Electroconvulsive Therapy (ECT)

aka shock treatment

My husband and I arrived at the outpatient surgery department at 6:30 a.m. on a November morning. While he sat in the waiting area, I stood in line to sign consent forms and confirm my address and insurance. I was given a number and joined my husband. A man sitting across from me held onto a clear, plastic bag containing a resuscitator bag, which resembles a clear balloon that’s attached to an oxygen mask.

That’s how I knew he was a regular; I had one, too. In our case, it was used for patients undergoing electroconvulsive therapy (ECT) or, shock treatment. After the first session, they packed up the resuscitator bag for us to bring the next time.

I’d been going once a week for a few months. I never looked forward to it. I hated having the nurses fuss over me, applying electrodes to my chest, and inserting an IV catheter into a vein in my hand.

A while later, a nursing assistant called our numbers. We followed her down the hospital corridor where the walls and doors were painted off-white. A guest could accompany us to the treatment area because presumably, they would drive us home.

Five hospital beds lined up next to each other and were separated by curtains. I raced for the bed on the end closest to the treatment room, because I knew its occupant would be the first to receive ECT, meaning the first to be discharged.

After closing the curtain, I changed into a hospital gown and a pair of tan, non-slip socks. They were always too big for my size 6.5 feet. I wasn’t overwhelmed or scared because I’d done this many times before. It was a routine I’d grown accustomed to. My husband waited while I changed, and when I climbed onto the bed, he opened the curtain.

Author photo 2016 or 2017.

A nurse swooped in, placed what they called “stickers” on my chest, and hooked them up to heart and blood pressure monitors. She placed a pulse oximeter device onto my index finger and then inserted an IV catheter into a vein in my hand. It was never just a pinch the way they always said it would be. It was painful. The ECT nurses called me a “hard stick,” because it was difficult to insert the needle into my veins, so sometimes they didn’t get it on the first try.

Minutes later, the anesthesiologist introduced herself and described how anesthesia would be administered—through my IV. I reminded her that my blood pressure tended to rise while under anesthesia. It was probably written on my chart, but I wanted to make sure she knew. The nurse anesthetist then injected medication that kept my blood pressure from rising into the line connected to the IV.

The guests were asked to leave. My husband waited in a lounge for the nurses to call him to the recovery area afterwards.

The sessions happened in a room in which the bed just fit. Several people surrounded me in the cramped space, including at least two nurses, the anesthesiologist, the psychiatrist performing the procedure, and on occasion, medical students. Instead of feeling claustrophobic, I felt comforted knowing all these people were around in case something happened.

The fluorescent lights were especially bright. The beeping monitors were a soundtrack to the procedure.

“How are you doing today?” the psychiatrist asked.

“Fine.”

“Any improvement?”

“Not really.”

“Okay,” he said, “we’ll continue weekly maintenance sessions for now.”

I nodded.

The ECT nurse handed me a rubber mouthguard so I wouldn’t bite my tongue during the convulsions. The nurse anesthetist placed the oxygen mask over my face. This was a relief because I knew that soon, it would be over. The prep work was what made me anxious.

The anesthesiologist informed me she was injecting the anesthetic agent. I was asked to count backwards from ten. I made it to eight.

The procedure took about fifteen minutes from the time I was rolled into the treatment room to when I woke up back in the curtained area, which had been dimmed. I felt groggy from the anesthesia.

I was then transported to the outpatient recovery area where I was given juice and saltines because I hadn’t eaten anything since the night before, as the doctor instructed. The nurse allowed me to dress in ten or fifteen minutes, and soon afterward, my husband arrived. At home, I spent the rest of the morning and the afternoon sleeping off the anesthesia.

Author photo, pre- and post-ECT.

ECT is a last resort treatment for people who are severely depressed. In the 2000s, Dr. S was concerned because my depression wasn’t responding to medication. We’d tried different cocktails, but nothing worked. Then he told me about ECT.

Despite recalling the scene in One Flew Over the Cuckoo’s Nest where Jack Nicholson’s character, McMurphy, a psychiatric patient, is held down and forced to undergo shock treatment, the decision wasn’t difficult. I was desperate.

Dr. S warned me about possible memory loss, both long- and short-term, usually of the events directly preceding therapy. Ironically, I remembered exactly what happened before my eyes closed. Still, I lost chunks of memories like the time I helped my dad move across the country and that my mom briefly lived in a suburban townhouse after their divorce and before she moved to the city. In My Poor Memory, I describe exactly what that memory loss is like. It’s a frustrating thing to live with.

In my patient portal, I recently counted over seventy sessions of ECT that I’d undergone between 2014 and 2017. It didn’t include the first sessions from around 2005, which took place at a different hospital. Had I known how much my memory would be affected, I would have done the initial therapy, but not the subsequent sessions. Toward the end of my treatments, they weren’t working well anyway.

Since 2017, I’ve experienced episodes deep enough that ECT would have been beneficial, but I refused. Instead, I played the waiting game, because the depression goes away eventually, even if it takes months. At one point, I was desperate enough to undergo ketamine infusions. But that’s another story for another time.