…
When I come in for an appointment what you see is not me as myself.
It is “high level masking me”. It is the version of myself that I have learnt is acceptable to people around me.
But it is not “me”. Not the honest me with no pretence.
You are a good doctor - one of my favourite doctors I have ever had. Clearly ADHD. Open minded. Obviously intelligent. Quick of mind, easy to talk with. Talks with me, not to me. I am one of those complex medical people…lots going on…and you keep up pretty well.
Usually I can go and not be as tightly masked as I normally need to be. Today, I learnt that it is most likely that I have been wrong in this feeling. I think I have almost certainly misunderstood previously, and probably caused offence even though I have had literally no idea about it. Until today, you never clarified what I meant and I remained oblivious to what I allegedly implied…(I didn't imply anything - far too literal in my Autistic brain to purposely imply anything!)
Having prepared over decades of medical challenges and appointments, I know what doctors want and what they need. I work hard to hold up my end of this arrangement and I do not always get it right. As right as I need to get it. I did think I was doing a little better this time…
When I identify the need for an appointment, I book it with your admin staff. If in doubt about the time required, I disclose the reason to them. They usually do not want to know & sometimes they don’t listen. For them, I guess this is oversharing & they are conscious of confidentiality & also of their own needs. What they miss is that I don’t know what type of appointment I need so I share to enable them to decide this. To avoid booking too short, too long or at the wrong time.
That appointment gets put into my calendar including notes about what it is for & what I need to do to prepare. Do I need to print anything to take? Do I need to sit down & write notes for it? Notes about what?
I do the notes as best I can given I do not know what questions I will be asked.
Nevertheless, not knowing, I “practice” for potential questions. What might he ask? How will I answer? What distractions might come up? My doctor is ADHD so distractions do come up…
Check the details the day before. Alarms for reminders have already reminded me and there are more to come before the appointment itself.
Try to sleep…
Check the day of.
How am I getting there?
When do I need to leave?
What do I need to do before that appointment?
What else do I have scheduled or planned for that day?
What is my son doing that day?
What do I need to eat?
When do I need to take meds?
What do I need to do with my dogs & birds before I leave?
What is the weather like?
Should I close windows or not?
What do I need to wear?
Do I need to take a water bottle?
… And so on …
The day before. The day of.
Have I had a coffee yet?
Pack iPad for notes and paperwork if needed.
Answers to questions I have not foreseen.
Pack ReMarkable for note taking.
Or to read in the waiting room. Better battery life.
Maybe pack other paper reading material…just in case… (Of what, I don’t know. But preparing for “just in case” is reassuring if nothing else.))
Pack paperwork between the iPad & the ReMarkable. Otherwise it gets crushed, destroyed & lost. Usually in that order but not always.
Phone.
AirPods.
Water bottle.
Pen & paper… Backup note taking.
Check & re-check.
Inevitably late anyway…
When you see me ramble during an appointment; if you hear me comment on the face you might have made at me; if I tell a seemingly irrelevant story with too many words and maybe no apparent point…
It is because you have asked me a question that I have not prepared for.
My brain is rapid-fire going over all of the things…
I don’t know what your face means…
I see “that type of face” so often and noone explains what it means so I never know and I am left dangling, panicking…
What are you asking?
What does that question mean?
What answer do you need?
What details are relevant and what does not need to be said… This is perhaps the hardest part… To me, All of it is relevant - or it might be. I don’t know.
I don’t know what is relevant.
What happens when I get this wrong?
What consequences for the wrong answer? For the right answer?
How do I stop rambling?
What is your face doing anyway…? Clearly what I am saying now is not correct or maybe not needed or maybe offensive…
And the appointment is taking waaayyy longer than the scheduled time…
I still haven’t even asked for the script I also need. I never do get to it during this appointment.
You have misunderstood my answer…
You are apparently displeased with my answer…
Apparently I offended you somewhere here…
You don’t see the panic inside of me because I don’t display it on my face in this context. This part of my mask remains heavily fixed - immutable. Almost inscrutable expression. (At least if I was neurotypical, I would be told my expression is inscrutable. Instead, I have the more pathologised “flat affect”...)
So you don’t see the distress or the confusion.
Perhaps - as on this day - you suspect you have offended me. You assume this because you mistake what confusion I do show, to be tension, offence, anger.
Honestly, at this stage, I do not know what has just happened.
For once, today, I say precisely this.
I do not know what information you need or why you need it. I no longer know what you need of me.
I simply want the medical certificate form completed. There was nothing new to add.
Today, because I disclose my confusion, you ask if I believe you are neurotypical. I don’t - clearly ADHD as we have laughed about previously. I don’t get the hint that you’re making here…
Today you believe that I am questioning your competence… Your intent and your capacity to understand.
What you don’t see is that I stopped knowing what you wanted of me a while ago now. For minutes, I have been panicking, distressed and increasingly confused about what is going on and what is needed of me. But you do not see this.
You don’t understand that I do not imply things. I am not even sure if you believe me when I say this…
So, once again, it is up to me to apologise for the confusion - for the miscommunication. Despite your assurances that I don’t need to apologise just for being myself, I continue to apologise, to assume responsibility for the emotional and cognitive load of communication between neurotypes. I don’t even realise until well afterwards that this is what I did.
It is Always what I do.
It has always been my responsibility to do it and fifty years of this is a hard habit to break.
(However, I deeply appreciate your attempts to meet me part way.)
What I know right now is that I have somewhere, somehow, said the “wrong” thing…
Ahh… You want me to show you progress? Progress I have made whilst not working?
And despite your best of intentions, what you mean is neurotypical or at least allistic, progress.
Because Autistic progress…it doesn’t look like “progress” should look.
There have been no obvious signs of progress. I disclose no signs of “progress”. And I do not know how to communicate this to you. I do not know what “progress” needs to look like in order for you to accept it as legitimate proof that I am not stagnating or bludging… I have said that I have made a lot of progress and I can see that you do not believe my words.
People - other people - do stay in a rut. They get into this position of not moving forward, of staying stuck, of backsliding. And I have been there myself - back when I “was neurotypical”...
And you say this, ask this, out of concern - medical concern.
Well meant. Best of intentions.
Needing and expecting me to live up to allistic standards that are unachievable.
I couldn’t say this in person, but this is what progress looks like for me just now…
I turn up to psych appointments and I talk.
Gradually, I increasingly disclose of myself. Please understand that this is something I have been “trained” not to do - never to do. Honest disclosure means nothing good will come of that interaction. 50 years of nothing good comes from interactions that involve me disclosing myself. Perhaps not every single interaction has ended this way but there is not one I can remember that didn’t.
In those psych appointments, I am addressing the trauma that brought me there. There was a lot of debris to clear before addressing it, and that took time.
I turn up to rehab appointments and I engage. Although I mask so highly that really, they are almost complete fabrications of my reality... My interactions with pretty much everyone are largely fabrications of myself.
I looked for support workers. I met and spoke to one.
She might begin next week. 14 months of NDIS funding and this is the first support worker I have met and tentatively engaged.
I have an OT appointment booked. It's been months since the last OT ripped me off with false transport charges.
I do my uni. Always overdue, but I do it. I learn. I struggle to deal with the constant presentation of people like me as deficient in so many ways…”sub-human” to quote one paper.
I work. I can’t work and be paid for it… That’s a psych conversation right there and I have told her this.
I don’t force myself to be someone else.
I lost my family. All of them except for my son who lives with me as a dependent. I Iost them because they dislike who I am. They liked who I masked as, but they don’t want to know me as myself. There is grief and agonising pain in this and I did it anyway.
But when you see me you don’t see this.
When I mention any of it, you still don’t see it because I cannot talk about this and feel it at the same time. Truthfully, I don’t think I feel it in the way that you believe I “should”. There is pain (& so much more) but it is not organised in the way I believe I “neuronormatively should” organise and express it.
Grief for me is so much slower.
And you don’t want me to disclose the details because that is not your job. So how else do I explain “progress” to you?
I leave feeling that today my mask has slipped too far and for my own survival, I need to fasten it still tighter again next time. And never let it slip…
I leave the appointment. You move onto your next patient and probably don’t give me another thought.
I leave numb and upset all at once. I don’t know what I feel. I don’t move on. I come home, numb myself with some food and tv. Then I write. I journal to process what happened and what I feel and think. My thoughts and feelings are stilted and jarring. I have uni to move on with - assessment due date looming… Unless I process and write, I will be unable to move on. Even if I process and write, I will return to this after my assessment is completed. Moving on is very difficult, especially when most of what has happened remains unknown.