Appt with Psychiatrist Week 4

The first thing we discussed was my weird reaction I had yesterday with Outpatient Therapy Day 9 (didn’t blog about it, as there was nothing new to report). When I woke up at 0200 I felt weak, my legs felt rubbery, and I was shaking all over. It was worse when I was standing, but even after sitting for a while, those effects returned when I’d stand again. At first, I thought my blood pressure was low, but it was normal. I was hoping it would pass by the time I had to drive for my group session, but it didn’t. I chose to drive anyway, but by the time I got to the location, it was worse. I couldn’t walk in a straight line and I stumbled a few times. I went right in and sat down and that helped a lot. The therapist thought it might be a reaction to my medication as I upped the Zyprexa to 40mg to aid my insomnia before going to sleep at midnight. I had my daily call to my psychiatrist later that day, so he dropped the Zyprexa back down to 20mg. This morning I did not have those same side effects.

Later, when I saw him, He had me go through a series of neurological exercises. The only one I didn’t do well on was the Romberg test where, while standing, you hold your hands out to your side, put your feet together and close your eyes. I couldn’t keep my balance. He is still wondering about my low B-12 values and a possibility that I may be low on Thiamine. I also see my regular doc this afternoon (God, I am so sick of having all these various appointments). We’ll be discussing the results of those lab tests I had drawn last week. I’m sure I’ll be told I have to go back to injecting myself with the B-12 shots monthly (cheaper to do it myself instead of paying for an office visit for the same thing). I wonder if you can test for Thiamine. If that’s low, I may be giving myself two shots for a while. My thighs will look like pincushions!

The only other change he made was to reduce my Geodon from 240mg at bedtime to 160mg.©2009

A Measure of Hope

I don’t where to start with this one, but in so many of my posts, I have demonstrated extreme rage towards my pastor. I have also invalidated another person with whom I’d grown very close to over the course of our friendship (she is the one who brought me those nifty tools to use to keep me safe at night during my midnight walks even while vilifying her).

As much as I have disparaged my pastor publically via this venue, there is something else I must do equally as public. I realized that I had to let go of all of the anger and hostility I have felt towards him. In addition, I have to come to understand how valuable my friendship is with him. I recognize that these emotions and thoughts regarding both of these individuals were irrational.

Today marks one month since I tried to commit suicide. This afternoon they came over to my house at my request. I needed to apologize to both of them for the unkind ways in which I treated them through my various posts. I realize now that their only motivation is one of compassion and concern. I didn’t see that in the midst of my turmoil. For the first time, I believed that it was possible for someone to care for me that much. I have to learn to accept that at face value—it is what it is. To know in my heart that their friendship and just as important, their acceptance of who I am while wrestling with BP and BPD, is a hard concept for me to accept. Nevertheless, I believed everything supportive and loving they said to me.

Having rejected everyone—by any means necessary—letting these two individuals back into my life brings me a measure of hope that I haven’t felt before. I discovered that I can use these tools to overcome at least one of my BPD hurdles.  Today I took off my mask, even if it was for a little while©2009

Individual Therapy #2

I met with my individual therapist yesterday right after group. My head is certainly having the time of its life! I didn’t think I would return after my first visit. However, this session went well. I’ve never done this before as far as dealing with a therapist one-on-one. Still not sure what to expect, but I liked the fact that I seem to get along with her fairly well. She’s upfront and direct—no bullshit. I’m not sure if I am going to chronicle these appointments as it appears that we are going to delve quite heavily into my personal life—more in detail than I want to publish. Suffice it to say that I think I can derive some benefit from this. At first I thought she was sold on DBT therapy (very similar to my group therapy sessions), but it appears not so much. I can’t take any more coping skills sessions than I am already exposed to through my group therapy. I like her (not so sure I can trust her yet; time will have to be the measuring stick on that one) and I feel I’ll be able to open up to her especially where my dysfunctional upbringing comes into play.

Oh, I did find out this morning that my medical disability has been extended through 30 November due to the paperwork my group therapist submitted. Evidently she doesn’t think I’m prepared to face going back to work tomorrow. I’m not being a deadbeat when I say this, but I don’t think I am ready yet to handle that additional stress right now.

Well, my plans for my midnight walks are quashed tonight. It has been raining like cats and dogs all day today. It’s absolutely miserably outside—chilly, dreary and wet.©2009

Outpatient Therapy, Day 8 and my Phone Check-in With My Psychiatrist

This group therapy is getting old. It’s the same thing everyday—too emotional for me, at least as far as some of the others in my small group. I know this sounds callous, but from the moment I sit down, I am just counting down those two hours of “sharing” before we have our break. Yesterday was no exception. There is one woman who, they decided a week or so ago, that she needed to be hospitalized again. It wasn’t an involuntary commitment—evidently she agreed to it. Well, her first day back into the outpatient program, all she did was cry while she was sharing but refused to go into any details. She said she was afraid they would put her back inside if she told the therapist what was really evoking this emotion. I have a handle on that one—I’m certainly not going to voice that I am intentionally suicidal (they gauge how “safe” you are as to how forward thinking you are regarding your actual plans to commit suicide). I can say that I was feeling suicidal the previous evening, but I have to show a coping skill I successfully used to avert that situation. I can say without a doubt that there are nights when I am suicidal and I go through the motions of preparing everything. If I were to say that I have the intent to follow through, that would land me right back inside the Big House. I don’t follow through, not yet, but at one point when will the intent be stronger than the want not to do it?

I can feel my depression getting worse even with my doc tweaking the cocktail. So far, nothing he has done has yielded any progress as far as my depression and insomnia go. I am living one day to the next with, at best, two hours of sleep. Oh, and get this, the results of my fasting blood work has come in. My psychiatrist always gets a copy from my regular doctor. He looked at the results while we were on our phone call check-in today (I’ve been on the phone everyday between my weekly appointments even over the weekends so he can adjust the meds, if needed, on the fly and spare me the expense of an office visit). Evidently, while my haemoglobin is 11 (low side of normal), my iron stores are pretty low. My ferritin level is only 5 (normal is 15-200 ng/mL for females). Ferritin is a protein that stores iron and releases it in a controlled fashion, in single cells and multi-celled animals. It is a buffer against iron deficiency and iron overload. The last time, approximately 6 years ago, my ferritin level was only 2. I tried taking vitamins high in iron, then iron pills to no avail. My body wasn’t absorbing the iron. I ended up having to take Infed (used to treat iron deficient anemia) administered IV. I had to have three separate infusions over a few weeks. That cost me one hell of a bundle. I can’t afford that now in view of all of my other medical bills recently incurred. In addition, ketones and protein are spilling into my urine. Ketones are produced in the body when fats, rather than glucose are used to produce energy, but my glucose is 94. Protein in the urine is a warning sign. It may indicate kidney damage or disease or it may be a transient elevation due to an infection, medication, vigorous exercise, or emotional or physical stress. Well, yeah, I am under a considerable amount of emotional stress. I don’t know the other results yet, but I see my regular doctor on the 12th. I am sick of doctors; I am sick of medical tests. I just want to be left alone.©2009

Another Lonely Evening Comes to Pass

I’m sure where to start with this entry. The house is quiet; I don’t even want to listen to music (pause) no, I changed my mind. Just opened my iTunes and am now listening to Frank Sinatra’s September of My Years. Hmmm, maybe the theme is a little too appropriate.

How do you explain to someone that you don’t want to get better? Yes, I’m about as mental as one can be. But, it is my comfort zone; it is what I know best. I know how to operate under this cover of darkness. Oh, sure, you must be thinking, why would someone choose to struggle with being suicidal so many nights a week? I do not know what normal is. I do not remember what being happy feels like. Was I ever happy—ever? Even when I was somewhat balanced while on my meds before I quit taking them, all I remember at best was being numb. At least when I am manic, I feel energetic; I feel as if I can do anything. Now, all I experience is the crushing defeat of morbid depression. Even after three weeks, the meds haven’t kicked in at all. My doctor keeps upping a dosage of one and waits a while, then he’ll add to the cocktail (he is rather conservative about how many types of changes he makes at one time). Either way, I don’t feel any different.

I am supposed to try to add yet another med tonight as a temporary measure to break my cycle of persistent insomnia. He wants me to take 10mg of Zyprexa an hour before I take the rest of my bedtime meds, and if I am not asleep in an hour, to take another 10mg. Then I have to do another phone call check-in with him again tomorrow (the addition of Zyprexa was the topic of our phone check-in today). He already knows how I feel about Zyprexa; it became a deal-breaker for me when I discovered what a weight gainer this drug was. Not trying to be recalcitrant, I argued with him since he already knew how I felt about this drug, but he said he only wanted me to try it for one week to see if it would break my insomnia and give sleep a chance. I agreed to take it temporarily. We’ll see what happens tonight. (Now Frank is singing “It Was a Very Good Year.” I wish I could say the same).

(later) I decided that I had to leave the house. The walls were closing in on me. I already know where that will take me. The weather is perfect outside. I decided to grab my atlas and don my new toys and go for a walk. I decided to go up to the corner Starbucks (yeah, I remembered to opt for decaffeinated). That meant I had to deal with people. I had no idea how many there would be. However, the evening was too nice not to go out. I was too exhausted to go for a power walk; there is no apparent rage seething within me at the moment—a welcome change. Just a short walk up to the corner to get some fresh air was perfect.

Starbucks just had two customers that were engrossed with each other, tucked away in the corner. I doubt they even noticed me. I got to the counter and looked up to the menu. There were so many choices. The cashier was waiting for me to place my order. I couldn’t make up my mind. I froze as she just stared at me and asked, “What I get for you?” a second time. Finally, I made my choice and just wanted to get out of there as fast as I could. Once I hit the door and the cool night breezes swept my face, I felt I could finally breathe. It was good to know I still had my bearings. I promptly left the parking lot and headed home.©2009

Outpatient Therapy, Day 7, the Gift Bag at My Door, & My Attempt at “Radical Acceptance”

I do not have much to say about today’s session. The therapist is concerned that I am not eating except a small snack to take with my Geodon. She is also concerned about my insomnia. I did not have much to share. Not much had changed from Wednesday, but I was able to report that I was not having any suicidal ideation Thursday night. Very depressed, yes, but I was able to leave it at that. She pointedly asked me if I could remain safe through the weekend and I could only tell her that I have demonstrated successfully one tool, and that was all I could promise her. I also told her that my psychiatrist has requested me to call him for a check-in call on Saturday and Sunday. She seemed rather pleased with that.

In actuality, my blogging has actually helped me with the ideation Thursday night. I spent a good deal of time writing, reading others’ blogs, and keeping up with my LGBTQ-oriented Facebook account (OK, a translation for you straight folks: Lesbian, Gay, Bisexual, Transgendered, Queer/Questioning), along with my Twitter feeds.

Something weird happened at break. One of the folks in my small group came up to me and wanted to know why I ignored her after trying to say hi two times. I had to honestly tell her that I really had not noticed her (remember me; I am all about blinders around other people). She started crying and I did not what the hell to do as she did this in front of everyone. Then everyone stared at me. Well, I am sorry that I must have hurt her feelings (I can recognize that from classic BPD symptoms), but I am not responsible for her feelings, only my own. I felt, with everyone staring at me, that I at least had to apologize. I really didn’t want to have to interact with her at all, but what was I to do? It is not as if I go around intentionally trying to hurt someone, or be rude or uncaring. I just simply want to be left alone. Soon enough, break was over so I went inside where both groups join and found my seat on the far wall. I also asked the therapist if I could crack open the emergency door right beside me in case I had to leave the room (I do not want to make a spectacle of getting up and walking by everyone to leave through the normal door). She said that was fine (no alarm attached to the door)

I came home and found this gift bag by my front door inside my porch. Curiously, I picked it up and brought it inside. The attached note said, “For your walks around the neighbourhood…a few things I thought would come in handy.” It was signed from the only church member (outside of my pastor and his wife) that I had been relatively honest with about some things. Evidently she has been reading my blog and noticed my entries concerning with my dissociative states while walking or driving. Inside the bag was some pretty neat stuff. It contained an atlas with very detailed set of maps of my city along with a street index finder. I found my house (conveniently already marked with an icon as there is a large city fire department up at the corner. Nevertheless, I am going to put an X right where my house is anyway because with a past dissociation, the fire department’s presence did not mean anything to me. I’ve even post-noted my relevant pages). It also marks subdivisions and schools—things I pass by on a regular basis. In addition, there was a device with a red blinking LED visible to one km with a range of 180˚. It came with a strap and three batteries. I can attach this to myself to make me visible when I take my late-night walks. There was also an LED pen light with a magnifier lens that only weighs 38g and has a metal clip attachment. The last thing in the bag thrilled me to no end—a new tool. This seven-in-one tool is only 12cm long. Get this—it contains an LED light, compass, thermometer, clock, safety whistle, safety mirror and a 2X magnifier. It comes with a lanyard I can wear around my neck. Now I can be all decked out in LED!

OK, time for an honest reality check here—my perception vs. my reality. This person does want to be close to me—not because of the gifts, but because of the intentions behind them. I wrote her a long email thanking her (I did not feel prepared enough to actually talk with her at that point). In the same email, I told her everything. I even attached two documents on bipolar and borderline personality disorders to help her understand the effects these have on me. She responded with such a kind email; it gave me some contact with another person who now knew me the way I wanted her to know me—no pretence about anything. She let me know that she clearly knew what my boundaries were and that she was not going to be in my face, but essentially would let me make any contact. Fearing that I would lapse into my normative state of isolation, I told her that it was OK to call me, but if I felt I was not capable to talk, she could leave me a vm. I was OK with that, so after reading the email, I actually felt better prepared to call her. I am trying so very hard to reach out, but I can only take baby steps. I fear rejection; I fear abandonment.

Now, onto my next hurdle—trying to use “radical acceptance.” The principles are 1) solve the problem, or, 2) change how you feel about the problem, or 3) stay miserable, or 4) accept the problem. It takes away the “judgements” and removes the “shoulds.”

The hurdle—all of the anger and resentment I have felt toward my pastor for placing the 911 call and coming by the house to show the police my text message. My perception? That he was disappointed with me, angry because I did not call first and ask for prayer before I got in that state, and that he would think less of me. Therefore, I took a very deep breath and wrote down everything I wanted to say before I called him so I could focus and concentrate on what I really wanted to say.

I called his house and thankfully, he answered. I am not really sure what I would have said if his wife had picked up instead…I wasn’t prepared for that scenario. I told him who I was not knowing if he would recognize my voice. Then I told him I had something to say and would he listen to me without interrupting me until I was done. I asked him if he would meet me because there were some things that I needed to say to him alone, that we could meet in a public venue of his choosing as long as I would not be seen as making a spectacle of myself if I got emotional, and it had to be a place where I could smoke (damn these city ordinances banning smoking to even include many outside venues). We settled on standing in the church parking lot (right across the street from me) for this Tuesday at 1630. When I finished what I said, he asked if he could say a few things. I hesitated momentarily—this wasn’t a planned two-way conversation. I wanted to say what I had to say, set the time and place and get off the phone, but I ended up saying OK. He helped fill in some more of the blanks. Evidently there were already three or four police cruisers and the EMS there across the street in the church parking lot before he arrived (I had been told earlier by one of the first responder cops that they parked there with no lights flashing on purpose so as not to alert me in case it was a situation of “suicide by cop”). The cops asked him who he was and he explained that he had placed the 911 call as a result of my text message. They asked to see the text message, but they would not let him cross the street to my house at any point. He told me that the only reason why he came over was that he was very concerned and worried about me. He said he had tried to call me after receiving the text message and I did not answer. Again, the problem with my perception vs. reality.

Am I ready for this conversation? I do not know. I have to find a way to let this anger and resentment go. While it is by no means my only trigger, I have obsessed over this a lot—primarily because I have always respected him. He is a WYSIWYG (what you see is what you get for you non-computer geeks) kind of guy—shoots straight from the hip with no guile. From the very beginning, he has accepted the fact that I am a lesbian and never has judged me. I owe him the same respect.

Well, I still have two days to process this. I am also going to discuss during my group therapy session on Monday. I also have my second appointment with my individual therapist on Monday afternoon as well. My question is am I sufficiently prepared to handle this type of conversation at this point so soon after everything has happened? I need to protect myself and not set myself up for failure. I am trying so hard to reach a point in my life where everything is in balance, but I have to put my needs first—a concept that never existed in my “I don’t give a damn” mode.©2009

Appt with Psychiatrist Week 3

My calendar said that we had our second appointment on the 29th, but I don’t remember that one. I can tell my meds have changed because I found his instruction sheet. He always writes everything out because he knows I may not remember. This visit was on 05 November.

My meds have changed again. Now my Geodon has changed from 240mg at bedtime to also include taking an 80mg dose in the morning along with a new drug called Provigil @ 200mg in the morning to help sharpen my focus and concentration. Its primary use is for the treatment of narcolepsy, shift work sleep disorder and excessive daytime sleepiness associated with obstructive sleep apnea. Other potentially effective, but similarly unapproved targets include the treatment of depression, schizophrenia, and disease-related fatigue. I guess my disease-related fatigue is the insomnia due to the depression

His primary concern is that I can keep myself safe. He has always been the only one with whom I’ve been able to be completely honest. I have been seeing him since June, 2000 when I was first diagnosed with BP (BPD didn’t become diagnosed until 2005 after my previous attempt at suicide). Aside from wanting to keep me safe, he is very concerned over my lack of sleep. He told me that I couldn’t expect to see measurable progress until I can overcome the insomnia. He’s also concerned about my weight loss. I’ve lost eight pounds since 28 October because I’m not eating. The only thing I eat is a small snack when I take my two doses of Geodon because it has to be absorbed with food.

Today he increased my Lamictal to 200mg QD. My short-term goals are 1) work on severe depression with medication changes as needed, 2) directly deal with my persistent suicide ideation as depression lessens and while my coping skills are still effective, 3) work on my rage issues as my depression lessens, and 4) work on my isolation as the depression lessens. He knows I am in the OP Therapy program Mon-Wed-Fri, so I am to call his office on Tuesdays and Thursdays and request a call back so he can check in with me. He also wants me to call his service on Saturdays and Sundays for the same purpose. He wants to keep me safe, and feels with this constant monitoring, if needed, he can make a med change on the fly. I couldn’t ask for a better psychiatrist. He gets me. And he said that once my bipolar balances out, he wants to work on my borderline personality disorder. He is more than just a psychiatrist. The time he spends with me and what we talk about is better than any individual therapist I’ve ever seen. I’m very grateful that the circumstances back in 2000 brought us together.©2009

Outpatient Therapy, Day 6

I couldn’t resist this video. It actually had ME chuckling a bit! It’s well worth listening to for you group therapy gurus out there!.

Yesterday I was a little more active about filling information on the daily check-in sheet we use for “sharing” (gag). I was able to verbalize and demonstrate (what they are looking for according to my treatment plan) three skills I have been using to further my treatment.

You know how I mentioned that I can be out driving my car and all of a sudden I don’t where I am, how I got there or how to get home? (which only causes an anxiety attack to no end). Well, what I’ve come up is this plan: I Google the map from house to location (and also do a return map) and I keep that in my car. I study the map so I know what exits to pay attention to if I’m on the interstate. I have been using “mindfulness” (skill #1) by concentrating hard on where I am at all times, mentally checking off the exits. In addition, I will call the location ahead of time (even if it’s been a place where I have gone before) and ask for prominent landmarks that I can start looking for as I approach the location. I mark these landmarks on my map.

When it comes to more locally centered destinations, I can zoom in on Google and it will note landmarks (restaurants, gas stations, churches, etc). It’s still up to me to study them ahead of time so I don’t have to be looking at them while I’m driving. I’ve have even had to resort to do this when I plan to take a long walk around my neighborhood. The other night, when I just wanted to get fresh air, I Googled the diameter of the area usually a minimum of a two-mile stretch (residential, no populated landmarks) and made notes on the map with regard to street addresses to go with the street names and would place arrows to make sure I would know how to get home. In addition, I take my walks when it is very late at night—no traffic, no noise. You might wonder if I’m taking a risk doing this so late. All I can say, pity the fool who wants to fuck with me whether he has a gun or knife. Besides, you’ve heard the phrase, “suicide by cop,” well, couldn’t this be just as easily “suicide by rapist?”

The other immediate issue I have been working on is facing being around a large group of people. When our whole group therapy rejoins us for the second session (we always split into two smaller groups for the “sharing” session), I can’t handle the room that is now filled of people. All of the chairs are taken. I can’t sit next to someone, or even be in close proximity. My coping skill has been to “retreat” (skill #2) where I find a chair alongside the wall, as far as away from the table that is possible. Again, I use “mindfulness” when I start freaking out and the walls feeling like they are closing in around me. I simply close my eyes so I don’t have to see anyone and just zone on what the therapist says. Sometimes I have to use my “deep breathing” (skill 3) when I actually have to open my eyes and look at the white board, or have to participate in the discussion (my extent of participation is usually having to ask her to repeat what she just said because I don’t understand something, or my poor concentration is acting up).

So, I am using three skills so far that seem to be working to an extent. I’ve developed quite a lot of neighborhood maps, by the way. I’m not one to retrace my steps every night. Since I am still alive writing this, the severe suicide ideation I experience on an all too familiar basis, what I have been doing for that one is to get out of my house, because it seems that being all alone in my house has become a trigger, so I “retreat” and take a long, hard walk. The exertion helps dissipate the wrathful rage I am experiencing at the moment, so by the time come home I am usually spent and exhausted. I simply take my bedtime meds knowing that they will knock me out for about two hours tops. When I wake up, the suicide ideation is usually at bay, even when I go into the other room and put all my “instruments” back in their lockbox for no one to find. I’ve carefully labeled it quite prominently Bank Statements, so no one would even bother looking there if the cops ever had the probable cause to search my house.

I am missing a time block from the time I left group therapy this past Friday from about 1215 until I woke up @ 0135 (you know, when I eventually go back to work, there is no point in having to set an alarm!). However, what concerns me most about the dissociative states is wondering what I do when I am in that headspace. I have to ask the obvious question: what happens if I become suicidal during a dissociative state? Will I have the frame of mind to attempt to use my coping skills? I only have this as a vital concern because the last time I committed suicide I cannot remember almost nine hours (which of course could actually have been precipitated by the incredible amount of ETOH I consumed along with the benzos).©2009

Outpatient Therapy, Day 5

This morning was rather interesting. Did the usual sharing, but when I commented that I couldn’t remember anything from the time I left group last Friday (but that I remembered Saturday and Sunday) she asked me if I remembered calling her Friday afternoon. I drew a complete blank. She said I wanted to meet with her afterwards today to discuss my treatment plan. It was news to me (as she scribbled).
Well, we did discuss my treatment plan. I asked why, under master problem list, it listed merely “depression” and no indication of persistent suicide ideation. She explained that I had not been honest from the beginning about that on my daily check-in sheets, and only just started mentioning it. I tried to explain to her that the ideation isn’t just something I think about here and there, but that I struggle with this almost every evening. The only thing that has kept me alive has actually been using one of the coping skills. I am discovering that my house…my fucking house (or rather, being in it all alone), has become a trigger. I have to leave the house and I end up going for a walk—a long walk. My reasoning? It’s late at night, and walking releases so much of my energy. When I finally get home, I’m worn out—physically and emotionally—utterly spent.

She looked at me and told me that she thought I needed go back inside the Big House—that this outpatient treatment program, in her opinion, wasn’t going to be sufficient to keep me safe. I pleaded with her not to make that recommendation (i.e., have me committed again), that I had shown that I was successful in using my skills. I practically begged her to let me go as long as I made the commitment to her that I would use my skills when I was in that head space. I tried to stay calm, although my heart was banging so hard. However, she relented but there was this look in her eyes that scared the shit out of me. All I kept thinking to myself was to just deep breathe and stay calm. I didn’t want to trigger any action on her part.

When I got home later, I looked at my entries on the blog and, sure enough, there was my entry about Friday that I posted on Sunday morning. Evidently, I did remember at that moment actually coming home, but it doesn’t say anything else about the rest of the day. And today, the last thing I could remember was someone making a comment about the fact that I actually smiled for the first time just before we left group. My mind is so fucked up. I swear there are times when I don’t know what is real and what isn’t.©2009

Outpatient Therapy, Day 4: Treatment Plan and My Diatribe about Pot

Friday was an uneventful day again. I’m glad this program is only Mon-Wed-Fri from 0900-1200. Once the group split, I realized that there were a few less of us in my half. A couple of people, evidently, had finished the program. I wondered when I was scheduled to be finished. As usual, we went around the room “sharing” what was on our daily check off sheet. While I understand that this is the opportunity for the therapist to get a good view of the progress each of us is making from day-to-day, I have a hard time enduring what some of these mentals say. Some of them can just go on and on about nothing, or repeat themselves endlessly as if to really underscore the problem they are having with their “issues.” Yelling “I heard you the first time,” would accomplish nothing. Meanwhile, when it came around to me, I sorta just tonelessly droned through my list (nothing had changed from last Wednesday, except that I was still alive). I did underscore that I am having repeated states of dissociation and time loss. I swear, there are blocks of time where I can’t remember shit. Not that I go into another room and forget why I got up in the first place; I’ll forget an entire day and have no idea what happened (no, I am not drinking any alcohol and my meds have never affected me this way before). Or, I’ll be driving down the road and all of a sudden I have no idea where I am, how I got to that point, nor where I am going. Kinda spooky. Of course, she did some heavy scribbling here. Then I reported back to them how well I controlled myself when the cop came back to my house on Wednesday to answer my questions. Then, break time (I always arrange it so I am the last to report in).

The group as a whole has pretty much figured out to leave me alone while I smoke my cigarettes during the break. If there are too many of them around the covered picnic tables, if it’s not raining, I’ll just walk around the parking lot instead. When we came back in, I found out that the whole group would be together again for the second half, so I just grabbed my stuff off of the table and found my seat along the wall in the corner. A few people in the other half of the group looked at me, and I just stared back with this “What’s your problem?” look while I shrugged my shoulders and held up my hands. That usually works. In fact, I had to smile—one of the women in my half of the group saw me do that and looked at me and gave me a thumbs up sign. At least she gets it.

Then, the door opened and one of the other therapists called me out to her office. She wanted to go over my “Interdisciplinary Treatment Plan.” In other words, what they perceived to be my problem areas and their stated goals for me. Basically, this is how it breaks down:

ADMITTING DIAGNOSIS (DSM-IV):

AXIS I: 296.62 Bipolar Disorder, Mixed

AXIS II: Borderline Personality Disorder

AXIS III: HTN, Asthma, Arthritis, Headaches

AXIS IV: Financial, Social, Occupational

AXIS V (GAF): 50 (explained below)

MASTER PROBLEM LIST:

1. Depression
2. Intense anxiety
3. Work-related stress
4. Low self esteem
5. Impaired thoughts
6. Lack of social support
7. Grief (deferred to individual therapist)
8. Shame/Guilt (deferred to individual therapist)
9. Hypertension, knee pain, headaches (deferred to PCP)

GLOBAL ASSESSMENT OF FUNCTIONING SCALE (GAF): “41-50=Serious symptoms (e.g., suicide ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).” [Alix’s note: this description comes from a manual; it by no way implies that I shoplift…LOL]

LONG RANGE GOALS FOR TRATMENT (Discharge Criteria): Alix will exhibit skills adequate to maintain the gains made in therapy and establish adequate resources to function at a lower level of care.

PRESCRIBERD TREATMENT MODALITIES/SHORT-TERM GOALS:
Problem 1: Alix will verbalize and demonstrate 3 skills used to manage depressive symptoms, such as mood swings, feelings of hopelessness, isolation, low motivation, poor sleep, & the impaired ability to function. (Target date 11/27/09)
Problem 2: Alix will verbalize and demonstrate 3 self-nurturing skills used to reduce and help manage feelings of anxiety. (Target date 11/27/09)
Problem 3: Alix will verbalize and demonstrate 3 skills used to manage current work-related and financial stressors. (Target date 11/27/09)
Problem 4: Alix will verbalize and demonstrate 3 confidence-building skills used to experience an improved sense of self esteem. (Target date 11/27/09)
Problem 5: Alix will verbalize and demonstrate 3 skills used to improve memory and concentration, and decrease racing, irrational, and confused thoughts. (Target date 11/27/09)
Problem 6: Alix will verbalize and demonstrate 3 skills used to strengthen or build a support system in order to experience less isolation. (Target date 11/27/09)

Well, folks, there you have it: all my problems summed up in a neat tidy package! I’m supposed to figure out a shitload of “skills.” Hell, I don’t even know what most of them are. I sure hope that teaching them is going to be part of this program (since I’ve only been to a few, I really don’t know what to expect). I wonder if the target date means that is how long I am to remain in the program. I did find out that my current FMLA medical disability goes through 10 November. If the target date does indicate how long they perceive my need to continue in the program, does this mean they are going to re-file w/the disability group @ work and extend my FMLA? I know that, according to federal FMLA rules, I cannot lose my job. They don’t have to give me my exact job back, but they do have to provide minimally a similar job with the exact same pay scale. If my manager deems that the team can no longer proceed with my absence and brings in someone new to replace me, maybe my replacement position will be much less stressful and require less than 12-14 hour work days.

I’m not sure how I feel about returning to my current position. I love the interaction with my clients and being able to provide my services, but the overall demand of having approximately 150 high-end clients (major revenue-producing companies), coupled with the many ongoing projects in which I manage the majority of the work product (and so many of them all having approximately the same deadline dates) have become too much for me to handle. The mere hours I work have finally exhausted me. I have tried to manage my time as effectively as possible, but all it takes is one little phone call from a huge company to throw me all off track (not to mention the number of voicemails I have to address throughout the day). Meanwhile all those inbound emails continue to flood my account with more demands of my time and “invites” to numerous customer meetings. At the end of the day, when I physically can do no more, I look at what I didn’t finish and how many unread emails I still have that day only to realize that it will snowball into the next accompanied by a new day’s worth of meetings and unread emails. I have had too many people tell me that I can only do so much and to let the rest go; however, I am bound by Service Level Agreements as part of the contract signed with my clients. I am required to respond to their emails/voicemails within 24 hours (in some cases, within only one hour depending upon the problem). I also have to take into account that I work for a global company. While I sleep, Europe and Asia continue to send emails and voicemails. I am slowly realizing that, as much as I want to, I can’t be all things to all people. Moreover, this doesn’t even take into account the many hours of continuing in-house corporate training I must complete (e.g., Six Sigma). Vacation time? Sure, I have 17 days left. I’ve been too busy to take any of those up to now—too many projects always underway. (I actually took 09 amd 10 October as vacation days; however,the evening of the 10th is when the nightmare began).  It’s already the first of November. If I don’t use them, I will lose them (no carry over). Can you imagine how many emails are waiting for me right this very minute? How the hell am I going to be able to take off any vacation time between now and the end of the year? I just can’t do it any more, but with the way the job market is, I simply have no choice to not do it. With what I do, trying to find a comparable job elsewhere is a pipe dream—everyone is downsizing, even my own company.

When I got home from group around 1230, there was nothing to do. Yeah, my house could use some straightening up, a good dusting and vacuum job (at least the kitchen always sparkles). I can’t tell you the last time I actually made my bed. I just sit on my couch and listen to my music. Oh how I miss the old days when I could fire up a number, sit back and catch a buzz. When corporate HR policies everywhere instituted the mandatory compliance of random drug testing, all that went out the door. I never envisioned not being able to light up a joint again. I have a big problem with this whole scenario. Go after the tweakers and the hard ball coke and smack users, just leave us well-intentioned potheads the fuck alone. I never got high before or during work; it was simply my “martini” at the end of a long, hard day. Tell me who doesn’t have a beer when they get home from work (or goes out with the gang)? In addition, the drug test policy doesn’t even address the alcohol issue. I can’t tell you how many times, when I used to work in a corporate setting, I would be standing next to someone who smelled like a brewery first thing in the morning, or those that came back from lunch looking just a little too much bloodshot for my tastes. Why not address that pervasive problem. Their judgment is equally impaired. It’s just not fair.

Well, tomorrow is Monday, yet another group session. I have some questions about my treatment plan. At least I know I have something to do from 0900-1200.©2009

Despair of Loneliness

Today is another off day for me. I actually set a goal last night. Laundry. Well, I’ve done that, along with moving all my summer clothes to my armoire. Winter, what a dreary thought. I hate the fact that we go back to standard time zone on 01 November. Crap, that’s this Sunday. Sunshine is important to me. There are periods of time when I will spend huge gaps of time on my front porch. Before I started working for my current company, I also worked from home. I can’t tell you the advantages of being able to work from home. Think about it: dress code (I am always in a tee w/sweatpants and barefoot), I can smoke (which probably explains why I am up to two packs a day), and talk about multitasking— I can pop in a load of laundry during the day, etc.. Anyway, at my old job, I did not have a company-paid business landline coming into my home. So, I snaked a patch cable under my office window that looks out onto my porch. I’d take my laptop, cordless phone and cell and just sit out there all day. It was wonderful. Whenever I had to unmute my phone during a conference call, the damn birds or a siren passing by would always give me away, but no one ever made a big deal about it. Hell, the birds were a pale intrusion compared to some assholes who worked from home and had constant barking dogs or a damn baby shrieking in the background.

I digress. I don’t even want to talk about work while I am on medical disability leave (for how long has yet to be determined). Getting back to today. It’s absolutely beautiful outside. Do I go anywhere? No. I can’t think of any place to go. I have no friends I can call up with whom I can make plans. I had one friend with whom I thought I could be upfront about my mood swings and I made the huge mistake of admitting to her during my last crisis earlier that afternoon that I was so depressed that I was feeling suicidal. BIG MISTAKE. She started crying and going on and on about how she couldn’t bear to lose me; think about all the people I’d be leaving behind who love me and care about me (I had no idea who she was talking about); how could I possibly do that to everyone. She never got it that she was my only friend). Then she told me that she wasn’t leaving me alone that day. Boy did that piss me off. As I got out of her car I told her that she could sit in my driveway all damn day, but she sure as fuck wasn’t coming into my house. Ultimately she calmed down and I finally got her to leave. (She was the one I thought had called 911 later that night). Then, not too much later she texted me and wanted to make sure that I was still OK, followed by a phone call which I did not answer. I texted her in all caps to leave me the fuck alone and not call back. Needless to say, I ended up with a bunch of texts and missed call entries that I had to delete.

I have quit going to my church (I’ve now missed three services in a row—something I’ve never done). One person had called and left a vm the other week that I just deleted. (What is nice about having an actual answering machine at home vs having your vm as part of your landline package is that you can screen your calls.) But, no one ever calls me. I’m serious. I have no friends. I had to use that one friend as part of my “safety list” upon discharge from the psych hospital to indicate that I had a support system. I actually used her and one person I knew at the church. I had to put in at least two names and phone numbers (no, they didn’t bother to call them to verify it; otherwise, I imagine one or both would have tried to contact me specifically about receiving that type of call). It’s ironic that, after three weeks now, she pinged me on my cell only twice (which I ignored) and hit my facebook account once (and I immediately blocked her). She actually hasn’t tried to call me. I hope she got the message finally. I don’t want someone around who feels they have to "fix" me.

So I am sitting on my couch once again (now listening to U2, the Stones and Jethro Tull) and there is absolutely no one I can call with whom I can talk. No one. I never understood just how much loneliness could hurt. I don’t have to worry about intentionally isolating myself. There is no one from which to isolate. And the most desolate part of all of this is that I have been like this for so long. Even looking at my past blog entries, I can see going back to April 2007 I made this entry.  So here I sit. All alone. Why bother?©2009

Outpatient Therapy, Day 3 and My Date with the Police

I was very uncomfortable walking into the group room today. While the entire group is split in two, everyone has to come into my room to pick up and fill out their daily check in sheets. Then they go to another room. The room is fairly large; there are 6 conference-sized tables arranged in a large square. There is a seat for everyone, but it still too many people for me. At least half of them leave after 10 minutes or so.

Today’s “sharing” session (which generally lasts for two hours) was the usual boring routine until it got to me. I have decided to be honest about everything: the isolation that is now bordering on the extreme to include not even wanting to sit near someone, the rage/anger, suicide ideation (as long as I can assure them that I am not going to act on it), etc. I told them about my egging the police cars Sunday afternoon as an example of how my rage is getting out of control since I am now acting out my impulses. I admitted the desire I have to want to beat the crap out of any cop, and that I have been looking for ways to provoke an incident. I also told them that the two cops who responded first to my 911 call back on 10 October would be coming over to my house this afternoon to answer some of my still yet unanswered questions. Boy did that get their panties in a wad. They asked me if I thought I could control myself while they were at my house. I told them I was seeking answers, and as far as this meeting was concerned, I needed their help so I could fill in the gaps. I’m smart enough to know not to bite that hand that feeds me. Then I was asked how I would respond if they told me something that made me angry, or if they patronized me in any way. I didn’t have an answer for that one. They’d better not patronize me. That’s about all it would take to send me over the edge. Who the hell do they think they are, anyway, strutting around flashing their badges and guns like they own everything? (but, of course, I didn’t say that!). They didn’t think it was a good idea, and suggested instead that I meet them at the police department. Oh, yeah, like I’m gonna want to go THERE (aside from the fact that there are too many people around). I just told them I would think about it, but most probably I was going to stick to my guns and have them over. Right now as I wait (should be here in about 45 minutes barring getting a call beforehand), I don’t feel that my anger is out of control. My driving force is to get these much-needed answers. I can behave, or at least play the game, to get what I want. We’ll see.

The second part of the outpatient program today was the presentation by the therapist. She usually touches on various stressors, reactions to stressors, and discusses possible coping skills (today was about anxiety vs panic and their associated decriptions/indications of the related attacks). However, as soon as we came in from our break, she announced that the whole group would be together for this. I immediately got up from my seat at the table and found a chair that was against the wall far away from the table. Everyone piled in and thankfully filled all of the seats so it didn’t look too abnormal to take a seat on the wall (however, I moved there before most of the other group had come into the room). I had a hard time during that session. Just too many people. And, God, can some people whine!

(later) Well, the officer just left. He was as nice as could be and sat down at the table I have on the porch. He said the police always respond to “suicide person” calls as SOP. He and the ambulance parked across the street (where the church parking lot is) so as not to alert me, reasoning being that the alleged “suicide person” may try suicide by cop (it’s a shame they know THAT trick). He went on to say, especially after interacting with me today, that I was highly intoxicated and could not walk without assistance. He walked me into my house to secure my wallet, keys and sandals, but said that he did not search the house. He can’t remember if all my house lights were on or not.

But, here is the kicker: my pastor arrived (he was waiting for the police. He also parked across the street) to show them the text message I sent him. That really pisses me off. OK, I get that he felt some professional obligation to call 911 based on the text message I sent. But to meet the police at my house??? That crosses the line in my book. That pisses me off to no end. Why couldn’t he just leave well enough alone? What was he out to prove?

The cop was completely courteous and respectful. He even said that he wouldn’t even have recognized me by my actions given the state I was in then vs how I was when he talked to me today. It said it was quite an amazing difference.

OK, I guess I have been able to fill in my blanks (except why the hell my pastor showed up…but I haven’t talked to him or anyone at the church since that night, nor do I plan to. Needless to say, I won’t be returning to church—that one or any other for that matter). Now I am just waiting on my medical records from my ER debacle and the copy of the .wav file with the original 911 recording. While I may now have my answers to what the fuck happened (no, I take that back. I can’t account for the hours between 2000-0300 or remember ever feeling suicidal), the whole nightmare has been very upsetting to say the least.©2009

Yet Another Decision

Today is a day off for me. No appointments with anyone. Yesterday evening I made another decision, diametrically opposed to this one only made here.

I had nothing but time on my hands yesterday after my first encounter with my therapist. I spent much of the time playing catch-up in reading the many blogs that I follow and reading comments made to my posts, along with some personal emails I actually received from truly caring individuals. As the day progressed, I did feel the intensity of my rage lessen somewhat (certainly not from anything purposefully done on my part, I assure you)

I had already made the decision to come back and see the therapist for a second appointment—a commitment that I didn’t think I was capable of making, much less caring about. Early evening it occurred to me that if I am going to make an effort with this therapist, I should at least be responsible enough to go back on my meds (a value judgment?). I went back to my bedroom and lined up all the containers (three of which are for blood pressure since it seems I’m having an issue there as well and swallowed them all (I always feel I have to add the caveat: as prescribed LOL). With my history, making the statement “swallowing them all” takes on a whole other connotation!

Went back to my living room and spent the evening listening to some really fine jazz (John Klemmer, Stanley Clarke, Chick Corea, Miles Davis, Jean-Luc Ponty, Al DiMeola). As the evening rolled onward, I made a concerted effort to also start trying to structure the time I try to go to sleep (an ephemeral experience to say the least). Even though I felt far from tired, I took my bedtime meds, crawled into bed and tried to read a book. I am so frustrated with this last action. I opened up to where I had last read (just the previous day) and I had no memory of what this book is about (I’m only about 12-15% into the beginning). This repeated problem really pisses me off, because, if given the chance to be focused enough to read, at least concentrating on that action temporarily quells all my racing thoughts. *Sigh* I return to the first page and start over.

After a few minutes, I realized that I had made an error with one of my blood pressure medications, a mild diuretic (hydrochlorothiazide HCL, hereafter referred to HCTZ). This one, for obvious reasons, taken once a day, should only be consumed in the morning—certainly not just before going to bed. When I hopped up to hit the head, all of a sudden I did not feel so well. No, I wasn’t dizzy per se, but I felt as if I couldn’t catch my breath and also somewhat disoriented. It occurred to me that perhaps the blood pressure crisis I experienced while incarcerated was indeed situational after all. Was my blood pressure now too low? I walked around for a little bit and found myself having to sit down. Very weird feeling.

So, as potentially stupid as this action could result, I decided to drive up to the nearest CVS and use their BP machine. I had much difficulty driving; it required far more dedicated concentration and focus that what I am used to. When I walked into the store, the lights were too bright and there were too many people milling around. Without asking, I blindly walked to the rear by the pharmacy and found the machine.

Now, mind you, when I was first put on the initial does of medication, my BP had skyrocketed to 228/156. When I was released 11 days later, I immediately saw my primary care physician and my BP was still elevated (165/110). What was eerie in both measurements was the fact that my heart rate was only around 56. My PCP decided to alter the medication I was discharged with from the hospital. He effectively doubled the dose of one (clonidine HCL from 0.1mg to 0.2 mg, but dropped it from, 3x/day to 2x/day), increased to dose of another (lisinopril from 30mg to 40 mg 1x/day) and added the HCTZ at 25mg 1x/day).

I sat in front of the machine and it turned out that my BP had dropped to 137/61, HR 72. The diastolic measurement concerned me as I thought that was a bit too low which might have explained how I was feeling. I drove back home, still trying to catch my breath and thought about calling my PCP in the morning. Went back to bed, read a little and actually experienced the feeling of being sleepy (hooray for me). Perhaps adding the Geodon to my bipolar cocktail might have made the difference. I actually got about five (count ‘em FIVE!!!) hours of uninterrupted sleep. I cannot even remember the last time that happened.

When I woke up, I decided to get my BP measured again before calling my PCP. Weird. It was back up to 150/95 HR 61. (I decided to purchase a BP wrist monitor while at CVS this morning to save on having to drive each time. The first reading, while still at the store, calibrated closely to their BP machine, so I was at least on a level playing field) Knowing it was still slightly elevated, I decided not to call my PCP and took all my meds this morning as prescribed. It has now been one hour. My BP is 112/66 HR 71. Perhaps my BP meds are stronger than they need to be. I’m going to take the rest of the BP meds today and monitor this closely and then possibly call my PCP tomorrow and ask if I should perhaps reduce my dosages.

Speaking of tomorrow, I have my second appt with my shrink. As far as he knows from the phone call he received from my therapist yesterday, I have been off my meds since last my discharge. While I did fill the scripts the shrink gave me on my first visit with him post discharge, I never bothered to take any of them (still in the “I don’t give a damn” mode). I am sure his first response is going to be along the lines of “Why won’t you help me be a better doctor to you?” What can I say? I am now willing to take my meds, continue with this outpatient program for this week and next, and then pick up with my individual therapist the following week.

Is this progress? I don’t know. I still feel resistant. I’m still in my “don’t give a damn” mode. I still face abject loneliness, utter sense of no worth, absolute pain over all the consequences arising from my actions throughout my life, and above all, I have no reason why I should be forced to continue this existence from which I want to be finally relieved. Nevertheless, in reality, what do I have to lose except my life, upon which I still place no value?©2009

DBT Therapist, Appt #1

Well, I am finally caught up with keying in everything I had written in my journal since my “visit” to the ER. No more date stamping my titles! You know, my handwriting can really suck at times!

I agreed to this appointment as a condition of my release (in addition to the outpatient treatment program I am in, they wanted me to start seeing an individual therapist). Just so it would appear that I was being a “good little girl” I showed up.

While I was in the waiting room, filling out yet more “new patient” forms (hell, they already have a copy of my records from the hospital, why can’t they just read that?), I could feel my anger building. I didn’t want to be here. I had no expectations. And I sure as hell don’t trust the system not to lock me back up if I say how I really feel.

(For the first time since I started this blog, I am not so sure I feel safe even writing what I really do feel here. No one who knows me personally has the link to or the name of my blog, not that I can remember, anyway. At what point do I end up surrendering my 1st Amendment rights?)

I was actually somewhat surprised by this first visit. I wasn’t even sure we would “click.” I tried to get through to her that I did not care whether things “improved.” Of course she asked me if I was suicidal and I just laughed and asked her if she really expected me to answer that after everything that had happened (she started scribbling on her clipboard). She asked a few questions about my history and previous suicide attempts (more scribbling), but all-in-all, she got it that I was incredibly angry. She said my continued participation with her was strictly voluntary at this point.

Sure, I told her that I thought that my life sucks (did not expand on why at this point, but more scribbling anyway), that I had no clue as to how I thought she could help me, and that I thought DBT was for the birds (more scribbling). Then I simply asked her, “How can you even deal with me if I’m in a space where I don’t even WANT to use the tools—that I just don’t give a damn?” And she said that this would be a good place to start. At least she acknowledged where I was rather than determining that I was “unwilling “or “uncooperative.” She said that a return visit was clearly up to me. She didn’t try to preach about tools/coping skills or what I should be doing. She said that obviously I had to decide if I wanted to try to figure out why I was feeling the way I did well before I could do anything about it. It was the first reasonable thing I had heard anyone say to me to date.

I could tell that the time was almost up. She asked me if I felt suicidal, would I be willing to call the hospital, and I emphatically told her absolutely not (more scribbling). Then she handed me my sheet with which to check out, gave me her card, and told me if I wanted to come back to just call and make an appointment.

As I stood in line to sign out, I looked at what she checked off under “diagnosis.” She indicated bipolar (good catch) and anxiety disorder (yet a new label for me, oh goodie). However, conspicuously absent (despite the records from the hospital and the information I filled out on her “new patient” form) was borderline personality disorder. She was still in the hallway, so I called her back up and asked her about that. She said that she didn’t think it was appropriate. Well, I got tagged with that label back in 2005, and with everything I tried to learn about BPD, it seemed to be right up my alley. I told her that I thought it was amazing how no one wants to deal with that issue with me, not even my own psychiatrist and now her. She said that I was operating under an assumption that she didn’t think was accurate, but reached over and checked it off on my sheet and walked back down the hall. What’s up with that? Is BPD the dreaded mental illness that no one wants to discuss? All anyone ever wants to deal with is my bipolar.

When I went to pay (yay—only have a 10% co-pay and today’s, the most expensive appointment since it was an initial workup, was only $12), for some reason I did decide to make a return appointment. Don’t know why, or what I expect, but I thought I’d give it a shot. She has been the only person so far that seemed to be interested in the reasons why.

Meanwhile, she’s going to contact the outpatient therapy program @ the hospital to indicate that I did complete the follow-up appt (I went to see her today instead of the outpatient program), as well as contact my psychiatrist (he asked me to have her contact him for ongoing continuity of care). Since I admitted to her that I hadn’t bothered taking any of my meds since discharge, I guess that cat is out of the bag. I see my shrink Wednesday. I wonder what that visit will be like?

Why am I so resistant to taking my meds—even the blood pressure meds? Everything keeps coming back around to “I don’t care.”©2009

Escalating Anger and Rage, Sunday 25 October

It’s Sunday evening. This weekend has pretty much been a wash. Accomplished absolutely nothing. I’m trying to figure out how many days it has been since I last slept. I feel like I’m on auto-pilot.

I did manage a quick grocery trip finally since being home. That was a strange experience. I found myself just wandering down each aisle trying to figure out what I needed. I’ve never walk in without my list. I didn’t even know what I needed. So I got the basics and beat feet outta there. Too many people.

But I am starting to see a pattern emerge. My anger and rage is escalating for no apparent reason (yeah, I know for you DBT fans out there, there has to be a trigger, but damn if I know what it is). On the way home from the grocery store, I stopped by this little sushi restaurant right around the corner from my house to order something to go. As I pulled into the small parking lot, I noticed five (yeah, count ‘em—FIVE) patrol cars all sitting there unattended. The only other places in this small shopping centre is a bank (closed since it’s Sunday), a Starbucks, a deli and an ice scream shoppe. I had to park next to one of them. I got out of my car, looked around, and couldn’t see a cop in sight. Then I walked into the restaurant (nope they weren’t here). For some reason, as I was waiting for my order, I became increasingly pissed off by the fact that there were at least five cops somewhere sitting on their butts doing nothing. So much for my tax dollars at work.

By the time I left the restaurant I was so riled up over this (don’t ask me why!!!), that I opened up my trunk and got out the carton of eggs. I grabbed four of them and slammed two of the patrol cars. God that felt good. Never mind the fact that anyone in any of these establishments could see what I had done through those large plate glass windows all facing back at me. Never mind the fact that those FIVE lazy cops were somewhere on the other side of those windows. I don’t even remember what I was thinking. Really stupid, Alix. That’s all I need on top of everything else. But nothing happened; no one came flying out the doors. I turned around, closed my trunk, hopped in my car and drove out of the parking lot (yeah, all the while checking my rear view mirror just waiting to see the blue flashing lights on my tail). As I said, this place is literally around the corner from my house. All I had to do was hang a right out of the lot, drive past six driveways and I was home. When I pulled in, I waited for a minute, so sure that the cops were right behind me—still nothing.

I just snapped. Where did all this anger come from? I have developed a rather unhealthy obsession of wanting to beat the shit out of a cop only to know that it would land my sorry ass in jail. There is just something so enticing about wanting to inflict the greatest amount of physical damage to a cop simply because of the fucking authority they represent. I don’t get where this is coming from. It’s like I am stuck in this stupid 60s time warp.©2009

Outpatient Therapy, Day 2 Friday, 23 October, 0900

At group, I was clearly still quite angry and was blatant about purposely not choosing to use any tools, and was very vocal about not giving a damn. Of course, the therapist tried to handle me (I hate being handled) and finally she let it go and went on to the next person. When I got home I was still pretty pissed off and feeling restless. Life really does suck. I can’t make up my mind. I sit in this huge house with a beautiful screened-in porch and all I end up feeling is so overwhelmingly depressed because I am so alone. Then I go off on the rage tangent because I can’t sand to be around anyone and all I want is to be left alone. What a fucking oxymoron am I?

I was reading Patrick’s blog today, catching up on what he’d posted while I was gone. (I still have a few other blogs I am behind in reading). So much of what he wrote resonated so strongly. All I want to do is just disappear and be where no one can find me—ever. Leave everything I own except the clothes on my back, walk out my front door, and drop off the grid with no notice to anyone.

No one will miss me—well, maybe except for my manager after the first day or so. I am currently on short-term medical disability leave totally screwing up my team’s workload. I generally get about 200-300 emails a day. By the time I eventually get back to work (perhaps by 09 November), I am sure my mail server will have shut down my email account just due to overload (I’m sure my clients will be thrilled to start getting “return-to-sender” notifications on top of the already existing “out-of-office” reply my manager had set up upon my admission to the hospital). I can’t even begin to imagine how many unread emails I will have waiting for me by the time I get back. If I get back.

I just plain don’t want to do “it” any more. I’m tired; I’m spent. There is nothing left in me. All I want is to walk out my front door and disappear into the wind leaving no fingerprints behind. It’s almost over now. Even though I had all my scripts filled (from the hospital, my regular doctor and my shrink), I haven’t taken any meds since my discharge. I have no clue as to what my blood pressure could possibly be (ask me if I care). Why can’t I just have a heart attack and die? Knowing my luck, I’d have a massive stroke instead, be left incapacitated and totally useless with no more control. God would find that amusing.

No, I still have the option to take control. I’ve been out of contact with everyone since the night I was taken to the ER. My CallerID was empty when I got home and only one personal email was waiting for me. Ever since I came home, I have only received one phone call and that was from my son. I am so proud of him. He’s 26 and has his head on straight. He has a great job and talks about going back to the university. Do you want to know what we talked about tonight? He was telling me how tickled pink he was now that he finally decided to get contacts (he thanked me profusely for my contribution to the gene pool) and went on about how long it had taken him to get the damn things in his eyes for about the first week or so. He sounded like a kid with a new toy. He sounded happy and that made me smile.

Do I feel guilty about what I will put him through? Sometimes I do because he will be the one to have to fly back east to pick up the pieces. But my job is done. I raised a great son and it’s probably the one thing I’ve done without fucking up to badly. He’s living his own life—he’ll be fine after a while. At least I can say, with past performances, he won’t be surprised. This last episode, however, he never knew of. He’s not listed on my emergency contact list (in fact no one is). But, to head anything off at the pass, the day I was admitted to the psych hospital I texted him that I was headed out of town on business for about three weeks, and oh, by the way, let mom know as my cell battery was getting ready to go. Kept the hounds at bay.

And while I was at the hospital, I missed two services in a row at church–something I hadn’t done in a long time. I’m not planning on returning. There is nothing there for me any more. The ironic thing is that the church is right across the street from my house (in this part of the country, churches are like gas stations—there is one on every corner). And all this time, my car has been parked right in front of my house. Oh yeah, that’s right, there was one member who left me a voicemail the other day wanting to know what was up since I had missed two in a row. Evidently, my pastor didn’t tell anyone what I had done. I just deleted it as soon as the connection broke. No one else at the church has bothered to call. I guess my pastor felt a professional obligation to call in the 911, but that was the extent of it.

It’s weird. I’ve only been home for three days and it seems like it’s been ages since I was in the hospital. It’s all just a distant, hazy memory. I just thought of something amusing. I wonder if there is someone at the hospital that is in charge of reading the obituaries every day just to figure out what their success rate is. But, it doesn’t matter. There is no one here to write mine and send it in.©2009

Post-hospital Visit with Shrink #1, 22 October, 0700

I’m glad he makes these early morning appointments. I get the first one for the day and I don’t have to wait. And, there is no one else in the waiting room—perfect.

It was actually good to see him again. It had been about a year (I quit making my three-month med check appts last year even though I was still taking my meds then). I have always enjoyed a good rapport with him. Compared to the comments I heard from the other patients whose psychiatrists only spend about 10 minutes with them doing their med checks, mine has always actually talked with me and asked me a lot of detailed questions even when everything was going well.

As soon as he came into the waiting room to get me, he was clearly glad to see me and asked when I had been discharged. I immediately spilled my guts from telling him how I initially got laid off back in April which sparked the financial reason why I went off my meds in the first place right through everything that had been happening that led up to the eventual involuntary commitment. He decided to add Geodon (80mg daily for now) to aid my severe depressed state and help with the insomnia.

I also talked about my memory loss. He said that it was highly probably that I was in a dissociative state, but without knowing the results from the tox screen and blood alcohol level, that could very well have contributed to my memory loss. He also wanted to get some more blood work done and said he would wait to get a copy of the labs tests from the ER and the hospital before coming up with the list of tests so as to not repeat anything unnecessarily. He also knew my regular doc was going to be doing a fasting blood panel on me in two weeks, so once he knew what additional tests he wanted run he would call over there and just have them add those tests so I would only have to be stuck once. At the very minimum, he wants to check my thyroid, my FSH (follicle stimulating hormone—an indicator of potential menopause onset), B12, Iron and Potassium. When he mentioned FSH, I thought, yeah, I’m 52. It’s very likely that menopause will be hitting me at some point. Great, I already deal with bipolar mood swings. Let’s just add hormonal mood swings to the mix. I can hardly wait.©2009

My Nancy Drew Act: The Quest To Find Out What The Hell Happened, Wednesday, 21 October, 1230

(If you haven't already read this saga from the beginning of this nightmare, go here first)

Immediately after the outpatient session was over I raced over to the trauma center I was taken to and put in a request to receive my complete medical record of my ER visit. I detailed that I wanted all the doctors’ notes, the nurses’ notes, all lab results, and any legal paperwork filed against me—or at least evidence that they were requested and ordered by the doctor. I was told it would take approximately 15 days. Then I thought to stop by the business office and get a copy of my bill. At least I could determine from that what tests were ordered and what medications were given and anything else that was billable. That they gave me immediately. It was a start.

What a fucking rip-off. The entire bill was $3910. Here is how it broke down: 5 0.1mg clonidine tabs @ $3 each, 40meq of potassium chloride @ $3/10meq, 1 800mg ibuprofen @ $3, venipuncture @ $25, blood alcohol level @ $196, 2 basic metabolic blood tests @ $200 each, 11 drug screens @ $88 each, CBC @ $105, urine culture @ $171, urinalysis @$93, ER Fee-Level V @ $1,524 (I was charged twice for that one), EKG @ $250, and finally the ER physician’s fee of $234. If I were that doctor, I would be humiliated to know that the damn EKG cost more than I did.

I can’t wait to get my hands on the medical records. I am going to match each billable item to an order in the chart. If I don’t see 11 orders for the separate tox screens, I’m sure as hell not going to pay for all of them

Aside from the ridiculous costs of each item and why the hell they had to run 11 tox screens, everything billed seemed to be a reasonable action taken by the ER considering my supposed presenting symptoms. But, just what were those presenting symptoms? I still can’t remember shit.

Then I went over to the E911 administrative offices. I told them I wanted a copy of the paramedics’ record on me that would reveal the time the 911 call came in, how they found me, what condition I was in, etc. I also told them that I wanted a copy of the 911 recording (they could send me the .wav file via email). While I got a hard copy of the record right away, I was told it would take about a week to get the recording.

As I sat there and read it, I was totally blown away. As best as I assumed before reading this, someone called 911 reporting a suicide attempt. Yet, at the top of the record, it states that they were dispatched at 0259 on 10 October with no lights and sirens. Hmmm…guess they must not take suicide attempts very seriously! They arrived at my house at 0313. But get this—they departed my location to transport me to the ER at 0330 (arrival to the ER @ 0338—again with no lights and sirens). They spent only 17 minutes at my home (btw, that bill was $250).

Then I flip to the second page. This only gets more bizarre. According to the report, “patient found sitting on porch with city police talking with her.” Talking??? So, I was up and talking. Explains HOW they gained access to my house. But, why were the police there? Oh yeah, that’s right, in my state it’s against the law to commit suicide.

I kept reading…”Chief Complaint: Category-Psychiatric Problems,” (geniuses, aren’t they?), “History of Present Illness: patient states that she has been having suicidal thoughts recently. Patient states she sent a message to her pastor detailing that she was going to overdose on medication with alcohol. Patient states she has been off her psychiatric meds for about three months. Patient agreed to go to the ER after admitting to sending her pastor the message about intentions of overdosing. Patient states she has not made an attempt to overdose or any other type of suicide yet.”

Third page “Neurological Exam—Level of Consciousness: alert, Orientation: oriented to people place and time, Loss of Consciousness: No, Chemically Paralyzed: No, Motor Comments: moves all extremities equally well, Sensory Comments: equal and normal sensory functions, Pupils: normal and reactive.” The GCS, airway, respiratory and cardiovascular entries all reported “within normal limits.” “Injury Details—Drugs/Alcohol? Alcohol, Drugs/Alcohol Indicators: patient admits to alcohol use, smell of alcohol on breath” Here is my favorite entry… “Impression/Diagnosis: mental/psych” (God love their training!).

Fourth page “Patient Authorization Signature Form” There was my signature, plain as day and clear as a bell. This was followed by a similar page for the receiving nurse’s signature at the ER.

Reading all of this only raised more questions. If I was so fucking alert and oriented, why the hell can I not remember a damn thing? Why would I send a message to my pastor of all people (sure enough, I checked my cell and there was an outbound text message basically saying what was in the report, so I now know WHO called 911)

What I do remember was being depressed at being so alone and pissed off that I couldn’t go to sleep, and making that huge Kamikaze. I don’t remember being suicidal (well, enough to actually do something about it). Besides, I already know how I plan to commit suicide—with an IV overdose of potassium chloride or insulin, whichever I can get my hands on (which I can quite easily). As I’ve said in previous posts, I’m certainly not going to take a chance by swallowing a boatload of pills and chasing it down with alcohol only to risk vomiting up all my resources. Plus, as evidenced by this occurrence, there is no telling what I might do in that period of time as my mental state starts altering after drinking a lot of alcohol (God forbid I make the mistake of sending another text message). With an overdose of the pills that I do have, there is the risk of resuscitation. With IV potassium chloride or insulin, especially the former, hell, I’ll be doing good to be around long enough to pull out the damn needle. No chance of resuscitation. It’s quick and it’s permanent.

Nevertheless, there are still more questions. Why were all the lights on in my house? Did the cops search my house? There didn’t seem to be any evidence of that. The only things out of place were the coffee table and the two speakers. Why were they moved if I was found sitting on my porch talking to the cops? Well, at least I know HOW the paramedics got in and WHO called 911. Huh, I wonder if the cops’ lights were flashing the whole time they were in my driveway? I’m sure the neighbors loved that. Well, at that hour, that’s probably a moot point. Besides, I don’t even know who they are, so I could give a flying fuck what they think.

Now I want to get in touch with the police department and talk to these cops who were on my porch. Maybe they can fill in some more of the blanks. And the nightmare continues…©2009