D.C.  Gonzales-Prieto

Ketamine Reflections

I.

You know, I was surprised to feel hungry. But I was hungry. Almost hungry enough to beg Emily to stop on I-295 to hit the WaWa for a Sizzli as she drove me home north. But I didn’t. She was kind enough to drive me to Ketamine therapy, and the honest and responsible thing for me to do was what I did: chat and be myself as I was heading home—feeling better than I had in decades. Expressing my heartfelt gratitude. And actually feeling hungry?

I got to enjoy the pangs of hunger being driven back home. And once I’d opened the door and let myself in, I tucked into the fridge to pull the kielbasa I got from Costco a while back, along with sauerkraut, potatoes, and garlic. Threw ’em all into a pot and about an hour later, I am eating and starting to jot down my thoughts after my first treatment. There will be six treatments. And the nurse told me that the first one is the most intense.

I have suffered from depressive thoughts, ideations, and aspirations for more than thirty years. Even as a young child, I had a shockingly casual relationship with remaining alive. One of my earliest memories of this arose with the threats of upcoming Ice Ages (a common concern in the 1970s, believe it or not, somewhat reminiscent of the threat of quicksand). I mentioned to my grandmother that an imminent Ice Age was predicted for thirty or forty years out (how foolish we were!), and “I’d like to know when so I can kill myself before it happens.” I don’t recall being particularly depressed then, but my specific interest in remaining alive when I was younger than ten strikes me now. I don’t hear my children saying anything like that, and I am forever grateful.

But in high school, and as an undergrad, my depression grew fiercer. I honestly don’t know if I have admitted this to anyone before, but one night in my junior year, I swallowed a full bottle of Tylenol. I don’t recall any particular catalyst for this, but I hated my life. I hated the school I went to; I hated what I was doing and how I was feeling. I mean, I couldn’t even kill myself properly. What kind of an idiot must I have been? And, of course, I got angry at myself for that.

Automobile accidents didn’t help, and my high school years were marked with them. Wrecked my step-mom’s car. Got my own car and wrecked that. Got another one, and wrecked that. How many accidents does it take to get PTSD? Somewhere between one and many, I’ve come to believe.

For the next several years I floated in and out of deep depressive episodes. I did make two more attempts while I was in college, and I had learned to associate these episodes with being alone. So I found myself desperately seeking folks out, and making new friends—which is a common thing to do in college in your early twenties. And I did. Appropriately, I tried a lot of new or newish things. I started drawing and putting an effort into it. I started writing poems. I picked up the drums and played in a bunch of garage bands. I opened up my first serious relationship. I started to feel a little more normal.

I will not try to convince my reader that I was saved by drugs. That’s a kind of nonsense concept. But my experiments with hallucinogens at the time actually helped me place the world, and my potential in it, into context. Sure, I had a few bad acid trips. But the mushrooms were super relaxing. And the good trips taught me what the bad trips scared me about. About myself, and about the world. And it came to feel okay. Growing older, going different places, and eventually getting married seemed to calm much of the gnaw that my depression exerted. Life got easier.

But the plague pandemic year was a super shitty year. Millions died. Where do you go after that? Well, if you’re me, your wife of twenty years leaves you right as that is happening. And then the divorce gets ugly.

And then the depression grew. During winter here in New Jersey, the sun goes down around 4 p.m. I remember that from living in Urbana, Illinois; the closer you are to the eastern edge of the time zone, the earlier night falls in the winter. But here I felt it worse. The darkness surrounded. I broke through my Vibryd and was put on an adjunct antidepressant that had the odd side effect of waking me half-conscious and trashing my room like an angry Keith Moon. Apparently, such sleep disturbances were a common side effect of the adjunct. Had some health scares that year, too. 2020 was very bad.

Sometimes, but not often, when we are extraordinarily depressed, we may be aware enough to reach out to others. Usually, it’s in the form of some attempt to commiserate. “Every day, it’s all the same: breathe, breathe, breathe, amirite?” And in such a state I reached out to a friend who told me she was excited to start Ketamine therapy as a dissociative analgesic to treat treatment-resistant depression. I was astounded that such was even available.

She found resources for me in NJ, and I found myself signed up. Which is what led me to today.

The first ten minutes were certainly the most intense. A flood of feeling, tears welling, but no pain, or sadness. Just that intense feeling at first—about ten or so minutes in. And it washes over. I chatted. I listened to music. The nurse who administered the medicine was born in Grants, NM, and knew the reservation lands much better than I. But it seemed right to be able to chat with someone from a place I knew.

I entered Ketamine therapy because I need to learn how to not loathe myself. I need to learn to accept myself as the human I am, and I’ve long had difficulty with that. The nurse told me that the medicine actually carves new neural pathways, allowing for new approaches to thoughts and stresses. It’s a good model: new pathways. It’s a useful model. I was both loopy and under emotional self-control as the session ended. You do feel the drop off when they pull out the needle (the therapy is intravenous), but it’s gentle, and more like settling in than anything else.

But this is my first day. We’ll see how I blather on tomorrow. It does feel like a giant ship starting into a turn. But it’s gonna be a long turn.

II.

What I recall most acutely about psychedelics is how they foster the user’s belief in and connection to a larger network of minds and beings. The world made this connection clearest to me in moments when, out of nowhere, I chanced into my old pal Rasputin in San Blas, or when I ran into Jare Bear at Red Devil in Seoul, or when I met Will Auther, for chrissake, at the United Lounge in the Narita Int’l Airport. But those connections, even after I stopped dosing, still hung around. I remember just bumping randomly into a friend during my college years, and the buddy I was with said, “That never happens to me.” By that time, I felt very nestled, very comfortable, in the wrap of whatever weird community of freaks and stoners and part- to-full-time drug users. But Professor Galvin, one of the most honest men I’ve ever had the privilege to work with, had reminded me long ago: “They are plants, not drugs. Nobody takes them to labs and extracts anything from them before you eat them. When you consume the plants, you are communing with nature.” And I felt that.

And still do, but today’s Ketamine therapy was oceanic. Was like standing on the shore, feeling outward. There were no plants involved, only a very long needle (which is both standard and my least favorite aspect of the whole dealio), and the tech who was opening up a sweet, cool little line in my arm under medical supervision. And these nurses are phlebotomists extraordinaire. In a lot of ways, I was very lucky to fall into the college micro-scene when

I did, because we were all scared of needles. In a town like Tucson, where heroin is everywhere, a fear of needles becomes a keen adaptation. I remember laughing with Séan when he reminded me that “if it involves a needle, it’s no longer a party. It’s now a medical procedure. And who wants to go through a medical procedure and then go see a show?” Not me baby, I’m too precious.

And today’s session really did reinforce the kinds of connections I recalled above. My ride for the day fell through yesterday, and last night was filled with anxiety. Ketamine patients are not allowed to drive home (for reasons that should be obvious) and the centers don’t really want folks being dropped off by ride services or taxis, so securing a ride is a second drawback (assuming you share my take on needles). But at the last minute, a neighbor who I had only known slightly beforehand volunteered, and the chance to get to learn more about him on the drive down reminded me that connection is available to those who reach out. I thought I had learned that long ago, but the most important lessons are the ones we need to relearn and relearn again. It is practice, after all, that draws us closer to perfection.

III.

Today’s session was about routine. And I learned that routinizing new neural pathways leads to new outcomes. I can feel the sessions making a difference in my mind and in my reactions. About a month ago, I was making a lasagna for Sunday dinner. I enjoy cooking, and it has been a point of pride for me to make delicious and attractive-looking meals for my children. And I also really love lasagna. I made the ragu from scratch: big cans of prepped tomatoes from Italy, fresh Italian sausage, loads of ricotta and piled with shredded mozz and ground Reggiano. I was into making this lasagna, and when the pan was complete and filled to the brim, when the oven was fully warmed and opened, instead of deftly sliding it into the stove I planted it face down, so that the entire casserole pooled around the hinges of the hot range door. I was absolutely furious at myself. Screaming and slapping myself at my utter, clumsy stupidity. A rage, I was; a glowing ball of pure rage. The kids were pretty scared. And I just fumed and stewed all that night.

Which, believe it or not, brings me to this morning. Because I was being given a ride by another exceedingly kind neighbor, I wanted to make her an iced coffee. And so I did: tamped the espresso into the brewing cup, foamed the milk slightly into bubbles so that it’d be cool by the time she arrived. And as thoughtlessly as a tail might wag, my left arm slid right into the large go cup of milk, spilling it all over the floor. And my first thought was that fucking lasagna that I’d ruined. And then just as quickly I thought, “This will be easy to clean up. And if you do it quickly, you’ll get it done before Samara arrives, and nobody will know a thing.” And it was pretty easy to clean. And about three minutes later I had finished the latte and it was cooling in the fridge as I wrapped up the rest of my breakfast. She showed up about ten minutes later and we were on our way.

Routine. Ordinary. Normal. Not flying into a rage at a harmless mistake. I never understood that. I never got that in my own mind. Consequences were always enormous and paralyzing, and the idea of dropping something and normally cleaning it up, as an ordinary matter of course: that idea had seemed so remote, so impossible, so utterly normal as to be wholly elusive in my life. Who can do that? Who can allow their mistakes to bounce off, effortlessly, carelessly, as simply as a rubber ball against a brick wall? I never could.

So the calmness that arose out of my mistake, and the ease with which I adopted it, felt somehow routine. It felt normal. It felt like an ordinary moment. I mentioned this to the nurse who said, “Yeah. It’s working.” It’s working. I am infusing elephant tranquilizers in a controlled medical setting to try to develop responses other than anger at my disappointments. And it seems, rather ordinarily, to be working.

The “highs” of the session itself were also normalized and routine. The time passed by with a surprising regularity, and none of the rushes that often accompany hallucinogens. I listened to Lou Reed, and his voice was both arch and relaxed, teasing the moment out and allowing it to flop around in its awkwardness.

Some of the sensations of the ketamine linger, long after the infusions. Motor control has fully returned by the time of this composition (I feel close to about ninety percent of normal between thirty and forty minutes after the needle is taken out). The giggly sensation doesn’t last too much longer either. But some of the less apparent sensations, a buzziness in the body and a tingling along the kundalini, can linger for a few hours. The overall sensation that one is left with is that life is good, and okay, and normal: things are not a disaster, though they may look like it. A generalized sense of overall well-being lingers, and it starts to feel routine.

IV.

When the sun is shining, and you’re in a BMW convertible with Sgt. Pepper’s Lonely Hearts Club Band blaring, I-295 northbound can be a beautiful thing. Of course, having my veins filled during an hour of therapy certainly doesn’t hurt either. And it’s also somewhat dull, two old dudes cruising north with the Beatles playing loud, telling war stories and laughing too loudly? We’ve seen that commercial before. Now I’m starring in it.

Just like the last time, the smiles and the genuine all-around-good-feeling are ordinary. It feels like life is supposed to feel like this, top down, engine gunning, radio cranked, and life is good. I always hated those T-shirts. Always hated those cutesy faux hand-drawn little cartoons and slogans. Life was, at best, a pain. Life was a hassle. Something to get over, and something to get done with. Christ on a cracker!

But not today, baby. And not for the past couple of weeks. This ocean liner seems to be turning nicely, steering into a more positive direction. I wake up, and I don’t think, “fucking hell.” I think, “I’m hungry!” or better, “I’ve got to feed the kids!” And it’s seriously okay.

The treatment that I’ve signed onto has a very laissez-faire approach: we are allowed to do pretty much whatever as long as we sit. Lots of folks listen to music, and I’m one of them. But I was also looking at social media during my latest infusion, and one of my old teachers posted the following bit of wisdom from Louise Erdrich:

“Life will break you. Nobody can protect you from that, and living alone won’t either, for solitude will also break you with its yearning. You have to love. You have to feel. It is the reason you are here on earth. You are here to risk your heart. You are here to be swallowed up. And when it happens that you are broken, or betrayed, or left, or hurt, or death brushes near, let yourself sit by an apple tree and listen to the apples falling all around you in heaps, wasting their sweetness. Tell yourself you tasted as many as you could.”

Sure, I was pretty high when I read that, but it just smacked me perfectly. Life is supposed to break us. We get broken enough, though, and we become bent. Our eyes lose focus on what’s straight ahead as we learn to see more peripheral threats, having suffered them enough already. Our field of vision metamorphoses from the hunter’s to the prey’s, and our focus gets drawn outward, away from our core, and towards the innumerable trials and taunts and threats and other crap we learn to look out for.

That’s what trauma does to a growing body. It twists it. It turns the eyes outward and turns the brain inward. It turns all sounds into warnings and all sensations into pain. And, if the medical model is correct, one of the reasons I’m feeling much better is that much of that learned neural topography is being overwritten, or re-routed.

Life is pain. Love is pain. Feeling, at least some of the time, is pain. And it has to be. But it’s the pain that we need to feel, in order to feel—even if just to feel healthy. It’s the pain that both teaches us to twist ourselves, and shows us how to truly revel in the joy. And it seems that this treatment is able to meet us when that pain has become too much, or just too long out of control. I know I will feel pain in the future. But I don’t fear it. In fact, I kind of look forward to what it may teach, and how I might make something better after it. At least, when I get lucky.

V.

As if on cue, Michael Pollan is being interviewed on public radio as I sit down to sketch out my second-to-last post treatment reflection. The sheer paradigm shift in psychological medicine over the past few years really does spin my head. Less than ten years ago, ketamine therapy would have been unthinkable, or the punchline to a cruel joke. My understanding (in all of the psychedelics I’ve taken, I have never taken Special K) is that it was a big club drug, got folks feeling relaxed like ecstasy might, and got people to feel really good, again, kind of like ecstasy. But the feeling of the infusion is certainly much more of a rush than a snort. And it has settled into a kind of routine over the past couple treatments. When I stop to think about it, about how quickly someone can get used to such a powerful tranquilizer, it kind of makes me shudder. Kind of the same way that trauma twists us quickly. We learn, and the smarter we are, the quicker we learn. Even super tough lessons. And especially the ones that go down like dreams.

But what strikes me today about the treatment is how well it works. Apparently, they have done so many clinical trials that there’s really no need to guide the patient through any work. It’s just dose up and feel good. Kind of ominous. Kind of Huxleyish in an ominous way. Kind of like soma.

And worse: apparently only available to Alphas, and some of the lucky Betas, maybe. Deltas? Gammas? Unless you got the dough-ray-mi, don’t even bother. The treatments aren’t covered here in New Jersey, right? You can get them, but they cost.

It’s a magic little shot. Only available here to those who can afford to pay. But that doesn’t make me feel as bad as it could. Does that make me an evil person? Callous and inconsiderate to the plight of those worse off than I? I know lots of folks who would benefit, greatly, from six hours of ketamine infusion. And the world would be better off if more of us felt better. But that’s the market for you.

I don’t know that I’m “okay” with this notion that one’s health should be a function of one’s ability to pay. In fact, I know that I’m not. But today it doesn’t gnaw and doesn’t weigh. I think of Erdrich’s words yesterday, about life serving to break us. I feel that as a part of the ebb and tide of life. And I feel myself caught in that flow, and feeling okay with it.

When I say the treatment is oceanic, I think back on the first session, where I was just gobsmacked up against a wall of feeling like a wave. And it washed over and through and past me. And now I am bobbing in the wake of the wave, its weakened refraction rolling back out to meet the oncoming tides. And me floating in it.

They say that folks can come back for a “booster.” And maybe I’ll be doing that in the dark of the New Jersey winter. I hope not, but maybe. But that’s okay too. The world is filled with disappointments, with less than satisfactory outcomes, with a bunch of crap, really. But that’s not killing me now. And now, floating in an ocean of feeling, it seems as if it never really could. Is that the fate of mental health? To be a reward for those who tow the capitalist line? And if it is, is there anything I can do about that?

It’s odd, this strange divorce from what I think I should feel (outrage at the man) and what I actually feel now (eerily normal tranquility). It’s not bad. And it’s not joyous. But it’s not usual for me. And it’s fascinating to see where it goes.

VI.

Today it is raining in New Jersey. We have had a series of brief and intense storms, coming off of various tropical depressions and whatnots that have made their way up into the heartland of the country and are blowing east. Today’s rain is intense and long, and on the way back from my last treatment, I am feeling the weather intensely. I used to think that was an affectation, like a character in a Salinger story claiming to be completely beholden to the weather. But today’s rain and heavy clouds seem comfortable, like a light blanket in the summer.

Today was my last treatment. I listened to Brazilian guitar music and felt saudade. It will be nice not having to get a ride an hour each way for treatment. And it will be nice not to have appointments taking up time in my day; I can get more stuff done. But I would lie if I said I will not miss the treatments. They feel really, really, good. It’s not just a somatic gentle buzz, though there is that. It is an utter tranquility. I have compared it here to the ocean and I did so because that was the most apt thing I could think of. It may be similar to the feeling one gets in space orbit, free from gravity. It may be similar to the tranquility that emerges from intense meditation. It is peaceful and all is very good when you are infused.

And I was loopy after, too. It’s a nice lightheaded feeling, a bit tipsy but super clear of mind. Just need to be careful where you put your foot here, or there. Balance is slippery right after coming out, and it’s good to take your time before stepping up. I will miss that giddy and delicate dance.

But I can see why the treatment is limited. I could see someone hungering for more of the peace that the treatment brings. Still, I feel at peace. I feel so fundamentally different, emotionally, from when I started the treatment over two weeks ago. But I also feel like me. I feel more like me than I have in a long while. I have appetites that are healthy, and I have enjoyed moments, even during things going wrong. In a clumsy rush last week, I was barreling home and came in too fast, slightly sideswiping and scraping my paint on a neighbor’s car. But you know what? Insurance handles that. I was a bit clumsy, but that doesn’t make me a freak, a reject, a loser, a worthless piece, or anything. It makes me human.

And so, you know, I feel as if I am about to learn what it means to be human, all over again. I have been picking up bits and pieces of it over the past few weeks, and I have found it delightful. Life is really not for loathing, and at 54 I have finally discovered that. I know that there will be good days and bad days. But the good days will be enjoyable, not merely tolerable. And I am hoping that the bad days won’t make me want to die. I will get things right, and I will also fuck up. But what’s more, Corin, when I’m gonna fuck up, I’m gonna fuck up alone. And I’ll be able to handle it. And that’s what I am new to feeling confidence in.