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.

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.

Object Permanence

My local Community Mental Health Center has a 24-hour hotline staffed by an on-call therapist.  During weekdays, this is generally going to be one of two staff members from the inpatient unit, but on nights and weekends other therapists are assigned to the task and you have to leave your name and number and have that person call back.  The first time I was introduced to the concept was when I signed my first Contract for Safety back in February 2014 and part of the agreement was that I would call the on-call therapist if I were a danger to myself.

I had made use of this service twice, in two very different experiences.  First, I called once on a Sunday, during a lunch break at work.  The call was returned within 5 minutes, and lasted for another 5 minutes, in which we discussed a few stressors that were compounding in my life and how to avoid self-harming while I was at work.  It was very helpful, and I decided to keep an open mind about calling again in the future.

The other time I didn’t call, but walked in to the main CMHC office to speak with the on-call therapist in person.  It didn’t end well for me.  I was hoping to sort out some issues that were weighing on my mind, but the on-call therapist, Jan, was convinced I was a danger to myself and needed to be in inpatient.  That was in August 2014 and though there have been many times since that I felt I should be calling the on-call therapist, I would play that scenario out in my mind to what I felt was the inevitable conclusion, and not call.

Today I am less than 2 weeks away from making it a whole year without being admitted to inpatient.  Speaking to the on-call therapist would seriously endanger my ability to accomplish that goal.  However, I spent my whole work day having vague thoughts of hurting myself to avoid having to go to my job for a while (if not forever).  This feeling has come up a few different times since I started working there, and right now it’s due to interpersonal conflicts.  I’m no longer insecure about doing the job well enough, but I’m feeling very unsafe in my work relationships.

I don’t want to get too specific here, but I had a very hard weekend working alone last weekend, and in a moment of panic I asked some coworkers for help.  This ended up backfiring on me, with other coworkers becoming involved and ultimately going to the supervisor with information designed solely to get me in trouble.  Some of my coworkers gave me warnings about other of my coworkers, and I became a massive ball of paranoia, not only distrusting all my coworkers (including the supervisor), but also distrusting virtually every person I’ve ever met.  I mean, I was to the point of wanting to cut off contact with everyone but my family, around half a dozen friends, and my therapist.

I knew suddenly removing 90% of my friends on Facebook would be a total overreaction in classic Borderline Personality Disorder fashion, so I used the Wise Mind skill (balancing emotional and rational minds) and instead deactivated my account for a while.  Same effect of removing information from access by potentially untrustworthy people, but much more reversible after I had time to cool down.  By lunch today, I was to the point that I could reactivate my account, along with defriending and blocking some coworkers, but even the coworkers who remained on my friends list got demoted from “Close Friends” status as I was still quite suspicious of their intentions.

After work, I was pretty sure I’d be safe through the weekend, but really needed to share how I was feeling and didn’t have a lot of options for who to share with.  I sat in my car, staring at the phone in my hand, with the CMHC hotline pulled up in my contacts.  I tried to dial it, but I was shaking and near to hyperventilating with anxiety.  After a few minutes I thought, “This is really stupid.  The on-call therapist is right next door.  Go see her in person.”  So I put the phone away and walked over to CMHC and asked the receptionist if the on-call therapist was available.

I was required to fill out paperwork, again, which I questioned her about because last time I had nearly finished the paperwork when Jan came to get me and told me that as a current client I didn’t need to fill it out.  The receptionist said I still had to, so I sat down and scribbled my answers in as quickly as possible.  When I handed it in, the receptionist didn’t even get to call Jan before she happened to come out to the waiting room of her own volition, and moments later she took me back to a tiny little office – the same one where she had coerced me into inpatient last year.

I told Jan that I was having some trouble with work and had thoughts of hurting myself to get out of it.  I wasn’t able to be specific about the thoughts, as they were flitting around among options.  All I knew was that I didn’t actually want to die.  Score 1 point for me.  I had to endure reviewing all the background questions that would have been asked if I’d been assessed in the ER, although since it was a review of information already on file it went fairly fast.  I had to update her on the medication I’m taking – her records still included trazodone which I stopped over a year ago – and correct her on my tobacco history.  She asked about smoking and I said no, so she congratulated me on quitting.  What?  I was never a smoker, unless you want to count less than a pack total spread out over several years of hanging with the theatre crowd in college.  She deleted that from the file.

We did come up with a plan regarding the work issues, sort of.  She encouraged me to talk to my supervisor, using my Interpersonal Effectiveness skills to plan out my objective in the conversation and figure out what to say to achieve it.  Primarily, I’m to ask for guidance on how to prioritize when the work load gets overwhelming.  My difficulty on the weekend was that I was getting bombarded with calls and faxes while also trying to do the usual checking and replenishing of supplies, and I felt like I didn’t even have the time to take 5 minutes to take care of myself so I could handle it better.  Jan asked me what my Mindfulness skills would have told me to do in that situation.  I said, “Focus on one thing at a time.”  I wish I’d been able to do that in the moment, as maybe this whole situation would never have happened.

Jan asked if I needed to be in inpatient to stay safe and I told her no, that I could go home.  She said, “If I remember correctly, you’re the one who doesn’t like safety contracts.”  I laughed and said, “I’ll sign one if you want, but I think they’re a joke.”  She asked me to promise that I would reach out for help again if I were in danger, and said that on Monday she’d be available again and if I needed to come in I could specifically ask for her.  Or I could say, “I want to speak to the on-call therapist but not Jan” and she wouldn’t be offended.  I talked about how scary it is to ask for help, and she said that I shouldn’t be scared of her since we’ve met 9 billion times.  That sounded bad, but she clarified that she didn’t just mean in this context, she was including the numerous times per week that we pass in the halls of the hospital.

I was also asked to promise that I would tell my mother how I was feeling, I suppose so she could keep an eye on me.  I really didn’t want to do this, but my choices were promise to tell her or let Jan call and tell her, and I didn’t really enjoy it when Sadie called mom for similar reasons.  So I promised.  Jan said she had to go consult the psychiatrist to be sure he agreed with our plan, and when she left the room I chanted over and over, “Please don’t send me to inpatient.  Please don’t send me to inpatient.”  Finally she came back and told me I could go, without ever asking me to sign one of those silly safety contracts.

What was weird about the conversation was that Jan kept talking about my progress.  She had commented that when she sees me at work I seem happy to be there, and I said that I fake it really well.  She told me that was progress, that when I worked at my previous job I wasn’t able to fake it and that now I was much more consistent about my work attendance.  Even weirder was that she used lack of inpatient admissions as a measure of progress, and said that she had just recently been talking to another inpatient staff member about how long it had been since I was in there.  I always get a bit creeped out when I find out people have talked or even thought about me when I’m not there.  Similar to how babies have to learn about object permanence and understand things still exist when they aren’t seen, I have yet to learn about my own permanence.  I feel that no one should or does think about me unless I make my presence known.

Fear of Showing Compassion

Occasionally I bring gifts for Sadie to my appointments.  While the first one, a handmade chainmaille bracelet, was objectively the best, the most meaningful thing I’ve ever given her wasn’t a gift at all.  A few weeks ago I wanted to commit to stopping my negative actions of nicotine gum and self-harm, so I handed over all the gum and blades for disposal.

Today I’m at work alone for the 2nd day in a row.  I got called to do the one task I truly dread.  The task itself didn’t turn out that badly, but when I arrived at the patient’s room a nurse gestured for me to wait outside, because a doctor was speaking with the patient.  I couldn’t help overhearing the patient begging for more pain medication and being refused.

When the doctor finally left and I was free to go in I wished I didn’t have to.  I didn’t want to speak to this unhappy patient.  When I went in, he kept asking me to ask the doctor to give him pain medication and I felt terrible as I lied and said I would ask.

I left the room shaken.  When I told my employment specialist I wanted to seek work in the health care industry I didn’t foresee the reality of doing so.  I regularly have to restock cadaver bags on the supply carts.  I’ve started mornings off by watching a gurney with a human-shaped sheet roll past on the way to the morgue (where I’ve thankfully never had to follow).  I have to check IV pump numbers in ICU rooms each day, hoping the patient is asleep and has no visitors so I can silently slip in and out.

Usually I don’t have to hold a conversation with a patient.  Sometimes they ask for their table to be pushed closer or their thermostat adjusted, which I’m able to do for them.  Sometimes I have to go to the nurse’s station and pass a request along.  Recently in ICU I was trying to slip quickly out of the room when the patient said, “Please don’t leave me!” I wasn’t sure what to do or say.  She was 91 and haltingly asked if she could have breakfast.  I told her I’d go ask the nurse and hurried out of the room.

A lot of times I leave kicking myself over the things I could have said.  I once asked a patient, who was holding a room service menu, if he was finding anything good for lunch.  He said he’d been looking at the menu for half an hour.  The rest of the day I told myself I was a total failure for not offering advice on the best food choices.

Today was my first time talking to a patient who was truly suffering and I have to say I didn’t do a very good job of it.  A friend told me that what I’ve been through probably makes me more compassionate than others, but what good does that do when I don’t have the confidence to show it?  Every time I talk to a patient I am terrified I’ll get in trouble for saying the wrong thing.

After leaving this patient’s room this morning, I wished I had those blades back.  I could have easily gotten another one, and the bandages to clean up after the fact.  I thought about calling the on-call therapist, but couldn’t guarantee I’d be available when s/he returned my call, so I used my Riding the Wave skill, and also Turning the Mind.  I was able to stop myself from acting because I don’t want Sadie to think I’m intentionally backsliding. 

I also used Crisis Survival Network, contacting a couple of friends and relatives, and the first response I got made me angry.  It was about how everyone’s job is stressful and stress is good for me.  How is it supposed to help me to tell me, in lengthier words, to just suck it up?  I considered the on-call therapist again, and again I decided to work through it on my own.

Guess who I ran into in the elevator a few hours later?  The on-call therapist.  We rode silently down to the ground floor and as we parted ways I realized I could have asked if he had a minute to talk.  I mean, that’s what he’s there for, right?