One Long Year Later

For the past year I have wrestled with demons, good times, manic phases…you name it. I have been trying to fly below the radar…keeps things that much easier. I want so much to be anonymous, but in today’s climate, that is virtually impossible. I hate the fact that my fingerprints are in the system (not that I plan on going out and committing a crime, mind you).

This past year was a hard one at my job (let me say this right now…I am blessed with employment!). I was still on a learning curve. But what soon became evident were the issues plaguing me during recovery. I still have short-term memory loss and we don’t know if it will be permanent. Things got so bad that I was put in a sort of probationary 3-month re-evaluation subject to my work performance. I’ve lost four accounts because of the mistakes I have made. However, that period soon passed once they understood it to be the cause of a medical condition.

Ironically, I have had a great month at work so far for January. I’ve shifted my focus. I now get up at the crack of dawn (0400, to log on to the employer’s VPN at 0700). That leaves me with 3 hours before I have to be at work. Now, every morning, I am drinking my hot tea while doing my devotions and Bible reading and praying. I am also starting to record Joyce Meyer so I can pause it here and there while I take notes. I figure that’s about the best way I can start the day.

My beloved little church finally succumbed to lack of attendance, so the Pastor chose to close the church. I have tried a few and I have come across one that I am going to attend a few more times before I commit to anything. This is a much larger church and is not affiliated with a denomination which I like. Their praise & worship is a little different from what I’ve become used to, but that can change in time. What’s nice is that my pastor from the previous church and his wife, one other couple and a single dad have decided that they really like this church as well.

There is so much I want to say and I don’t even know where to start. My mom celebrated her 90th birthday last September and she is feisty as ever. She mall walks everyday, plays bridge twice a week and attends several social butterfly lunches. You’d never know it to see her. I have this picture of my Mom and I with our heads together and we have the same colour hair considering I am 36 years younger than she is. I sure hope I come from her gene pool!

Unfortunately, my niece and all of the “precious” great-grand children came with her. She knows she smells like a rose and can do no harm. That pure bull. While she can smile and laugh with the best of them, she is quite devious underneath. Just remember that she is the one who refuses to invite me to the family holiday festivities. I am the only one not invited. Well, after everyone had eaten their dinner and was just sitting around the table in the restaurant, I pulled K outside to finally end it all and call a truce even though I still don’t know how I ever pissed her off that much (hell, maybe she’s homophobic, I don’t know). I pointedly asked her why had I been excluded all these years and she said, “but I only invite my family.” Heck, I am her Godmother and her Aunt. What part of “her family” does that not fit? So what am I, chopped liver…LOL?

My Mom once told me to rise above the circumstances. So, regardless of what K said, I still decided to send her a 5x7 close-up of Mom already framed and a framed wallet-sized photo of Mom and Santa. I also happened to send it to my nephew (her brother) and my brother (yeah, I know, surprise, surprise). Today is 13 January and I have gotten a thank you from everyone except K. Well, now I can wash my hands of her. The next time I will see her will most likely be at my Mom’s funeral. My intention after my mother dies is to make no overtures towards anyone left in the family. If someone calls me, then that’s a different story. But I am an adult and I don’t have time for such foolishness. The only person I can see having a loose relationship with is my older sister P. We have been on good terms, but she is so much like Dad was. Always offering advice when none is asked, and always reminding me of how I could have done something better. Come to think of it, my brother L has the same rock to stumble over.

And so it begins—a new year filled with possibilities. Last October and the ensuing months were the absolute low point in my life. I don’t wish to be faced with the same set of circumstances that led me to attempt suicide.

I quit seeing the therapist I was first assigned to because her available hours conflicted with my work schedule. So she graciously referred me to another therapist she had good words to say regarding her, but I went to two sessions with her and she was a tad bit over the top. Look, I don’t care what time of day it is, I cannot deal with chirpiness. She was just wa-a-ay to happy a camper. So, I called the office, indicating that the second therapist was not a good fit and could I return to seeing the first therapist. The woman who answered the phone said they would have to check my medical records and have the request referred to the nurse and someone would get back to me. Well, it’s been a month and I haven’t heard anything. Yeah, I know, I should probably call and follow-up; I just haven’t had the energy to accomplish much of anything.

I am still seeing my psychiatrist and now my visits are once every three months—more of a med and status check than anything. Nevertheless, he is quite concerned about my lack of attention, focus and my short-term memory issues that have had a measureable impact on my job. He wants me to go in for neurophysiologic testing to see if we can pinpoint either the cause of the problems or if it’s temporary or not (it’s been over a year now…sounds kinda permanent to me). My psychiatrist is worried that I may have caused some injury to my brain when I attempted suicide (God only knows what flowed through my veins that night). Then, after the results are in (I have no idea what tests they would be performing), I may have to do neurocognitive rehab. I have no idea what that is all about either.

Well, I’ve now had my car for one year and I am still happy with it. But get this, I only have 3900 miles on it. I just don’t have long distances to drive around the city. Almost everything I do except for grocery shopping is within walking distance. That’s my effort of getting off my lazy ass and generating some energy burn. I found out yesterday from my Mom that the Honda Fit made Consumers Reports their best value, and Car and Driver put the Fit in their top ten for five years in a row.

OK, shift in focus. Sunday night it began to snow heavily here (I live in the southeast US). We usually don’t get snow, but ice storms instead. At night, it was so serene and picturesque. It was like looking at a huge Ansell Adams mural. When all was said and done, we ended up with 10 inches of snow. I had so much fun. However, I did learn one lesson…don’t attempt to make a snow angel in 10 inches of snow. When you fall back, it’s a longer way down than it looks, and then, once you’ve landed, all the snow falls in and buries you (my most graceful move yet). 4 days later, only the streets are finally cleared, but all of our yards are still covered with the leftover snow. The fact that the temp hasn’t risen above freezing all this time is making it harder for the snow to dissipate. But it sure was peaceful and beautiful. That, most probably, will be our big storm of the season.

I can tell I am losing some of the ground I gained when I was in that outpatient therapy program for 3 hours a day Mon, Wed, and Fri that lasted for three months. I feel the BPD becoming an issue again. I am isolating again and at the same time having a pity party that I don’t have more friends, then I take solace in my aloneness (I prefer that to loneliness). When I really think about it, I love living alone so much that I don’t even entertain the idea of dating much less having a girlfriend move in. I love my privacy. I love not answering my door (unless I know already that someone is on their way…I make them call me when they get in my driveway). I had fun with the Census Bureau. I did not fill out the form and mail it in. I feel it’s an invasion of privacy despite all their protestations that ALL information will be kept confidential. HA! They started coming by the house, first one, then another for a total of five visits. I ignored them completely. They even went to my neighbours twice (they had already been coached to answer in such a way that it did not reveal gender and number of people living in my house). I just don’t want someone knowing my business. While I applaud the medical community and their HIPAA regulations, we could sure use some of that stringent guideline in the private sector. Face it. Too many people know too much information on everyone. All it takes is this wonderful Ethernet world.

I promise, I promise to get back into my blogging on a regular basis. I guess too many of you are sick of listening to Santana. I left it as my playlist for this past year. Today, when I post this entry, I will change the music (I promise). It sure is nice to be back again.©2011

Week in Review 20 February 2010

I apologise for the delay in posting my weekly reviews. I have been so busy at work that time has just flown by. So let me catch you up since my last entry of Week Ending 30 January 2010 (see post below).

Work: My job is slowly piecing itself together. My confidence has risen a little bit and I finally got ahead of my emails. For the past three weeks, I have ended the day with as many as 90-100 unread emails. By Wednesday of this week, I finally tackled them all and now I may only have 6-12 emails I have not gotten to. What an improvement.

I feel as though I am actually accomplishing tasks at work and being able to scratch off items on my to do list. I still have about 20 requests I have not handled—some more complex than others.

My circadian rhythm has settled now. I am going to bed around 1930-2000 each evening because I am awakening on my own around 0345. My job requirements changed while I was out on medical leave. Before, if I was in the middle of something crucial and it went past my eight-hour workday, being salaried but non-exempt, I would be paid overtime. I ended up working 10-hour days frequently, which very easily made me feel burned out. When I came back to work 04 January I was told no more OT would be approved which really lightened my burden. Oh, sure, that always left me with not enough time to get my daily job done, but I was freed from the expectation that I would work the OT if I had to. So, I clock in at 0700 and clock out promptly at 1530. Because I am getting up so early, it gives me a chance to drink my hot tea, eat breakfast and stay on my strict medicine schedule.

Now, here is the bad news. Now they have decided to make us salaried exempt meaning if I have to, I am expected to work additional hours without being paid for it. In my book, I think that is a punch in the gut. That is management trying to cut the bottom line while still expecting superior work effort. Not sure when it goes into effect, but this had the potential to increase my anxiety levels.

My Psychiatrist: I had my appointment back on 03 February. He seems pleased with my progression, but concerned that I am still battling the depression. Overall, since the mood swings have stabilised I can see some improvement. He did not make any changes to the cocktail and now I have graduated to only having to see him once a month for the time being. I am looking forward to reaching the point when I only have to see him once every three months.

We talked about my residual symptoms of incurring Wernicke’s Encephalopathy which is still lingering. I am still having problems with my eyes as I am still experiencing saccadic movement  which slows me down at work. It is very frustrating. Also, I still experience short-term memory loss which is equally as frustrating. I have to take copious notes during integrated phone/data conferences so I do not forget anything. I cannot tell you the number of tablets I go through just collecting facts and action items on my part. My psychiatrist believes that my brain will heal slowly over time.

Individual Therapist: My last appointment with P was 03 February 2010. It was a non-event because I told her I was going to have to switch to a different therapist. P’s last appointment of the day is 1300, right smack in the middle of my workday. I need someone who can meet with me at 1600 or later. She highly recommended one of her peers equally qualified, but when I tried to make an appointment with S for two weeks, she was booked. I now have to wait until 09 March—one month out. I will try her on for size in hopes that we can make a connection. It is going to be a bummer having to start from scratch even though she has P’s notes in my record. I just hope she takes the time to read it before our first appointment.

My Car: Well, I am now the owner of a 2010 Honda Fit Sport. I have had it since 06 January and have only put 78 miles on it! I just do not have any long rides to takes around the city. Almost everything I do is right in my own neighbourhood. There is a small part of me that is excited by the fact that I have a new car. However, what is first and foremost in my mind daily is wondering if I can really afford this car. I did well in negotiating it down from the MSRP, but a car payment is still a car payment. It still has that new car smell. Also, I have made the decision that I will not smoke in this car. Hasn’t been too difficult. I just make sure I do not bring my cigarettes with me.

I will try to be better at really trying to nail down a weekly review on time. It’s hard to remember the small, but important details two and three weeks out.©2009

Week in Review 23 January 2010

There are subjects that I have not caught you up on since returning to work full-time. I am going to use this week in review to address the various issues that actually encompass more than just this past week.

Iron Infusions: The study included receiving 1000mg of IV iron infusions. I received 200mg Mondays and Wednesdays for 5 days. Throughout the process, the clinical specialist drew blood to check my haemoglobin and ferritin levels. This study will go on for a year although no more iron infusions are to be given. All subsequent visits are geared towards monitoring my blood levels to see how I fare over the course of the year. On day 35, after the final infusion, my haemoglobin only rose to 12.1 (normal is around 12.3-16). However, my ferritin level (one of the key indicators in my case) rose from 5 before the study to 96. While I am pleased with the ferritin level, I still have borderline iron deficient anaemia. I am disappointed that my haemoglobin did not rise any higher. I am curious to see how the blood level results will be over the rest of the year. My savings grace is that I have not had to pay for any of this as being part of this clinical trial, and the added bonus is, once I have completed the yearlong study, I will be compensated for my travelling costs.

Vitamin and Mineral Deficiencies: If you recall, I began having symptoms of ataxia on 13 November 2009. It began with being unable to keep my balance then progressing to ocular involvement called nystagmus then to short-term memory loss. I failed certain neurological tests (most notable the Romberg test. The combination of all three symptoms indicated that I had Wernicke’s encephalopathy that does, in effect, eventually causes organic problems with my brain. If left untreated, the transient symptoms will become permanent. It was suspected that mine was caused by a vitamin B1-Thiamine deficiency. As a result, my GP decided to run a huge panel of vitamin and mineral blood work. The results showed that my B1 levels were undetectable as well as my Selenium levels (essential for the proper functioning of the immune system). I was ordered to start taking 100mg of B1 twice a day and 200mg of Selenium once a day. After six weeks, the repeat blood tests showed marked improvement and my balance had almost come full circle, although I still have some ocular involvement and short-term memory loss (my brain is healing slowly). Another level that was far below normal was vitamin D. Instead of taking an OTC version of vitamin D, my GP wrote a prescription that I am to take once a week for eight weeks, then once a month forever. This does not even include the fact that I have to give myself 1000mcg vitamin B12 shots monthly forever. My doctor essentially told me that I would be taking these vitamins and minerals forever, along with a multi-vitamin that I am supposed to start taking. Coupled with all of my bipolar medications and the ones for my continued high blood pressure, I am swallowing a horde of pills a day.

Individual Therapy: Now that I am no longer in group therapy, I have starting seeing an individual therapist. 20 January was actually my third visit with her following the intake assessment and one follow-up appointment a couple of months ago (my group therapy took precedence). This visit I determined that one of the first factors I had to deal with was my borderline personality disorder.  You’ll note further down in the link what the causes are—I meet all of them. In examining the causes, I decided to deal with my disruptive family history first. I have discussed at length in previous entries how I have been treated as a pariah at holiday gatherings these past seven or eight years always celebrated at my niece’s home. She patently exclaimed that I was not welcome the first time she hosted these events. I ended up attending, even though I had not received an individual invitation, as a result of my nephew’s insistence. He said, “Alix, family is family. You belong there.” When I showed up at the front door with my nephew, my niece clearly displayed her anger and let me know I was not welcome, but she could not refuse my entry because other people had already noticed me, so she was stuck. The entire time, even my mother showed her displeasure, I was uncomfortable. Always the queen of protocol, she said I should not have come because I did not receive an invitation. To this day, I have no idea why my niece hates me—my mother will not volunteer any information and my sister even told me not to confront her daughter. So much for my supportive family.

Getting back to my early years, I was sexually abused at age five. Upon my mother and older sister finding out, my mother shook my shoulders and told me I was never to ever speak of this to anyone. This was during a generation when it was not understood nor dealt with. I was made to feel as though it was my fault. The family dynamic changed forever after that. I felt abandoned by everyone because no one would help me with all of the shame and guilt I felt. Years later, those memories were buried during the haze of my years-long addiction to smack and coke (I used to shoot speedballs). I eventually cleaned up and have been clean for 23 years. However, during my detox period, all those memories came flooding back. I worked up the courage to confront my mother about the sexual abuse and at first, she denied it ever happened. Then, with further insistence, she simply said it was in the past and refused to discuss it with me ever.

A few years later, my parents had a huge celebration for their 50th wedding anniversary. I was living out of town, but my mother wanted my son and me to attend. I simply asked if that particular family member who abused me would be there and she replied yes. Then she told me that I was only welcome if I did not create a scene. I promised I would not (always being the dutiful little girl trying to find that ever so elusive but never found approval). However, I was very anxious about seeing this family member (whom I shall refer here as L). I had not seen L since the memories surfaced. I was not sure how I would react. When I saw him I felt a flood of emotions wash over me and I was not sure I would be able to control myself, but I remembered the promise I had made to my mother. He acted as if nothing had ever happened. I kept my limited contact to perfunctory responses and immediately found someone else with whom to interact.

The next two obligatory times I had to be around L was my father’s funeral and my nephew’s first wedding. I could not keep my distance as far as I wanted because these events were small family gatherings, but I was determined never to attend any events where he would be present with the exception of my mother’s eventual funeral.

Or so I thought. My sister called me this week and told me she wanted to do something special for my mother’s 90th birthday in September. She wanted everyone to be there. Not only will I have to deal with my niece (a favoured one as she has produced my mother’s only great grandchildren), but there is an outside chance that L will be there. My sister did mention that L had declined because he had already booked a hike in Italy and that was his priority. To tell you the truth, that pissed me off. Isn’t my mother’s 90th birthday, an occasion that will never come again, something that should take precedence above all else? Tell me that he did not know that the week he booked his hike was during my mother’s birthday and that it was her 90th. How callous can someone be? Of course I already had a very poor opinion of him (to say the very least), but this was the last straw. As oxymoronic as this sounds, I hope he changes his mind, if only for my mother’s sake.

So, getting back to my therapy session…I made it a special point to tell P that this celebration would be coming up in September, one that is creating enormous anxiety for me, even now. I need to process all that has happened since childhood. Since the event is not until September, this will give me quite a while to try to come to terms with everything. I wonder what the process will be concerning trying to deal with everything. I can only afford to see her every two weeks, so I hope we can accomplish a lot.

My Psychiatrist: I am now seeing him every three weeks—a far cry from weekly appointments along with daily phone check-ins. R seems pleased with the state of my bipolar disorder, and so am I. The cocktail he has me on (Lamictal 200mg 2/day, Geodon 80mg in the morning and 240mg at bedtime, Provigil 200mg 2x/day, Lexapro 40mg daily, Ativan 2mg 4x/day, and Ambien 20mg at bedtime) has been very productive. I am being cautious about the Lexapro since it is an anti-depressant. In bipolar patients, while these types of drugs can battle the profound depression I found myself in, I have to be aware if I progress to any mania since these drugs can produce this side effect. I am monitoring this very carefully. I do not want to mess with this cocktail as it is servicing a precious need of keeping everything in balance right now. However, R has discussed getting me down to a maintenance cocktail that would probably result in taking me off some of this medication. I do not think I am ready for this yet. It been too soon since I tried to commit suicide. While I have made great strides, I still feel as though, at times, I am teetering on the edge. Even though my next appointment is not until 04 February, I know I can call him at any time. He always calls me back and spends however much time I need without the cost of an office visit. I am very blessed to have such a wonderful psychiatrist.

My return to work: The days leading up to my first day back to work on 04 January was met with much trepidation. I was full of fear and anxiety as much as I tried to stay in the moment. As part of my medical disability status, R sent a letter to the group managing my FMLA program indicating that I should only work four-hour days the first week and six-hour days the second week. My manager was very supportive about that suggestion. I also asked my manager if I could adjust my schedule to work 0700-1530 opposed to 0800-1630 which he agreed to. This serves a two-fold purpose. First, it frees up the afternoon to make available opportunities to have my continued appointments without missing work. Second, I am finished working while the sun is still shining—something that is important to me. I used to hate waking up in the dark and finishing my day in the dark, especially during the Standard Time Zone in winter.

The first two weeks my manager wanted me to concentrate on taking some mandatory computer-based training that was indicated during my absence. Then he wanted me to cull through the 1000+ emails that had collected during the three months I had been away. Just as an aside, no one from work ever knew why I had been on medical leave. Nevertheless, I had to explain to my manager that one of the side effects of my “treatments” was a vitamin B1 deficiency which resulted in a transient short-term memory loss. He seemed to take that OK. But that factor gives me a lot of anxiety as I don’t remember how to do a lot of my job. I was only in this new job for two-and-a-half months before being gone for three. So, I am still on my learning curve. My team may not appreciate the fact that I still have to ask questions, especially on some things of which I had already displayed knowledge.

After the first two weeks, then all of my clients were informed that I was back to supporting their accounts. Just when I had cleaned up my email box, as of the 19th they started flooding in again, yet another source of anxiety. I made it clear that I was not capable of working any overtime, so I am always left with emails that I have not read by the end of the day only to snowball into the next day. Too many critical projects are all happening at the same time. Meanwhile, my day-to-day responsibilities go on.

I try to stay in the moment each day and that, along with relaxation techniques such as being mindful and deep breathing, are helping somewhat. I have to admit, my Ativan plays a roll here as well. My goal is to do the best I can for my clients during my eight-hour day, and when that is over, to simply walk away from the laptop and let my business line go to voicemail (I work from home). I am giving myself room to acknowledge that I am going to be slow on the uptake for a while, but I have to believe that, at some point, I will be back up to speed.

Overall, I am now in a much better space than three months ago. I am quite surprised at the insight I have discovered about myself along the way. I know I will never “recover” from my bipolar disorder and will be on my meds for the rest of my life. That is a sobering thought (and an expensive one—the Geodon alone costs about $1200 before my $1200 yearly deductible is met). It hurt to pay that much a week ago for my refill, but how many people can say that they have met their deductible during the second week of January! At least now, my coverage for everything is at 90%.

I know this was a long entry, but I had so much to review. It is my intention to do a week in review each Saturday since I am back to work full-time. I have to admit, after being on the computer all day at work, sometimes the last thing I want to do is to get back onto my own computer after work.©2009

Appt With Psychiatrist #10 (Thursday 17 December AM)

Today is going to be the last weekly session I will be attending. From this point forward, I will be seeing my psychiatrist every two weeks for a while, then once a month. I will miss the weekly visits, but he and I both agreed that I have made tremendous strides since I tried to commit suicide. It will also be much easier on my billfold as my insurance does not cover any of his fees (he is out-of-network and that deductible is $5500—it will be quite a stretch to incur that much of a balance any time soon).

He has decided to increase my Lexapro to 40mg/day. We have both been pleased with how effective it has been even though I am currently experiencing a setback in my depression (which is the reason increasing the dosage). It has been the only anti-depressant I have ever taken that has had such a marked difference in my depression without tripping a manic phase.

I learned something new today. I just happened to mention the strange reaction I experienced on Monday after my first iron infusion. He said it sounded like I experienced Cataplexy that would explain the sudden onset of fatigue along with the loss of muscle tone. It is frequently associated with narcolepsy and Provigil just happens to be one of the drugs that combat narcolepsy, which might explain why I did not have that reaction yesterday.

Overall, I am glad that I have made such progress thus far. I have received excellent therapy support from both my group and my psychiatrist. I think I am going to have therapy withdrawal once I go back to work. I have arranged to start seeing an individual therapist once I finish with group. I have already seen her two times and I think we have the chance to build a good rapport.

What was nice about today is that my appointment was at 0700 and I have nothing else scheduled for today. It will be nice to have some down time.©2009

Outpatient Therapy, Day 23/Psychiatrist Appt #9

Today’s session went really well. My therapist said I had made such strides over the last seven weeks that she agreed that I could be discharged on the 18th. Today, in fact, we had some new people and some that have been in the group for a little while that had it rock bottom and the therapist used me as an example how things can really get better. I feel good about myself today—something that I did not foresee being able to say even a couple of weeks ago.

I have built up a small coterie of close friends that know me intimately—the ins and outs of my mental illness. This has become my support group, yet another thing I about which I did not even think about. I was isolating so much and vindictively pushing people away to purposely further isolate me. The ironic thing is that the majority of this small group is made up of people with whom I had gone to church. That is my next major hurdle—reinserting myself back into my church. I am feeling less anxious about it, but something is still holding me back. Perhaps it is because not everyone knows my complete story and I certainly do not want to share that with anyone who has not been along for the ride.

I still do not know what “normal” is, but I feel more content than I have for a long while. I have not had any suicide ideation for a while, but the main concern I have, feeling this good, is that I am not ramping up to swing into the manic dark side. I am carefully looking for signs, and my friends know what to look for, so they may see it before I do.

I am going to try to go grocery shopping by myself, cane aside, this weekend. I will see how I deal with being around a large group of people. This should be a good test for me. It has been the one hurdle I have not passed (aside from returning to church). I have gone shopping with a friend that lessened the anxiety, but it is time I try to do it for myself.

I also saw my psychiatrist this morning before group. He also seems pleased at my bipolar improvement. Now that I am getting about six hours of sleep these last two days he has agreed to start reducing my Zyprexa, yet one less pill to take. He is going to submit an extension of my disability (currently ending on the 16th) to return to work on Jan 4th for two weeks at half-time to gradually get accustomed again with full time beginning on the 18th. I hope they approve this extension, as I am simply not ready to return on the 17th. He is not sure if it will fly since I have made such improvement, but he is certainly going to try. He is going to send in the paperwork on Monday.

Well, folks, that’s my story for today and I am sticking by it!©2009

Outpatient Therapy, Day 22

Yesterday was the first day that I have driven anywhere outside of my own neighbourhood area for a couple of weeks, since I sideswiped the 18-wheeler on the interstate. I have not had one of those dissociative episodes when driving in a while, so I thought I would take a chance yesterday and drive myself. The weather was just awful. It was pouring and visibility was cut to almost 500 yards/457 metres. I left an hour early just in case and was quite anxious about driving on the interstate the whole way, but I got there OK.

Had the weather been fine, having arrived so early, I could have sat outside and smoked until group started, but I was relegated to sitting in our room for a while before some of the others started to file in. I had my daily check in sheet already filled out since I do it from home before I get there (gives me more time to think and try to remember the details).

After the huge group split we started out “sharing” routine. I volunteered to go first as I had to leave early since I had an early appt with my GP yesterday as well. I had a good report to share and even had a smile on my face that everyone made a big deal about. Afterwards, the therapist commented that I was showing marked improvements exponentially. I think it has a lot to do with my psychiatrist putting me on the Lexapro a couple of weeks ago. I asked the therapist if she could mark some time for me after one of our sessions as I want to talk with her about my discharge from the program. While I have made huge strides over the last eight weeks (it was eight weeks ago today that I tried to commit suicide), I knew it was getting to the point that I could no longer afford to be in this program. Yes, my insurance is helping, but 10% of this, that, and the other adds up with all of the appts I have been having. I feel that my seeing my individual therapist now, along with my psychiatrist should be enough to continue with my recovery. I do not necessarily want to leave the group, but I have to make some decisions financially.

I cannot believe it has been eight weeks since I tried to commit suicide. The whole memory seems like such a hazy nightmare to me. On the one hand, I want to forget about everything. Yet, I have to remember it all to keep where I am at now in proper perspective. I have made some huge strides since then and I cannot forget this. So much has changed for me. There are more evenings than not where I can be in my house all alone at night and be safe. I am not sure what “normal” is supposed to feel like, but I do know that I am not as profoundly depressed as I have been. It seems that my bipolar is slowly being reigned in. The positive aspect is that I haven’t swung onto the manic side since starting the Lexapro, a valid concern my psychiatrist has as giving anti-depressants to bipolar patients in a profound depression can kick off a manic episode since the anti-depressant can kick you over to the other side. I have been carefully watching for that. I am getting more sleep now than I have been, and my talking does not seem to be any more excitable than normal. When I am manic, that is the first sign I can spot. I will get on the phone with someone and not shut up the entire time and I talk fast and excitedly. So far, I do not see any evidence to that.

Could it be that my bipolar is finally coming into balance? I am almost afraid to think that one aloud. Once my bipolar is in check, then I can start looking at my borderline personality disorder issues that, for obvious reasons, have been put on the back burner. I can continue that work with my psychiatrist and individual therapist, although I am not sure how to begin that whole scenario. There are some deep-seated issues that I have to work out, and this is going to take some time.

Meanwhile I am socialising more. My friend A called me as she was leaving work last night to check in with me and I asked her if she wanted to stop by my house on her way home. She enthusiastically said yes and I thoroughly enjoyed having her visit for almost 90 minutes. It is so nice to have people with whom I can talk about every day things. This is one area that I have seen positive changes in me. I am not isolating nearly as much. Right now, all my socialising is one-on-one; I have not tried to be in a group of people yet outside of my group therapy sessions, so I am not sure how I am going to handle that. I am going to try to start attending the NAMI meetings (National Alliance on Mental Illness) that take place Monday evenings right around the corner from my house. It is going to be similar to group with a different twist. According to the facilitator I spoke with the other day, there are only about 10-12 people that attend regularly and I will not have to say anything if I do not want to. I imagine I will just sit quietly for the first couple of meetings until I can get the lay of the land.

I am still on full-time short-term FMLA disability, but that runs out January 18th. Right now I am approved through December 16th, but I am now going to have my psychiatrist (instead of the group therapist) put in for the remainder of the time to see if they will approve the extension. My psychiatrist does not think I am ready to return to work anyway, and he wants me to start back only working half-days. I’m thinking, with the deadline coming up (yes, I could always convert to long-term disability, but that’s only at 70% of my pay which I cannot afford) I could put a return to work start date for the 4th of January to work half-days until the 18th. I personally think I need more time than that, but I am financially constrained. To tell you the truth, what I dearly wish I could afford is to go on full time SS disability, but I cannot afford what they would pay out, and Medicaid will not kick in until you’ve been on disability for one full year. I cannot afford to be without insurance. Sure, I could get COBRA from my employer, but since I cannot already afford what disability would pay, there is no way I could also afford the COBRA coverage. Caught between a rock and a hard place.©2009

Appt with Psychiatrist #8

We’re still doing psychotherapy for 50 minutes weekly with phone calls interspersed. He’s concerned over my profound depression. I made a half-hearted attempt to commit suicide Sunday night. I say half-hearted because I didn’t drink any alcohol which I know would seal the deal. I think halfway through, once I swallowed the pills, I realized I didn’t want to go through with it. My consequence: well, I did sleep for 4 hours, but felt very groggy. That morning tried to drive my self to group and got sideswiped by an 18-wheeler—my fault, I veered into his lane. Luckily, I self-corrected and stayed in my lane. Unfortunately, my car has the scars to prove it. Moreover, I fell asleep during the whole first session of group (no I didn’t snore, but no one woke me up either). At the break, I guess all of the noise woke me up, but my therapist wouldn’t let me drive home, so I called a friend to pick me up. I guess some of the drugs I had only taken a few hours earlier had not fully metabolized.

Well, back to my shrink, he has increased my Lexapro to 30mg. I found out that the normal dose is 10-20mg. I sure hope this helps me. I am on so many medications. Maybe once my Thiamine levels get within appropriate range things will start to change.©2009

Appt with Psychiatrist Week 5

On Tuesday, after posting this entry I called my group therapist out of politeness (yet another quirk—I can be completely suicidal and yet stop to be polite…go figure!) to let her know I would not be attending yesterday’s session. This was after canceling my psychiatrist’s appt for today and my appt with my GP tomorrow. In that state of mind, I did not want to be around anyone who was going to parse my emotions. When she asked me why I wouldn’t be attending, I simply replied that I couldn’t deal with being around anyone. Then I sorta lost it on the phone despite my keen attempts to be stable. I ended up telling her what had been going through my mind on Monday night when I was quite suicidal and how reading a comment yesterday morning on this post before calling her upset me so greatly. She asked if I could read to her the comment and then my response to that comment. She tried to remind me that this comment only represented one person’s opinion—an opinion that she was allowed to have, but one I did not have to agree with, nor let it have power over me. We talked on the phone for about an hour (unheard of with most in this community). I also told her that I had canceled the other two appts as well. She asked me if I was still feeling suicidal and I had to tell her that I did not know. Then she asked me if I could make a commitment to her to remain safe. If I didn’t tell her what she wanted to hear, I knew she would call 911 because she said as much. Not wanting to go there, I told her what she wanted to hear. Then she asked me if I would be able to call her before she left the office later that afternoon and I said I would.

When I get in this state, I always sabotage myself. That’s why I canceled the other two appts. I simply no longer cared about wanting to get better. However, after talking with her, I rescheduled both appts.

Well, the rescheduled appt with my psychiatrist gave me a valid reason for missing Wednesday’s group that I wanted to do in the first place. When I went in to see him yesterday morning, I could not make eye contact with him. His primary concern is that the meds cocktail he has me on is not working to get me out of this severe depression. He decided to finally add an antidepressant to the mix and gave me a sample of Lexapro. Not wanting to trigger a manic phase, he only wants me to take 5mg once a day. I also told him of my financial problems since I incurred all these medical bills. I also found out Monday afternoon that my 16-year-old Honda with 250,000+ miles on it was not long for this world (power train and transmission—the same quote I got from three different auto shops). I simply cannot afford to buy another car, and the cost to repair my car was going to be four to five times the blue book value of the car, an amount I couldn’t afford anyway. He told me not to worry about the cost of the Lexapro, as he would keep me in samples for the time that I felt I needed it. That doesn’t even touch the $175 I just had to shell out on my other bipolar 90-day scripts.

I also convinced him that my balance was much better and that I thought he and Wallace had just been alarmists. I said that because I don’t them to make such a big deal of my continued imbalance. I received some of the results from that blood work that Dr Wallace had ordered.  The Magnesium, Phosphorus and Zinc were all within normal limits (albeit on the low side). Now we are just waiting on the Selenium and the most important one of all, the B1 which, in part, may be causing my ataxia (we already know that my B12 is on the low side of normal, so I’m back to giving myself the shots again once I mail off Dr Wallace’s scripts—and I don’t even know if I have the money for all of those). I am sure my B1 should come back too low to account for the ataxia; I just don’t want to think that it may be because of an organic process in my cerebellum. If my B1 is too low, I wonder if they make an IM version I can use to shoot myself in my thigh, or if it only comes in IV form (we already know that I can’t absorb it orally because of my bypass surgery). Dr Wallace also wants me to schedule a time when I can get the Infed, the iron infusion by IV, but when I did that before, it was approximately $1600 a pop. The doc said I might be able to participate in a clinical trial currently being offered so I could receive the Infed for free, but I’ve yet to hear a reply on that one. If I can’t qualify, I won’t be able to raise my Ferritin levels, already abnormally low, even though my hemoglobin is only just slightly lower that normal in comparison.

So here I sit Thursday morning with nothing to do. I don’t know what I am going to do with my car. At some point very soon, it will die on me. I just hope I’m not on some interstate when it does. When it does crap out on me I will truly be up a creek.©2009

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

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

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

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

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

Involuntary Commitment—Day 11, 20 October

(…continued from previous post)
Last night I actually got a little bit of sleep. My morning vitals had my blood pressure elevated again; the two meds, while reducing the BP as a whole, have not quite stabilized it yet.

I decided over the weekend, after I spoke with my shrink on Friday when he told me that today was a reasonable discharge date, that I didn’t want any of the patients to know I would be going home before I actually leave.

I know that nothing will be “final” until the shrink signs the papers for my release this morning and then faxes it to the court to await their decision. Apparently, I do not have to personally go before the judge. Being ever so hopeful, once shift change occurred @ 0700, I pulled aside the one staff person with whom I had a good relationship and told him that I did not want the rest of the patients to know of my discharge before I actually leave. I also asked if it would be possible to arrange my exit while everyone else was in a group therapy session so I could avoid the “goodbye scene.” He just smiled at me and said, “I love a good plan.” I would be leaving with just the clothes I came in with (no packed suitcase or anything), so strolling down the back hallway would mean nothing to anyone.

Then my shrink came onto the unit just while all of the patients were getting ready to go to breakfast, so they all saw me go into his office. I sat down with confidence, had a relaxed smile on my face (with my heart in my stomach) as he opened up my chart. We went through the usual “well, how were you yesterday?” chitchat as he reviewed all of the nurses’ and therapists’ notes. I also mentioned that I was grateful that I was finally able to get some sleep. Then dead silence. I wanted to jump up on the desk and yell, “Well, am I going home today or not?” as I just sat there watching him read my chart.

Finally, I took a deep breath and just spit it out, “So, Doc, is it a go for today?” and he looked at me and said it was and smiled. He took out all of the legal docs and asked me all of the requisite questions (e.g., do I currently feel suicidal? Do I feel homicidal? Do I attest to the fact that I do not have in my possession a gun? What is the name and phone number that can be called to confirm the latter? and so on). I gave all the proper answers to assure my release and watched him sign the papers.

Then he wrote up prescriptions for all my meds to carry me for the first month until I met with my own psychiatrist that had already been scheduled by the discharge therapist for the 27th. He increased my Lamictal dosage again, stood up, and shook my hand. I quickly got rid of my smile as I turned my back to walk out of the office. A couple of patients immediately asked me if I was going home today (the standard fare whenever anyone came out of their shrink’s office each morning). I simply replied that he changed my medication again which basically means I’d be there for another 24-48 hours. Well, I didn’t actually lie—sort of—just ducked the question.

Meanwhile, the whole staff now knew I wanted to keep this news under wraps. So, I had to go through all of the motions of the daily schedule with everyone until the court rendered its decision (whenever the hell that would be). Talk about being distracted during morning group. Then, halfway through group, I was called out (not an unusual occurrence as we were all on different med schedules) and I was immediately told that the court had faxed back my release. I just grinned like a Cheshire cat. My nurse asked me if I was good to go as they surreptitiously handed me back my wallet, keys and cell (it seemed, damn it, that one patient—of course the one with the big mouth— got pissed off during group and walked out and was now hanging around the nurse’s station). I told my nurse that all I had left to do was call a cab.

Then he told me that they could not let me leave the unit until the cab actually arrived, nor was I allowed to wait in the front foyer (on the other side of the locked doors) by myself. I nervously looked at the clock knowing that group would be over before the cab would arrive. Then he said, “Relax, Alix, I promised you that I had a good plan. I promise that you’ll be able to walk through everyone and they won’t even have a clue.” I wasn’t so sure.

Then the patient with the big mouth came up to me and demanded to know if I was going home, but I just blew her off and tried to casually walk over to the lounge area and wait. Thankfully, she didn’t pursue the matter. Meanwhile, my nurse kept calling up to the front desk to see if my cab had arrived. He was looking at the clock. I was looking at the clock. We both looked at each other. The doors to the two group sessions flew open and out poured all 17 patients. Then I got up and walked over to the nurse’s station with this panicked look on my face. He said to just hold tight for a minute. He quietly talked to the other nurses, then came back to me and told me to casually walk down the back hallway as if I was going to the laundry room (certainly not suspicious; we always had some free time between groups to take care of various things). He told me when I got to the end of the hallway, take the left and wait by the back door. He said he would follow me in about 30 seconds so it wouldn’t appear as if I was being escorted out.

I held my breath and nonchalantly walked through everyone as they were milling about getting coffee, talking on the phones and generally chit-chatting among themselves, praying that no one would notice me or stop me. When I got past everyone, headed down that back hallway and got to the end, I quickly dashed to the left and waited. My heart was beating so hard. Freedom—so close.

Sure enough, he casually came around the corner, quickly inserted his key and we walked through together. Turns out that my cab still hadn’t arrived, but they decided to let him accompany me and wait with me in the foyer. As we got to the front doors, my cab arrived. He turned and looked me and said, “I told you I loved a good plan.” The front door…my ride home…everything was perfect. I managed to play my role beautifully for 11 consecutive days convincing everyone that I was not suicidal and that my bipolar and borderline disorders were on their way to getting back under control again.

The ride home was an odd experience. I just stared out the window watching all of the traffic on the interstate. Everyone in the world was just going about his or her normal routines. My life had been on hold for the last 11 days.

It was so surreal when the cab pulled up to my house. As I was walking up my front walk to the porch door, I started to look around for any evidence that the paramedics had been there. I didn’t even know what I was looking for. I still have no fucking memory of those first hours. I opened up the porch door and it had not been forcibly opened. Looked around my porch—nothing. Then I walked up to my front door. It appeared to be closed and locked properly, so that door wasn’t busted in. How the hell did the paramedics get into my house?

As soon as I walked though my front door, I could tell that there had been some commotion. My living room coffee table had been pushed all the way to one side and two of my surround sound speakers had been pushed out of position. This was eerie. Then I noticed that ALL my lights were on throughout the house. What the hell had happened that night? I can’t begin to tell you how disconcerting this whole “coming home” experience became.

All of the windows were closed and locked. The back door was intact and locked. It was odd knowing that strangers had walked through my entire house. Why? The last thing I remember was sitting on my couch around 2000 hrs Friday evening, 9 October, polishing off that killer Kamikaze (no pun intended). I have no memory of taking any pills or even thinking about suicide. What were they looking for? Nothing seemed to be out of place in any of the other rooms. (To be continued…)©2009

Involuntary Commitment—Day 10, 19 October

(…continued from previous post)
Saw my shrink this morning (btw, I haven’t even mentioned that he did put me back on my Lamictal starting with 25mg daily to slowly ramp up to my normal dosage of 400mg daily, along with 2mg of Ativan QID and 20mg of Ambien @ hs—ironic, huh? Two of the same drugs that popped on my tox screen). I’m guessing that I’ve pulled the wool over everyone’s eyes sufficiently. He agreed that I could be released from this Godforsaken place tomorrow, the seventh “legal” day (what crap that weekends “don’t count”). The one catch is that I’d have to enter their three-day-a-week 0900-1200 outpatient program for two weeks. So, my head will continue to get shrunk for a little while longer—two more weeks of mastering my perfected façade. Then I can get back to my master plan.

I must say that my one savings grace has been my Army vet compadre. Over the last couple of days we actually started talking about all the bullshit we’ve been through that ultimately landed us both here. I could so identify with everything he said and vice-versa—we’ve sorta become comrade-in-arms. What’s nice about developing a connection in a place like this—full of strangers that you know you will never see again—is that you might just find that one person to whom you can remove your mask.

I am at a crossroads right this minute. I know I am only here because it was court ordered. I know the actions I chose (not that I still remember a damn thing) prior to the paramedics rushing me to the ER were stupid—stupidly resulting from the alcohol. Yet, even at this very moment, even now knowing that I am being discharged tomorrow, I feel more suicidal than I have in a long time. All that has been accomplished during my stay here has been the opportunity to reflect and dwell on just how pathetic and miserable my life is. The pain—the loneliness—is suffocating. I just want so much to just disappear down my lonely dark hole forever. (and to you DBT fans out there—no, I don’t want to use mindfulness, distraction, self-talk, or any of the other bullshit tools).

But I can’t show this. My mask must be firmly affixed for the next 36 hours. I have interviews with my primary therapist, my shrink, the discharge therapist and finally I go before the judge. Can I keep up this façade successfully enough to get through these interviews and truly convince them that I am sane enough to be discharged? I just hid in the bathroom while everyone else went to group (I had permission to skip to start preparing for my potential discharge. Potential because no papers have been signed yet). While in the bathroom, I promptly fell to pieces, crying uncontrollably. I couldn’t even tell you where it came from or what triggered it. I can’t let anyone else see me like this—not now, when I am so close to getting out of here.

You know, if they found this journal, I’d really be screwed. They issued me a pocket folder upon arrival where I was store handouts and other papers, and I’ve hidden it here, and this folder is always on my person at all times.

(later) Met with my discharge therapist. She’s all on board with my release. That’s one hurdle cleared. Now for the others whenever they tell me when they are ready to see me.

I know that any of you reading this probably think I’ve wasted a perfectly good opportunity to get my head on straight. But you just have to understand that I don’t want the help—not any more. I don’t have anything left in me. No emotions. There is nothing left to care about, and certainly no one that really cares about me. I can’t begin to explain the abject pain of my loneliness. All I have left is a darkness that pursues me and envelopes me.

I have made my decision and it is final. I have the resolve now; nothing has been clearer to me. As to when? I have to wrap up a lot of loose ends and put my affairs in order (what a classic phrase). This will take time because it needs to be executed perfectly. All Is dotted, all Ts crossed. Plus, what the hell, I might as well vacuum the house.

Tonight is probably my last night here. I have no idea how long processing out will take tomorrow. I just pray that there are no last minute hiccoughs with the judge. (To be continued…)©2009

Involuntary Commitment—Days 4 through 9, Tuesday through Sunday, 13-18 October

(...continued from previous post)
The day-to-day routine got old really fast. So far I have been able to hoodwink my psychiatrist and primary therapist (the two responsible for reporting back to the court) that I am indeed improving. However, and this is where I think the healthcare industry has a fine racquet going on—I was told on Day 5 (remember, my minimum legal hold was five to seven days not counting weekends, so Day 5 in real time was only actually Day 3 legally) by both of them that they were still unwilling to sign my release papers for at least two more days. That would bring me through Friday forcing me to stay another weekend. Their chief concern was that I lived alone and had no visible support structure to return to (OK, here is where I sorta fucked up…no one knew I was here and I had no visitors or phone calls). Translation: I needed to stay on until they felt I had sufficient time to develop and practice those oh so cool coping skills (a decided subjective scale I was being graded on).

So, for each of these days I towed the party line as best I could. During this time on Day 6, my roommate was discharged and for the first time I enjoyed having some actual privacy—well, as good as it got if you don’t count all the nurses and techs constantly sticking their heads in to make sure I was doing “fine.” Of course I was!

On Day 7 (legal Day 5), I was told that it was a reasonable expectation that I could be discharged on the 20 October, next Tuesday, followed by two weeks of outpatient therapy and one additional week just regrouping at home before I had to return to work. So I called my manager back and left a voicemail indicating that 9 November was a potential return to work date. I also gave him the fax number of the hospital to give to the medical disability company (thankfully, an outsourced function due to HIPAA regulations—my employer does not get to know where or why I am here) so that FMLA paperwork could be filed and I would continue to be paid. It was nice to know I still had some time before I had to go back to my incredibly stressful job.

Days 8 and 9 (the weekend) was not so bad. Yeah, there were still groups to go to, although the schedule was pared back and not as rigid. A lot more down time for me. The weather was autumn beautiful and with the extra smoke breaks, I got to spend a lot more time outside in the sun. My privacy/solitude bubble was burst Saturday night. There was a new female admit and they assigned her to my room. Boy was I pissed. And I thought I was getting royally screwed. She was only 17 years old (she should have been in the adolescent unit but there were no beds, so I was stuck with her until one opened up). Geez, all I needed was some whiney, needy teenager to share my breathing space.

By the time she had processed her admission paperwork it was already late in the evening. I purposely took my evening meds earlier than usual (we had a one-hour swing on when we could take our 2100 hrs meds…any time from 2000 to 2200 hrs). I turned off the lights in my room (but I did leave the bathroom light on with the curtain drawn), hit the sack and pretended to be asleep when she came in, hoping that she would be too intimidated to turn the lights on and “wake” me up. It worked beautifully.

This morning, when we had our 0530 vitals taken, I said absolutely nothing and simply walked out the room to catch the first smoke break of the day. When I came back to the room still saying nothing, I went into the bathroom and took a long enough shower so she would be gone for breakfast by the time I got out. The rest of the morning was busy work with group therapy, and during the lull before lunchtime, I sat on my side of the room at my desk writing in this journal. She picked up the hint. She said nary a word.

(later) Well, it’s 1945. Time for the last, although most informal, group meeting for the day (a la “what new things did I learn about myself today” bullshit). It’s run by one of the techs and mostly we had to fill out this required check sheet and turn it in (how many times could I word the same bullshit in different ways each night surprised even me). My roommate has continued to stay quiet. Now, mind you, I haven’t been ugly or mean, or even rude to her by a long shot. I’ve simply shown no interest in wanting to get to know her, much less have a conversation.

As soon as group is over at 2000 hrs, I will spend the rest of evening outside until I have to take my evening meds at 2200 hrs. Thank God for such beautiful weather. I would go stir crazy (no pun intended) if I had to stay indoors for the entire weekend (yeah, even in the rain we still take our smoke breaks as there is a covered patio we can sit under aside from the rather nice back yard they have here). The campus is fairly large as each unit has their own “back yard.” Ours backs up to the detox unit’s, but, believe this or not, while inside the building each unit is locked separately apart from each other, we are not allowed to interact through the fence with the detox unit patients while we are outside. Crazy rules for crazy people.

Tomorrow is Monday, back to the weekday grind. Hopefully, only two days to go. (To be continued…)©2009

Involuntary Commitment—Day 3, Monday 12 October

(...continued from previous post)
Morning vitals still showed my BP to be very elevated, so they started me on yet another medication. Actually, in this case, they added an additional med (lisinopril) along with a prn order for Tylenol for my headache (like that’s gonna do me any good—no, not drug seeking behaviour attitude, but give me a break…Tylenol??? At least Excedrin has the caffeine in it like those old APC compounds you used to be able to get which worked great for headaches…aspirin, phenacetin and caffeine). I was actually more concerned about the dizziness.

Monday morning…I’d finally get to see what kind of shrink they lined up for me. That’s when I was told the “good” news. My court-ordered 72-hour hold had now been stretched into a minimum five to seven days starting with today (get this….weekends don’t count!). While I was pissed off as shit, I mustered my best façade from the get-go, determined to get the fuck out of Dodge ASAP. I could play their games. Been there, done that. I was required to attend all group therapy sessions as a condition of my release along with participating in their outpatient treatment center after release (not a long-term thing, perhaps two to three weeks tops). So I looked appropriately cheerful and eager to understand all about my labeled diagnoses (no surprise here…Bipolar 1 and Borderline Personality Disorder). Read all the handouts they gave me so I could spit it out effectively in group to also include being able to identify what my triggers were and the supposed corresponding effective coping skills (this place was steeped in DBT…don’t even get me started with that subject). Now, granted, coping skills can work IF you choose to use them. Personally, I just no longer give a damn. But they didn’t need to know that. I now began marking off my time to discharge (picture the prison wall with hash marks on it…LOL).

The other patients were a pain in the neck. I made myself as unapproachable as possible. There was one exception, however. There was an Army vet with PTSD that was in the same boat I was. Neither of us wanted to be there (well, I get that no one WANTED to be there). Neither of us wanted to interact with anyone else, and soon we ended up isolating ourselves together against the herd. He was doing the same as me…The Master Façade. During our limited, brief conversations we both realized that we actually “got it” about each other. No, we didn’t hang together, but when forced into a group of people, we could isolate together. Nothing ever had to be said, and no one ever bothered us for the most part. We took great pains to dare anyone to even come up to us and start a conversation (this whole attitude was, of course, after all the official therapists and shrinks left for the day. During the day, all of us were always being observed, so I had to tow the party line for at least some part of the day).

The schedule was quite structured. My only freedom was the frequent smoke breaks and choosing not to eat the meals. Having to sit with everyone in the cafeteria listening to their chirpy, Xanax-driven banter was more than I could handle. And I got so fucking tired of the other patients who actually dared approach me asking me how I felt (like the response, “How the fuck to you THINK I feel?” wouldn’t be so far out of line), why didn’t I smile more, why didn’t I socialize with the group, etc., etc., etc. A simple reply of “fuck you” usually did the trick (again, after hours).

I survived the various group therapy sessions. Thankfully, the current census of 17 patients was split into two smaller groups, so that made it palliative. Yes I participated and spoke (I considered it the ultimate audition), and yes, I offered what appeared to be constructive feedback when others spoke (oh how I had to censor what came out of my mouth). I did what I had to just to make it through the day. And God, what a long day it was. (the hardest one to endure was the rec therapy where they forced us to have “fun.” If I was going to lose any points it was gonna be with this session.) I could actually breathe a sigh of relief once dinnertime came around and all the psych staff left for the day. I felt like I could let my guard down somewhat. Yeah, I couldn’t be blatant about my “fuck you” attitude as a nurse could always write something in my chart for my therapist to see the next day, but they weren’t around in our faces all the time, so I could pretty much get away with it And the thing about skipping the meals was no big deal. Evidently, the dietary folks kept the two huge refrigerators we had access to loaded with fresh fruits, veggies and juices. The only thing missing was caffeine. All the coffee and teas were decaffeinated. The ironic part was that we had access to vending machines with drinks. I found Mountain Dew to be highly effective in combating caffeine withdrawal today. I don’t particularly like carbonated beverages, but one does what one must—necessity is the mother of invention. Luckily, I actually had a bunch of singles in my wallet that I could get access to upon request.

So, the day finally winded down, I took my evening meds (my BP was finally getting under better control), disappeared to my room, sacked out on the bed and just stared at the ceiling (I didn’t really envision getting any better sleep here than I did when I was at home) until the tech would roll around at 0530 to start taking morning vitals. Oh goodie, yet another day to endure. (To be continued…)©2009