I don’t need to be

What’s the point of anything anymore? Why do I write in here at all? Just to hear the sound of my own voice I suppose.

I ended up back in the hospital and now face losing my job.

Am I ready to work again? No. Do I need to work? Yes. But I’m terrified to go back in any capacity. My moods aren’t stable and for once I’m 100% compliant with my medication. I vacillate between stable, numb and moderately suicidal – an improvement according to my psychiatrist.

How the fuck is having my husband hide the mags of his gun under his side of the bed, having nightmares of me killing myself and waking up in a panic a fucking improvement exactly? Oh, I see. Because I’m not manic anymore my mood swings aren’t a major concern. Not like I was ever truly manic to begin with. Let’s be very fucking clear, people – I experience hypomania. Not full on mania. Totally different.

Right now I’ve lost the ability to give any fucks. I don’t care about anything anymore. I don’t care about life, I don’t care about death, I don’t care about you – the same as you don’t care about me. I. Don’t. Care. I’ve tried to explain to my husband – who probably wishes he’d choked on the phrase “I want you to share everything with me; we shouldn’t have secrets” – if for some reason I was in a severe car accident and a call to the authorities was the difference between saving my life and not, the call would never be made. Because I don’t care enough at this point to make the effort to go out of my way to survive however have no thoughts or plans to harm myself at this time (let’s be clear with each other, shall we?). I don’t take the meds, I end up in the hospital. I take the meds, still feel like absolute shit. What fucking incentive do I have to continue to work towards wellness here? Absolutely none.

I went to lunch with my mom and my favorite uncle. He knows about what’s going on and has been hospitalized himself. He asked me how I was doing. I told him: “You ever step in dog shit? Ever try to shake it off the bottom of your shoe but it just doesn’t come off – it’s just stuck there no matter how hard you shake? I feel like that piece of shit.” He just stared at me, no words. What can you honestly say to that? Nothing. I feel like a car windshield under a power line most days recently.

I know I need to go back to work because I need the money. My husband says it will be okay and he’ll take care of us, but that’s a hard sell. He falls asleep while he’s driving home. He falls asleep while we’re having date night. He falls asleep while we’re watching tv. He’s exercising almost daily to lose weight. He’s going to school online. He’s working full time graveyard shift. He’s breaking his back and without my income, we’ll have maybe 100 whole dollars at the end of the month – you know for incidentals like doctor’s bills and, you know, food.

So I have to work no matter how unstable I am. But then I get fed this bullshit line: “you have to take care of you, Alison. Your health comes first.” Bullshit. You know it doesn’t. My mother doesn’t give a shit – she wants my money. Always has her goddamned hand out. She asked me for gas money the other night because her car isn’t as economical as mine and we were on a family outing. A family outing! I told her to get bent and a non-Luxury car that takes regular. The night before I went to the hospital I told her I only didn’t feel like dying when I was at work because my mind was occupied; the minute I’d step in the house I’d want to die. She told me it would behoove me to go work – I’d feel better eventually. [But, like, a bitch has to come home sometime though, right? And be in my own thoughts? The ones that wanted me to die? Does that not worry her? No? Ok.]. No one gives a good goddamn.

So I repeat: what’s the point? I don’t think there is one. So why bother.

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Where the dogs of society howl

Lots going on.  Mainly feeling lost.  I’m still on FMLA per my psychiatrist.  I’ve been off all this month and won’t be going back until next month.  I’m having a hard time keeping my medications down and we’re not sure why.  My moods are cycling rapidly and I’m thinking it’s because they aren’t being absorbed properly since the surgery.  I’m worried about having all this time off, how it’s going to affect my job.  It gets more interesting: I have an interview for another job next week.

I reached out to a friend of mine regarding a possible job opportunity in a private practice setting.  I was doing some research and found that working midnights with bipolar disorder is a no-no.  Apparently most people working midnights – mainly those in the healthcare field like nurses – with bipolar disorder have circadian rhythm issues, leading to shift-work disorder (which I’ve been diagnosed with).  This triggers mania and many times, hospitalization.  Sound like anyone we know?!  

So I got freaked, reached out to a friend and asked if she knew of any job opportunities.  She reached out to her boss who reviewed my resume and offered me an interview.  I miss doing therapy.  I remember my old supervisor said to me ages ago while I was in training after graduate school and doing therapy in an underprivilaged area with substance abuse clients.  I was burning out hard, between the clients and the administration I couldn’t seem to meet anyone’s expectations of me and wanted to quit doing therapy altogether.  I told him that I wanted to work in a hospital doing intake assessments and case management to take a break.  I said that it would be “one and done” – I’d never see the people again after they left; no need to build rapport and no need to terminate; they couldn’t accuse me of abandoning them if I’ve known them for 20 minutes.  He told me that I was an excellent therapist and working in a hospital setting was “a waste of my talent.”

He burned out too and moved out of state.

I didn’t listen and got a job doing assessments.  The population I work with tend to abuse the system.  I often see the same faces – sometimes 3 times a week.  I’ve had some people discharge because they tell me they are not suicidal, turn around in the parking lot and walk directly back into the hospital stating they are suicidal and homicidal and want 3 sandwiches.  The record turnaround is 7 minutes – I actually counted.  It is rare that I assess someone that actually needs help.  I got into this profession to help people.  Will I have better luck doing so in private practice?  I think so.  I think I will because people are paying to be there.  Sounds messed up, but it’s true.  This is your “managed” care/health system at work, USA.  I have “managed” in quotes because there is nothing manageable about it and you, my dear reader, know it.  I’d be ignoring the system by leaving, but I’m not single-handedly going to overhaul the health care and mental health system – I know that.  Contrary to popular belief by many recent graduates in my field, you cannot change the world.  You can only make a dent.

Here’s where my trepidation lies.  I would have to file quarterly and withhold my own taxes.  What a pain in the ass.  I’d also have to go on the exchange for health insurance.  God please no.  Right now every doctor I work with is in network because they all work for my employer LOL.  If I go on the exchange, there’s no guarantee they take that insurance and I’d have to pay astronomical premiums.  It would take several weeks to build a caseload and get paneled with insurance companies, which means I would not be paid by the patients or insurances for those weeks.  Weeks.  Flipping WEEKS, man.  I’m torn.  Do I liquidate my house fund to pay my bills while I’m not paid for those few weeks – if I’m even offered the job?  Do I leave my awesome co-workers because I hate the population I work with?  The population, the crushing rules of administration and low wages are what keep me from wanting to stay are my job.  I know once I get a full caseload as a private practitioner I could rake in double what I’m making now, but I’m afraid.

I’m terrified.  What if I’m not good enough?  What if I fall on my face?  What if I messed up my taxes?  What if my clients don’t like me and I end up without anyone and I’m broke?  My psychiatrist told me it takes a while to build a caseload too.  How do I work both jobs to cover my butt?  Work midnights and days?  I freaking can’t.

And Mom’s going into surgery.  They said it’s going to last 8 hours and due to the definite blood loss, she had to sign a waiver permitting them to give her a blood transfusion.  So I’ve been scared about that.  Lately her voice has been irritating me for some reason and I’ve been blocking out most of what she says, but I think it’s me being irritable because of my mood cycling.  I apologized to her if I had been short or curt with her and explained I had been tuning her out.  I told her I’m scared shitless about her surgery next week.  I wish she didn’t need it.  She’s going to lose 20% functionality of her back in all directions.  She seems excited she’ll never have to load the dishwasher again.  Lucky.  Not the way I would want to avoid that chore, but still lucky.  I’m just scared – I keep telling myself not to tune her out.  Not to put this bed vibe out there in the Universe, but if her being annoying is the last thing you ever hear her say, hear it anyway.  I try to remember that and listen to her give me instructions about how to feed her fakakta fish.

But the levee was dry

So many changes, so little patience to write about it all.  I guess I’ll start with my latest. 

Decision to leave my job. 

I’m still 70/30 on the whole thing, but that’s still enough for me to cut ties and go. There is so much wrong with what I’ve seen and sometimes been a party of that I cannot take it anymore. I’m going into private practice where I belong. Where I’m my own boss, I make my own decisions and my own hours and I only answer to (technically) the insurance carriers during an audit of my files. I’m fucking done, y’all. 

This hospital work is draining. I thought it would be easier because you don’t form attachments to people; they’re in and out – goodbye!  Nope. Not this population. I see the same people week after month, month after year. Each time, coming into the ER with the same problem, same story:

Suicidal without a plan.
Withdrawal from drugs.
Chronic back pain that’s causing some suicidal thoughts – but they’re allergic to all pain medications except for Dilaudid.
Suicidal with a plan to OD on heroin; is an IV heroin user up to 1 gram per day usage – no history of attempts. 

Now, when I say the same people, I don’t mean the same backstory. I mean the same fucking people. Joe Blow and Heywood Jablowme come in two, maybe three times a month. I’ve had patients discharged at 10AM denying suicidal or homicidal thoughts and come back at 2PM, saying they are suicidal and now, homicidal with no defined target or plan.  And can they have something to eat?  Because, well what the fuck else is this place for?  I’ll go in to talk with them and ask how I can help them, what has helped in the past and some will turn me away. Because, you know – they really need some rest. Nevermind this is an ER and 5 beds away we have people having heart attacks and dying. People treat this place as a drunk tank or a free bed and breakfast. It drives me up the wall. 

What makes things worse is policy. In the ER, it’s liability and licensing. Patients who even breathe the words suicide or harm are begging to be petitioned. (A petition is a legal document that allows hospital staff to hold a person involuntarily until they can be examined by a psychiatrist or psychologist to determine if inpatient psychiatric hospitalization is necessary).  Patients don’t need to be petitioned because they have had thoughts of suicide.  People with major depression have thoughts of suicide regularly and have no intentions of committing suicide. Petitioning them could prevent them from being honest with mental health personnel in the future when they actually do have the desire to act on those thoughts.  

But lo and behold, they get petitioned and held for hours until they are evaluated by social work.  Here’s the fun part. Depending on which social worker/counselor one gets, one’s outcome for getting placed inpatient or discharged home differ.  It’s fucking subjective. I spent most of my first year trying to avoid putting people inpatient if they didn’t need it – and was fought by other social workers who would change my disposition after I left for the day (which would set me off), physician assistants, nurse practitioners and doctors.  

I realized at year two, I was fighting a losing battle. It was even more of a loss when the “frequent flyers” became more aware of what was needed for hospitalization.  Patients who we know have a very, very low likelihood of harming themselves or others, yet report otherwise with plans?  No doctor would take the liability; they go inpatient despite all of us gritting our teeth, knowing full well they are malingering. 

There are 2 sides to malingering, as far as I’m concerned. One is that the resources being used to care for the malingerer could be used for someone in a real crisis and that really chaps my ass.  Two is that someone who takes to malingering needs some type of help.  To feign illness for any type of secondary gain (e.g. Financial resources, medical care, etc.) takes a lot. The dedication used to feign illness could have been used to obtaining whatever the secondary gain was. 

Anyway. Yes. The ridiculousness. 

There is no upward mobility in the hospital unless you’re a nurse and I will be goddamned. 

I miss doing therapy. I miss actually helping people that want to be helped. Every now and again, maybe once every 2-3 months, I run across someone who is legitimately looking for help and legitimately sick. That is awful considering how many people I’ll see in a night. Many of the people I see want pain meds or a bed to sleep in and food because they’re homeless. Some people just love the attention they get in an inpatient facility because it’s more than they get at home. None of these reasons are good enough to go to an inpatient psychiatric facility – NONE – yet these are the only reasons lately that I’ve been seeing people going. I get defeated seeing it. What good am I if this is all I’m doing? Filling beds with people that don’t need the help?  

We’ve tried countless times to help the homeless people who come in, but most don’t want the help. They dismiss the shelter referrals we give out and have burned all their bridges at local transitional homes. It burns you out when you’re doing all the legwork, people do nothing and expect the world. The expectations along with the entitlement when one is not putting any effort is beyond irritating and exhausting. 

I’ve got more but I’m tired of writing.