Shame, Executive Dysfunction, and the Complexities of the Medical System

Shame.

The little voice, in the back of my head that says “you just aren’t trying hard enough”

It crawls into my ears, and down my throat, then it forces itself back out of my mouth so I hear it in my own voice as it reminds me of all the ways I’m falling behind.

Ironically, shame even finds a way to use self compassion against me.

As my mouth speaks unkind words at my reflection, shame says “Come on Andrea, you know better than that,” but it does not offer any counter argument.

Now that some time has passed since Zazz’s little health scare—and I’m removed from the situation and equipped with some new tools and perspectives from my therapist—I can hold a bit more space for myself. But at the time, I was struggling with executive dysfunction and didn’t really understand what that meant.

Executive dysfunction is a disruption in the brain's ability to control thoughts, emotions, and actions. It’s common in neurodivergent brains, like those with ADHD. Executive functioning, therefore, is the normal processing of thoughts, emotions, and actions—and it can be disrupted by trauma, both acutely and chronically.

The one benefit of existing in a state of executive dysfunction is that I was in no place to make any rash decisions about my medication at that time. I was in no place to make a decision at all. Instead, I plugged along at the same dose, deciding that my best bet was to give myself another week to see how I felt before increasing, decreasing, or quitting altogether. Which, of course, was when I approached the bottom of the bottle.

I knew I needed to call the doctor’s office soon to get it refilled, but you know how it is. There was still some left, I was still struggling to get back into my routines, and it slipped my mind. I also wasn’t exactly sure what to say when I called, and the deep sense that I needed to explain myself to my doctor—or nurse—was strong. I hoped I could request the same prescription again to give me a bit more time to experiment, but I feared seeming like a patient who was just seeking medication, or like I somehow knew better than the doctor. So I procrastinated a bit, trying to plan exactly what I would say when I finally called.

And then there were only a few pills left.

I had only a few days’ worth when I called my doctor’s office. “It will be fine,” I thought. “How long could it possibly take? I just need to call and let them know where I’m at. They’ll fax off my prescription to the pharmacy, and it will be ready in a couple of days—no big deal.”

Wrong.

I first called my doctor’s office on a Monday morning, just after they opened. I was told by admin that they couldn’t do anything for me but would put a message through to my doctor. As the end of the business day approached, I decided to follow up. I wasn’t sure if I was supposed to be waiting for a call back, but I thought if I could just explain what my doctor had told me when we spoke, I could move the process along. I knew it would likely be another month before there was an appointment available with my doctor, but surely they’d understand that they were supposed to connect me with the nurse my doctor mentioned in our last conversation.

When I got through on my second call, the person on the other end of the line was short with me. As I started to explain, “I had a phone appointment with the doc a couple weeks ago, but I hadn’t determined my dose then. She told me to call—” I was cut off.

“The doctor is busy with patients who already have appointments today. You can call your pharmacy and ask them to fax a refill request to us.”

“Okay, thank you,” I said, defeated, and ended the call.

“Alright, it’s okay,” I said to myself afterward, trying to shake off my annoyance at the abruptness of that conversation. “If I had known to call the pharmacy, then obviously I would have just done that—but my doctor said to call them.”

I then proceeded to navigate the shockingly convoluted pharmacy telephone system in order to finally speak to a human who, in a matter of moments, assured me that they would fax the request to my doctor’s office right then. I ended the call with a sigh of relief and went about the rest of my day, confident that I would have my prescription filled in a day or so.

The next morning, I was enjoying a vanilla latte at a cozy local coffee shop, determined to focus on work for a couple of hours, when the pharmacy called. I answered anxiously, worried they were going to tell me there had been a problem—that my doctor had denied my prescription refill, or something equally frustrating. Instead, they called to ask for the exact dosage clarification that I had been told I needed to relay to the nurse.

Knowing better at this point than to try to explain myself or ask for anything specific, I simply told them that I was currently taking three 10 mg capsules daily and left it at that. After all, I wasn’t prepared to make any changes to this dose yet, and perhaps it would just be easier to stick with it and request a change later on if I needed to.

With this conversation out of the way, I now felt absolutely certain that the matter was settled and I could relax for a while. So when I opened my prescription bottle the next morning and saw that there were only four pills left, I didn’t worry. I did, however, decide to take only two pills that day—just in case.

My rationing turned out to be necessary, but ultimately insufficient, because by the following Tuesday, when I set off for my morning latte and work session, I had been out of Vyvanse for five days and had not heard a single thing from the pharmacy or my doctor’s office.

Initially, I wasn’t too worried about being off my meds. After all, I had been unmedicated for 35 years, and although I wouldn’t have said I thrived all throughout those years, I did know I would get by. I always have. As the days stretched on, I observed myself reaching for cannabis more regularly, but I also worked quite diligently to utilize some of the tricks and strategies I had adopted pre-diagnosis to keep me organized and manage my day-to-day anxieties. I wrote lists, I set calendar reminders, I planned, prepared, and packed everything I would need for the following day before bed each night—and I tried so hard to be kind to myself.

A lot of these small habits had fallen away in the previous weeks—some because medication made me somewhat less reliant on the lists and reminders (though not entirely), and some because I had been stuck in the bottom of my spiral pit and simply could not muster the energy or attention required to do them. I wasn’t fully out of the pit at this point, don’t get me wrong, but I had begun the climb anyway, and that was something.

At this point, it had been a full week since I spoke to the pharmacist, and for a few days I had been intermittently checking their online prescription refill system, always seeing a “no refills available” label next to my generic prescription listing. When I finally called the pharmacy to follow up (I’d learned my lesson about trying to call my doctor’s office first), they informed me that they had sent the request and follow-up information to my doctor’s office but had not heard back. They told me they would resend the request immediately but that I should also call the office and let them know.

Thankfully, no one cut me off during this call to the doctor’s office, and I was met with incrementally more compassion than on my last call—but unfortunately, they still did not seem to know what the fuck I was talking about. The administrator explained that when requests come in, they are placed in the appropriate doctor’s mailbox, and my doctor goes through them at the end of each day. She told me that my doctor wasn’t in the office the previous day and hadn’t gone through her mailbox yet. She also told me that she didn’t see my request in the box, so my doctor must not have received it yet, and to request my pharmacy resend it—which, thankfully, they were already doing.

I sighed as I ended the call. Once again left waiting, with no way of knowing for how much longer.

It was another week and a half, another call to the pharmacy, and a near-total breakdown before I finally got my prescription filled.