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As it turns out, overdosing is mighty expensive. It has been 28 days since I overdosed, and the bills have poured in to my insurance company. Here is a breakdown of all the charges, with original cost and insurance-approved cost in parentheses:

AMBULANCE
* ALS1-EMERGENCY ($1,100 -> $400.06)
* GROUND MILEAGE ($112 -> $50.12)
* AMBULANCE O2 LIFE SUSTAINING ($35 -> $0)

EMERGENCY ROOM DOCTOR
* EMERGENCY SERVICES ($506 -> $332.16)
* ELECTROCARDIOGRAM REPORT ($25 -> $17.78)

ICU DOCTOR
* INPATIENT PHYSICIAN SERVICE ($501 -> $233.99)

COUNTY HOSPITAL
* MISCELLANEOUS SERVICES ($42.15 -> $34.14)
* MISCELLANEOUS SERVICES ($58.72 -> $47.56)
* MISCELLANEOUS SERVICES ($8.60 -> $6.97)
* MISCELLANEOUS SERVICES ($47.10 -> $38.15)
* MISCELLANEOUS SERVICES ($67.40 -> $54.59)
* COMPREHEN METABOLIC PANEL ($322.40 -> $261.14)
* ASSAY BLOOD ETHANOL ($105.00 -> $85.05)
* ASSAY URINE ACETAMINOPHEN ($159.60 -> $129.28)
* THERAPEUTIC DRUG ASSAY ($97 -> $78.57)
* DRUG SCRN 1+ CLASS NONCHROMO ($250 -> $202.50)
* AUTOMAT HEMOGRAM-COMPLET DIF ($77.50 -> $62.78)
* AUTOMATED, WITHOUT MICRO ($48.60 -> $39.37)
* CRITICAL CARE FIRST 30-74 MN ($693.20 -> $561.49)
* NONINVAS EAR/PULSE OXIM;SING ($88 -> $71.28)
* ELECTROCARDIOGRAM, TRACING ($207.90 -> $168.40)
* INPATIENT PHYSICIAN SERVICE ($584.70 -> $473.61)
* MEDICAL SERVICES ($75.40 -> $61.07)
* ELECTROCARDIOGRAM REPORT ($26.70 -> $21.63)

ON-CALL THERAPIST
* MEDICAL SERVICES ($82.50 -> $58)

MENTAL HEALTH CENTER INPATIENT UNIT
* MISCELLANEOUS SERVICES ($2,000 -> $1,050)
* MISCELLANEOUS SERVICES ($56.33 -> $0)

PSYCHIATRIC APRN
* INPATIENT PHYSICIAN SERVICE ($85 -> $85)
* INPATIENT PHYSICIAN SERVICE ($75 -> $65)

The grand total was $7,537.80, of which my insurance approved $4,689.69. Fortunately for me, I had already reached my maximum coinsurance for the year and did not have to pay a cent of this. Unfortunately for the purposes of this post, I cannot give an idea of what the out-of-pocket cost would have been.

niagara-river

The real cost of an overdose isn't monetary though. It's the risk of having permanently damaged internal organs. It's the awkward silence when you try to explain what you were thinking, or possibly not thinking. It's the knowledge that everyone is looking at you distrustfully, wondering how long until you try it again. It's the awful realization that you could very well be dead, and after coming that close you understand that you never wanted that to happen. It's the fact that once you've overdosed, it continues sounding like a legitimate solution, no matter how mild your depression may be.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/22/the-cost-of-an-overdose/. Please comment there.
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At the beginning of Thanksgiving week, I got up in the middle of the night, stumbled around my living room, and went crashing to the floor.  I couldn't get up.  I screamed for my mother, who leaped out of bed and came to help.  Then, of course, I refused her help.  I managed to pull myself into a dining room chair, but was shaking too hard to drink the glass of water she brought for me.

After some interrogation she asked if I had taken a bunch of pills.  I denied it.  Then she asked again and I confirmed it.  In total, I had taken somewhere between 40 and 50 Benadryl.  When mom realized she couldn't get me to the hospital on her own, she called 911.

benadryl

Many hours of my life are a blur.  I thought I remembered the presence of "Deputy Wayne" from Celebrating February 14th.  This made no sense, so I assumed I hallucinated.  I remembered ambulance lights and being helped outside to get in it.  I remembered a bedpan.  That's about all until I woke up hours later in the ICU.

Things were not much clearer in the ICU.  From that portion of the day, I remember repeatedly getting out of bed.  I remember trying to yank out my IV needle.  I remember a really sweet nurse who offered to order my meals for me so I wouldn't have to make scary phone calls.  I remember the on-call therapist dropping by to determine whether I should be admitted to inpatient, but I don't remember the slightest thing about what I said to her.  I remember mom visiting and telling me that Deputy Wayne really had been there, but I had to ask her about it all again the next day because I wasn't sure I hadn't also hallucinated the conversation in which she confirmed his presence.

I told many different stories about the overdose - some of them during the time when I was not coherent enough to know what I was saying, and others during the course of the following week when everyone wanted an explanation for what I'd done.  Some of the stories:

"I did it for attention."
"I don't know why I did it."
"I wasn't trying to kill myself."
"I wanted to hurt myself."
"I took a few for sleep and it impaired my judgment so I took more."
"I overdosed on Benadryl."  (no reason given)
"I tried to kill myself."

In the beginning, "I don't know why I did it" was pretty close to the truth.  This was what I told my psych APRN when he came to see me the next morning in inpatient.  He tasked me with figuring out the reason(s) I did it so we could prevent it from happening again.

I told most of my friends that it was an accident.  That I took them for sleep and took a few more when they weren't helping, and took a lot more when my judgment became impaired.  The truth in that was that I did only take a few at first and my judgment really was impaired by the time I took the rest.

I told one close friend that I wanted to hurt myself, but wasn't trying to kill myself.  I did want to hurt myself.  I had wanted to hurt myself for days.  I didn't plan to kill myself, although suicidal thoughts had been stuck in my head just as long.

With a few people, I didn't give them a reason and let them make their own assumptions about what happened.  With one particular person, I needed to impress upon him the severity of the situation, so I said I tried to kill myself.  This is sort of true too...I did try, even if it wasn't entirely intentional.

It took me a while to figure out exactly what happened and why and how to explain it, so here's the truth:

I had been having suicidal and self-injurious thoughts for days.  The kind of thoughts for which I'm expected to call the local mental health center's emergency hotline.  The kind of thoughts I didn't think were that much of an emergency and surely I could handle them myself.  The afternoon of the overdose, a friend confided in me that she had been suicidal the night before, for the first time in her life.  She said the only reason she didn't do it is because she had a "painless and tidy" method in mind but lacked the tools needed to execute it.  I don't blame her for my thoughts, but it did spark something in me.  The idea that I really could do it; that nothing was stopping me.

I didn't really plan on dying.  I didn't make any sort of preparations.  I just knew that I had once taken 10 Benadryl with no lasting effects so maybe this time I could try 15.  I was clearly a chicken about it, because I only took 5 at a time, giving myself the chance to back out.  5 pills every half hour, until I reached 15.  Then 20.  At 20 I still felt fine, if somewhat groggy.  I dumped another huge pile in my hand, tossed them in my mouth, and swallowed.  I knew when I took all those at once that it could kill me, but it's true that my judgment had been impaired.  I didn't have the capacity to make a decision about whether I wanted to die.

I was terrified going into inpatient this time.  I was convinced I would be permanently committed.  In reality, they only held me 2 nights.  I got 5 nights once for lying about having suicidal thoughts, but when I overdosed I only got 2 nights?  This was baffling.  I can only imagine that they were trying to get me home for Thanksgiving.  I didn't argue on being released, not wanting to ruin Thanksgiving, but I was still very depressed the next few days and would have benefited from a longer stay.  I'm still working on learning to put my own needs first.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/09/keeping-the-stories-straight/. Please comment there.
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There was a post in a bipolar support group the other day that asked "Am I the only one who loves coloring?"  The response was a resounding "I love coloring too!"  Nearly every commenter expressed the same interest, with many talking about coloring as the best part of their inpatient experiences.

On my first inpatient stay, I used some dull colored pencils.  When they were beyond usable, I could go to the desk and, with supervision, use a pencil sharpener.  I sharpened a couple of pencils that I needed to finish my current picture, and was tempted to bring the whole box full and sharpen them all, just in case anyone else wanted those colors.

On my second inpatient stay, I didn't do much coloring as I wasn't there long enough.  Had I known what would happen in the next week, I'd have colored to my heart's content.

On my third inpatient stay, a week after the second, the colored pencils were all dull and we were no longer allowed to sharpen them.  In that intervening week, a client we'll call Stefanie had managed to get the pencil sharpener away from watchful eyes, break it open, and use the razor to make a deep cut along her whole forearm.  It required many stitches and staples, a big bundle of gauze wrap, and her placement on one-to-one supervision - someone staying with her and watching her at every moment.

The irony here is that Stefanie was more interested in coloring than any other client.  She was constantly having the staff print off new coloring pages for her.  At first she used crayons, and then her husband brought in the Crayola Twistables colored pencils.  Her only lament was that there were only 12 colors.

Upon my discharge, I found a package online that had 30 different colors.  I ordered them for Stefanie, and attempted to go visit her as she was still in inpatient.  The staff wouldn't let me in.  Something about being too recently discharged.  I was disappointed, as I had fought past a lot of anxiety to even make the trip, but I did have the staff member deliver my gift to Stefanie.

coloring-page

Recently when I've been stressed out, I've remembered how much coloring relaxed me in inpatient and pulled out my colored pencils.  It still helps in the outside world as well.  It helps so much, in fact, that when my therapist assigned the task of creating a "self-soothe first aid kit" I promptly ordered miniature coloring books and my own pack of Crayola Twistables to include in it.  Then I had to brainstorm a while in order to figure out what other items it should contain.

The idea of self-soothe is to use the five senses to comfort oneself when in emotional distress.  Coloring is obviously sight, and I also have photos of family and index cards full of inspiring quotes.  For taste, a pack of chewing gum.  For hearing, an iPod shuffle full of upbeat music.  For smell, a roll-on of scented oil.  For touch, tiny knitted swatches in a variety of soft yarns.  As a bonus, there's also a pill container with a few of my anxiety medication.

My therapist loved the kit.  She spent forever looking at it and said she just wanted to play with everything.  My only dilemma with the kit is that I can't actually have it handy when I need it.  I can't carry something like this into my workplace, where everything I bring has to be inspected by security on the way out.  At this point in the year, it's too cold to leave it in the car, and I wouldn't really have access to it in the moment of need.  I'd be waiting until lunch or after work to go out and fetch a soothing item.  So while the kit was fun to create, it doesn't fit my current life circumstances very well.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/11/22/never-too-old-for-crayola/. Please comment there.
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medical-records

In an online bipolar support group, I recently posed the following questions:
How many of you request copies of your medical records? If you do read them, how do you feel about what you read?

I have requested records three times (and received them twice...still waiting on the third batch).  The first time was in March, immediately out of my first stay in the IPU.  Aside from general curiosity, I wanted some specific information that had not been shared with me: my exact diagnosis and the results of my first-ever blood tests.  I got my answers, and a few moments of humor, and a few other moments of being really annoyed.  For one thing, my appearance when I arrived at the IPU was described as "bizarre".  I showed up clean, in dressy clothes and full makeup, and just happened to have purple hair.  This is not bizarre.  In fact, it was quite pretty.

I also was annoyed that every time someone did an assessment of my intelligence, they wrote down "average".  The staff members who have seen me over the long term would definitely laugh at the thought of me being average.

A few months later, in late May, I submitted a request for everything added since that first batch.  The day before they arrived, my therapist told me she had been notified of my request in case she had any concerns.  I would still receive the records either way, but she did tell me she was concerned that as a people-pleaser I may read things as criticism that weren't intended that way and become upset.  And possibly injure myself in response.  She made me promise that I would talk to her about anything in my records that upset me.

I tried not to be upset by anything.  I knew my reactions were irrational.  However, some things kept nagging at me, so when I next saw her I told her we needed to discuss it.  Most of my concerns were things she couldn't really address since it was about other people's notes.  The only thing I was bothered by in her notes was that she refers to me by name instead of as "the client" like my former therapist did, and I got a reasonable explanation as to why that's done.

Last week I stopped in to submit another request, this time for the past 4 months worth of records.  Aside from being a longer time period, it is also one that was quite eventful, so I'm expecting a very large stack of papers, including:

  • Updated Adult Needs & Strengths Assessment (ANSA)

  • Updated treatment plan

  • 2 inpatient nursing assessments

  • 2 inpatient physicals

  • 2 admission notes to the inpatient unit

  • 2 discharge notes to the inpatient unit

  • 21 inpatient shift notes

  • 7 visits with inpatient psychiatrist/psych APRN

  • 3 visits with regular psych APRN

  • 21+ visits with regular therapist

  • 1 visit with therapist's supervisor

  • 1 visit with on-call therapist

  • 1 phone call with a different on-call therapist


In fact, I won't say "including".  I don't think I've missed anything, so if there are additional pages beyond a few more times seeing my regular therapist between now and when the records are printed, I think someone should take me out back and shoot me.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/10/25/medical-records/. Please comment there.
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rummy

On the first evening of my latest inpatient stay, I was surrounded by strangers and desperate to find a way to socialize.  A woman we'll call Stefanie had a deck of cards and a crowd had gathered around to play 500 Rummy.  She invited me to join, but I opted to just pull up a chair and watch for a while, as I didn't know the rules of the game.

The next evening, I joined the game.  I was 50 points from winning, and far ahead of most other players, when we were interrupted by visiting hours.  We never finished the game, but presumably that means I won.  The other players kept commenting on my "beginner's luck" and that they "taught [me] so well".

The next time we played I was again winning when we got interrupted by someone needing to speak to Stefanie.  I was sitting alone with a woman we'll call Yasmine and I confessed to her that I was not new to playing cards, I just didn't happen to know the rules of that particular game.  She thought that was hilarious, and she kept it to herself, so I left there with everyone else still thinking they were excellent teachers.  There was some luck involved though - everyone was frustrated by my ability to get multiple wild cards in every round.

My game of choice, which I started playing before my hands were big enough to hold all the cards (I borrowed the racks from Rack-O), is Shanghai Rummy.  It's been a long time since I've gotten to play, as I'm rarely with more than one other person who knows the game.  Maybe I should try being an "excellent teacher" with someone new?


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/12/beginners-luck/. Please comment there.
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I was released from the inpatient unit 2 weeks ago.  I was released from the inpatient unit 2 days ago.  Wait, what?  Yes, as a matter of fact, I did get myself locked up twice within a 2 week time period.  Both instances were the result of my inability to STFU and stop saying things that will cause overreactions in people who have the power to detain me.

See, when I went to see my therapist last Thursday, I confessed to the fact that I had lied in order to get out of inpatient the previous week.  I felt honesty was necessary if I wanted therapy to work.  Well, upon hearing that I told the psych APRN in inpatient that I was perfectly fine when I happened to be considering the possibility of overdosing when I got home, my therapist promptly decided I was going back for a longer stay.  Maybe a week or two.  She even offered to find me a different facility if I did not like the inpatient unit affiliated with her organization.

I kept saying no, that I could not do this.  She wasn't taking no for an answer.  When I finally resigned myself to the fact that I was going whether I liked it or not, I asked to go home first and have mom drive me back.  I've done this in the past.  The deal has always been that if I don't report back within a certain time period then the police will be called to do a wellness check.  This time I didn't even get that time period - she said that if I left her office to go home, she'd call the police immediately.  She wanted to drive me over to inpatient herself.

So I spent another 5 nights without any freedom.  I chose to practice my radical acceptance and be calm about the fact that I was there and just let things happen instead of fighting it.  I had a lot of time to think, and while there I saw what would happen if I didn't get better - one client already had a court order committing her to a state hospital as soon as a bed became available, and another one was waiting to see a judge for the same reason.  Watching these events unfold frightened me into a deeper determination that I will work hard to overcome my problems and especially to stay out of inpatient in the future.  

There are a lot of hours in a 5-night stay.  My time was filled somewhat with meals and meds and psychiatrist's visits and group activities, all of which I fully engaged in.  That still left a lot of hours for socializing with other clients, visiting with mom for 2 hours each evening, kicking butt at games of rummy, writing in my journal, and (possibly most importantly) doing exercises in my DBT workbook.  

My stay was somewhat lengthened by the fact that they weren't going to let me out so easily on a return visit - they even considered petitioning for emergency detention - and by the unfortunate timing over the holiday weekend.  However, there were indications that they might keep me several more days beyond that point, and I feel that the reason they chose to let me out sooner was because they were impressed with how hard I was working on the DBT skills.  It even came up in my final visit with the psychiatrist on the morning of my release.  He wanted to know which coping skills I would use if I got home and started wanting to hurt myself.  I told him the ones that were most effective at this point were putting ice on my wrists and reciting the Fibonacci sequence (not necessarily simultaneously).

ladybugs

I learned many more coping skills though.  I created a distraction plan of 10 ways to distract myself from painful thoughts.  I created two relaxation plans of 10 ways (each) to self-soothe using the 5 senses.  One plan can be done away from home and the other can be done at home.  I learned to relax by using a cue word and by visualizing a safe place.  I even worked on identifying my values and setting goals to spend time on those areas of life that I value most.

So I got to come home, and today I go see my therapist for the first time since she dropped me off at inpatient.  She made a comment at the time that ended with "if you're not furious with me" and I said that I wasn't.  After all that thinking time, I decided that I was.  Well, maybe furious is too strong of a word, but I am definitely upset with her about the fact that I came into her office prepared for a very productive session, with a thought diary and several of the DBT exercises to discuss, and instead we accomplished nothing because she latched onto my confession which was never intended as more than a passing comment.  

I have a poem that I wrote for one of our group activities, which addresses that situation using a theatre metaphor.  My plan for the past few days has been to give her that poem as part of a little speech I prepared that has some negative criticism about how she handled things in our last appointment.  The speech ends with "As a result of this experience, I will never be able to fully trust you.  The next time I go to inpatient it will be kicking and screaming in handcuffs."  I am no longer sure about giving the speech, but I do still intend to share the poem.  It may be more powerful than the speech was anyway.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/04/dbt-freed-me/. Please comment there.
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colonial-williamsburg-jail

A week ago I was being held prisoner.  No, I didn't get arrested, although I guess you could say someone arrested my negative thoughts.  See, I was having a bad day at work the previous day.  Objectively, it wasn't that bad of a day.  I spent nearly 8 hours doing one task, because I first did it using the wrong login and had to start over and do it all again.  Then in the course of doing this, a coworker made some comments that offended me (saying that anyone who wouldn't do one of my other tasks a certain way is retarded, although she knew nothing about that task and was completely wrong about how it should be done).  Neither of these events sound that bad, right?  Well, as will be further addressed later on, I have very few skills in the area of distress tolerance.

In response to this situation, I wrote "kill me now" on my arm.  Then it looked so lonely there that I started writing related words.  Words like "noose" and "pills" and "razor".  Eventually my entire forearm was covered in suicide-related terms.  Did I actually feel suicidal?  No, not at all.  It just seemed like a thing to do to channel my frustration.

I had been planning to write a letter to my therapist and give it to her in my appointment 2 days later.  Some things have not been working for me, and I knew I'd freeze up if I tried to explain it out loud, so a letter seemed like the best way to bring up the topic.  Suddenly I felt as though I couldn't possibly wait 2 more days.  I was even willing to try saying it out loud, if that was what it took to get it over with.  So the next time my boss checked in on me, I asked if I could leave after I finished up the task I had almost completed (for the second time).  He said yes.

I was out of work in the early afternoon and showed up at the mental health center to ask the receptionist if my therapist had any openings.  She did not.  I was halfway out the door when she asked if I needed to see the on-call therapist.  I declined and kept walking.  As soon as I stepped out in the bright sunshine I started crying.  I sat in my car and cried until I couldn't tolerate the heat anymore, then got out and went to sit on a bench by the building where there was shade and a nice breeze.  I kept trying to talk myself into going back and saying I'd changed my mind.  I sat there for nearly an hour before going in.

What convinced me?  A random man walked up to use the ashtray by the bench.  He introduced himself.  I introduced myself.  He said, "Want to see a neat tattoo?" and pulled off his shirt.  As he turned around to show me a silhouette surrounded by flowers, he said, "My son committed suicide.  He took my rifle and shot himself."  I managed to say the socially appropriate things: that it was a nice tattoo, that I was sorry about his son.  After he left, I burst out laughing at the absurdity of the situation.  There I was with suicide-related words written all over my arm and someone coincidentally came up and mentioned suicide.

Once I contained my laughter, I went back inside and said I'd changed my mind.  I was sent over to a different facility where the on-call therapist was currently located.  I had to fill out pages and pages of redundant paperwork, and was almost done when she came out to tell me I didn't need to finish that because she had all that information on file.  Now, I was planning to just get some things off my chest.  Maybe talk a little about my plan to discuss some potential changes in approach with my therapist.  Maybe share the frustrations of my work day and get some advice on how to better handle those situations in the future.

This is not what happened.  Yes, I shared those things.  Then she started talking about wanting to admit me to inpatient.  I said that wasn't necessary, that I wasn't really going to kill myself and I would have mom hide my medication again just to be safe.  She was not buying that.  She tried to convince me that I'd feel better in a safe environment, and that maybe I needed some medication adjustments that can be more easily done in inpatient.  I am weak and just went along with what she was saying.  I guess maybe part of me wanted that little vacation from reality.

She sent me out to the waiting room while she consulted with the psychiatrist, then came back to tell me he agreed with her.  I had another brief moment in her office, then was sent to the waiting room again.  She wouldn't let me leave to take my car home and have mom drive me back, and as it turns out mom wasn't even home at the time so I guess that worked out for the best.  However, I sat in that waiting room obsessing over the idea of running out the door and driving off and being anywhere but home when she sent the cops to find me.

It felt like an eternity, but I guess it was only about 15 minutes that I sat there before I was called back again, this time to actually walk into the inpatient unit and start the admission process.  It was a weird feeling this time, knowing exactly what to do and say, what questions I would be asked.  It was also weird feeling so strongly that I did not want to be there.  From almost the moment I walked in, I was desperately plotting how to get out as fast as possible.  I had realized that I was going to miss a major event at work.  I had realized that I would probably miss some dinner dates with friends that weren't firmly scheduled yet, but I had been planning to try scheduling them for a few days later.

I was sure I'd be there for 4 nights again this time, but on the first morning after I arrived, I spoke with the psych APRN and immediately started asking when I could leave.  At that point she said she'd speak with the psychiatrist but if I left that day it would probably be AMA.  In the afternoon, after many hours of going stir-crazy, I called and left a message for my therapist that I was being held prisoner and wanted to know if she could come see me there in the event that I wasn't released in time for my appointment the next day.  Mere minutes later, the woman who had insisted on admitting me came up and asked if I really felt like I was being held prisoner.  Yes, I did.

The evening was filled with drama pertaining to mom's wishful thinking that my request for a prison break meant I was coming home that evening.  I ended up storming off to my room during visiting hours, pulling myself together, and coming back to talk to her more.  However, I did have her leave half an hour early as my medication was sending me into the land of grouchy and exhausted.  I went to bed without attending evening group or having my final snack of the day.

The next morning, the psych APRN came to talk to me about being discharged.  I continued telling her that I felt fine, just like I did when I was admitted.  She told them to release me, and I got out of there a little before 11 am.  What I didn't say to her is that I didn't actually feel fine.  I felt impatient and agitated.  I was fighting to not find ways to injure myself with the "safe" objects that we were allowed to have.  Most importantly, I was strongly thinking of overdosing the moment I arrived home.  I felt terrible about lying, but at that point I valued freedom over honesty.

I did not overdose.  I held out until the next day, and then handed my pills over to mom and admitted that I lied to get out of there.  In the time since my release, I have been depressed and clingy, and mom has asked if it was a mistake that I came home.  I think it was, but I'm scared to say it in front of anyone who can send me back there.

Inpatient this time was a very different experience from when I originally went there in March.  The only thing that was different was me.  The first time around I was in such misery and so convinced that I was going to kill myself, but I had hope that being there would help solve the problem.  Plus I was curious about what the experience would involve.  This time I didn't feel nearly as bad going in, so I fought against being there with everything I had.  Maybe it could have helped me if I'd been more honest.  Maybe they could have adjusted my medications then instead of having me wait 3 more weeks to see my outpatient psych APRN.  Maybe talking with the other clients could have changed my perspective.  I didn't give it a chance to work.

What did come from this experience?  The day I was released I went to my therapy appointment.  I handed over the letter I had written while being stuck in inpatient.  My therapist said we could try to make some changes to our approach.  However, the inpatient staff had strongly recommended making an addition to my diagnosis.  Previously we had a deferral on Axis II, with a note to rule out Borderline Personality Disorder (BPD).  Now it has been ruled in.  I'm still struggling to come to terms with this addition, despite the fact that I know it fits very well.  It explains the missing pieces to the puzzle that weren't covered by my existing Bipolar I diagnosis.

So our new approach is going to involve half the session spent on a more freeform approach where I can ramble on about whatever pops into my head (my preferred method) and half spent on the highly structured Dialectical Behavior Therapy (DBT).  I was asked which set of skills I wanted to work on first, and there was no hesitation when I said "distress tolerance".  Like I mentioned before, I have no skills in that area.  I do not cope with things going wrong, no matter how minor the wrong is.  I get frustrated by what people say or don't say, by dropping things, by breaking things, by just not feeling perfect.  Let me tell you, I never feel perfect so it spirals into me always feeling miserable.

Tomorrow will be our first time with this new approach, and I am anxious but hopeful.  As much as I love the freeform talking and feel it's necessary in order for me to feel like I'm being heard, I can admit that the structured approach is probably good for me.  I need to feel like there are tangible things I can do to make progress.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/08/27/the-prison-break/. Please comment there.
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I started at my current employer as a temp last holiday season. When I started, I was terrified to bring in a lunch due to the huge number of employees and my conviction that my lunch would be stolen. So for the first couple of months, I ate nothing but a bag of SunChips from the vending machine in the middle of each of my 9 hour work days.

When I was hired on full-time in January, I was in the early stages of a manic episode. At this point I stopped eating anything at all during my work day, which was now up to 11.5 hours long. The mania subsided after a month, but by then I was so used to not eating that I still didn't pack a lunch. Then, in mid-March, I landed in the hospital.

I was told while being wheeled from the emergency room to the psychiatric unit that the food was delicious. I trusted that opinion, but my mom insisted this could not possibly be true. She goes to a hospital in a nearby major city, rather than our local hospital, and for at least the past 5 years the menu there has been exactly the same every single day. 5 or 6 options at each meal, none of which are any good. I know, because I always taste a bite after mom pushes it away in disgust. They even manage to ruin things like lemonade (too tart and a bit watered down) and sugar cookies (not actually made with sugar, so technically they should be called Splenda cookies).

That first evening of my stay, I arrived after the normally scheduled supper time but they managed to bring me a meal anyway.  The main dish was the most amazing cheeseburger ever.  I don't even like cheeseburgers.  Or hamburgers without cheese.  Or really like anything made with ground beef all that much.  However, this cheeseburger was delicious.

hospital-menu

Over the next few days, I was convinced they were trying to feed me to death.  Going from 2 meals a day to 3 meals and 3 snacks a day was a shock to my stomach.  Over the course of my 4-night stay, I had all of the following:
cheeseburger, fries, green beans, vanilla wafers, milk, Cheerios, milk, bacon, scrambled eggs, toast with grape jelly, coffee, milk, orange juice, orange, Swiss cheese, saltines, apple juice, coffee, milk, cold cut sandwich, vegetable soup, saltines, pretzels, mixed fruit, banana, grape juice, roast beef in gravy, mashed potatoes, carrots, dinner roll, peaches, raspberry sherbet, milk, cranberry juice, graham crackers, Froot Loops, sausage links, scrambled eggs, toast with grape jelly, Rice Krispies, milk, orange juice, coffee, Swiss cheese, club crackers, grape juice, apple juice, pork roast, baked baby potatoes, broccoli, dinner roll, pumpkin pie, grape juice, milk, coffee, meatloaf, mashed potatoes with gravy, green beans, dinner roll, vanilla pudding, milk, mixed fruit, banana, pretzels, apple juice, scrambled eggs, oatmeal, blueberry muffin, cranberry juice, milk, Swiss cheese, saltines, grape juice, tossed salad, grilled ham & cheese sandwich, lemon meringue pie, assorted crackers, Sierra Mist, banana, grapes, baked cod, garden rice, cheesecake, Sierra Mist, Froot Loops, grape juice, pretzels, banana, bacon, cheese omelette, bagel with cream cheese, milk, Swiss cheese, saltines, grape juice, apple juice

On the day I left, I regretted that mom could arrive before lunch.  My meals for the day were all ordered, and I was really looking forward to them.  Instead, I left less than an hour before lunch was served, and haven't eaten anything nearly as satisfying in the 4 months since.

I returned to work on the day after I was released, and I packed a lunch.  Also, snacks for both of my breaks.  Also, we had a department meeting (affectionately known as break 1 1/2), and I asked permission from my supervisor to buy a snack from the vending machine and eat it during the meeting.  I told him the hospital had trained me to eat 6 times a day and it would be hard to readjust.  In fact, I never have readjusted.  I'm still packing lunch and snacks every day for work.

No, they still aren't as satisfying as what I ate in the hospital.  There is something magical about food where you only have a couple of choices to reduce the stress of decision-making, then the food appears in front of you and the dirty dishes disappear without you having to lift a finger.  When you add in the fact that this magical food tasted amazing, it shouldn't be a surprise that I've found myself longing to go back for a week or two, just to have other people care for me.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/07/11/do-hospital-cafeterias-deliver/. Please comment there.
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In the days leading up to my psychiatric hospitalization in March, I was extremely unwell.  This might seem obvious, as otherwise why would anyone suggest a hospital stay?  I guess it seems like a surprise to me, because I've spent many, many years experiencing varying levels of unwell, and even at my previous worst (which was extremely bad), I don't think the unwellness was hospital-worthy.

I spent days feeling depressed, anxious, restless, hopeless, irritable with everyone about everything, and completely unable to focus on anything for more than 15 seconds.  My mental state was compounded by the fact that I'd spent the past month doing my highly physical job while in pain from injuries - first a sprained wrist, then a nasty fall on the ice - neither of which got the medical attention they warranted.

I landed in the hospital by going to only my second real counseling appointment (third if you count the 90 minutes of torture known as an intake interview) and confessing to my counselor that I had spent the past week researching the details for my suicide plan, and would be headed out the next day to purchase the gun I'd be using to enact it.  I knew this was the kind of thing that would get me locked up - in fact, my backup plan in case I chickened out on telling my counselor was to have a friend call the cops to come take me there involuntarily.

So, all this is to say that at the time I entered the hospital, I was pretty damn crazy.  I use the term crazy affectionately.  I know some people find it offensive, but I, as one of the crazy people, just find it to be effective shorthand.

Once I entered the hospital, I felt like I didn't belong.  In fact, I looked around at all the other patients and thought that, while I seemed like the craziest person in the room on the outside, in there I seemed like the sanest.  So it was difficult to adjust to some of the logic of the place.

A couple of days into my stay, I was doing a crossword puzzle.  Really, I was doing dozens of crossword puzzles, and skipping over the many puzzles in the book that had been partially filled in by others.  I encountered one puzzle that had a single word, "AGAVE", filled in, and decided I was okay with completing that one despite the fact that someone else had started.  I worked all around that word, finishing with the intersecting clues, and was stumped when I knew the answers but they didn't fit.  I finally looked at the clue for the one that was answered, and found that it was "Discovered (2 wds.)".  The answer should have been "DUG UP".

Suddenly, I realized where I was and thought, "Oh right, crazy people!"  Until that moment, it had never occurred to me that someone might fill in a completely illogical word in a crossword puzzle.  After that point, everything else started to make more sense.  There was a sign I'd been staring at for days which read, "Please do not put food in the drawers or cabinets."  I just kept thinking, "Why do they need that sign?  Who on earth would do that?"  Now I was able to answer with, "Oh right, crazy people!"

Then I was meeting with a psychiatrist who was reviewing my file with me for the millionth time.  It stated that a part of my suicide plan was to pin a note to my chest requesting that one of my kidneys be given to a loved one.  He looked at me very seriously and asked, "Does she need a kidney?"  I was only baffled by the question a few seconds, wondering why on earth I would write such a note if she didn't, before remembering, "Oh right, crazy people!"

It was this kind of revelation that really underscored my conviction that I was in the wrong place.  I mean, yes, I showed up at the inpatient unit in the throes of a suicidal despair.  By the next day, though, I didn't want to kill myself anymore, and I was eagerly jumping into the group activities and reading books and writing drafts of blog posts.  They kept asking what had changed, and emphasizing that they hadn't done anything for me yet.  I genuinely thought the answer was, "Now that I'm here I have hope for things getting better."

I spent several days there participating, making notes on the experience, being fascinated by what I could overhear.  I thought to myself, "Hey, I'm not sure I really need to be here, but it's great for some writing ideas."  In fact, I thought to myself, "I'm kind of like an investigative reporter."  Imagine my reaction when I picked up a book soon after I was released and read in the examples of delusions: "Feeling that you're in the hospital as an investigative reporter."  Perhaps that abrupt change of mood was mania after all.

I clearly didn't see it as mania at the time.  I mean, sure, I was constantly in motion, unable to sit in a chair without frantically tapping my foot, and blasting through the questions in Trivial Pursuit Junior.  However, I was surrounded by people who were so heavily drugged that they couldn't think straight, and spent half their day napping or staring at the television with glazed eyes.  How was I to know that my contrasting level of energy was in any way abnormal?

This energy led to me taking charge in group activities.  One day we played a game called Social Bingo.  Each square on the card had discussion topics, such as "What is your prized possession?"  Before the first number was called I had answers prepared for every question on the board.  So when we were asked questions about how we wanted to play, I was the one jumping in and making decisions for a group that would have otherwise sat in silent indecision forever.  "Do you want to number your own cards or use the pre-numbered ones?"  "Let's use pre-numbered."  "Should the next round be regular lines or coverall?"  "Regular lines."  "Do you want to play a third round?"  "No, I think we're done."

social-bingo

Being so filled with energy made me extra alert to small connections between events.  In the course of this game, one young woman in her late teens or perhaps very early twenties answered "I feel best when people _____" with "compliment me".  A few more numbers were called and she daubed the square that said "Share what the greatest compliment is that you've received."  Her answer?  "No one has ever complimented me."

I looked around the group with tears threatening to well up in my eyes, wondering if anyone else had connected her two answers.  They seemed unaffected.  I kept hoping to daub "Give someone in the group a hug." so that I could hug her, but alas that number was never called.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/07/05/oh-right-crazy-people/. Please comment there.

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