Tag: work

Mornings

One of the larger tasks I have had to work on during this whole mental health process is sleep. My sleep patterns have always been odd, at least that’s what I’ve always told myself. When I was younger I would tend to wake up in the middle of the night and have difficulty going back to sleep. Then I spent the better part of 25 years working night shift. Mostly 12 hour shifts but there was a good bit of that time spent working 24 hour shifts on an ambulance. This meant, of course, that any time, day or night, the pager could go off and I’d have to wake up and at least be able to pretend to be functional. I got used to it pretty quickly. I was even pretty good at it. I wouldn’t even take off my uniform, I’d get back to quarters, kick my boots off and fall asleep in the recliner. As soon as I stopped moving I would fall asleep and as soon as the pager went off I’d be awake.

The unfortunate thing is, apparently brains and sleep patterns aren’t really supposed to function like that. I’ve tried various pharmacological and non-pharmacological techniques to help regulate my sleep but what finally seems to have worked is Lunesta (eszopiclone). I’s the only thing I’ve found that will put me to sleep and not make me a total zombie the next morning. The difficulty is, it turns out I’m kind of a zombie in the morning anyway. I have probably slept more in the past year than I did for any two years I was working put together, I slept for eight hours right before I sat down to write this very post, and yet I still take literally hours to feel like my brain is fully on-line in the morning.

I have been assured, and also noted myself, that this is something of a family trait, and I come by it honestly but it’s still troublesome. I’m sure this arrangement is much healthier for my brain-meats but I do miss being able to get out of bed and start the day instead of spending two or three hours bumping into walls.

Optimism?

Talking about feeling better and making progress is more difficult for me than bitching about being miserable, which makes a little bit of sense considering I don’t trust not feeling gloomy and on edge. It just isn’t normal. Hopefully this is something I will have the opportunity to get over.

From the above, astute readers may guess that I have been feeling a bit better. Why? Who f@#*ing knows. Again, this is my frustration with brains. There is really no way to determine why they do anything. I can come up with a dozen plausible theories but there isn’t any way to find out which, if any, are even remotely related to what is going on. That said, my baseline mood has been better this month and, over the last few days, I would even say I’m approaching what I think “normal” might be.

One of the contributing factor to this improved mood is almost certainly that we finally got some assistance from the social safety net in the form of SNAP1 benefits. They’re giving us kind of a ridiculous amount of money for food every month, for a household with only two people2. It does carry over month to month, which is nice, and having a dedicated (and more than adequate) food budget has expanded our options somewhat. I’m certainly not going to complain.

Getting SNAP money does not cure all the financial uncertainty going on right now. It has, however, been enough of a relief that if I ever manage to get disability benefits, I’m actually pretty optimistic about what that would do for my mental state. I’m not holding my breath.

  1. Supplemental nutrition assistance program? I think? Something like that. It’s the new and improved version of food stamps. ↩︎
  2. SNAP does not cover pet food which is an understandable but unfortunate gap. With two animals on special diets, the amount per month we spend on their food gets pretty close to what we spend for human food. ↩︎

Clever Title

November kicked my ass all month and then it kicked it some more. Now we’re in to December and the ass-kickings continue. I was denied disability benefits for the second time. Again, I haven’t seen any indication of why. I assume it would be the same reason I was denied last time, which was The Powers That Be not seeing any reason I couldn’t just go back to work.

This was going to be a much more cheerful post about a couple of times I had managed to talk myself out of having a panic attack but then I found out I was denied benefits and I’ve had all the stuffing knocked out of me again1. This is the beginning of my third year of sitting on my thumbs and I can’t seem to even get started without the carpet being pulled out from underneath me.

I am incredibly lucky that I continue to get support from my family but I shouldn’t have to be. I don’t know what The Powers That Be see that gives them such confidence in my ability to just go back to work but whatever it is, I definitely don’t see it. Or feel it. Its hard to not return to my personal favorite explanation, the “Lazy Piece of Shit Theorem” but I have been assured by many people that doesn’t hold up2. I still have a long list of appeals available to me, and the process continues but I don’t see much reason for optimism3.

Edited to add – A while ago, as part of the disability application process, I finally got all the dates of where and when I worked sorted out. It isn’t really relevant to anything right now but here it is:

February 2013 – Start at Swedish CVICU

July 2019 – Leave Swedish Cherry Hill for staff RN position at Swedish Issaquah

October 2020 – Leave Swedish Issaquah for staff RN position at Overlake

March 2021 – Leave Overlake for staff RN position at Virginia Mason

January 2022 – Leave Virginia Mason for RN Supervisor Swedish Issaquah

March 2022 – Leave Issaquah for UWMC

November 2022 – Last worked

So after spending close to seven years at one job I suddenly changed jobs 4 times in the space of two years. That has to mean something?

  1. Please don’t bother pointing out the significance of small victories like this. I’m aware that this is progress, of a sort, but being able to occasionally self-regulate my emotions (a skill most people learn as small children) pales in comparison to the disaster that is this country’s social safety net. I also realize I’m somehow supposed to remember that failures in one area don’t invalidate successes in another but, again, I have a hard time seeing how having a delicious dinner on the Hindenburg is supposed to make up for being horribly burned to death ten minutes later. Call me cynical. ↩︎
  2. Expert opinion is definitely against me on the Lazy Piece of Shit Theorem but all the evidence I’ve seen is, at best, Grade V (things you believe that I don’t) so I remain unconvinced. ↩︎
  3. I have a great deal of difficulty maintaining any sense of optimism about anything but, as a wise person once told me, that’s depression for you. ↩︎

Great Way to Spend a Friday

For reasons that aren’t relevant to the rest of the story1, we spent a good portion of Friday night/early Saturday morning in the ER at Highline or whatever teh fook CHI rebranded it to.

I’m not really sure what I want to say about this. It was horrible, of course. Being in health care environments still is quite difficult. Highline uses the same cardiac monitors and IV pumps as most of the other hospitals I’ve worked in recently so there were lots of very familiar sounding beeps and alarms. By the time Shannon was discharged I was about ready to crawl out of my skin.

Today is Wednesday and I still don’t feel like I’ve entirely put myself back together yet. This is yet more evidence that going back to work in health care is definitely not in the cards, at least for the foreseeable future.

As mentioned, my brain is full kind of scrambled. It’s difficult to string thoughts together. I may try this again in a couple of days.

Edited to add – Somehow I managed to turn on a function I didn’t even know WordPress had, subscriber only access. If anyone visited earlier and got a subscriber only notice let me offer my sincere apologies. I don’t know why anyone reads this in the first place and I certainly don’t want to make it any more difficult to access.

  1. Shannon was having issues with her chronic pain left over from cancer treatment. She’s back to baseline now. It’s not like any of this or secret or anything but I’m lazy and don’t feel like typing out all the background context. If you want details feel free to ask her and I’m sure she’ll fill you in. ↩︎

Clever Title

It turns out Dr. Psychiatrist is very likely correct in that I have found a plateau of stability with my current medication regimen. There are unquestionably still some bumps that need to be smoothed out. I still startle at just about any unexpected noise, although this is better than it was previously. I still have occasional episodes where I see or hear something three or four conceptual jumps from anything hospital related, my brain immediately decides to make those jumps, and settles on “Hey, isn’t this just like [$awful_thing]”? No, it really isn’t like [$awful_thing]. In fact it isn’t connected at all. Thanks for bringing it up though, because now all I can think about is [$awful_thing]. My brain is not particularly helpful a lot of the time. And, of course, I still can’t seem to tolerate being out in public for more than 2-3 hours. On the up side, the first hour or so seems to be getting a bit easier but when it’s time to go, it is still time to go.

Bumps aside, this calming of the inner turmoil has allowed me a bit more clarity than I have perhaps had in the past, which brings me to the point of this particular post1. I am improving, and I continue to improve, but I am not doing it quickly. Also, there really isn’t much I can do to speed up the process. It has been brought to my attention that putting pressure on myself to recover may, in fact, be counter-productive. This is a realization that has been growing for a while now and I am only starting to really grasp what it means.

Among the more obvious sequelae of not being able to hurry recovery is the effect it has on my prospects of returning to work. Previously, as recently as this summer, I had been operating under the assumption that when it came right down to it, and I had used up all the resources that have been made available to me, if I wasn’t ready to go back to work I would sweep everything under the carpet again and just go do it, much like I have in the past when I was feeling run down and burned out. What I have come to realize is, this is how I ended up here in the first place. There is no room under the carpet anymore and I can’t keep trying to sweep stuff under there. Not “can’t” as in “shouldn’t for my mental health”, “can’t” as in “am actually unable to”. I find that I can’t2 ignore things anymore, which may also explain why I jump every time there’s a noise.

I know I have posted about how I never really understood how people who survive disasters could describe themselves as lucky3. If you were lucky, your house wouldn’t have been hit by a tornado. My difficulty was misunderstanding the word. You can have Win The Lottery luck, or you can have I Didn’t Die luck. I bring this up because I am incredibly lucky4 in that I have a great many supportive people in my life. The time will come, sooner rather than later I suspect, when I’m going to have to lean on the people in my life even heavier than I am already.

  1. Penalty; unnecessary alliteration. Five word penalty and repeat the paragraph. ↩︎
  2. See previous discussion on the intended sense of the word “can’t” ↩︎
  3. Nope. Still not going to go back and look up which post it was. It’s back there somewhere. ↩︎
  4. In the I Didn’t Die sense of the word. Again, in the I Won The Lottery sense I wouldn’t be in this position to start with. With as vague as this goddam language is, it’s a wonder anyone can communicate at all. ↩︎

Non-Linear Progress

On Friday, [$_random_thing] reminded me of [$_random_patient]1 from a million years ago and I’ve felt a bit off ever since. I have been assured that events like these are more “speed bumps” than “setbacks” but it is difficult for me to not see it as something of a step backwards.

I’ve been feeling quite tolerable over the last week or so, Friday through today (Sunday2) excluded. Good enough that I had been pondering what the next step might be. Among the steps somewhere in the region of “next” is, of course, going back to work. I admit, in the past, I have had some unrealistic expectations about my ability to go back to work. This most recent event has helped to once again clarify my thinking on the issue.

I won’t pretend I’m not frustrated about the whole thing. I think a great deal of difficulty is coming from my overall mood improving somewhat. I feel okay most of the time, so why aren’t I doing anything? Because when I start trying to do things, I stop feeling okay most of the time.

Frustrating.

  1. I am aware of, and could provide the details of both these random events but this was one of those patients where explaining what was wrong with her and what we were trying to do would take longer than it would to tell the relevant part of the story. Take my word for it, she was a doozy. ↩︎
  2. I know all these posts have dates on them but I thought I’d save people the trouble of looking up what day it was when I posted this. Except now you’re distracted by looking at a footnote. Alas. ↩︎

Timeline

There have been some events recently that have prompted me to think about what happened when. As I have mentioned previously, my memory of the period between Fall 2019 and Winter of 2021-2022 is pretty vague. Kind of a big blurry smear. Blurry enough that when I sat down and started thinking about this, I was sure I had misplaced an entire year somewhere in there.

Completely by accident, I stumbled upon a possible explanation for why I might have expected there to be an extra year between 2019 and 2021, and why the first six months of the pandemic seemed like a lifetime. The possible explanation came in the form of a BBC News article about how, and why, children and adults perceive time so differently. The TL; DR, as I understand it, is that memories are more likely to come from new, interesting, or unusual experiences. The whole world is new for children, so their brains take a lot of memory snapshots. As we age, the novelty wears off and long stretches can go by without much film being used up. The TL; DR for the TL; DR is that children’s brains work more like high-speed cameras, running at 5000 frames per second, while adult brains tend to run at closer to 60 frames per second. Adult’s brains are still capable of running that fast, but it takes unusual, exciting, interesting, or otherwise high-alert types of situations. Like a global pandemic for example.

Below (I hope) will be an attempt to un-jumble some of this in my head. I make no claims about accuracy. A lot of these dates I had to look up because I couldn’t narrow anything down enough just by memory. It will also include some non-pandemic related events, just for reference. This is also incomplete. I may try to add more later and I might not.

Okay, fuck it. I’m done trying to get this damn thing to format in WordPress. Here is a link to a pdf. Share and enjoy.

Inactive

The State of Washington requires 96 practice hours per year to maintain an RN license, a very low bar but one I am unlikely to get over this year. Fortunately (for a small, and ongoing fee, of course) I can put my license on “Inactive status” instead of just letting it expire. The reason for doing this is to avoid several layers of hoop-jumping should I be inclined to reactivate my license at some point in the future. If I reactivate it within three years, I wouldn’t even have to take a refresher course. Which I find frightening.

This will be the first time in 30 years that I haven’t had an active health care credential of some kind. I’m not sure how I feel about that.

Almost A Year Later

Oh look! This place is still here! I am not going to bother trying to summarize what went on over the last year beyond saying, things have continued to be a little closer to the “Dumpster Fire” end of the scale than I’m happy with.

I am, as we speak (read? type? communicate?), unemployed. I left my non-patient care job at Swedish and started an actual clinical education job at the University of Washington hospital. Unfortunately, the environment was still much too hospital-y for my anxiety and I was having almost daily panic attacks at work again. I’m not at all sure what this bodes for my future employment, but I’m still looking. I’m branching out to non-hospital jobs but the one offer I’ve had so far paid less than I was making 10 years ago. So no. I could write a great deal about the experience of applying, and being denied unemployment benefits, but that may be for another day.

The other big development over the last year has been an increasing difficulty being out and about in the world. It seems that people with PTSD and other panic disorders are prone to develop symptoms of agoraphobia. Who knew?

My symptoms aren’t so bad that I can’t leave the house, but they do kick in when I’m around crowds, especially if I have to stand in a line and wait. The checkout line at a busy grocery store is just about guaranteed to make me go sideways.

I’m not sure what this means for the future. I’m not sure if this is a permanent thing. I do know that it’s kind of a pain in the ass.

Back on the SSRI

Those sertraline girls really knock me out1

As previously mentioned, I had a cast on my dominant hand for the last few weeks. This condition didn’t make typing or writing impossible but it did make both activities more frustrating than was tolerable for anything less than absolute necessity. Astute readers will doubtless have reached the conclusion that, since this post was typed out by me, and nothing I do here is even in the same neighborhood as anything even remotely necessary, I must be out of the cast now. This is, in fact, the case. Dr. Ortho-Hand was satisfied enough with how the fracture had healed that he didn’t even feel the need to put my in a removable splint. I have an entirely bare naked hand and, in spite of my wrist feeling like it tried to fuse solid and is now only grudgingly moving again, I could not be happier with the situation.

On the topic of not being happier2, astute readers may also have reached the conclusion that, based on the title of this post, my prescribing provider and I have been messing around with the medications again. My PHQ-9 and GAD-7 scores3 have been getting uncomfortably high again and I have still been having panic attacks multiple times per week4. Fortunately my health insurance situation has stabilized and I was able to go back to the primary care provider I had been seeing for several years prior to starting my whirlwind tour of employers. Given the degree to which I have been symptomatic, Dr. Primary Care felt that adding a serotonergic antidepressant would be beneficial. I have been on sertraline twice previously and we’re at 50/50 in terms of it being effective. I did, however, tolerate it well as far as side effects go so that’s where Dr. Primary Care felt we should start5.

One of the complaints I have with antidepressants is they can take a ridiculously long time to really take effect, weeks in some cases, so it may be difficult to tell if any improvement is from the medication or from me just settling back into a work/school routine with a lower baseline stress level.

On the topic of work6, I have started my new, non-patient care job and I feel like it will be okay once my nervous system adjust to the idea of me going to work in a hospital but NOT going to work in an ICU filled with people dying from a pandemic respiratory virus. I’ll talk more about work later (probably) but for now I’m going to go eat some tylenol and rest my wrist.

1 Apologies to Lennon/McCartney

2 How’s that for a transition!

3 Patient Health Questionnaire and Generalized Anxiety Disorder scales for assessing depression and anxiety symptoms. These are a desperate attempt to put an objective measure on the extremely subjective experience of emotional distress. They’ve been validated in peer-reviewed studies and people more knowledgeable on the topic than myself rely on them, so ¯\_(ツ)_/¯

4 I don’t want to leave people with the impression that I’m getting worse. I still think I’m improving in general but “better” is not the same as “well” unfortunately.

5 For those keeping score at home, this brings the total number of prescription psych meds I’m taking to three.

6 I am just killing it with these transitions!