The Positivity Kit

Eleven days ago I called the hospital where I had my two November inpatient stays to ask about admitting myself.  Ever since my psychiatrist failed to tell me that my latest suicide plan was non-fatal, I’ve been obsessed with dying.  I didn’t want to die.  I have so many things to live for.  I just feared the 10% chance that impulsivity would overtake me and I’d wind up dead.  Just as I was feeling I needed to go to the hospital, Sadie told me that Sierra suggested a therapy vacation.  (As it turns out, she only meant individual therapy, not DBT group, and DBT group is what I was actually burnt out on.)

So I was in the three week time span of this “vacation” when I called and asked if I could be admitted.  The hospital is in a neighboring state, and the admissions nurse was prepared to have me drive up there and come in, until she found out I have out-of-state Medicaid.  She told me they absolutely would not admit anyone under those circumstances.  Except…I was there twice last fall, with the same insurance situation.

I called again the next day, hoping someone else would give me a different answer.  It took over two hours to receive a call back, then that nurse said she’d need to transfer me to the financial department.  I left a message there, and never received a return call.  Around 6 pm I had mom take me to the local ER, in hopes that the staff there could facilitate a transfer as they had in the past.

I met with an on-call therapist, Charles, who I had previously met and hated.  He didn’t think a 10% chance of suicide was worth worrying about, but it’s not his call, and the on-call psychiatrist disagreed.  The plan was to try getting me admitted to the hospital I’d called, and if they wouldn’t take me I’d be willing to be admitted locally.

That’s not what happened.  Through a series of lack of communication and being bullied by ER staff, I ended up at an unfamiliar hospital in my state, but two-and-a-half hours from home.  I had been prepared to tell the staff at my preferred hospital to keep me at least a week no matter what I said trying to convince them otherwise.  I know me.  I know I will try to get out.  That’s exactly what I did at this new hospital.  I didn’t even give it a chance.  I just freaked out and in less than 24 hours had signed an AMA form (to be discharged against medical advice).

The psychiatrist who saw me the next day said that, since I actually wanted to leave Monday, I needed to fill out the form again.  This made no sense to me or to any other staff, except that one nurse suggested he was using it as a loophole, because he had to choose between discharging me AMA or getting a 72-hour emergency detention from a judge and maybe he really disliked both options.

At any rate, I saw the normal weekday psychiatrist for the first time on Monday, and by 9 pm Monday night I was back home.  I knew almost as soon as I left that this was a horrible mistake, and it doesn’t seem like my mom even cares.  The closest she came to seeming concerned was to interrupt a sobbing meltdown yesterday to ask if she needed to call 911, to which my response was, “That would land me in jail because I would fight their asses.”  I would.  I adore cops, but there is no way in hell I am ever letting one take me to a hospital again.

So where does the “positivity” in the title come from?  Well, to explain that I must first explain the turtle.

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On Sunday we had the option of leaving the unit for art therapy.  This is normally my favorite part of any inpatient stay.  Not so much this time.  The art room was crowded with furniture and way too many people.  The tables were filthy with paint smears and plaster dust.  Then, instead of announcing a project, the art therapist gave us a quick tour of what was in every drawer and cabinet, and told us to engage in free expression.  I was anxious in that room and overwhelmed by the choices.  I chose the fuse beads because those supplies were already sitting out, on a table away from the rest of the crowd.  I had my turtle ready in record time, then asked if I could please stand in the doorway because the room made me anxious.  They went so far as to let me sit on the floor in the hall.

I looked at my turtle all the time during the rest of my stay.  Despite the suffering associated with him, I think he may be my favorite thing I’ve ever made in a hospital.  Then I stumbled upon a book titled The Positivity Kit by Lisa Currie.  It was marked on the front that we should have copies made rather than writing in the book.  As with the art room, I was far too overwhelmed to choose pages, so I asked a staff member to copy four or five random pages for me.  When I got home I ordered the book for myself.

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I have yet to even write my name on the first page as the book instructs me to do, but I hope to make it a colorful reminder of happy memories and wishes for the future.

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Stolen Freedom

On Monday I had an appointment with Sadie.  I wanted to summarize the week since I’d last seen her before addressing my real issue, which was a friend who was staying with me.  I didn’t even get to summarize the positive parts (including seeing a play and going to a sober prom), because I briefly mentioned a suicide plan I’d had for about two days, and that led into a lecture on needing to adjust my attitude so that I can be content within my current life circumstances.  45 minutes of lecture, and then Sadie completely blindsided me by wanting to send me to inpatient.  I didn’t need that.  I was not in danger.  I had pills on hand, but did not intend to use them.  In the past she would have had me call my mom to dispose of them, but this time she leaped straight to inpatient.

I specifically said I didn’t want to go to the inpatient unit affiliated with her organization.  So what happened?  She contacted my psychiatrist and arranged for a direct admission to the very inpatient unit I didn’t want to go to.  I had a 10 minute time limit to arrive at the main center before the police would be called.  Don’t think I didn’t look at my gas gauge and calculate how far away I could get if I fled.  But I did what I desperately did not want to do and drove straight to the main center.  My psychiatrist spoke with me for about 10 seconds, reiterating her decision to admit me despite my objections, and then I sat in the waiting room for THREE HOURS AND THIRTY TWO MINUTES.

Initially I was waiting with a friend who was also being admitted.  They even ordered us lunch trays from the cafeteria and we ate them in the waiting room.  My friend had arrived first, so he was admitted first, leaving me to wait there alone.  When I finally got admitted, I saw that a “friend” who had gone missing weeks ago was there.  I do like her, but I don’t consider her a close friend, and guess what?  She found out I was about to be admitted and told all the staff that I was her best friend.  I quickly corrected that misconception!  She would not leave me alone, even when I specifically stated that I’d like to be alone.  She would not let me visit with my mother in peace or eat in peace or journal in peace.  I hid in my room whenever possible to avoid her.

Every time I spoke to a staff member I had two things to say: that I didn’t belong there and that this other patient was causing problems for me.  On the first full day, the nurse who went over my treatment plan hinted that leaving that day might be possible, but my psychiatrist said, “Maybe tomorrow, but that’s not a promise.”  I was asked if it was okay for a certain other patient to move into my room with me, and I didn’t feel like it was a real choice, so I said okay, before realizing that her psychotic ranting would keep me up all night.  When I tried to hide in my room to get away from the first problem patient, she came in and was talking about murdering people, and was not completely caught up in her hallucinations as she made references specifically to what I was doing and wearing.  I was terrified.

I didn’t know what to do.  I just wanted out of there as fast as possible.  I went to hide in the back bathroom, where I screamed at the top of my lungs.  Jan, the prior on-call therapist who has been covering some shifts lately, ran out of her office saying, “Did anyone else hear that?”  The staff said no, some patients said yes.  She went around locating patients and I heard her ask where I was.  A moment later she was knocking at the bathroom door and calling my name.

I ran out, frantically saying, “You have to get me out of here.  There isn’t anywhere safe.”  After we talked, she said that she would talk to the staff about letting me sleep in the quiet room that night.  The quiet room is scary too – restraints built into the bed – but still less scary than spending the night thinking my roommate might strangle me in my sleep.

When evening came, I asked the nurse who brought my meds about sleeping in the quiet room.  He said, “I don’t think that’s going to be possible tonight.”  About 10 seconds later I was invited out for snacks and a different nurse informed me that I didn’t need to worry because they had moved my roommate again.

I did manage to go home after two nights, but that’s two nights of my life that I can never have back.  I don’t understand why Sadie felt the need to send me there.  I thought she knew me well enough to know that if I need to be in the hospital to stay safe I will be the first person to say so.

Also, that particular inpatient unit, which I didn’t want to go to, is completely useless.  No actual treatment takes place, and it’s basically like the drunk tank in jail.  They lock you up until they think you’ve sobered up.  The real tragedy here is that I no longer trust Sadie.  I have always been honest with her, even sometimes sending an e-mail if I accidentally lied by omission, but I know there are going to be intentional omissions now and therefore therapy is a complete waste of time for both of us.  She will never again be the person I confide in when I’m feeling really down.  This is exactly the opposite of what she’s been trying to accomplish with pushing me to express my emotions and not put on a smile to make everyone else feel better.

I hate this.  I hate all of it.  I had asked my psychiatrist if I could become a meds-only client and discontinue therapy, and Sadie’s response was that I was obviously angry with her about something.  I was, but that wasn’t the whole story.  The few weeks I managed to not see her were some of the best weeks of my life.  I know therapy isn’t meant to make me feel good, but I shouldn’t leave feeling a thousand times worse than when I came in.  There’s something wrong if I am in a great mood when I arrive, and then go sob in my car after the appointment.

Bree

Every time I have a stay in the inpatient unit there are one or two people I really connect with and we exchange contact information to stay in touch.  In my most recent stay, one of these was an 18-year-old girl I’ll call Bree.  Bree was depressed and suicidal and had a tendency toward self-harm.  She had been there for two weeks, and spent the past week sleeping in the “quiet room” so she could be monitored more closely.  I shouldn’t be impressed by this, but she fought the staff and it took four of them to hold her down – she had a real fire in her, despite the depression.

Nearly another week later, on Thursday, Bree was released despite telling the staff that she wasn’t ready to go.  She immediately began messaging me on Facebook to talk about how scared she was to be at home because she was still suicidal and didn’t understand why they sent her home.  I talked with her nearly continuously all evening, and again the next evening.  On Friday night she attempted suicide while talking with me.  She had taken an unknown quantity of an unknown combination of pills, and the moment she said she had taken them I called for help.  I didn’t know her address, but I called the inpatient unit and asked them to call 911.  13 minutes later she stopped responding, after sending a final message of “I’m started to feel funny.”

I have to assume that the inpatient staff took me seriously and that help arrived.  I have to assume that she was taken to the hospital and her physical symptoms were managed and she was readmitted to the inpatient unit.  I have to assume these things because the only way I’ll ever know that she’s okay is if she messages me again, which could be weeks or even months from now.

I know that I did everything I could, yet I still feel like I failed her.  Like when she refused a ride to go back to inpatient, I should have offered to come sit with her.  Or when I woke up Friday morning, I should have messaged her immediately instead of waiting until she decided she wanted to talk.  I feel like there was something I said, or something I didn’t say, that would have made a difference in her decision.  I know this is unreasonable.  I know she was in pain she thought she couldn’t bear anymore, and nothing I said in a Facebook chat was going to magically fix that.  It doesn’t prevent me from thinking about her non-stop, unable to concentrate on anything else.

Self-Harm and Buddhism

At work there is a program called Illness Management and Recovery (IMR).  It was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and consists of 10 modules on managing mental illness.  I am not trained to teach it, but have been working through the modules myself to learn more.  Most recently, the assignment was to explain a symptom to others.  I wasn’t sure which symptom to cover, until I spent 5 nights back in the inpatient unit last week.  I’ve struggled a lot with suicidal ideation and urges to self-harm over the past three months, and reached a point where it was beyond time to take a breather from life and go somewhere safe where I could focus strictly on taking care of me.

While there, I began reading The Buddha and the Borderline by Kiera Van Gelder.  It is a memoir of her experience of Borderline Personality Disorder and her path to recovery via Dialectical Behavior Therapy (DBT) and later delving into its roots in Buddhism.  Early in the book there were some fairly graphic descriptions of self-harm, which I only felt okay with reading because I was in a safe place.  It turns out, it wasn’t entirely safe.  They do the best they can with keeping dangerous objects out, but those of us who self-harm can get pretty creative.  At one point I found something dangerous that was built into the architecture.  I showed it to a nurse and she said she would report it to the director of the unit and that I should come tell a staff member if I was feeling tempted.  One night I did.  I’d been feeling anxious during visiting hours and when my mom left I called the same nurse over and told her I felt tempted toward the thing I had shown her previously.  I also handed over my statistics folder mom had just brought for me and asked her to please remove the staples from the packets of notes.

The nurse told me to stay put, but it didn’t totally register and after a different staff member handed back my folder without even speaking to me I started to get overwhelmed by the noise in the main commons and moved to a smaller area near my room.  The nurse came rushing in and happened to see some recent scratches on my arm from before my admission, which led her to exclaim, “Did you hurt yourself?  I told you to stay put!”  I explained that the scratches were older, and she told me that they would like me to sleep in the quiet room that night so they could keep an eye on me.  The quiet room?  That’s the nice term for seclusion room, which is the nice term for restraint room.  The only furniture was a bed in the center of the room, with restraints built in.  The lights were controlled from the outside, there were cameras monitoring the room, and there was no handle on the inside of the door.  Now on the bright side, they really just were putting me there for the cameras, and the door was not fully shut.  I was allowed to get up and leave to use the bathroom or go to the water fountain or ask for sleeping medication.  It was still rather intense.

It was also completely warranted.  The dangerous item I had found wouldn’t do serious damage, but it was in a place where no one would see and stop me, and I could have hidden the marks had I acted on my urge.  So why self-harm?  It can be many things.  It can be a punishment.  It can be a release of psychological pain in physical form.  Those are the main two things for me.  If I’m hurting intensely, it’s less painful to transfer that into something physical.  I’m also usually tempted toward it when I feel shame, which unfortunately I feel frequently and for sometimes inexplicable reasons.  The important part to note is that, while many people both self-harm and feel suicidal, the act of self-harm is not a suicide attempt.  Severe acts of self-harm could result in death, but it’s different if death is not the intent.  Self-harm is a coping skill, just not a very healthy one.  Some people come home from a hard day and have a glass of wine or eat a comforting meal or go exercise intensely for an hour, and all those things reduce the pain somewhat.  Self-harm does the same thing for some of us, and therapy (such as DBT) is about replacing that with a healthier way to reach the same end result.

I finished reading The Buddha and the Borderline last night, a couple of days after my release from inpatient, and toward the end the author asked one of her Buddhist teachers if suicide was the same as killing another person.  Likewise, is self-harm the same as attacking another person?  The conclusion was that it is impossible to fully practice loving-kindness toward others if you cannot love yourself.  I can’t say that I will never slip and act on those urges again, as that’s much too simplistic to think a line from a book is going to undo decades of experience, but the book did inspire me to look more into Buddhism.  I am not a spiritual person.  I am even less a religious person.  I have, however, found myself drawn toward Buddhism over and over throughout my adult life, and have benefited immensely from DBT and the elements of Buddhism Marsha Linehan incorporated into it.  So I am steering my upcoming focus on reading toward books on the topic, to discover if it is something I want to explore further.

A Coming Out E-mail

At the first meeting I attended of the Crisis Intervention Team we discussed a difficulty with CMHC’s inpatient unit.  That is, that they were experiencing a nursing shortage and had to limit their census to 4 clients (down from the maximum of 16).  They usually have no more than 5 or 6 at a time, so that’s not a huge reduction, but it did mean that the emergency department was having to hold people longer while trying to find another facility to send them to.  This is difficult as we are near the state border and the nearest hospitals are all in other states.

I was asked not to spread this around to other clients and alarm them, since there is a solution,  even if it’s not a great once.  So I haven’t discussed this much.  However, there was recently an e-mail sent to the entire nursing staff of the hospital asking for RNs to work 2 shifts per week at CMHC for a 60-day period.  This e-mail stated that inpatient was closed, and unfortunately that seems to be the case.  I’m no longer seeing their meal and laundry carts in the hall, and when I wait for the elevator I can’t hear the TV that they have blaring during all waking hours.

I’ve never been very quiet about my mental illness…it comes up in conversation and I don’t have much of a filter as far as who to share with.  It was still a huge leap when I hit reply to all on that e-mail and asked for the nurses to please consider helping out.  I said that inpatient is a vital part of mental health care in our community.  I said that they had saved my life and I hate to see that resource be unavailable for others in crisis.  I probably haven’t even met half the people who received my e-mail, but I felt something had to be said.  Maybe hearing from someone who has actually been there will persuade some people to volunteer.

Super Picky Directions

In inpatient they are really good about accommodating client preferences in regards to medication.  My BuSpar prescription was originally written with the directions “TAKE ONE TABLET BY MOUTH THREE TIMES A DAY AS NEEDED”.  The next time I entered inpatient, they were expecting me to come ask for the BuSpar if I needed it, but at that point I’d been consistently taking it on a schedule and when I told the psychiatrist that it got put on a schedule.  A very strange schedule, that I’m sure made sense to them, but I was used to taking it with meals and that lining up pretty well with when I started to get anxious.  So I mentioned that and next thing I knew I was getting it with meals.

Latuda is designed to be taken with a meal – it requires 350 calories to be metabolized properly.  Unfortunately, if I take it with a meal I am going to be antsy and irritable within 60-90 minutes and have to resolve that by going to sleep.  So I’ve traditionally taken the Latuda at bedtime, with Brent’s approval, despite the fact that I rarely eat that large of a snack before bed.

On my latest inpatient visit they were quite agreeable to moving it from breakfast (their preferred time) to supper, but reluctant when I asked to wait until bedtime.  The first night the nurse came to check the calories in my snack and made me take a second carton of milk because there weren’t 350 calories.  The next night, I had some Fritos given to me by another client and that nurse suggested I take peanut butter and graham crackers to fill up the rest of the required calories.  I did not want peanut butter and graham crackers, but I ate them and was halfway through the Fritos when she came back with the Latuda and didn’t want to give it to me because I hadn’t finished my snack!  I promised to eat the rest of it but felt an overwhelming temptation to throw it away out of spite.

I picked up my Latuda prescription today and happened to notice the directions.  It now says “TAKE ONE TABLET BY MOUTH AT BEDTIME AS DIRECTED WITH 350 CALORIES SNACK”.

The Joy of Lamictal

I’m writing this on my phone so it will be shorter than usual, but I wanted to share that I’m really glad I went to inpatient last week.  I wish I had done it 6 months ago, although that would have been bad timing with my then-new job.

I started asking Brent for Lamictal over a year ago.  He consistently put it off, trying to fiddle with dosages on my existing meds instead of trying anything new.  When I threw the idea out there in inpatient, I expected to get a similar response from Dr. Bhatia.  Imagine my surprise when he said, “Okay.”  Well, what he actually said was, “Four medications is a lot, but that’s a class you aren’t already on.”

A week and a half later, I feel stable.  I’ve had days here and there in the past that felt okay, even sometimes several days in a row, but this sense that I am calm and can handle stress and everything is going to be okay?  That’s totally new.

For the past few days I’ve been on vacation, staying with my best friend, her husband, and their 5-year-old daughter.  Their daughter is intense, to put it mildly.  She has not calmed down any since my last visit in summer 2014, and has actually been wilder since she’s getting over chicken pox and has been cooped up in the house.  On my last visit I had a very difficult time handling her and had to practice my newly-learned mindfulness skills to survive the week.  This visit is going much smoother for me.  The mindfulness skills are much easier to put into practice now, partially because I’ve been using them longer, but mostly because I’m just not feeling the stress. 

There have been some studies that indicate Lamictal is also helpful for the day-to-day mood swings associated with Borderline Personality Disorder, and it feels like that might be true.  There have been the occasional thoughts of suicide or self-harm popping into my head, but instead of temptation to do it I just think, “Gee, why would I want to do that?”  The real test will come when I am back home and have my first conflict with mom since my release from inpatient.