"That Doesn't Apply to Me" by Sylvia Khoury

The PHQ-9 is the validated questionnaire employed to screen patients for potential depressive disorders in a healthcare setting. It consists of nine questions that interrogate how often a patient experiences certain behaviors (such as tearfulness) or emotions (such as hopelessness) in a given two-week period. The patient is meant to rank the frequency of such behaviors/emotions on a scale of 0 (“Not at all”) to 3 (“Nearly every day”). 

The below is based on the notes I scribbled down as a third year medical student on the subway ride back from clinic one night. I had just administered the PHQ-9 to a patient in her seventies who had been experiencing several months of fatigue. In this particular clinic, the PHQ-9 was typically given as a sheet for the patient to fill out themselves, but this patient had forgotten her reading glasses at home. I’ve altered any identifying details to preserve her anonymity, but have strived to faithfully render the spirit of our encounter. 

How many times in the last two weeks have you been bothered by the following? 

1. Little interest or pleasure in doing things? 

Now, here’s the thing. 
I do the things I need to do. 
I wake up, I take my medications. 
I don’t take them all at once.  
I know the doctors told me I can take them all at once. 
Well, I don’t like that.
So I have seven or eight pills,
I take one every half hour. 
And the reason I do that is so that I know, 
If something goes wrong, 
Which one of them is to blame.
You understand?
Which pill is to blame.

And then, once I’ve done that,
I have to check on my cat.
You ever had pets?
Oh, so you know.
I have two cats.
Clover and Stella.
One of them,
Stella—
I don’t really call her Stella,
I call her The Cat—
Anyways, once a month she gets sick
And by sick I mean she shits everywhere
Blood, vomit, shit,
All over my apartment.
So in the morning I’m hunched over,
Looking everywhere she might have gone to the bathroom in the night.
I have to check every corner.
That cat, she will find the strangest places,
And she will shit all over them.

Now, do I like doing that every morning?
No, I don’t like doing that.
But it’s the morning and that’s what I have to do. 

2. Feeling down, depressed, or hopeless?

No, see, now hopeless?
That doesn’t apply to me.
No.
I don’t let myself do that,
No, I do not.
I tell myself, 
What is the point of dwelling on my troubles?
That is to say—
I don’t think about those things.
So if you’re saying hopeless
Or depressed,
No, I wouldn’t say that applies to me.

You know I see some people on the street
With their sad, mopey faces
Looking like they got all the trouble in the world.
Now those people are hopeless,
You know what I’m saying?
Or depressed.

But me, when I go out to play the numbers,
I’ll have a little conversation with the people I meet,
I’ll be friendly and such.
That’s who I am.
I don’t let things bother me too much.
I say, why would I let things bother me,
When I can’t change them? 

And down?
Down, let’s see.
Yeah, maybe I feel down sometimes. 
But that’s just because of other things.
That isn’t being depressed,
You understand?
If I feel down it’s because of my elbow
Or my hips
Or my cat,
Having to clean up after her all the time.
So yeah, maybe I feel down
But it’s because of other things, you understand?
So I would say those words don’t apply to me.

3. Trouble falling or staying asleep, or sleeping too much?

Ooh, yeah,
I don’t sleep very much.
That’s been my whole life,
No sleep.
Sometimes I would look at my husband when he was sleeping and think,
How does he do that?
Can someone teach me to do that? 
Please, Lord, teach me to sleep! 

You know,
I take some gummy bears
I think they are—
What do you call them?
Antacids? 
But they also have this chemical,
I don’t know what it’s called.
Anyways I take that.

Yeah, yeah, that’s it.
Melatonin.
That’s it.
So maybe that helps.
Actually, it probably doesn’t! 
I don’t sleep at all, do I?
Well, I do sleep a little.
Maybe without the gummy bear—
Without the—
What was it?
Melatonin, yeah.
Maybe I wouldn’t sleep at all.

My husband still sleeps really easy.
I hear him waking up in his room,
I look at the clock and it’s eleven o’clock!  
Eleven o’clock in the morning! 
Do you know how many times I’ve already cleaned up after the cat?
I’m here with my bleach, hunched over,
And he’s getting out of bed at eleven in the morning.

4. Feeling tired or having little energy

Now what do you mean by little energy? 
Because, you know,
It don’t matter what’s going on,
If I slept or not,
If I’m sick—
I still do everything I have to do.
I wake up,
I fix myself something to eat—
Well, that is, after I’ve taken my one big pill
The doctor, she told me not to eat with that. 
I take that pill,
I eat, 
And then I go looking for any mess the cat made.
Well, I already told you about that.
And then I fix myself something to eat,
A fruit and those Belvita biscuits. 
And then during the day I clean.
It’s hard to get under the couch with the broom,
With my elbow.

I’m so sorry,
What was your question?
Little energy?
I don’t think that applies to me.
I’m tired, yeah I’m tired, but I do everything I have to do.
I am tired.
You could say I’m tired.

You know,
I never got good at taking my licks with grace.
Someone told me that once.
But I always do what I have to do
And I never complain.

You know when we were talking about sleep,
Sometimes it’s cold in my apartment,
Which used to make it hard for me to get comfortable.
So I got this plexiglass,
And I put it over my window.
And when it gets really cold,
I put plastic over that, too.
So that’s not really a problem anymore.
If only I could put plexiglass over my cat, right?
Ooh, she would hate that.
You know, cats.

5. Poor appetite or overeating

See, I eat. 
I eat, I wouldn’t say too much.
Or too little.
With the diabetes, the doctor says I should be checking my sugars,
But I told her last time,
My machine is broken!
And she told me she would send it to the pharmacy.
Well, I got there, to the pharmacy,
And they told me all they got was those little
What are they—
Alcohol wipes!
Now, what good are alcohol wipes going to do, if I don’t even have a machine?
And I waited there a long time, you know?

I don’t complain though.
No, I do what I have to do.
I told you about my cat.
My neighbor tells me,
Why don’t you get the cat put to sleep?
But the thing is,
After each time she gets sick,
She bounces right back!
That doesn’t seem right, you know
Put the cat to sleep, when she’s bouncing right back.
I won’t do that. 

Oh, and sometimes I do eat things I know I shouldn’t.
Like last night I had three pieces of candy.
Ooh, they were sweet.
They were so sweet that I didn’t eat any snacks in my bed.
Normally I do that.
I guess it was good those candies were so sweet, right? 

6. Feeling bad about yourself, or that you have let yourself or your family down?

My family.
Ha.
I don’t feel bad about that—
I’ve done everything for them!
My husband and I,
You saw he just came in here
Interrupting because what—?
I’ve been here forty minutes?
I tell him, you will bring me to the doctor.
You’re everyone else’s chauffeur, aren’t you?
You can be mine for the doctor at least.

He’s selfish, you know.
I go to his doctor with him all the time.
I never complain,
Even if it goes for hours and hours,
I do what I need to do.
And I’ve been here— 
What, a little longer than he thought?
And he’s coming in the room,
Interrupting the doctor.

You know, I thank God my niece has calmed down.
Thirty-two and she’s been acting like she’s twelve.
You know, the whole bathroom cabinet is filled with her things.
I don’t know what they are,
I don’t snoop around.
But because she has all those things,
I close the toilet seat before I flush.
Maybe that seems strange to you,
But she has all those things, so I want them to be clean,
So before I flush the toilet,
I close the seat.
The problem is,
I feel like I’m losing my mind
(My memory, more like)
And I can never remember if I flushed.
Now sometimes it’s an hour or two later,
And I’m doing something else—
Cleaning,
Or running after the cat—
And I think, did I flush the toilet?
Then I have to go check.
And it would be okay if it was just one of those habits.
But you know—
Sometimes I didn’t flush.
And I would say that bothers me.

7. Trouble concentrating on things, such as reading the newspaper or watching television.

Me?
No, I focus on the TV just fine.
I love the TV.
I get wrapped up in all those stories.
Now I got a TV in my bedroom.
My husband has one in his,
But he’s always sitting in the front room,
On his chair,
Watching his sports,
And I figured, I should have one in my room, too.
But I don’t do much reading.
I would say that doesn’t apply to me.

8. Moving or speaking so slowly that other people could have noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual.

Hmm.
Now that’s an interesting question you’re asking me.
It’s funny, you asked me that question!
I would say my niece and my husband—
They say opposite things.
My niece,
She’s always saying,
You know—
Ma, stop rushing to clean under the couch! 
Ma, stop rushing, your elbow!
But my husband—
He would say things like
Why you moving so slow now?
Hunched over like that,
Like an old woman.
You saw him! 
He always thinks there’s somewhere to be.
You know,
He wants me to be Wonder Woman.
You know, my husband,
He’s a stubborn man.

Our relationship?
I’d say our relationship is more like—
Companions?
No,
Roommates.
That’s what I’d say.
He has his room,
I have my room.

No, no we don’t eat together.
He fixes his food,
I fix my food,
My niece fixes her food.
Because he eats so much earlier than everyone else!
He wants dinner at five.
Tell me, who wants dinner at five?
Not me. 
I feed the cats around four.
You know,
I give them a hard time, but they’re good cats.

I guess I’m probably talking about my cats too much.
I’m sorry about that.
They take up a lot of my day.

9. Thoughts that you would be better off dead, or of hurting yourself.

No, no.
I’m telling you.
I don’t let negative thoughts stay in my head. 
I don’t do that.
But yeah, I had those thoughts when I was younger.
Much younger.
I was thinking, why me?
Why I got this body?
This family? 
That was before I learned not to let myself think about things.
But you know,
Some things do bother me.
When I look out of the window,
I see the little kids on the playground,
People strolling around, enjoying the weather.
I don’t know.
That bothers me.
Some things do bother me. 
But I wouldn’t say I’m depressed.
Because there are reasons, you know.
I’ve told you my cats, 
The pain in my elbow.
So, no.
I would say that word doesn’t apply to me.

Oh, you can put zero.
Zero for all of these questions.
They don’t apply to me.