Check in: Just chugging along

First off, my apologies for the quiet spell; I’ve been finding it really hard to write here recently. I don’t know why, but I’ll bet it’s not a good sign. I also know I’m not alone in experiencing this at the moment, so I’m sending out a wave of empathy to those who are also finding their communicative channels blocked up!

Thursday of last week was my last day at the Acute Services Day Hospital (psychiatric), and I didn’t think that was a big deal until everyone starting saying goodbye and wishing me all the best at the end. I was a bit overwhelmed by how many people seemed to care, and I wasn’t a million miles from crying. I’ve swapped phone numbers with a couple of the friends I made there, and I hope we do keep in touch. It has been fantastic to spend time with people who’ve experienced similar problems that just aren’t talked about in the outside world.

I’m not exactly being cut loose from the hospital though; one of the nurses had a chat with my consultant, who has decided I should have a care-coordinator/CPN again. I think this is a good thing, but I’m nervous given the wounds left by Nurse L a few months ago. Perhaps the way forward is to have very, very low expectations of the new CPN.

My mood is stable at the moment, and a bit better than it was on Wednesday. I guess I calmed down, and that last day at the Day Hospital reassured me that my social skills aren’t non-existent. However I still didn’t feel up to attending a dinner party full of people I don’t really know, so I invented a reason to head to my parents’ house for the weekend.

Visiting them presented challenges of it’s own given the whole ketamine-infusion ultimatum thing, but I managed not to let slip that I’m going ahead with that drug therapy. It starts on Friday, and I can’t say I’m feeling nervous about it.

Not yet, anyway.


A bad session

This post might be messy so forgive me, but I’ve just come out of therapy and I’m really not okay.

You know the session is going badly when: you can’t sit still, and Dr T keeps pointing out that you’re tense and says you’re not breathing properly, but you think you’re breathing fine, and the last thing you want to do is take deep breaths with him and help ‘soothe’ yourself, or relax your muscles or whatever else he’s coming up with, so you think to yourself that next time you’d better wear a scarf so he can’t see whatever movements in your neck he think he’s picking up today, and you wish you could control your body language but you keep noticing you’ve clenched your fists or you’re shaking or that you’re rocking side to side without even realising.

You know the session is going badly when: you tell Dr T about the bus driver thing and after digging through why it’s made you react the way you have, he keeps telling you to let yourself off the hook a bit, to remember you’re only human and so make mistakes etc, but none of that undoes the fact your irresponsibility will hurt another person, so when Dr T almost begs you to see the funny side of all this and you can’t you just sit there and think that he’s wrong, but that thinking he’s wrong means you’re broken. Well done.

You know the session is going badly when: Dr T asks why you didn’t want to tell him you were thinking about a career in mental health, and instead of letting it go he refuses to move on until you’ve answered, for the first time managing to match your stubbornness, firmly sitting outside your defensive walls until you have to let him in.

You know the session is going badly when: Dr T spots that you’re thinking of stopping lithium because you want to be able to end your life, and asks questions about it when THIS IS NOT HIS AREA. The one positive I can take from losing my GP and Nurse L is that there’s no one monitoring my safety. Now is not the time for Dr T to take an interest. I won’t facilitate this.

You know the session is going badly when: Dr T keeps asking you to be kind to yourself, look after yourself, relax etc and you sit there thinking you don’t a) need to, or b) deserve to.

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.

Let me get this out of my system

I’m angry.

I’m facing financial issues: I graduated in July, and despite sending off a number of applications, I haven’t landed a job. Maybe I haven’t tried hard enough. Maybe I’m too picky. Maybe I lack experience. Maybe I picked the wrong degree. The upshot is that my money is fast running out.

I’m angry.

My tremor is not diminishing. I lack coordination. Picking up change out of my purse is a public embarrassment. My memory is appalling. I’m a walking zombie. And the guilty party is lithium, the med that is arguably keeping me alive. What kind of trade off is that?

I’m angry.

I miss Dr T, and I don’t want to miss him. That feels dangerously close to needing him, which just can’t happen. Thank you Nurse L for the sudden reminder of why that’s so important.

I’m bored because there’s nothing in my life that interests me, I’m worried about things like finances and jobs, and I don’t even feel like I’m enjoying any positives of the human experience because of depression + lithium. Take away the lithium and the depression just gets worse.

So the anger at the bottom of all of this is anger that this is happening at all – I could, and should, be dead. I’ve tried twice before, and failed. Without lithium zombifying me, I might have even reached #3, which would have worked. Nothingness.

I’m stuck in pretty much every sense, and I hate it.

Rant over.

Nurse L quits

I haven’t been this close to tears for a while, but today has brought some jarring pain. I had my weekly appointment with Nurse L, which was supposed to be the last one before she takes a two week holiday. Except it turns out she won’t be coming back from this holiday; to use her own words she’s accepted ‘a more exciting job’ as a long term therapist. There will be no replacement.

I am really struggling to process all the thoughts and feelings this is stirring up.

Perhaps first I should give a reminder of who Nurse L is/has been to me: during my last (and worst) crisis, my psychiatrist referred me to a team of psychiatric nurses who support suicidal patients. Nurse L volunteered to take on my case. I’ve been meeting with her on a weekly basis at the psych hospital for what I have labelled ‘Reasons Not To Kill Yourself’ sessions.

In our first meeting, Nurse L asked a million and one questions about my situation, and then struck a deal with me: if I completed her ‘programme’ and still wanted to kill myself, she’d respect my death. Her optimism about the chances of her programme being persuasive amused me, but I agreed to the deal because I wanted someone, somewhere, to understand and respect my death.

The ‘programme’ was her compilation of worksheets borrowed from other books, and it pretty quickly ignored addressing suicide ideation altogether. But that was okay; we had some useful discussions about self-harm, keeping busy etc. It seemed a bit random, but the most important part of each session was the opportunity to honestly tell Nurse L how I was doing, with the hard, dark details I struggled to share with Dr T. I can’t describe how valuable that has been. Before Nurse L, if I had problems/thoughts/issues that were hurting me but I couldn’t tell Dr T about, I’d end up feeling very hopeless.

For the first time in several months, I found myself able to think about the future again. It became more real, and touchable, and actually stood a chance of fighting against the persistent suicide ideation.

More recently that fight has intensified, and my mood has been all over the place, as my recent posts probably suggest. And now I find I’m losing Nurse L.

On an emotional level, my heart screams the word ABANDONED, even though that isn’t true. There is nothing personal in this – Nurse L isn’t ‘leaving me’, she’s taking on a new job.

But this is opening an old wound, with scars that never healed properly. Here’s why:
– Last week my GP of two years left, without telling me himself. He was the person I trusted most out of pretty much everyone.
– Last year my psychiatric nurse discharged me, again without telling me. I found out six months later, after a long time wondering why she hadn’t contacted me like she said she would.
– I lost my first psychiatrist, who I REALLY liked, because he was an SHO on rotation and had to move on after six months.

This is why I maintain my defences around therapists, doctors, nurses etc. I’ve learned a clear lesson over time: THESE PEOPLE COULD DISAPPEAR AT ANY TIME. YOU CAN’T BE DEPENDENT ON/ATTACHED TO THEM, OR YOU’LL GET HURT. I know this holds back my progress in therapy, but the alternative is to be vulnerable to pain I can’t imagine – it hurts as it is.

It is such, such bad luck that Dr T went on vacation last week (until mid-September). And now I’m wondering when he’s going to quit on me, or disappear for whatever reason. We’ve had this conversation many times before, but given my history he can’t be too surprised.

When Nurse L gave me the news, I think I must have dissociated a bit; I was aware of her speaking, and the rough content of the words, but for the rest of the session I felt things collapsing in on me. I felt disbelief that this could be happening again.

And what adds to the pain is that Nurse L couldn’t get out of there fast enough. She didn’t even show me out of the room like she usually does.

We have a last appointment lined up for Sunday. I don’t know how I feel about that. Deep down I’m angry at her, but my brain says that isn’t fair, so I don’t want to take it out on her with an attitude. But even if I play normal, I don’t know how I can sit there and listen to her talking about mental health topics – we had a deal, and it’s been forgotten. Even if I remind her, there’s nothing she can do now to fill the deal. The ‘programme’ is unfinished, and will remain so. The deal that helped keep me alive was a sham, as made up as the programme was. I think it’s just as well she won’t be replaced by another member of the team; I couldn’t trust them.

And so the world becomes just that little bit smaller.

Mood dips are dangerous

I guess the title is obvious, but today I’ve really had the truth of this statement rubbed in. I’m in pain, I’m embarrassed, and I’m left looking at myself with a fear that I can’t be repaired.

As mentioned in the edit to last night’s post, I self-harmed, and I did so very destructively despite the work I’ve done with Nurse L ONLY LAST WEEK about safer alternatives. I took a sharp pointy thing, and opened a couple of veins.

Not clever. Not clever. Not clever. Not clever. Not clever.

One of the puncture sites has hurt a lot ever since I made the wound – it hurts whenever I move my wrist, which I figured could be related to the lump that developed under it. So, despite every instinct to keep quiet, I felt I had no choice but to show the practice nurse when I had my blood test today. I asked her if she’d just take a quick look and tell me if it would be okay – she did so, informed me it wasn’t okay at all, and reached for examination gear.

The conclusion: haematoma – bleeding under the skin, and a mild infection.

It turns out it wasn’t the blood loss that was the most dangerous element of my self harm – it was the hygiene. I sterilised the sharp pointy thing with boiling water, but apparently that’s nowhere near good enough. I received a ‘gift’ of 25 pre-injection swabs which have 70% alcohol.

Mood-wise I’m feeling a bit better today. The not-eating thing means I’m REALLY cold despite the current warm weather, and all I want to do is curl up in bed. Since I’m a bit brighter I am trying to address the appetite problem; I’ve bought a few things I might be able to tempt myself with later. I think I’ll spend most of today having downtime – sofa + thick blanket + tea + TV = calm and relaxed. And safe.

Tomorrow I’m due to see Nurse L for the next ‘Reasons Not To Kill Yourself’ session before she leaves for her holiday. I’m dreading this meeting. How can I tell her that after an hour of discussing and planning safe alternatives to self-harm, I somehow forgot all of that and attacked my blood vessels?!?!

But I’m not going to worry about that today. Today is for recovery.

Alternatives to short term self-harm (TW)

I have a history of DSH in response to feeling emotionally overwhelmed; when I cut/burn/overdose, I effectively shut myself down. A year ago, my (now) ex-CPN was the first to address this, and she introduced me to two techniques: 1) wearing a rubber band around my wrist to ping myself with if I felt the need to self harm, and 2) delaying: if I want to self harm, I have to wait five minutes and see if I still want to do it (and repeat until the urge goes away).

These are good ideas in theory, and I found they worked for a while, but eventually they weren’t enough. My CPN couldn’t understand why my DSH persisted, and apparently decided that since she ‘wasn’t helping’ (her interpretation, not mine) she might as well discharge me.

Since then I’ve been relatively un-supported regarding my DSH, until today at my weekly ‘Reasons Not to Kill Yourself’ session at the psych hospital. First off, Nurse L identified that my DSH methods are intense and short term, (as compared to alternatives like denying food/drink etc), so she wanted to give me alternatives that would have the same kind of immediate impact but without any lasting damage. She came up with the following, adapted from techniques used with adolescents:

1) Ice bowl: Fill a bowl with water and ice, and then dunk your face in it for 15 seconds. Come up to breathe, and then repeat until you’ve done this 5 times.

2) Cold shower: As it sounds, turn the shower to the coldest setting, and jump in WITH your clothes on. Stay there until you’ve counted to 60.

Nurse L explained the theory behind these suggestions; primarily that they are painful, and will cause an adrenaline rush, but they won’t actually harm you (in fact, the ice bowl is apparently really good for your skin). After the temperature shock from both of these, you’ll be freezing, and all those overwhelming emotions will be dampened for the time being – all you’ll want to do is wrap up warm and sleep. This is what they used to do before tranquillising patients in psychiatric hospitals: put them under a cold shower, and a minute later they’ll calmly go to bed.

I like that Nurse L explained to me how and why these techniques work. I like that they’re private, and relatively easy to do. The trick is turning to these methods before your brain goes for the old (and more damaging) ones; that’s why you have to get in the shower with your clothes on – in the time it would take to undress, you might change your mind and do something harmful to yourself.

People aren’t born with tendencies to self-harm; it’s a learned behaviour. I don’t remember where I learnt it, so I would guess I must have seen it on TV, or read it in a book. There’s something really sad in that, but there’s a positive to take away too – if self harm is a learned behaviour, it can be unlearned, or altered.

That’s what I need to remember now. It may be a long time before I lose the urges altogether, but I can learn better ways of acting on them.