Job Adjustment Struggles

Nearly a month ago I posted about my upcoming new job.  I’ve been there for 3 weeks now.  The first week I spent about 5 hours in orientation before going in the next day for the start of training.  I ended up smiling for the entire 40-minute drive home, so pleased to have taken the job.  The next day I trained with my boss, Tilly, on day shift again, then with a coworker on night shift over the weekend, then back with Tilly on Monday.  At this point she encouraged me to dive right in and work alone on nights.  At least she let me do a little training…her boss, Brice, was pushing for solo work before my first day even ended.

The first night alone was a nightmare.  Two different clients managed to manipulate me and by the end of the shift I had spent two hours sobbing and nearly called the on-call therapist.  Tilly and Brice were both there to check in that morning, and both reassured me that every new employee gets manipulated at first and what I did wasn’t going to harm the clients.

I’ve worked three more nights since then and each one has been better.  I’m struggling a bit with the paperwork I have to fill out.  Rochelle kept sending them back for revision and Tilly and I got into a debate about the clients’ abilities.

Less specific to the job, I’ve been struggling because working night shift has left me filling in all those daytime blanks on my schedule and not sleeping.  This past week I was up for 63 hours with only two brief naps in between.  I’d been skipping one of my medications while not sleeping, as it’s one I must sleep immediately after, and then I was starting to skip other medications as well.  I’m seeing the start of some manic symptoms, but also having prolonged sobbing fits where I have to freeze in place because I’m convinced that if I move I’ll kill myself.

I’ve been struggling with the feeling that all of us are too many different people as I try to balance my life as an employee and a client and a CIT volunteer and a student.  I felt like I couldn’t ask anyone at all for help.  I did schedule an earlier appointment with Sadie, coming up on Wednesday, but there were things I couldn’t discuss with her.  I scheduled an appointment with Rochelle, which isn’t until Thursday after I’ve worked both days next week.  I definitely was sure I couldn’t say anything to Tilly, because I know there should be a boundary for things I cannot disclose at work and I had no idea where that boundary would be.

I finally went on Friday to see the new on-call therapist, Kallie.  I had been reluctant to ever use that service again, despite Sadie’s reassurances about Kallie being nice.  Then I met her at CIT when she was a presenter and that made me just comfortable enough to try talking with her.  I told her that I didn’t need to be in inpatient right at that moment, but I was headed in that direction and needed help developing a plan to prevent it.  We talked about the disruptions to my sleep and I agreed that I would schedule sleep onto my calendar so I could see not to schedule other activities during that time.

As for the issue of medications, she brought Dr. Flanders in to consult.  I said that Latuda has been good for me, but I absolutely must go to sleep after I take it which is causing me to take it on an irregular schedule.  So I was hoping for an alternative that I could take at the same time of day regardless of my sleep.  I asked if we could just increase Lamictal and drop the Latuda, but he said that was a weak move.  I told him what other medications I’d tried and what the effects were.  He was pushing Risperdal, with Zyprexa as an alternate option that he didn’t really recommend because of weight gain.

I asked about the Zyprexa Zydis that is available in inpatient and he said having that PRN might be an option.  Then he threw out the possibility of retrying Abilify.  I said I’d be more comfortable with that than the Risperdal, because I’m still adjusting to a new job and don’t want to deal with potential unfamiliar side effects.  I had been on 5 mg of Abilify before and tried 10 mg but experienced akathisia.  Dr. Flanders prescribed it as 2 mg twice a day, but told me to deliberately be noncompliant.  I’m supposed to take one of them on a schedule and only take the other if I’m struggling with symptoms.

Kallie asked him to clarify whether we were trying the Zyprexa or not and he decided against it.  I took the prescription to the pharmacy and couldn’t fill it because it was Friday evening and required prior authorization from insurance, which can’t happen until Monday.  I was stressed about the delay, and happened to be back at the store for other reasons that evening so I inquired about the out-of-pocket cost.  $1,694.  For a generic.  The pharmacy tech did not seem at all concerned when she said, “Well, it should be approved Monday” so I ended up very irritable the rest of the night.

Dr. Flanders, upon finding out what my new job was, strongly advised me to not say anything to anyone at work.  I think that’s what made me decide that I disagreed.  So I was texting with Tilly yesterday and explained the situation.  She asked if I wanted to quit, saying she doesn’t want me to but my health is more important.  I absolutely don’t want to quit!  I said she could help me by reminding me before I leave that sleep is absolutely not negotiable.  Also that just the fact that I was able to share this with her helped a lot, because I’d been feeling there was no one I could ask for help anymore.

I’m feeling better, but still very anxious about the medication issue.  I don’t know if it’s going to help and I don’t know if I’ll still be having a hard time when I work this week since the medication change was delayed by 3 days.

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