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. 

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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.

And I just can’t hide it

Exciting news: I passed my licensure exam. I scored a 92%. I studied for 3 weeks. This is not grandiosity or narcissism; I’m truly proud for the third time in my life I accomplished a task that I was determined to do.  I graduated college, graduated grad school with honors, and now I’m to be licensed before the end of August (damn bureaucrating paperwork).  

I’m out at a therapy seminar this week and I’ve found out quite a bit about myself in the past few days.  

It’s amazing how much clarity one can gain from just a little break from the everyday grind.   

in the end, it doesn’t really matter

The stress I feel is unyielding. 
Or is it that I’m looking for an excuse to use?

At this point I don’t know which would be worse. 

I take my national licensing exam this week. I usually get test anxiety about stuff like this, but I’m not nervous. By this point, I should be sweating blood. I feel unprepared despite the fact I’ve spent most of the past couple weeks opening and closing the library. I finished my study guide on schedule, yet still… I feel numb. 

I guess it comes from some insurmountable feeling that if I blow this, I’m forever fucked. The test will allow me to go into private practice, the military – whatever I want. If I blow it, I have to wait 3 months before I can take it again, leaving me stranded at a job I both tolerate and despise. If I don’t pass, my salary will still be the equivalent to that of a general manager (with an associate’s) at McDonald’s. 

And let’s not even get into my addiction. I just ate my weight in fries and onion rings when I was on day 2 of my ketogenic diet. So much for hitting ketosis. I did it to myself, but all I want to do is blame it on my stress, my mother, my pets, my husband, the exam, work…everything. 

I feel sick to my stomach, but I can’t differentiate between binging and feeling stuffed, my growing disappointment in myself or my fear of failure.

How do you tell yourself that you’re not a failure when you’ve failed? What do you tell yourself when everyone’s counting on you but you’re uncertain of what you can realistically deliver?

Deliver me into my fate / if I’m alone I cannot hate

Work has become a living nightmare. My patients are OK, but administration is making it very difficult for any of us to do our jobs. They’ve increased the level of our required face-to-face time with patients; if patients don’t attend scheduled appointments it will count against us (apparently because we aren’t “engaging” enough… Look, I can be the nicest person in the world, but if your car doesn’t start or your kid’s in the hospital, it has less to do with my skills to build rapport and more to do with shit happening beyond anyone’s control). If your percentage of face-to-face contact is not at or above expectations consecutively for 8 weeks, you can face probation and fast track your way to unemployment.

I am to spend 7/8 of my day listening to some of the most horrifying, gruesome, sweet, touching stories of my life – with only 1/8 of it left to finish paperwork – paperwork that better not be late or unfinished or my ass is on the chopping block.

My job has now become less about helping others and more about saving myself. As far as I know, our company is the only county-funded company making these outlandish and exceedingly fucked up changes.

Oh, not to mention my patients, who are also receiving state assistance of some sort but may hold part time or seasonal employment, often MAKE MORE MONEY than I do. I’m just a tad bit sore as I have about $200,000 in student loans (that’s with interest) and an advanced degree.

I’ve been abstinent for over a week now. This morning I think I finally broke down and had a slip (yes, there is a difference between a relapse and a slip). My normal breakfast consists of one serving of Greek yogurt, one serving of homemade granola (barely any sugar – I add 1/4 cup of honey to 3 cups of oats, 1 cup of pumpkin seeds, and 1 cup of coconut flakes and some spices), and a banana. This actually fills me up and it tastes so good!

This morning, however, I went into the kitchen unscripted. I tried to make a breakfast with a fruit, protein, milk, fat and grain serving. And I royalty fucked it up. I ended up with 2 proteins, 2 fruits, 2 grains, 1 milk, 1 fat. My husband asked me, “Where’s your food log?” See, this is where shit got ugly. I knew what the fuck that meant. Just like I knew what the fuck “What about doing the lap band and OA?” meant. Even if I’m wrong, the female translation of these sentences to someone with my negative mindset is: “You’re eating too much; get thinner quicker because I have to turn my head to look at all of you.”

:::sigh::: I’m sticking with my damn yogurt in the morning. This going rogue stuff is for the birds.

Exit stage left

Today I was dragging my ass. I think I took a catnap in front of my computer at work this morning. I almost called in. I’m glad I didn’t; 15 people came to my group today – the LARGEST turnout ever. Either people have nothing better to do as winter draws near, or people actually enjoy coming to group.

All I ate were carbs and it felt like it; my kingdom for a fucking salad or raw vegetable. Thanks to my severely low paycheck, grocery day is two weeks off. Looks like we’re sticking to carbs for now. Blech.

Awkward silence countdown: day 3 or something childish. I hope she’s not counting on me for an apology. I said what I meant; I always do. I love her, but I am burnt out. At work and at home there’s a constant push/pull; my candle is being burned at both ends. When I say no as a means of self-preservation, I get nothing but guilt and attitude. My priorities are not her priorities, which I’ve noticed she finds very inconvenient, frustrating, and plain wrong.

I’ve found the dishes can wait. I haven’t seen my husband all day.

The clothes can wait; I haven’t changed out of my work clothes into regular clothes yet.

Rearranging and cleaning the fridge can wait; I haven’t used the bathroom since 7:45 in the morning – it’s 6pm. (Not to mention that she’s retired and home all day… Sets my head spinning.)

I’m trying to set boundaries, but because of the enmeshment issues we had when I was younger, it seems more difficult. I find it easier to detach from her completely than to draw a line in the sand but I’m not sure how healthy that is. I preach to my patients about boundary setting on a daily basis, but the waters get muddy when applying some of the same ideas to my own life – this one in particular.