Hush/just stop/there’s nothing you can do or say

How do you stop being angry? When the reminders of your anger are shoved in your face?

I shouldn’t be here.

I shouldn’t be dealing with this shit.

I’m stuck in this house and it makes me angry. I was able to pay my half of the rent; my husband couldn’t. We moved back in with my mother. I freaked out so bad I couldn’t move any of our stuff in. It was years ago that I had the opportunity to go to a local graduate school to get my Master’s and disenrolled. I enrolled to a much more expensive, Big 10 school 1.5 hours away to get away from my mother. Our relationship had become so toxic I felt I had no choice. Now I was being forced to move back in with her after the loss of my child. Fucking great. We’re still here 5 years later and the relationship between her and I continues to deteriorate.

Now that I’m unable to work because I’ve fallen off the tuna truck, I’ve left my finances in his hands. And I can barely look him in the face without becoming angry. A part of me is so fucking angry that he was so fucking selfish. If he’d committed to something, anything besides 18 things other than what he thought he wanted I wouldn’t feel obligated to go back to work before I’m ready. A degree. A trade. A job that led to a career. Fucking anything.

But alas here I go, back to work despite the fact that the meds have caused permanent damage to my kidneys and they will be taking me off them and starting me on something else. Probably sending me back before we know whether or not I’m stable at this point because we need the money. I don’t have a choice anymore. We need the money to move out of here for good.

Talking out of both sides of their mouths. My mother says not to go back to work until I’m well, but has her fucking hand out asking for money every 5 minutes. Husband says the same thing, tells me he’ll take care of and pay for everything. He says he’ll get a second job to help support us while I recoup yet he talks about falling asleep while driving home, can’t sleep because he works midnights and sleeps through date nights. Yeah, I see that second job going real well. I’d be collecting his social security after he dies if he gets a second job. I can’t have that.

The clownery is real. I know you can’t fix the past, but I don’t know how to move past this anger. It stares me in the face when I wake up and when I go to bed. I know he’s trying to fix it. He’s the absolute perfect man in every other aspect.

The only solution is to pick myself up by my proverbial bootstraps and go back to work even if it kills me (like it tried to before). I’ll fix this myself.

Like I always do.

Y’know, one day, one of these years I’d like for someone to say they’ll “handle it” and mean it. And by “mean it,” I mean have a plan and resources by which to handle it. Saying that you’ve “got this” isn’t actually having it. There’s no security there. I fear failure. My overarching need to control will kick in and I will fix it.

Like I always do.

The problem is that I’m getting tired of being the one to fix things. I feel like some days I’m hanging on by a thread and I’m yelling out for help but people just keep walking by. They stare me dead in the face while walking right by.

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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.

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.

I’m meaner than my demons/I’m bigger than these bones

It’s been such a long while since I’ve written in here.  I don’t know if it’s avoidance or forgetfulness at this point.  What I do know is that I’ve backslid and I’m slithering around on my belly like a tongueless snake.

I had the surgery and I’ve lost about 50 pounds.  I honestly think, for once, I’m returning to my baseline physical self.  I never saw myself as this fat, huge overweight thing. Body dysmorphia is quite common for people after the surgery; my mother struggles with it daily.  I wasn’t always fat – I was a skinny kid.  I see myself losing weight and – don’t tell anyone – but I feel fucking awesome.  I think I look fucking hot.  Aside from the loose skin I’ve acquired, I feel my confidence going up.  People at work keep commenting on how great I look, and while I don’t particularly enjoy that, I do like the looks I give myself.  Pretty narcissistic sounding, huh?  It’s not like that, though.  I used to look at myself and glare.  I’d give myself a once-over in the mirror, gazing at each body part with hatred and disgust.  Each body part was subject to ridicule and hazing by me, every day.  There were some days I couldn’t bear to look at myself at all.  I’m fucking done with that.  I look at myself – loose skin and all – and see someone who struggled with a lot of shit, but won’t give up.  I see a woman who is not just a fighter, but gorgeous inside and out.  Not just because she has a sexy husband that wants to fuck her every minute of every day (God he’s seriously relentless), but because she believes it now.  She doesn’t need his validation or anyone else’s.  Who knew it would only take a $40,000 surgery to get to this point?  Oy vey.

So I just got out of the psych ward.  Ha!  Didn’t see that coming, did you?  Alice: always full of surprises.  It had been over a decade since I last graced their halls with my presence.  The staff remembered me.  I’m still trying to decide if that’s good or bad.  My schedule affected my medication schedule and then I stopped taking it all together.  Then I slipped into a manic phase.  I told my family that I wasn’t taking that “poison” anymore, I was “normal” without it.  I was also unable to concentrate on anything, I was the best at everything ever in life, I was getting 4 hours of sleep at night, and couldn’t sit still worth a damn.

Then I fell.  Hard.

I couldn’t get out of bed.  I wouldn’t shower for days.  I would cry at nothing.  Or something, anything.  I’d get frustrated at little things.  I just couldn’t function worth shit.  So I called my psychiatrist.  He told me he was having me admitted to the psych ward.  I was there for a week.  He put me on FMLA and here I sit, at home, taking my meds… ish.

I told him I’m fucking trained.  I know better than to not take them.  I know that the incidence of bipolar patients not taking their meds is higher than any other mental illness because we think we’re getting better, stop taking them and fall on our faces.  I said I know the stats, I’ve read the studies, I know this shit and did it anyway.

He said, “That’s how you know it’s the disease, Alice.  Not you.”

Being in the psych ward as a mental health professional was a nightmare.  You think they treat you any better?  Nope.  Still just a fucking nut in a ward full o’ nuts.  I didn’t expect to be treated better than anyone else but I think I’ve become more aware of the stigma than I had in years past. I never remember the staff being so dismissive and cold. Even the social workers, who claim to help even the playing field between the professionals and the patients were at times condescending and patronizing.  I reminded them that we shared the same credentials, same degree and performed the same functions in our profession as a way of humanizing myself however I doubt it did much good as I was still cast aside when asking for simple things like respect.  During a group session, one social worker stated part of their job is to educate the other staff members, including the doctors, about mental health.  I actually fell out laughing.  I said that, as noble as that may be, the worst stigma against mental illness I have ever seen has been in the medical community.  I explained that I am terrified my co-workers will find out that I am in the psych ward, as I was in my own employer’s medical system and in our computer system it will show that I was there.  I further explained that none of the doctors I work with have any interest or desire to work with psych patients; they actually express disdain for the entire population.   The nurses at my hospital are mostly impatient and rude when treating a psych patient and want nothing more than for my department to hurry up and get them out of the hospital.  I have social workers who actually said to me they hate working with “bipolars” because they are constantly going off their meds and have wild mood swings.  So, excuse my skepticism when discussing “educating” the medical staff – I’m sure it’s going well.

The nurses and nurse’s aides were a fucking nightmare.  It didn’t help that they’d rather surf Facebook and Instagram than do their fucking jobs. Aside for a select few, they treated me like I didn’t know my own body.  And, not to sound like a dick, but like they knew more about psych than I did.  As someone who’s been on both sides – a patient and a professional – I can safely say that’s bullshit.  And as an employee at that hospital I knew corporate policy, so they couldn’t fuck me around when it came to that either.  Plus, this isn’t my first rodeo.  I’ve been hospitalized about 7 times.  Go fuck yourself; I know how this goes.  I wasn’t in the mood to be fucked with.  Not to mention the fact that my psychiatrist is on staff and we’ve been working together for over a decade.  I know that he always has my best interests at heart and will go to bat for me (and did) when I need him to.

So.  You’re caught up.  Time for my meds.

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. 

Devious stares in my direction

It’s been a minute, I know. I’m hanging in, but barely I feel. 

I’ve been struggling at work the past few weeks. I feel drained and overwhelmed. I often wear my bite guard to work to keep from grinding my teeth while I’m awake. The job is stressful while at work, but I don’t often take it home which is nice. When I do, it’s usually a personal problem, not a patient’s problem. 

For instance, the other day I had someone call me a fat bitch.  While normally I wouldn’t pay much mind to what others have to say to me, that stung for some reason.  Maybe because they hit that right on the head. Obviously the “fat” thing pissed me off more than anything. And it hurt. It cut really, really deep. Then I had a situation where I felt I did something right – I felt confident about my work and I was ripped apart.  Later that shift I assessed a situation and my disposition was not what anyone wanted to hear. I was ripped apart by family members, nurses – and I broke down. I was so frustrated and angry that I started tearing up and couldn’t stop them from falling.  It didn’t help that I’d had a UTI and hadn’t been able to pee all shift long.

What I’ve realized since then is I can’t allow people to dump on me. My supervisor said that’s what happened – everyone felt like crap and needed to release their frustration and crap and I happened to be the nearest one there. 

I am not a trash can. I am not a dumpster. I am not here for people to dump their crap onto. This was a step further than projection – this was blame, guilt, manipulation, and avoidance.  

See, when things don’t follow the natural order of things in my department, the staff gets freaked. It’s admission, assess, and either discharge or transfer.  Not to mention cleaning up the ancillary bullshit that no one else “knows” how to do. (They sometimes know, they choose to shove it into our laps).  That shift, things were so fucked up it didn’t go that way for several patients and each time I had a gaggle of nurses and 1:1 sitters in my office asking me the same questions: 

“What are we doing with them?” 
“Bed 58 wants to see you again.”
“So what’s the game plan?”
“I know you’re super super busy, but Bed 58 said they wanted to see you again.”
“What’s the ETA for transfer for Bed 13?”

When the staff gets freaked, I’m usually good at holding my own, but that day I couldn’t keep it together. I had 2 nurses, 1 security guard, and a 1:1 sitter standing there just pressing and pressing.  I answered the same question three times.  At what point should I stop talking? At what point did you stop listening – were you ever listening?

Coma black

I’ve been avoiding this page for months now. I think about posting daily, but I don’t. A lot has happened since my last visit here. I’ll try my best to play catch up, because I’m going to need some way to help manage my emotions as they seem to be spiraling out of control.  

First, I finally got a new job and I really like it. I’m an intake and discharge coordinator for a local hospital. The staff is welcoming, the pay is astronomically better than I used to make in community mental health, and when my shift is over, it’s done; I punch out and someone continues where I left off. No need to worry about building a deep, unshakable, everlasting bond – they will only be here for a few more hours.  

Get in, get out, have a good day. I like the fast paced life of crisis intervention; I’m addressing your “right now” problem; if you have a “sometimes this bugs me problem,” here’s some resources to help you with that. This sounds like a heartless thing to say, but I’ve burned out so quickly putting in the work for my patients in community mental health – making the calls, connecting them with resources, locating and arranging transportation… The list goes on. I put more energy into their recovery and treatment than they did. Is that true across the board? Of course not, but the people that had been involved in CMH longer had a higher level of learned helplessness and an external locus of control.  

If you yell the word “victim” loud enough and long enough, it will be the only word you hear. You’ll hear it, see it, taste it, and eventually, become it. Why be a victim of circumstance when you have the power the change your circumstance? And if you can’t change your circumstance, you can choose the way you view and respond to it.  

My counseling friends and I meet once every other month to let our hair down, drink, and be very, very merry. I was explaining the nuances of my new job to them and the looks of horror were written all over their faces. The idea that we should promote autonomy in those that we council seems to be a foreign and despicable concept. Personally, I think it’s insulting to assume that every patient I come across is unable to make a telephone call or make decisions about their treatment. The only person guaranteed to follow you from womb to tomb, birth to Earth is you. Asking for help is 100% acceptable; we are not a species that can exist in a vacuum. However, dependence, this learned helplessness, victimizing of self – isn’t where it’s at.  

I just read over everything I wrote and realized that one of my next updates is parallel.