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hospitalization
  • Summer Meltdowns, Loss of Control and Missing the Hospital

    Today was one of those days. It’s been coming for a while. The type of day where I recognize my mental health is in a precarious state due to many circumstances I have zero control over and I’m all at once slowly and rapidly losing my shit to the point I miss the hospital. I want the hospital. I meet zero criteria for the hospital, but the hospital is controlled, with rhythms and routines and predictability. My life presently is not. My brain and my body are seeking it in any way possible.

    I’m not sure when I began to recognize the tides were turning. Was it when my two “best” friends turned on me inexplicably and iced me out without word? Perhaps. That wound is still bleeding from lack of understanding and closure. There are three sides to the truth. All I know is my truth is I was always kind, always there when asked, willing to lend a hand when needed, there for every child birthday party or major event invited. I am not perfect, so sometimes I was needy with my mental illness and needing someone to listen at perhaps inconvenient times. Or just needy. Maybe that’s what did it. I’ll never know. I do know that my children’s birthday party is not prioritized the way I would and one person was supposed to have a major role in the surprise twist to my children’s birthday party. But not anymore, I think they actually forgot.  BOTTOM LINE IS: take all that away, my heart hurts, I still lack closure and a major portion of my mental health support system is gone. Poof. Just like that.

    I did learn I had another support system around me, subtler, less in your face but equally precious. One that I’m grateful this ‘ice out” has given me the opportunity to grow and blossom, though not healing the wound any less. 

    Perhaps the tides were turning when we grew more and more suspicious with the behavior of one of our children. Despite extensive evaluations, our guts kept telling us it was something more than what every doctor had told us. We kept watching and tracking and adding up symptoms. No sleep. Limited food intake. Irritable aggression. Going on for over a week. My faulty genetics being passed down the line and parental guilt kicking in as I never wanted to pass this wretched disease onto one the boys. It has been and always will be my worst nightmare and my worst day as a mother: diagnosis day for my son. 

    I already feel a bit like a parental pariah with his other diagnoses, and now to add this to the pile. I can’t publicly advocate for him, loud and proud the way I do for myself. He has to understand his disorder first. Then, when he’s older, it will be his story to tell. In the meantime I need to figure out to fill up my fuel tanks for puberty for this will be a loathsome combination.

    Perhaps the tides began to turn when I did publicly advocate for my children. One in particular was subject to racial slurs two years in a row by classmates and as a family we took it public to bring about community awareness and change. Being a maven and fomenting change is exhausting and uncomfortable at times while being exhilarating at it’s best. I am confident not everyone is on board with my loud message of preaching diversity be it skin tone, mental health, or being neurotypical/atypical.

    Then we have my grade in my current class for my doctoral program. I am used to being a very high achiever. I graduated UVA with masters summa cum laude. To get punched around in a doctoral level class and be one point below a passing grade is humbling. It’s not reflective of the hours of work I put in each week and my capabilities as a student. It wears on my psyche week after week after week.

    I needed to ugly cry today. I needed to get it out. I needed to ask my husband to hospitalize me. I needed to hear from him that it wasn’t the right thing to do, that I have better choices (and days) ahead of me whether I have the ability to recognize it or not. Right now, I need stability, routine, calm, and peace. I need the chaos, lack of control, zero predictability and no sense of routine to stop. Most of all, I need to my support system is there when I need it.

  • Even The Mighty Fall

    Buckle up kids. It’s been a long while since I have felt well enough to write and I have a lot to say today. You see, I’ve been talking to you for the last few years, educating you and advocating for others from the enviable position of having my bipolar disorder being in a stable state of remission. Remission is a beautiful thing. In some ways it’s almost as seductive as mania, only remission when sustained over years can make you feel as if you will never get sick again. Now those who follow this blog regularly know I deal with bipolar 1 disorder, most often associated with the oft-reckless highs of mania. However 40% of bipolar patients are initially diagnosed with unipolar depression. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945875)

     

    Depression is a far more common mood episode and apparently I am no exception. In mid-late August I presented to my psychiatrist with my husband for concerns over an increasingly low mood at which point all I can recall is collapsing in his office and sobbing uncontrollably. It’s a blur, to be honest. A decision was made that I needed to be hospitalized for a course of ECT (electroconvulsive therapy) as it was felt there was not time to wait for medication to work. I felt too poorly to argue which said something to both my doctor and my husband given my feelings on repeat hospitalization after the last experience four years ago. We went home to pack a bag and give me the opportunity to say goodbye to my three boys.

     

    The psychiatric ER, which served as the entry point for my admission, was a strange experience. My psychiatrist had to coach me on what to say when I arrived as his desire for my admission alone was not sufficient to meet the criteria that would ensure I would have a bed waiting. My husband was not allowed to visit and sit with me except during certain hours. I was not allowed to “just have” the bag I packed. It had to be inspected and locked away. Anything I had at my bedside required a physician order. The attending psychiatrist who came to determine if I actually would be admitted is on my town’s Board of Education. I recognized the name immediately. Heck, I even voted for the guy. (That should have counted for something, but I was afraid to ask.) I told him everything my psychiatrist told me to say, although a phone call still had to be placed to my psychiatrist to discuss my case and whether or not admission and ECT truly was the best option. Dude. Seriously? I. CANNOT. STOP. MOTHEREFFING. CRYING. I don’t care if I live or die at this point. Just make the pain stop.  They decide I will get admitted but tell me it may take days to get a bed. I push them to start the pre-ECT testing process while I am still in ED so it is done by the time a bed opens up. Luckily I get a bed the next day.

     

    I’ll confess. I do not remember much about my admission. I was severely depressed and significantly anxious. I did not both to interact with any other patients. I refused to leave the unit to attend groups or go to meals. I refused to attend groups on the unit. I spent my time sleeping pretty much around the clock. I did meet with my treatment team each day. I came out of my room for visitors – my husband visited everyday and my dear friend Barbara came once in addition to calling every day. It is the first time I allowed non-family to visit me. I went to ECT. The team adjusted my mood stabilizers and when they stated I could go home after my second ECT treatment, I held them to it, even when they tried to back track expressing a desire to keep me there longer.  The hospital is a tough environment. It’s challenging to find fellow patients to connect with, particularly when your mood is so low that you just don’t care to talk to anyone else or you feel so anxious any behaviors they do cause you to isolate further. In hindsight, I can’t even tell you if I slept so much due to major depression (likely) or to escape (also a very strong possibility).

     

    I was discharged to home to attend ECT three times per week. Monday, Wednesday and Fridays. No driving while this process was occurring as I was receiving anesthesia regularly. One of the known side effects of ECT was the risk of memory loss, typically thought to be transient and slowly return once the series of treatments is complete. There are two types of ECT, right unilateral and bifrontal. (https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014161) (www.psych.med.umich.edu/ECT/common-side-effects.asp) Fortunately my providers have a strong interest in the cognitive effects of ECT on the patient. I had to undergo baseline cognitive testing and then periodic cognitive testing during and after treatment to measure any rate of memory loss.

     

    ECT took place in the basement of the psychiatric hospital. I would get brought into a six bed holding area. They would place a cardiac monitor on me and start an IV line. Before every session I would get a dose of Zofran to quell any nausea and Labetalol, a beta-blocker, to lower my blood pressure. When it was my turn, the attending psychiatrist of the day (there were three who reliably rotated through) would come wheel my stretcher over to the area in which ECT was being performed.  There another nurse and my anesthesiologist greeted me. Electrodes were placed on my head. I had 17 treatments in total over 6.5 weeks; 14 were right unilateral treatments, 3 were bifrontal in an attempt to mount a more robust mood response. Anesthesia provided Toradol, a powerful anti-inflammatory to stop the aches I typically complained of later, usually in my jaw as well as my anesthetic. Off I went to sleep and woke up in recovery later. After a half-hour of monitoring by the nursing staff, I was delivered back to my husband and able to go home.

     

    Due to the anesthesia, I couldn’t have anything to eat or drink after midnight on treatment days. My husband always stopped at Starbucks and got me a chai latte to sip on when we were driving home. Once home I retreated to the bedroom to take a nap still feeling fatigued from the anesthesia. Or some days I might choose to nap on the couch and pretend to pay attention to the television. I did find I had the attention span of a gnat. The longer my course of ECT ran, the worse it got.

     

    As I explained before, memory loss is a serious side effect of ECT. When I underwent ECT in 2012 I experienced some. It eventually came to the point where I finally had to learn to stop calling my husband a liar, trust that he was telling the truth and just reply “I don’t remember, but that sounds nice.” I went into ECT this time optimistic and hopeful that no memory loss would occur given all the cognitive testing they were doing. Part of me also worried they would not know if I had memory loss as they were administering tests to me that I give my dementia patients all day long every day. I mean I was going to rock those tests with one hand behind my back and my eyes closed. Well, let’s just say now I understand why we tell patients depression can impair cognition. I certainly was not thinking straight at the start of treatment. With regards to memory they do right unilateral first as it’s been shown through both research and experience to have the least impact on memory. However my team moved me to bifrontal, as they felt right unilateral was not making enough of a difference in my mood. It became apparent rather quickly that the bifrontal was impacting my memory in a negative way.

     

    This was rather stressful as I work using my brain all the time. I am a nurse practitioner highly reliant in my knowledge and intellectual capacity. I already deferred graduate school one semester due to the mood episode and now recognized deferring a full year was the most reasonable and rational course to take. As always, I feared never getting my memory back.   I chose to stop the ECT against medical advice due to the rapid nature of memory loss. That was probably of the hardest decisions I have ever made regarding my care. Even now as I write this I have to ask my husband so many questions about that time as it’s “foggy” “hazy” “blurry” and I cannot trust my own brain for accuracy.

     

    What happened next is I was left a shell of myself. I had zero interest in anything or anyone. I became quiet. Afraid. Anxious. Paranoid as Fuck. The minute light started shifting in the sky all curtains in the house had to be pulled and blinds closed. I was convinced people were able to see in or coming to get into the home. This irrational fear of peepers or home invasion existed within my brain.  (We live in a rural wooded area and there are limited neighbors.) I would, and still do, go around checking all the doors ensuring they are locked. My husband couldn’t understand why at 3:30-4:00 pm I would be pulling the curtains and my only answer would be “because.” If a door got opened for any reason, I’d start shrieking to close it and be unable to stop until the door was closed and locked again. I couldn’t have the lights off at night. I had to sleep with the lights on in the bedroom.  Not a nightlight. The actual lights. When we lost power with a recent storm, I insisted flashlights be on in the room all night to quell the anxiety I felt.

     

    The symptoms were brought to the attention of my doctor. Initially I was placed on a first generation antipsychotic to try to decrease the paranoia and improve my functioning in the home. Unfortunately it did not work. I was unable to allow Halloween decorations this year as I found the theme and spookiness of the holiday too distressing. It fed the paranoia. I continued to struggle with sleep as the hours of darkness were simply serving to make my soul distraught. My husband called my doctor and told him we needed a change.

     

    I came off the first generation antipsychotic and went onto a second-generation antipsychotic. My brain seemed to like it better however I needed to have the dosing adjusted a bit to find the magic number. It’s fatiguing and helps me sleep; however at higher doses caused some akathesia (feeling of inner restlessness and compelling need to be constant motion) and other uncomfortable side effects. It finally felt like the paranoia was coming to a dull roar. I still come home and check locks, ensure the curtains are pulled though as of one night ago I slept with the lights off. (Baby steps, people, baby steps.) I have a need to have every day the same if I can manage it. If my husband watches one more episode of Shark Tank in the evening I suspect he might lose it.  I hate to be alone in the dark. My office manager walks me to my car in the evening. It’s been tough on my husband. He tried to go to the grocery store one evening and I cried at the thought of being alone in the house without him here. It worked only by him promising to be gone no more than a half-hour and to call/text me every step of the way.  He recently had a nighttime photo shoot and a friend came to “babysit” me until he returned.

     

    Given that there is still a level of impairment and I have still been checked out of portions of my life with some concerns for mood beyond the paranoia, at the next medication check visit we added more. We added a low dose SSRI cautiously as the goal is to improve my mood, decrease my anxiety and improve my functioning without inducing mania. My psychiatrist also added a benzodiazepine for emergencies.

     

    I think we finally have the right combination, now I just need to wait patiently for me to return bit by bit. It’s not going to happen overnight. It’s been a long three and a half months. My family has really suffered with this particular episode, as I have been physically present in this house but emotionally completely checked out. Nothing hurts more than to hear your child ask “Mommy, are you still sick?” and you genuinely have no answer for them.

     

    I do have to say my friends, my family, this town I live in have been incredible during the worst days. They all proved mental illness can be a casserole illness. From those who came and simply lay next to me in bed when I was too sad to move, from all those who took the time to make and leave a meal for my husband and children, from the little trinkets that showed up in the mail, the bouquets of flowers, the Facebook friends who showed up at my door in real life and lifelong friends who dropped everything to be at my side and family who came to help with needed: we thank you for the kind gestures and stigma-busting attitudes.

  • Nevertheless, She Persisted

    From time to time, I struggle with writer’s block. I think to myself that I have nothing to say and that I have nothing to say in which people want to hear. I often view it as normal and part of the process of a writer/blogger. In the advent of a rare snow day resulting in the closure of my office, I anticipated spending the day writing and drinking tea. The reality is I spend the day binge-watching Empire and asking my husband what I should write about. He suggested politics. I laughed.

    Until I didn’t. This week, a quote making the rounds in the news has sat with me as I rolled its words and meaning around my head.

    “She was warned. She was given an explanation. Nevertheless, she persisted.” This was a statement Senate Majority Leader Mitch McConnell said in defense of his cutting off Senator Elizabeth Warren from remarks during a confirmation hearing for the position of Attorney General. Women all over have adopted this as a new rally cry in defiance of a new administration in Washington, which has been less than friendly to women’s rights. I digress however, as this is a blog about life with mental illness.

    “She was warned.”

    I was warned, sort of. I see this as more of the stinging rebuke once passed onto me by a therapist who chose to give up on me as a patient than take the time to assess if my diagnosis of postpartum depression needed to be revisited. I was deemed by the provider to still have the diagnosis, but that I was unruly, untethered, wild, and unable to be properly treated. And so, with the unruliness statement and the subsequent discharge from the practice I had my warning. I had the warning that I was too sick to manage, too sick to be treated and too sick for other providers to consider.

    “She was given an explanation.”

    In time, I was given an explanation. It took a second suicide attempt and hospitalization to get one. It was explained to my husband and I that I was bipolar. The diagnosis of postpartum depression, while once fitting, no longer applied. It was an explanation that I would need to hear over and over and over before I could really hear it. I would be hospitalized two more times before I would begin to understand what this explanation, what being diagnosed with bipolar disorder really means. This explanation still needs to be repeated to me from time to time as a refresher to best grasp the implications for my family and myself. I have an explanation no matter how many times I need to hear the words that I live with bipolar disorder.

    “Nevertheless, she persisted.”

    And how. This diagnosis, this challenge, has not kept me down. I persist due to my family. I persist due to the psychiatrist who thought “what the hell, I’ll take her on.” I persist due to my own bullish tenacity to prove others wrong. I persist to prove my old therapist wrong. I persist to prove any and all naysayers wrong. I can and did achieve a fragile state of remission. I persist to demonstrate to the attending psychiatrist during my last hospitalization that she was right. She told me I needed to get better and use my voice, my knowledge, my medical training for good rather than self-pity.

    Nevertheless, I Persist.

    And so can you.

  • Maintaining a Little Hope

    Next week is Thanksgiving and the official beginning of the hectic holiday season will begin. Since diagnosis, I have learned to live with a pit in my stomach and a hairball of anxiety in my throat from November to January as the trend is for me to have a setback during this season. It is simply stress and as much as I try to anticipate what needs to be done, my brain ends up defeated. I have been thinking a bit more about hope in the last few weeks as it pertains to me, to the season, to evolving moods and to 2017.

    Hope is all I have. Hope that medications continue to work. Hope that I can control my moods. Hope that my disorder remains in remission. Hope that I am a loving wife and mother. Hope that I am a patient and kind friend. Hope that I am a better, more effective provider. Hope that my patients keep hope for themselves.

    2016 has not been the best year for so many of us. I started off rough, with a deep depressive episode. Hope for symptom relief kept me moving forward and out of the hospital. Hope keeps me thinking the year will end differently than it began. I have advocated and spoken to so many congressmen and woman regarding the need for mental health reform. The hope of so many of us got HR2646 passed and we maintain hope that the Senate will soon act, continuing to push reform forward. Hope keeps me in action, showing the “world” exactly what I am capable of even if it’s not in the timeline I would prefer. 

    Four short years ago, I started spiraling down. Four short years ago, I could not recognize the symptoms nor understand that I had a problem. I could not understand I had bipolar disorder. I thought I had an ineffective therapist. Three short years ago, I believed my career was stagnant and over due to my diagnosis. I felt the knowledge of my disorder would preclude me from ever achieving anything further in this life and would ruin my family. Two short years ago I started writing. I started writing to change the way the public viewed mental illness, and in particular a nurse with a mental illness. I did it for myself, to hold onto the hope that my life was bigger than my diagnosis and would mean something to my husband, my children and me. One short year ago, I accepted a position that I never dreamed I would have. Hope always wins when you want it to.

    I suspect one has to be shown hope to have hope. I found hope when a psychiatrist believed in me and told me that during one of my hospitalizations. Prior to that moment I had truly believed I would be spending the remainder of my days in and out of the hospital. Recovering and relapsing repeatedly. I just may still. I cannot predict the future. However I have hope my new-ish pattern of stability and symptom remission will continue.

    What do I look forward to in 2017? I look forward to continuing this career I love. I look forward to working on my doctorate, provided acceptance to a program. I look forward to writing more. I look forward to presenting at a conference. I look forward to continued remission. I look forward to maintain hope.