Obedient sheep

A couple of days ago I received a letter in the post from my GP surgery, asking for me to come in for a blood test (lithium related). I had it done this morning, and the nurse told me to ring in a few days to get the results…except, I’m not sure I care. And if I don’t care, why on earth did I bother to have the test?

The lithium clearly isn’t killing me. I doubt I’d really mind if it was, so it doesn’t matter if my lithium blood level is too high. And I can’t tolerate a greater dose, so there’s not much I can do if the level comes in too low.

I had the test because the letter told me to. I’m just a sheep. Do this MQ. Okay, sure. Just don’t ask me to feign interest.

One day I’m going to reach the point where my vein is damaged-beyond-use from all the tests and the donations. Then I’ll regret this.

Advertisements

Swaying in the wind

Today I made a bit of a change and told my doctor I want to go back to having monthly prescriptions (I’ve been on weeklies for a long time to reduce my OD risk). In truth my OD risk hasn’t really disappeared, but I know that if I wanted to OD and didn’t have enough prescription meds, I’d just turn to over-the-counter sleeping pills.

The reason this change feels noteworthy is that it’s me finally acknowledging the loss of the second part of my ex-treatment trinity; my GP. This time a year ago he had me coming to see him each week, and I knew that if things were rough he could help me through it. He retired last summer, and I switched over to a different GP who is quite possibly the loveliest, politest woman in this town, but she’s not the same. The support isn’t the same, and the trust isn’t there. My old GP knew my mental state by looking at me. He knew when I was lying, and he knew what was best for me when I didn’t.

As you can probably tell, I miss him a lot, and I valued his support so much that I continued going to the surgery every week to get my prescription and sometimes see the other GP, just in case things changed. But they haven’t. I’m giving up, and saying goodbye to the hassle of phone calls and pharmacy queues every single week.

The other news today is that I’ve got a job interview lined up, for a (temporary) flexible and well paid job near where I live. It’s very computer-system based, but the person I’ve spoken to knows I have little relevant experience and is still interested based on a positive reference from my last employer. If this works out (and I don’t dare hope that it will), it would solve an awful lot of problems. Bye bye stressful-childminding. Hello financial independence, most importantly the ability to pay my own therapy bills.

I’m going to head up to my Dad’s office tomorrow to try and get a bit of relevant experience by playing around on their systems (safely, of course).

For now, I’m going to bury myself in hobbies again, and pretend that I’m okay.

The uneasy middleground

Despite my self-reminder yesterday, I was still surprised by how strong 7.5mg mirtazapine (Remeron) is. I swallowed, and about 10/15 minutes later I felt extremely tired. I then slept like the dead. This is with only half of a pill. I don’t feel terribly tired today, but I was able to sleep in until about 11am. Tomorrow I have to get up early to go and puppy-sit, so that’ll be a better test of how long the drowsiness lasts.

The extreme-sounding suggestions from the psychiatrist yesterday are continuing to play on my mind, and the more I hear about it, the more I come to think ECT is something I really don’t want to have. I’ll keep researching both ECT and ketamine-infusion, but I do wonder if they’re both a step too far.

If my regular GP hadn’t retired, I’d ask him. Sad times. I don’t feel like I can discuss this with Dr T, who’ll be back from his six week holiday in a fortnight. He’s pretty anti medicine, so I’ve been filtering out that side of my treatment for a long time. He has even phoned up my GP to suggest taking me off meds altogether (without telling me). I have no doubt he’d have a negative reaction to what my psychiatrist has said, but then again, I expect he’d react the same if she’d said I should have more vitamins or something minor like that! This is one of the reasons my GP was so valuable; he sat in a perfect middle ground between medicine and talking therapy – he could see and appreciate the merits of both, with no vested interest himself. Dr T didn’t believe that, but I’m pretty sure of Dr T’s bias from what I’ve heard from another of his patients. 

It is hard to find a balanced view, when most of the medical professionals sit pretty firmly in one camp or the other. Of course Dr T is going to largely disregard meds in favour of therapy given the focus of his training, and of course my psychiatrist is going to push meds over talking therapy given her background. And I would have expected my GP to push meds too, but he made it clear from the start he didn’t want me taking anything I didn’t absolutely need. We only started my medication regime after we’d established therapy alone wasn’t enough (as evidenced by a lack of progress in 10 sessions).

Sometimes it feels like the patient has to sit in an uneasy middle ground, where navigating the way forward is a real challenge. I have a feeling that most people who have a therapist and a psychiatrist see more of an alliance between them, or at least don’t see them in conflict/opposition to each other. 

I won’t let you hurt me

Stop telling me you’ll be there for me.

I don’t need to hear that you’re around every day

Don’t look at me, don’t use that gentle tone.

I won’t let you hurt me.

Maybe that’s a little strong, but I’m feeling super-defensive after the demise of my treatment-trinity. Today I had a GP appointment, with a doc I used to see on occasion when my regular GP was on holiday. She is very friendly. Very softly spoken. She’s always running late because she takes time with every patient to find out exactly how they’re doing, medically and otherwise, and then writes up their notes in detail.

This scares me, so when my original GP left I chose to see locums instead of switching to her, but today I didn’t have a choice.

I haven’t seen her since Easter time when I rather desperately asked for an extension on my dissertation. She remembers that, and noted that I looked pretty ‘flaky’ today compared to last time. But I was not going to play this game. Every time she asked how I was or anything like that I’d say ‘fine’ and immediately ask about my prescription/lithium level results/ANYTHING. 

I could almost feel bad, because she was trying really hard, and I must have come across as pretty stubborn, but I don’t feel like I have a choice anymore. She kept reassuring me that she was going to be working every day so I could talk to her any time etc…and I just had to get out of there. 

Aaaaah.

My lithium level came back at 0.5 after taking 800mg nightly, which is still a little below target. In fact, I think it’s the same reading we got at 700mg. I’m seeing my psychiatrist tomorrow, so she’ll decide if I should keep taking it or not. If I keep taking it, I have to deal with worsening side effects like this tremor. If I stop taking it, I risk losing the suicide-protection it seems to have given me (unless that has more to do with the fluoxetine). 

We’ll see.

I miss my treatment-trinity

As I was packing my stuff ready to move back to my usual house (in my uni city, shared with another family), I realised I was feeling sad. Given the recent void of emotion, this was surprising, but the cause came to me quite quickly: I miss my treatment-trinity.

My treatment-trinity: Dr T (therapist, on a 6 week vacation), Nurse L (psychiatric nurse on the crisis team, recently quit), and my old GP (recently retired, my most trusted person for two years).

I don’t just miss them, I really miss them. Their guidance, their trustworthiness, the safety I feel in their presence which allows me to take off the mask of ‘normality’, and most of all…the sense that they understand my mental chaos a lot better than I do. I can’t tell you how reassuring that feels at times; when it seems like your world is falling apart, or your brain has finally broken, knowing Dr T, Nurse L, or my GP might see it as something they understand/have seen before can be a powerful thing to cling on to.

And this all feels like an excruciatingly painful admission. My instincts whisper that I should know better than this: I’ve learned over and over that you only set yourself up to be hurt if you’re not prepared to lose these people at any given time. They’ll quit, or find a better job, or retire, or give up…(and if this sounds a little harsh, forgive me, but this has been my experience in the world of health professionals). The mantra: don’t be dependent on them. Don’t need them. Repeat ad infinitum.

Something else tells me it’s natural to miss them, and that as much as I’d like to be the super-independent-woman-who-doesn’t-need-anyone, I’m not that strong. Maybe that isn’t even strength; maybe strength would be to allow yourself to need someone. But I can’t do that right now. I can’t risk pain. And I can’t shake the feeling that I’m failing if I miss people like Nurse L, given the number of reminders I’ve had not to let myself be attached in any way.

It all means this sadness rubs against me as a reminder of failure. Sadness about the sadness.

Closure on a crutch

Today I had the appointment to meet my new doctor (GP) and get the lithium blood test results. When I entered, my secret wish that my usual GP might just be on holiday was crushed: there was a sign announcing his official retirement, and giving details of his replacement. The sign also said the staff were making a retirement book of patient messages, and I’m quite proud of myself for being brave enough to go up to the desk and ask to sign it.

This is the closest I will come to finding closure on the loss of a person I have trusted more than anyone else in my worst and darkest moments. My GP was a crutch; the most reliable of three with Dr T and Nurse L. Now he’s gone, and I expect to lose Nurse L next month, as her help was only supposed to be very temporary when I was in crisis.

I don’t think I can say anymore about that; it hurts. It doesn’t matter too much right now because I’m reasonably stable, but I’d be lying if I pretended I wasn’t absolutely terrified at the prospect of coping if things go downhill. Here’s hoping that won’t happen.

After signing the retirement book, it then turned out that the GP I was meeting today was a locum, and the permanent replacement doesn’t actually start until October. Fortunately I really liked the locum (unfortunately I have no idea if I’ll see him again!).

Blood test results: my lithium level has gone down to 0.4, without a change in diet or anything else. This means we needed to up the dose a little bit, but this brand of lithium rather unhelpfully comes only in doses of 200mg and 400mg, which means jumping from 600mg to 800mg just for a tiny rise in lithium level. Our solution is that I’ll alternate between taking 600mg and 800mg each night, and have a blood test next week to see how that’s working.

Can I just point out that there’s a problem here: the blood test result next week is going to be different depending on whether I took 600mg or 800mg the night before. I think I really ought to have two blood tests, one after each dose. I’ll point that out to the nurse next week.

Now my GP-shaped crutch is gone, I won’t be going to the surgery every week except to pick up a prescription. As much as I liked the locum, by nature of his temporary status I won’t be sharing anything with him that isn’t strictly related to my meds, and he won’t ask (like today). In October I’ll make an appointment with the replacement, and see if I get on with her. I really hope I do.

Therapy and a tribute

Despite the nerves I expressed yesterday, therapy today went quite well. As predicted, I had to revisit the pain over my doctor not telling me he was leaving, and I’ve been encouraged to ‘feel and deal’; feel the emotions I’ve been blocking over that, and do something to deal with them. At the end of this post I will write a draft letter to my doc, and if I’m brave I’ll send him a card next week.

Dr T and I also realised in session today that at an unconscious level I’m really angry about something – it’s so important that unlocking the repressed event/finding the source might make a huge difference to my depression. Sometimes when I go to bed, I find myself saying something out loud without really realising, and without any previous thought. Throughout my late-teenage years I would say ‘help me‘. In the last couple of weeks, I’ve started saying ‘do you even realise the damage you’ve done??!‘. As much as I hate the concept of my unconscious communicating something, this can’t be ignored. I’m just scared I won’t ever find what I’ve repressed.

It was also good to share what happened last night: one of our cats brought in a live (injured) bird, and I was really upset while dealing with it. I couldn’t save it. And people find it funny that I even care, which in turn makes me angry about human arrogance. Anyway, Dr T didn’t laugh at me like others have, and he reassured me that my distress was normal. But why should anyone give a damn about my distress…that bird lost its life. I couldn’t help it. And that bird didn’t exist in a vacuum – it was a living being, a part of an ecosystem, and it’s death will affect other parts of the ecosystem…

*Rant over*

Next week will be my last session with Dr T before he takes a month off, and I’m trying to figure out how to turn that month into something really positive. I’m thinking of setting some goals, like being able to tell Dr T upon his return that I’ve found a job/applied for several jobs, things like that. And I might use that time to think about therapy itself, and see what I can do to make things a little smoother.

Dear Doc,

I’m sorry I can’t say these words in person, but it’s important you find them one way or another.

I want to thank you more than words can express. Thank you for your un-ending patience. Thank you for being so trustworthy – we both know how much I’ve cut myself off from other sources of support over time, and there have been occasions when you were the only person I felt I could ask for help.

But most importantly, thank you for never giving up on me, even when I had clearly given up on myself. You may have saved my life.

I will never forget what you have done for me, and I really wish you all the very best in your retirement.

MQ