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.

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.

Eventful Weeks

A couple of weeks ago I went off all my meds.  I’d been perfectly compliant since January 2nd, but I was planning to kill myself the next morning so I didn’t see much point in taking the medication anymore.  I missed them all for 6 days straight, until having to confess to Sadie.  I told her I’d restart them but needed to consult Brent for instructions on the Lamictal.  I immediately went to the receptionist and asked if Brent’s nurse was available for a few minutes.  She took me back to her office where I confessed what I had done and she told me to just restart them all.  I pointed out that I’d previously been told (by Dr. Bhatia in inpatient) that if I missed Lamictal for over 3 days I should restart at the lowest dose.

The nurse sent me back to the waiting room for about 15 minutes while she waited for an opportunity to talk to Brent.  She came back out and said he’d given the same advice she did.  She asked if I could contract for safety and I said yes.  She told me to keep my appointment coming up the next Tuesday and to call if I had a problem before then.

I felt perfectly fine off my meds.  I had some fatigue, but my mood was stable.  This definitely did not encourage me to take the meds again, even though I know that state won’t last.  When I did get to see Brent, I asked to try getting off some of the medication.  We agreed that this month he’d reduce the Latuda dose to 20 mg with the aim of eliminating it next month, and if there was a negative impact on my mood he’d increase the Lamictal to compensate.

There has been an impact.  Yesterday I woke up at 4:30 in the morning and was too restless to stay in bed, so I got up and went to work super early and ate breakfast in the cafeteria.  Then I got the giggle fits over and over again.  Initially I looked at an “oral hygiene kit” and thought, “What if we had anal hygiene kits?  Oh wait, they’re called enemas.”  I laughed so hard I nearly suffocated, and after this happened several times throughout the day my coworkers suggested drug testing me.

I crashed from this elated mood around 3 pm and felt inexplicably sad, then got super irritable for the rest of the evening.  We went grocery shopping and out to eat and I had some very unkind thoughts about every person who crossed my path.  Today is not so bad.  I’ve been very motivated and accomplished most of the to-do list that I wrote on my arm yesterday.  I’ll definitely keep an eye on the mood, but I already suspect Brent is going to need to increase the Lamictal.

A few days after I went off the meds on my own, I had a very eventful day.  I was scheduled for a mental exam with a psychologist for him to determine whether I was disabled, because Social Security couldn’t seem to figure it out from my records.  Spoiler: he said I wasn’t and my claim was denied a few days later.  Since applying, however, I’ve started to feel much better and more capable and I’m not going to pursue it any further.

In the middle of the mental exam, after I couldn’t remember 3 words after 5 minutes and started to get confused by repeating a series of numbers backwards, there was a knock at the door.  The psychologist asked if I was expecting someone, which seemed like a rather weird question, but it turned out the knock was for me.  Mom was at the door saying, “I have to go to the hospital now.  Bye.”  Not specific enough!  I said, “What hospital?  Why?” and she said, “Christ.  Kidney.  Bye.”

Yes, I was finally able to use the Hello Kidney gift.  Monday of last week, mom got a kidney transplant.  I completed my mental exam, which was rather unfair since I was too distracted to elaborate on the difficulties I have at work, and rushed home to pack a suitcase for mom and then rushed to the city to be with her until the surgery.  The doctors had to give her several units of plasma because her blood was too thin, plus three different antibiotics, so it was around 8:40 before they finally took her down to the operating room.

Mom was in the hospital for 10 nights, but I finally got to bring her home on Thursday.  Her news certainly overshadowed my acceptance to college.  Today I’ve worked super hard on preparing for that.  I received and replied to an e-mail from my academic adviser and have an appointment to meet with her in 2.5 weeks.  I e-mailed the disability services office at the college to request a meeting time to discuss possible accommodations.  I e-mailed the vocational rehab counselor who I worked with for job hunting last year to see if there is any assistance he can provide with continuing education.

I’ve also been busy with the Crisis Intervention Team.  I prepared a Google Drive where we can store the handouts from each presenter so that the participants can access them at any time.  I sent information out to everyone who was present at the last meeting so they can see the format and make sure everything is working okay.

Other busyness has included working on my book (a chapter and a half plus the epilogue to go) and changing my name.  I’d been going by a nickname for 17 years but still use my legal name for things like employment and medical care, so Sadie pointed out that I might be feeling inner conflict due to this incongruity.  She suggested that I needed to choose one, and due to my laziness I chose to go back to my legal name.  It’s not what I wanted and I’m unhappy about the choice, but I didn’t want to deal with a name change and updating my driver’s license and debit card and all those other documents.  I didn’t realize until after the fact that I would have a few hundred internet accounts to update.

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?

Tweaking Meds

11 days ago I called and left a rambling message for Brent about feeling worse and fearing that I was going to screw up my job and could we please do something about this before April?  His nurse called me back and after some phone tag she interrogated me about what was going on and asked me to hold on a moment while she went to talk to Brent.  He didn’t want to change anything without seeing me, but they squeezed me in for an appointment the next morning.

10 days ago I saw Brent, for the 4th time in a month.  I repeated all the information on how I was feeling and he said we could either increase Lamictal or Wellbutrin, but that his preference would be Lamictal.  I had mentioned the persistent thoughts of self-harm, and he thought it would help with that.  So we agreed to increase my total daily dose to 75 mg, with 50 mg in the morning and 25 mg at night, because I said that it tends to give me difficulty with sleeping if I take it too close to bedtime.

I went ahead and took the extra 25 mg for that morning when I got home, so today makes the 11th day on the new dose.  For the first several days I was feeling rather agitated and irritable, and my pre-existing urge to run away from everything I attended was persisting.  I want to say there’s been a hint of improvement since then, but I can’t put my finger on what has improved.  I guess maybe that I’m really not thinking about self-harm all the time, but it’s hard to see that as improvement when I actually acted on it for the first time in 5 months.

I still have no motivation, but I’m trying to force myself to do things anyway.  Basic life necessities, like helping with the dishes or doing the laundry or taking a shower before going out in public.

It’s 11 more days until I see Brent again.  I don’t think we’re done adjusting the medication yet.

Happy Blogday to Me!

Today is my blog’s 2nd birthday.  I wish I had something insightful to say at this point, but instead I’m just going to talk a little about how I feel.  February was a little rocky, as always happens in February, and as a result Brent didn’t think I needed medication changes but instead to just wait it out and see how I feel in March.

Well, last Friday I was reading a Chicken Soup for the Soul book, and instead of being inspired I was struck by what a worthless pathetic person I am for struggling so much with problems that seem so trivial.  I started to cry about this, and over the two hours of crying it developed into recognizing that my thoughts and my actions – the bad things I’ve done and the good things I haven’t – make me a horrible monster.  I was convinced that I should have died 2 years ago when this whole drama began.

The only bright side is that I had no plans to act on it.  I’ve had plans many times and this time all I had was the feeling that I would deserve it if I went to sleep and never woke up again.

This feeling did pass after about 24 hours, but since then I’ve been completely lacking in energy and motivation.  I’ve done the bare necessities, but mostly I’ve spent my time lying down staring at walls.  I feel like there’s no point continuing medication because even though changes sometimes help short-term, I always come back to the point of feeling terrible and wishing to die.

I was supposed to see Brent today.  When I came in for that emergency appointment 2 weeks ago he said to keep the one that was scheduled for today, so I showed up there 15 minutes before my appointment time.  His nurse called  me back to her office, and asked if I had an appointment for that day.  Ummm…  I said yes, that it was supposed to be at 10:30, and when she looked up my name and saw the list of my appointments it was on there, but on her list of people who have appointments today, it was not.  I was the third person so far today that had this happen.

She was flailing helplessly.  Brent was overwhelmed.  People were chewing her head off.  I am not one of those people.  I could see that it would be a real burden on them if I insisted on being seen, and I asked if they could fit me in Friday if that would be better.  She asked how I was doing and I told her I’d been a little suicidal a few days ago but it passed.  She was hesitant to make me wait, and asked multiple times if I would promise to call her if I had a problem between now and Friday.  I swore that I would be fine, and accepted an appointment at 3:30 Friday (but if I show up any time after 1 they’ll try to squeeze me in earlier).

I know what it feels like to have your job imploding around you.  One particular person at work was on my nerves Monday, and by the end of the day I refused to go back to that floor because I was afraid I’d punch her if I went near her.  I am usually very good at being nice to someone’s face no matter how irritating they might be, but I was past my breaking point by then.

I feel good that I felt confident I’d be okay if my appointment were postponed.  It helps a little that I see Sadie later today (and have the exciting plan of taking my cat along for her to meet), but mostly I’m in a good mood even if my energy level is crap.

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”.