Sometimes the Hardest Thing and the Right Thing Are the Same

I was absolutely delighted when I was hired for my job working in housing for people with mild-to-moderate mental illness.  This was back in January.  The delight did not last.  I spent most of the past 5 months becoming increasingly miserable, despite every attempt my supervisor, Tilly, made to help me fit in the position.  I made pages of pros & cons.  I did thought diaries until my hand cramped.  I exchanged a ridiculous number of phone calls and texts with Tilly.  I even took 3 weeks of medical leave, spending part of that time in inpatient, certain that the problem was me.

Sadie kept telling me I was a square peg trying to fit in a round hole and “it’s not the peg’s fault it doesn’t fit”.  I just didn’t know what to do if I quit.  Two weeks ago I finally took the leap and submitted my resignation.  My last day was supposed to be Friday, but after working Monday and telling the clients I was leaving, I started wishing that could have been my last day.  Tilly agreed that Friday would be very hard on me, and said if I wanted Monday as my last day she could make it happen.  So on Wednesday I went for my exit interview and turned in my badge and keys.

When I was lamenting that what I’m good at and what the job description consists of don’t overlap, Sadie encouraged me to take the StrengthsFinder 2.0 test.  I ended up with my top 5 strengths as Empathy, Strategic, Developer, Input, Responsibility.  These do fit in the mental health field well, but in a more administrative position.  That’s exactly what I was starting to discover while working – that I understand people and can help them, but I’d do better at more organizational behind-the-scenes work.

Even so, it took 5 months for me to stop being convinced that not fitting in at the job didn’t make me a failure.  I was so sure that I could do well at it and that clearly it was my mental illness standing in the way.  That’s how I ended up in inpatient, with Dr. Flanders dumping my entire medication regimen and starting over.  I thought clearly the meds weren’t working right and trying something radical would help.  In fact, it made things worse as the medication didn’t get to a therapeutic level so I was getting more depressed instead of less so, and I also had an array of unpleasant side effects, including being constantly drowsy and unable to concentrate.  I keep wondering if things would have worked out had I not changed medications.

My follow-up with the psychiatrist is not until the 24th, over two months after my discharge from inpatient.  I went to my family nurse practitioner for help, as she’s the one who normally manages my medication anyway.  First she increased my dose of lithium, after acknowledging it was the cause of my side effects.  Then when I started feeling tempted to skip my meds I returned, asking to switch back to the medications I was on before inpatient.  She was unwilling to make drastic changes, and instead of a gradual shift toward what I’d been taking before, she tripled my dose of Abilify.

Close to two weeks ago I couldn’t tolerate the drowsiness anymore and stopped taking the lithium.  A couple of days later I ditched my other psych meds as well.  Upon learning this, Sadie encouraged me to call the mental health center’s head nurse for advice on what to do until my appointment with the psychiatrist.  I was pleasantly shocked when the nurse told me to stay off the meds and just monitor for symptoms carefully and call if there’s a problem (or ER if there’s an enormous problem).  She indicated that maybe I don’t need so much medication continuously and they might be able to come up with a PRN medication instead.

It’s wishful thinking to believe that would actually work out, but I keep on wishing.  My mood is good, my anxiety is fairly mild, and the only thing worrisome I’ve noticed is a little bit of irritability.  Nothing unmanageable.

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Tidying Tasks

Two weeks ago I wrote about getting Support from Coworkers and how much it was helping me adjust to the job.  I’m still not adjusted.  I thought I was doing great, and then I was texting with a coworker while at work and we had a bit of a disagreement regarding whether I need to continue therapy, and I had a bit of a meltdown over thinking that I’ll never be “well enough” to properly help others.  I completely freaked Tilly out by texting her that I couldn’t do the job.

Then the night went terribly, or well, or both.  I had two major situations with clients that I thought I had handled well, but when I talked with Tilly in the morning it seemed like I had just horribly screwed them all up.  She had asked during the night if I wanted to quit or was just upset, and I told her that I honestly didn’t know and that I would do a pros & cons sheet to try to figure it out.

I e-mailed Tilly the pros & cons sheet, which resolved nothing for me, because I felt like everything was equally important.  I made a special trip out to work on Monday so that we could talk before my next shift.  We agreed that I would write out some “what if?” scenarios and how I would respond and then we could review those and she’d make suggestions.  She was concerned about the fact that my pros & cons sheet had indicated the possibility that I might end up harming myself, and made me sign a form that ended up essentially being an administrative version of a safety contract.  I felt very uncomfortable about it despite her promises that it would stay in her desk and not go to anyone else.  It indicated a follow-up plan regarding the “what if?” scenarios and that we would meet on Thursday mornings to talk before I went home.

This week went better.  I have a client who had previously told me I had “too much philosophical education” and didn’t know how to talk to regular people like him.  I’ve worked hard to remember QTIP – quit taking it personally – but this one was definitely meant personally and I knew he was right.  This week I managed to engage him in conversation and he has become friendlier again.

I had to attend first aid and CPR training Wednesday morning after working all night.  A coworker and Tilly’s boss both indicated that I never seem tired.  I said I do get tired, but I usually perk up again quickly.  I was showing signs of tiredness during the training – fidgeting a lot and having trouble focusing – and also I ended up having to take the nausea medication I keep in my purse because the first aid video nearly made me throw up.  On the bright side, my hands-on CPR test went perfectly.

Yesterday Tilly was coming in a bit late and told me I could have her boss sign my timesheet for practicum class, but I wanted to wait for her.  We talked for a bit, and went over to look at the office to determine what needs to be done before the auditors arrive in a couple of weeks.  I apologized for my obsessive tidying over the previous two nights.  Tilly touched the baskets of supplies on the desk and said, “I saw this and thought, ‘That’s my girl.'”

We came up with a list of other cleaning and tidying tasks that I would take care of before the audit, one of which was to update a calendar markerboard with more activities for the clients.  We noticed that it still said March and had March’s dates, so I was going to fix that before leaving.  I ended up staying until 10 am to erase and rewrite the whole thing because it was too messy trying to erase tiny spots and not smear the rest.  I feel like I should be frustrated at getting all these cleaning tasks, but really I just feel needed when I have special projects.

I’ve also gotten mutual support from a coworker who is experiencing some of the same challenges at adjusting, and I got a lovely e-mail reply from Tilly’s daughter, who had a rough time starting out when she worked in the same position I’m in now.  All in all, I’m still a bit shaky about whether this is the right place for me, but feeling a lot better about it than I was last week.

 

Support from Coworkers

My new job is…challenging.  I’ve been there for 2 months, and I’ve had many moments (even hours at a time) when I questioned what I was thinking when I even considered working in the mental health field let alone accepting this particular position.  I am brimming with self-doubt and insecurity about whether I’m suited to work with people who have similar issues to my own.  Despite this, I am constantly grateful to be given the opportunity, delighted at what I get to do, and genuinely like the clients I’m working with.  One of them accuses us of just working for a paycheck and not caring, but I truly do care.

What has been carrying me through is the amazing support I’ve received from coworkers.  Not a single one of them will tell me I’ve horribly screwed up, instead referring to mistakes as a learning process.  I’m a thousand times harder on myself than they are on me.  Multiple people in the field have commented on my position being particularly difficult.

I appreciate that I’ve been able to be open with coworkers about how I am struggling and give them the opportunity to share their experience and knowledge.  This week I worked evenings for the first time instead of my usual night shift, which required significantly more interaction with clients.  I made 7 shopping trips within 19 work hours, teaching clients to choose a balanced diet, compare prices and shop within a budget, use self-checkouts, and other skills needed in order to successfully shop on their own.

This evening my supervisor, Tilly, let me see some of her own weaknesses.  She told me a story of a…learning process she had when she first started.  She also told me that she doesn’t like the grocery shopping appointments and that I had taken some of the most difficult clients to shop with and done it successfully.  This was precisely the conversation I needed to have tonight.  It’s one thing for people to say that the job is difficult or that they don’t always make the best choices, but quite different to hear concrete examples.

I still didn’t do everything “right” on these shopping trips.  I had clients criticizing my driving since I’m still not used to the company van, and one client had to teach me how to cash a check at the bank drive-through as I’ve always gone inside for all my banking business.  However, I felt a huge boost of confidence upon learning that these shopping trips weren’t expected to be easy and that I handled them well.

Despite the positive experiences, I’m more than happy to be returning to night shift next week.  Being constantly bombarded by clients and their needs and wants for an entire shift was draining and left me wanting to crawl under the desk and hide.

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.

Job Transitions

I started working at the local hospital in May 2015 and have recently grown increasingly dissatisfied with my position.  Several of my coworkers did things to make work difficult on the rest of us, I got stuck working every other weekend (I agreed to it, but it got tiring after a while), I unwillingly got stuck working both Christmas and New Year’s weekends, and I was given just enough hours to stay right under the level of receiving benefits.  Outside my department there were no issues, and I enjoyed the job itself, but unfortunately the environment inside my department made it hard to sustain that enjoyment.

When I returned to college in August, my adviser encouraged me to consider the practicum course, in which you work 8-10 hours a week in a mental health setting and can earn 3 credit hours for basically just chatting with classmates about what you’ve learned.  She didn’t have any connections in my state, however, and the connection I had was struggling to think of something they could legally allow me to do.  My adviser did mention that a paying job could be used for the practicum, and in mid-November I submitted an application to work as a Residential Technician in the local residential facility for dual-diagnosis.  It wasn’t ideal, as it would make me have to quit DBT group and choose a new facility for any future inpatient care, but I was desperate to move on to the field I’ve chosen.

I heard nothing about that position.  My job became more unpleasant.  I wanted to actively search for a job, but winter had begun and I decided to wait for spring so I wouldn’t be learning a new job while having to drive to another state on icy roads.  Then I got a surprising e-mail.

A few days before Christmas, a lady from a different branch of the same organization said that she had seen my resume and wanted to know if I was available for a position she had open.  Let’s call this lady Tilly.  The position was also for a Residential Technician, but in apartment buildings for people with mild-to-moderate chronic mental illnesses.  She said the clients are mostly independent, but need some assistance to stay that way.

I had seen this job listing on the website and not even considered it, because it’s a 40-minute drive instead of the 10-minute drive I have now.  I was really excited that someone would approach me for a job instead of the other way around, so I scheduled a time to drive out there for an interview.  Tilly and a male coworker conducted the interview and it seemed to go really well.  I asked a lot of questions.  Then I told them I wasn’t sure if I wanted to pursue it further and would have to call in a day or two once I made a decision.

I had expressed a preference for days or evenings, then discovered that the clients need to be driven places, such as banks and grocery stores, every day.  I’m not very comfortable with driving in general, less so in unfamiliar places, even less so with passengers, and absolutely not at all with a large vehicle.  I went home prepared to call the next day and say I wasn’t interested.  Then I remembered one more question I forgot to ask, so I e-mailed Tilly again.

Her response requested that I consider night shift, in which driving would be limited to emergencies, and they would allow me to do homework in my down time.  She went over all the reasons she thought this would be a great opportunity for me.  I immediately raced over to see Glenda and we did a pros & cons sheet, which was pretty strongly in favor of the new job.  So the next day I dropped by the main center next door to the hospital and filled out paperwork for the background checks.

I got a call from Tilly the next day asking me if I could think of anything at all that I hadn’t mentioned that would show I’m a good candidate for the job, as the HR department had told her I wasn’t qualified.  I couldn’t think of much, and hung up the phone in tears.  I had gotten my hopes up, and there was clearly no way I’d get the job if I didn’t meet the qualifications.  Then I didn’t hear anything.  I was just about to contact Tilly and ask if there was anything else I could do to help the process, but I happened to mention the silence to Sierra and Rochelle after DBT group and Rochelle told me to hang in there because they were trying to work it out.

I got the job offer by e-mail that evening.  The qualifications in the job description they sent do not match the listing on the website, in ways that make it so I qualify.  I accepted the job immediately, turned in my two weeks notice on that Thursday.  My official end date was supposed to be January 26th, but my last scheduled day was the 19th and they made it clear they wouldn’t be calling me in to cover if anyone got sick in that final week.

Orientation for the new job is scheduled for January 31st, with me starting training on February 1st.  I’ll do a couple of days on day shift, one on nights, then back to days for a day so the supervisor can assess whether I need additional training days.  Yesterday I got another e-mail asking if I can attend the monthly RT meeting on the 26th.  I won’t get paid since it’s before my orientation, but I’ll get the opportunity to meet my coworkers, including the ones I’ll rarely see.  It would be great to meet people in a less stressful setting than training, so I agreed to go.

I’m excited, yes, and also a little terrified.  This will be my first job where making a mistake could have serious consequences.  Sadie said something that sounded harsh but I really needed to hear: “Sometimes clients commit suicide.  If you can’t accept that you can’t work in this field.”  I guess I won’t know if I can accept until it actually happens, at which point either I’ll cope or I’ll end up quitting my job and trying to figure out what to do with the rest of my life.

Struggling With Urges

Yesterday was World Suicide Prevention Day.  I had sworn off doing anything remotely productive that day, so I didn’t post then, but now I feel I should have said something.

Things have been going quite well in my life for months.  So far in my Abnormal Psychology class I have a perfect score, and even though we haven’t reached the first exam yet I have every online quiz done for the whole semester.  All the little details of college have been falling into place.  I’ve managed to drive to campus 6 times on my own.

Then I had some personal losses.  Brent began working in inpatient and I was no longer able to see him, so instead of meeting his replacement I transferred all my prescriptions over to my family doctor.  I tried to share good news with some people who’ve been very important to me in the past and despite knowing what to expect it still hurt terribly.

I had a conflict with Sadie and e-mailed her to say I wanted to terminate therapy.  She said we’d discuss it in person the next Monday (2 weeks after my previous appointment) and then was sick that day and I couldn’t get another appointment for 2 more weeks.

I got some hopes up about possibly becoming part-time at work, so when I was asked to work every other weekend (instead of every 6th) I agreed, thinking that was the solution to making me part-time.  As soon as I said yes I was told I would only be a .3 (part time is .5).  I was so frustrated and upset, and went to talk to HR about it, where I was told my supervisor can’t make these kinds of changes without consulting them.  So they planned to get involved, but I had no idea where that would lead.

I was working the weekend immediately following that Friday, and my weekend was going well.  There was a short period of panic Sunday morning when the phones weren’t working correctly, but other than that it was a quiet weekend.  Then I was walking casually down the hall, returning to my department, and out of nowhere I felt an intense urge to slit my wrists.  Not the kind that results in a few bandages, but the kind where you bleed to death.  I got downstairs and locked myself in my department, sobbing about how this kind of thing is going to keep happening over and over and I will never be fit to be a therapist for someone else when I can’t get my own life together.

That evening I struggled with these suicidal urges.  And again on Monday, and still on Tuesday, when I followed up on DBT group by walking over to the main CMHC building and asking to speak with the on-call therapist, Jan.  I rambled a bit incoherently and she smacked me with reality a few times.  She said it’s quite possible that I won’t be able to work with people who are acutely suicidal or actively self-harming, but that leaves a wide variety of options that I can handle.  She also talked about no one ever having their life together and feeling like an adult.

I explained about the plan to stop seeing Sadie, and how I said it was a Wise Mind decision, that I would be able to focus better on school if I wasn’t dealing with therapy and the reminders that I’m ill.  I admitted that I was trying to pretend none of it was real.  “And when has that ever been helpful?”  Never.  And I can never pretend it’s not real because I have to take medication four times a day, so there’s 1,460 reminders a year.  After nearly a month of not seeing Sadie I’m no longer even sure about my decision.  I felt confident at first, but over time I became sad and scared.

Jan went to talk to Dr. Bhatia, telling me that she worries about me sometimes and could go either way on the subject of inpatient.  I begged her not to send me, as missing school would just make my life get worse.  She came back from consulting him and had me sign a contract for safety with notes that I would: a.) see Sadie on Monday, b.) see my family doctor on Tuesday, c.) call a friend from my safety plan, and d.) follow the rest of my safety plan as needed.

So I got home, not telling mom where I’d been.  It wasn’t until the next day that I mentioned it and she could not understand why I might need to talk to someone.  The next day I had class, and I did not want to go.  Mom offered to drive me, and it wasn’t that I was worried about driving, but I let her because that way it would guarantee that I’d go and not just drive off somewhere random.  On the way home I was saying that if I’d gone to see Jan after class instead of two days earlier, I would have let her admit me.  Mom told me to stop talking that way.

I have used so many distractions and so many social interactions trying to avoid these persistent thoughts.  I do not want to die, I want to stop hurting.  Before my last inpatient stay I had weeks where every little thing made my heart physically ache, and that feeling is back.  Yesterday I finally got home and didn’t have the energy to keep fighting, so I gave mom a basket full of my pills and razors and asked her to go stash them somewhere hidden.

A part of me longs to go to inpatient.  I can keep myself safe without being there, but staying 4 or 5 nights would help me feel better.  Unfortunately it’s too late to do that without messing up my life again.  First exam on Thursday, work on Friday.  My window of opportunity has closed.

Wandering Restlessly

Last time I saw Sadie I suffered from An Embarrassment of Tears.  I managed to not cry when I saw Brent last week, but am really apprehensive about seeing Sadie again this afternoon.  I spent last night sobbing and suicidal, so either I’m going to cry again and feel embarrassed, or I’m going to not cry and feel ashamed that I’m not fully participating.

When I saw Brent he initially told me that he was making no changes and to return in a month.  Then he hesitated and said he could increase the Lamictal since my dose is so low, and maybe that would help the depression that still pops up frequently.  So I’m now taking 50 mg twice a day.  Dose increases in the past have led to a few days of feeling agitated, anxious, and irritable, so I was unsurprised when that happened, but then when I’d been on the new dose a week and it hadn’t improved I realized that this feeling had actually started a few days before the dose increase.

I called Brent’s office and his nurse called me back so I could repeat the same things I’d said in my voicemail.  She asked if I was having thoughts of hurting myself and I said no, because I wasn’t in that moment, but after she hung up to go talk to Brent I realized I probably should have said yes.  The nurse called back a few minutes later and said that Brent wanted me to wait for my next appointment (in 3 weeks) but call back if things got worse.  I hung up and burst into tears.

Brent had just commented to me on the fact that I tend to bottle things up and not ask for help, which leads to him and other practitioners being surprised when I am “suddenly” not doing well.  Except when I asked for help, I got told it wasn’t bad enough yet.  How am I supposed to know what bad enough is?

So I continued with my restless wandering and my snapping at mom over trivial annoyances.  I continued feeling tense and nauseated and having my heart race over absolutely nothing.  And I started taking more and more of my BuSpar.  I’m prescribed 45 mg a day, but a couple of times in the past I had taken a little extra and Brent was not concerned by that so long as it didn’t happen regularly.  Not sure what he’ll say about it being a lot extra for several days, but I’m sure it won’t be good.

The maximum daily dose is 60 mg.  I took 115 mg yesterday.  I laid in bed unable to sleep and fighting the urge to go swallow the whole bottle…and all the other bottles of pills in my possession.  I fought the urge to make a long, deep cut in my flesh.  I also fought the urge to call Deputy Wayne and sob to him about how horrible I am and how I should die, because it would just end up with me walking through the inpatient doors as a client again.

I’ve wanted to work there for two years and finally have some feeling that it might be possible.  I’ve talked with a number of CMHC staff members about the idea of working in that field, even in their organization, and they all indicated that it would be okay.  Brent said he currently has a client who works there.  Sierra said she’s known other staff members who still need to be hospitalized a couple of times a year, and the rule is just that they need to go to a different facility to do it.  I’ve submitted applications several times and recently wrote to the HR staff and explained why I think I’d be great for the job.

So going in as a client is not going to happen.  Except it might, because I don’t see how it can be possible to work in that field.  My dream was to work as a program assistant in inpatient while I finish up a BA in psychology, then work as a case manager while I get a master’s in counseling.  Then I realize that I can’t actually do any of these jobs because I’m a shitty person who is unfit to help others.  What’s the point of any of the plans I’ve been making, when I know they aren’t going to lead anywhere but to more misery?