The Rehab Diaries Week 4 – Holiday Time is Over

 

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Finally, I got to see the new doctor.  He was a pleasant character and after a few leading questions I found myself pretty much telling him my life story, including how I had applied for medical school this year, and missed the UMAT cut off for my school of choice my just a couple of points.

He was supportive, saying that he had several patients who had gone on to careers in medicine, and some much older than me.  He tried to decipher my doctor’s notes – apparently he has typical doctor’s handwriting – and it appears that he eventually intends to supervise me onto 100mg of Zeldox, which would indicate 2-3 more weeks of rehab.  He told me that he would be putting it up to 60mg this week.

When mum picked me up for leave that afternoon I passed on that information and her reaction was one of despair.  How could I be there for a month?  Don’t my doctors understand the havoc I am wreaking on my family yet again? Thanks mum, real helpful…  (Actually I’ve been there for five weeks before but I think this admission will top that.)

If last week was the week of agitation, this week is the week of anxiety.  I’m still experiencing racing thoughts, racing through everything I could possibly be anxious about.  Just leaving the hospital makes me feel so ill.  BF and I were going to the beach last week but that’s out of the question now.

For some reason thinking about moving home is triggering me badly.  It’s just the whole moving process being such a pain in the butt, I just want it over with.  We’ve been going to my place to get bits and pieces and that’s so hard.  For some reason being in my suburb is giving me anxiety over the fact that it’s a super rough area.  Which it is, but I’ve lived there for two years and never been broken into or had any such trouble from the residents.  The drama stayed out of our house and on the street but still I can’t help agonising.  It sucks.

I’ve been catastrophizing something dreadful.  My mind latches onto a dreadful idea, and I can’t relax until I’ve been able to confirm it.  For example, while I was on leave one morning I became convinced that someone had gone into my room and stolen my contraceptive pill.  Which is ridiculous, right?  That’s a horrible thing to do and I haven’t even talked to the other patients enough to infuriate someone to the point where they would do that.  But I couldn’t let it go.  I ended up calling the nurses’ station and making one of the nurses check that it was in my drawer.  Which it was.

I’ve had many ‘ideas’ like this.  When I have them I make sure to tell the staff so that my irrational thinking is going on record because this needs to stop.  Of course the fact that I’m aware that these thoughts are irrational bodes well for me but it’s still eating me alive.

And then to add a poisonous olive on the side of this paranoia laced anxiety cocktail, I woke up one morning and the double doors between ward one and two had been thrown open.

Holiday time is over.

“Oh yes, we’re back to normal functioning this week.  Prepare for fifty thousand admissions.”  My nurse confirmed cheerfully as she brought my morning tablets.

I later found out that this number is actually closer to seven.  Admissions generally happen two days of the week, so they were able to stagger the patients coming in.

The advantage of course is that all the staff are running at full capacity, including the therapists.  Group therapy is back.  I gave groups another chance, and the first one I went to left me feeling positive – the therapist allowed us to check in, so the self pitying ramblers were not allowed to talk over anyone or hog the air time.

I’m certainly not above talking too much, and it’s something I’m very self conscious about; I’ve noticed in group therapy that those who talk the most tend to apply the skills the least and I can’t possibly be the only one.  I always cringe and swear I’m going to pass ever time they start going around the circle to check in but let loose when it’s my turn.  Those damn therapists sure know how to ask leading questions.

I was also eagerly awaiting the return of my therapist this week to finally start unpacking all this anxiety but my excitement was premature.  I saw her once before she had to go on leave for a week for surgery.  LAIM.  Am I going to get any kind of decent interpersonal therapy before I get discharged?

We’ll find out next week I guess.

Mac

 

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The Rehab Diaries Part 3 – Week 1

Finally, we touched ground at the clinic.

The first thing they do, after you fill out the paperwork and pay the gap, is take your vitals and take a picture to put in your file so the staff coming in on the next shift can match names to faces.  I’ve had several pictures taken over the years to account for aging – and my hair being a different colour in each one.

In all my previous pictures I look either depressed or agitated but in this one I was concerned that I look inappropriately cheerful.  There’s a good reason for that though – after I’d had my medical and was awaiting the nurse with my admission package, BF ducked into my bathroom.  The nurse came in while he was doing his business.

She apparently didn’t hear him flush the toilet and wash his hands while she was setting up the camera.  When he threw open the door just as she was pressing the button, she startled so badly that she jumped and we had to take the photo again.  The second one came out but it was obvious that I was trying to supress my amusement.

After BF left, I was to have my admission appointment with a doctor who I hadn’t worked with for five years, as my regular hospital psychiatrist was away.  I was a little nervous about this meeting; I had been a difficult patient to deal with at the time but was having a lot of trouble expressing what was wrong with me, and took a lot of frustration out on my care team.  As a result I was told again and again that they had no idea how to help me.  I harboured a deep distrust of mental health professionals for a few years after.

My communication skills have improved since then and bearing in mind that I didn’t get along with my current psychiatrist when we first met, I was willing to give him a chance.  I figured it was a better option than starting with yet another doctor who I don’t know at all.  I was relieved to find that he was willing to give me another chance too, and after the official admission business he asked me what I hoped to achieve with this admission.

I explained the deal with my current medication.  The mood stabilisers seem to be struggling on their own.  The efficacy of Topamax is unclear.  My anxiety is out of control.  I probably need to be on antipsychotic drugs as well as mood stabilisers – as many bipolar patients do – but we’ve had trouble sticking with one so far because of side effects.

He listened, and conceded that this would be worth a try…and if I left it with him, he would come up with something.  Wait, what?

Turns out I didn’t have a good appreciation for how gung-ho my regular psychiatrist’s approach is.

In our next appointment three days later I found my frustrations from five years ago resurfacing somewhat.  The doctor seemed unwilling to make a solid decision and kept throwing the conversation back to me, asking me if I had other ideas.  Um, why go through three years of psych residency if it were that simple?

I pressed him and he listed off some antidepressants to treat my low mood which was met with an (admittedly ungracious) groan from me.

“Pristiq?  PRISTIQ??? Don’t you remember what I was like when you put me on pristiq before?”

“remind me?”  He quipped innocently

“kinda nasty.”

He suggested Cymbalta, saying that some of his bipolar patients had seen improvements on the drug but I was hesitant, maybe unfairly due to the number of people of mental health forums I’ve been haunting despairing over side effects.  I said I would ask my dad, also a doctor, for a second opinion.

Finally he printed out some information on the natural supplement SAMe, explaining that it could be a cheaper way to regulate my sleep and depression.  Oh great, now we’ve exhausted all our pharmaceutical options I thought glumly as I left.  Clearly he thought he was giving me greater autonomy over my treatment plan but at the time I felt like I had all these decisions on my shoulders that I’m unqualified to make.

I spend a lot of that week in bed.  I was low, in mood and in energy.  BF normally cares for his mother but she had been in respite for a few weeks so he was with me constantly.  Whether I liked it or not.  All BF all the time.  I just didn’t have the energy to entertain him and I was getting more annoyed by his presence because I felt like he was just doing it to ease his own guilt, rather than because he thought he was helping me.

On one such day he said he was coming over.  I told him no, I wasn’t up for company but he turned up anyway.  In the mood I was in I told him that if he must be here fine, but I said I didn’t want to talk so I wouldn’t.  And rolled over and went to sleep.

I napped most of the afternoon while BF lay on the floor playing candy crush, every now and then being woken up by an overdramatic look-at-me sigh from him.  About two hours in when sighing his feelings out got him nowhere he got up and stormed out.  I’m not sure how long he was gone for as I was asleep in between but he came back with my nurse who looked a little perplexed.

“You should get up.” She turned to him “She hasn’t eaten today.”

I pulled the covers over my head. “Too bad.”

He yanked the quilt off my bed. “Nope!  We’re going for a walk.  Even if I have to wheel the bed out the front door.”

After some protests from me – and a threat to roll me off the bed that probably would have been carried out – we did go for a walk to the nearby lake, and ate Thai food in the sun.  My mood improved for about five minutes.

I was hoping to debrief with the nurse over whatever my boyfriend said to her, but she wasn’t in for the rest of the week.  If he wants to be around and harass me fine, but I don’t want him annoying the staff.

That was a conversation I wasn’t able to have until week two.

So you’ll be hearing about that in the next instalment of the rehab diaries.

Mac

 

The Rehab Diaries Part 2 – The Waiting Game.

Waiting, waiting, waiting.

After stressing out about getting the referral, turns out that was much ado about nothing compared to the limbo that followed.

Usually what happens is the referral gets triaged and paced in line based on need.  The line moves based on discharges, or you may be moved forward if they think your need increases which I’ll provide an example of later.

So when you’re next in line and there’s a discharge planned for the next day, you get a call informing you of there being a room free and could you be there the next day at a certain time?  However, patients do discharge themselves before their program is complete – being a private clinic, we are all supposed to be there of our own free will, after all – and I’ve be called in on the day with two hours’ notice one time.  By then the staff knew me well enough to know that I lived close enough to make it there in that time, and I have people who would take me.

You need lifts because patients are not allowed to drive to and from the hospital.  I would organise that as soon as the referral is sent because you never know when the call is going to come – previously I’ve gotten it the day after, or a week after.  This took two and a half weeks, which is the longest I’ve ever waited.

Turns out, everyone wants to go to rehab over Christmas.  Funny that.  I believe that the clinic was also trying to slow down their intake leading up to the closing of the ward three days before Christmas to reduce the strain on the staff who operate at half strength this time of year.

This doesn’t stop a lot of people looking for a convenient cover to get away from their families – and after some interactions with the residents I can’t help but wonder if some of the families were overly supportive of the idea.  This isn’t speculation, we’ve had whole group therapy sessions on the topic and I couldn’t get a word in edgeways for all the venting.

I’m not looking to get away from family, we certainly don’t have the type of dysfunction that the other patients are dealing with.  I need help.  That’s the long and short of it.

So I waited a week.  A week and a half.  I called the triage nurse (I really didn’t want to do that because we can’t stand each other, but luckily I only ever spoke to her minions) to check the referral had gone through.  It had.  Alrighty then, I’ll wait some more.

I called again two days later, because I was suddenly anxious about the wards closing.  I knew it happened, I just couldn’t remember when and I was convinced it was going to be in like three days before the line got to me.  The nurse assured me that no, it was more like three weeks.  Crisis averted.

Then the next day, the nurse unit manager called me.  And yes, he’d been notified of my calls and was concerned that my need had increased. He had a spare bed for me if I wanted to come in…only problem was, it was a shared room.  I’d had some bad experiences with shared rooms so I knew I had to decline.  He said he thought so but just thought he’d check.  More waiting.

While this was going on I was staying at mum and dads, my hospital bag, doona and pillows perched in a neat pile in the hall way, ready to go.  Mum started asking with concern if they could have forgotten me.  I told her about my calls and assured her that was not the case.  All I could do was wait some more.

And then, two and a half weeks later, it finally came.

There was a room, ready for me.  The time had come.

My boyfriend wanted to be the one that drove me, so we said goodbye to my parents and headed out.

And so began my stay…which you will be hearing more about in the next instalment of the rehab diaries.

Mac

The Rehab Diaries: Getting the Referral

I had an appointment on a Wednesday.   The sole purpose of this appointment was to get me a referral to this private rehabilitation clinic which I’ve been umming and ahhing over whether I should go to for a few months.

It occurred to me that if I’d been thinking consistently for months with no signs of stopping, it was time to cut my losses and go.  My depression was intense for that whole time it felt like, and then I’d gone the other way and was a mess of raw nerves.  The mood stabilisers clearly weren’t doing their jobs.

So I had my appointment.  Then on Tuesday afternoon, the receptionist called me to say that my doctor had cancelled all her appointments, and would it be ok if she scheduled me with someone else?

Well, FUCK.

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