Inpatient ED treatment

So I find myself back in hospital at A St, in the same ward I was in during May. Which makes it my 6th psych admission, though for the first time it’s not after being sent from the emergency department after an overdose but instead for an eating disorder. Or specifically, anorexia nervosa, though it still feels odd when they call it that as I don’t feel as though I’m thin nor sick enough.

On Tuesday I had gone to see my GP. “I can see you’ve lost a lot of weight, I almost didn’t recognise you,” she said, which I thought was a bit of an exaggeration. I weighed in at 35.4kg and according to her records, the last time I’d been weighed in her office I was 43.6kg. She requested for me to get my bloods done, after which I started experiencing nausea, dizziness and my vision started going fuzzy. They put me in a wheelchair so that I could be taken to a bed to lay down. My blood glucose at the point was 3.7 which according to GP was quite low, and my blood pressure dropped to 76/40. “I’m not surprised you fainted,” she told me, after quizzing me on what I had eaten the previous day & the weight I had lost.

On Wednesday morning I had an appointment with the psych registrar at A St. She again kicked me out if the room while she consulted with her consultant then told me they wanted me admitted to hospital. I agreed this time as I did not want to be put under the Mental Health Act and really, I’m just tired of it all. I went home to pack my things and in the afternoon returned to be admitted to the ward. The medical doctor on the team did a physical check up on me, and they also had the results of my blood test back. They were all quite normal, except my white blood cell count was just a little bit low. Which again made me feel like I’m not sick enough to require hospital and don’t need to be here.

After lots of waiting around I was finally taken to the ward. A nurse did the admission paperwork and took my observations, and also did an ECG. She’s a recent graduate and was nice which was good as we both had a bit of a laugh when it came to doing the paperwork and her having to ask me about using weapons, wanting to harm others, and my non-existent drug and alcohol habits. “It’s good to do groups,” she said, in which I just laughed in response.

This morning I was seen by the doctors. My current BMI is about 14 and he reckons an ideal BMI would be around 20. I disagreed and told him that would be too high. “How about we make a goal for you to gain 10kg?” He asked. How about no. I was told I’d have to have daily blood tests to check I don’t develop refeeding syndrome. Given I really dislike needles and blood tests, I was not pleased to hear this. I asked him how long I’d likely be here, he said probably a couple of weeks.

Then met with the dietitian who said that they will do a meal plan for me and also give me nutritional drinks in the form of Ensure.

Unfortunately me being in hospital meant that I missed the last session of emotional regulation group. It also means missing uni and having to cancel with work, and they did not sound happy when I did so :/

Content

It’s been over a week now that I’ve moved out, and I’m beginning to settle in and even enjoy my new found freedom and independence. At first there were bumps, as I was pushed out of my comfort zone. I missed my home, where I had spent the majority of my life. There were tears as I wondered whether I could really cope and even contemplated picking up and going back. But now I’m glad I took the initiative to escape a situation I did not want to be in.

Moving to a new area, I went to see a new GP close by. He issued me the scripts I asked for; Pristiq and Seroquel, with enough repeats to last six months. Prior to this I had still been having only a week’s worth of medication dispensed to me at a time. Though it may be a little deceitful of me not to disclose this to the GP, I was tired of having to go to the pharmacy every week. Besides, I haven’t overdosed in 9 months and if I really wanted to, I could anyway. And for the moment, I don’t. Things are going well. I’ve finally moved out. I passed all my units at uni and will be going into my third year of occupational therapy in 2013. I have friends, and I even have a boyfriend now. The guy I’d been dating has become my boyfriend, in fact my first at the age of 21. And I too am his first, at the age of 25. For now, I am rather content.

I’m trying

It’s difficult trying to find the balance between trying to stay on top of everything, trying to take action in my life and not overloading myself with too much stress and end up completely giving up on life. Have been feeling rather anxious lately, which is probably understandable given all that I’ve taken on and am trying to do.

Had a try of a new job this week. It’s an easy job, just spending time going on an outing with a woman who has a mild intellectual disability. It pays well too. Whether this will be ongoing though I’m not sure, as they are trialling another person too. I also potentially have an interview for another job next week. It’s for the position of being a live-in support for a woman with Downs Syndrome, free rent in exchange for part time support. I’ve also been looking for a room to rent so I can move out. Though I want to be free of living in the same house as my father, I still have a lot of doubts and anxieties about whether I can do so. Can I afford it financially? Can I manage independently? In some ways I still feel like a child pretending to be an adult in an adult world.

On top of it all I still have uni work and assignments. Was totally panicking and crying about it all this week. Failed my neuroscience test yesterday. I feel bad for using my mental health issues as an excuse, but I went to my GP to get a medical certificate so I can get an extension on the assignments. Ended up crying when GP started talking about stuff. How for me, it’s been a cycle for a few years now that I end up in a crisis then back at hospital. That I can take medication but it doesn’t get to the bottom of it if I’m not seeing anyone. She doesn’t want to see me when I’m still 40 and doing this And that there are people who have been through so much, but they don’t act like victims. Which I thought was a bit unfair, as I AM trying, dammit. I’m trying to keep on top of uni, and asking for a bit more time on assignments, instead of just overdosing when the pressure gets too much, as I have done in the past. Because my father is one of the big triggers for unhappiness at home, I am trying to see if I can move out. I am trying to find employment so this plan is financially viable. Last uni break we had, I was the one who organised for us my group of friends to go out for lunch which in the past could be quite a challenge for me. Even though it can be hard, I am trying not to let friends who are unwell trigger me. I. Am. Trying. Dammit. GP seems to think that not seeing a psychologist equates to not taking action to try to beat depression and again suggested I consider seeing a psychologist. Seriously? That’s like putting me on the fast track to becoming unwell again. She did acknowledge though that it’s been about six months now that I haven’t overdosed and said “You should be proud of yourself.” Yes it has been six months, which is the longest I’ve gone without overdosing for about 2.5 years.

Met K

I met with K, the replacement psychologist for I, this afternoon. She acknowledged that yes, she is temporary while the psychologist I am meant to be seeing is away, so I may not want to go into the deep stuff when I won’t have the opportunity to get to trust her and see her for a longer period of time. And so we talked about general and some rather light hearted stuff. Stuff which included my cultural background, what I do when I’m not studying, where I did my prac placements, countries I’ve visited and would like to visit, and my cute little Maltese-shihtzu puppy. She also explained that when people are discharged from hospital they usually offer a psychiatrist appointment as follow up. “Psychiatrists can have some helpful things,” she said, which I struggled not to laugh at, but was told that ultimately it’s my choice whether I go or not. I see her again in a fortnight.

Later on in the afternoon I called to cancel the psychiatrist appointment meant for next Wednesday. “What’s the reason for cancelling?” I was asked by the receptionist. “Ummm….” I stalled, not expecting to have been asked. “Just so I can put it in the computer,” I was told. “Umm…I just don’t need to see him,” I answered. It’s not the principle of seeing a psychiatrist I object to, it’s that I’ve met him once and felt uncomfortable and he’s not someone I’m able to talk to. There have been a couple of psychiatrists I’ve found okay and would more willingly attend an appointment with. Unfortunately he isn’t one of them. While I was at A St to see K today, I saw that my psychiatrist whilst I was in hospital in October/November last year is now one of the outpatient psychiatrists at A St. See he was okay, why couldn’t I have been allocated to him? Instead I get allocated to the one I don’t feel comfortable with. Sigh.

Dr L provided me with new scripts today and typed up a letter, instructing me to hand it to the pharmacist. The contents of the letter basically asked the pharmacist to only dispense my medications weekly. That’s a big assumption to make, that I’d willingly hand over the letter to the pharmacist myself. Was very tempted to just not do so- how would Dr L know? In the end I did. I’d like to say it was my integrity and honesty, but really, it’s just me being afraid of the consequences I may have to face if I don’t and I’m found out. “It’s a good excuse to go shopping!” remarked Dr L of the weekly trips I will now have to make to this shopping centre. Except hey, I don’t have spare money to spend on frivolous things after spending $123 on Pristiq and Seroquel today. Yay!

Tomorrow I’m meeting up with M for lunch whom I first met when we were both inpatient in Oct/Nov. A social meet up with a friend? Well that’s something new. According to my diary records, it’s only been since February that I haven’t met up with friends. It feels a lot longer than that though :(

Being made to get help again

It seems like I’m back on the ‘getting help’ bandwagon again. Huh. So much for my resolve to be rid of all services.

Received a call from the GP office this morning. 8:15am. Yep, not like I was asleep or anything… Was told that Dr L wants to see me and so I agreed to come in this morning. It seems as though she’s been bombarded with all these letters about me; from F Hospital telling her that I overdosed, from B Hospital telling her I’d recently been discharged, from the psychologist at A St telling her I’ve declined to see her, and another one from A St advising her how my medications should be managed.

Was asked by Dr L what I want to do if I don’t want to see anyone from A St. Could only shrug and shed some tears in response. She said she can’t comprehend being discharged from hospital following an overdose, slipping back into life where everything is the same, and deciding to accept no help whatsoever. And so she’s making me go see a psychologist again. Boo. Was told to either choose to go see the one at A St or be referred to a private one again, and come back with my decision in a week. I’m also about to become best buds with my local pharmacist, as apparently A St has advised her that I’m only to have weekly prescriptions. Yay, I can’t wait to become known to the pharmacy as the mental who can’t be trusted with more than a week’s worth of medication. FML. I’d complain about how humiliating it is, but then I’d probably get some smart arse commenting that I only have myself to blame for getting into this situation.

This afternoon I then received a call from K, the psychologist at A St. She told me she didn’t feel right leaving me be without any support, especially given my most recent hospital admission. I admitted I was upset and angry when I cancelled the appointment with her and “I guess” I could come in and see how things go. Not to mention Dr L is making me see someone anyway. Sigh. May as well go to the psychologist that’s free…

Both times I’ve spoken to K on the phone she’s sounded lovely. And that’s partly what scares me. I know she’s only temporary until I, the regular psychologist, comes back from holidays.  I’m afraid of getting to like her only to have her leave, like so many others before her. Knowing it’s unavoidable doesn’t make it hurt any less. I don’t have anyone in my life I can talk to about deep and emotional matters and it’s just so painful when that one person I do have disappears. It leaves me feeling all the more lost and alone. :(

It seems as though today is mental health professional “Let’s contact WFH day” and in the spirit of it all, D also emailed me back. It basically said that he appreciates what I’m saying and is still happy to attend an appointment with me should I decide to see a psychologist after all. Feeling bad about the “bugger off and screw services” email I sent him, I apologised, explained I was upset and irate when I wrote it, and informed him I’m going to see K after all, though I declined his offer to attend with me. I learnt that people are more likely and willing to respond to a civil email. Who could’ve known…! Ten minutes after I sent it off, I received a reply back telling me not to worry, he didn’t take it personally as he thought I was probably just upset when I wrote it, and wished me all the best. Well that’s that then with clinical psychologist #4. Surely if it doesn’t work out with #5 and #6, I’m allowed to quit then…?

Uni Meeting & Avoiding the Professionals

I had a meeting with the OT course coordinator/my gerontology tutor on Monday. Considering she’s been the contact person during all three hospitalisations in my over a year of studying OT, I was afraid of her thinking me too mental to do this course. After all, there’s been a couple of OTs I met in hospital who haven’t had the most positive response when they’ve found out I’m studying to become one of them. She was lovely though and accommodating and helpful. I don’t need something as drastic as being in hospital to ask for an extension on things if I’m struggling, she told me. Oh. But still, I’d feel guilty and hesitant in doing so. She also suggested getting an Access Plan done up through the Uni Disability Office, which is used to provide to lecturers and the such if I for example need an extension, without having to go into detail about my situation. If I did decide to go that route though, a letter from a medical practitioner or psychologist is required. Given my current, self-imposed situation of not having one, that poses a bit of a problem. And even if I did, I’m afraid of people thinking I’m taking advantage and using my mental health issues as an excuse. I was also asked by the course coordinator whether I have someone to talk to for support. “Err…I’m meant to be seeing someone,” I answered. Before I told them all to eff off. Heh.

Oh, and regarding the email I sent D? He hasn’t replied. Apparently if you tell someone to bugger off, there’s a good chance they will in fact bugger off. Hah, who could’ve known? I was curious about how he’d respond to my email, but never mind. I did receive a text message from my GP’s office this morning though informing me I missed their call and to please ring them back. I haven’t. Too much of a coward, I am. I know I’ll have to see her sooner or later for my meds, but I’m dreading being questioned on what the hell I’m doing by refusing to see a psychologist and psychiatrist and how I plan to stay safe and get well otherwise. Lol, beats me. Oh yeah, and the fact that the day straight after I saw her for an appointment, I went and overdosed on the meds she wrote me a script for. My bad :/ But, I am a pro at avoidance and if I keep putting the problem off, it’ll go away eventually, right?

Lesson learnt

I could feel depression enveloping me last week in its blackness and bleakness. What was frustrating was I had no idea why.  If I knew, at least I could understand and perhaps try to fix it. As it was though, nothing particular had happened. I just felt low, tired and unmotivated. I hypothesized maybe it’s because Uni is looming closer and closer. Why is it I’m feeling better this week though when the commencement of Uni is even closer still?

I had an appointment with D on Wednesday. He asked me how my mood has been and whether I had self harmed. I reported I felt okay and had not self harmed this week, though I had last week when I wasn’t feeling so great. He said that when one felt low it’s usually something that has happened to cause it. That’s the thing though. There was nothing I could point my finger to and say, “Aha, that’s the reason why.”

It only came to me today whilst I was daydreaming on the bus. It was so simple I couldn’t believe I hadn’t realised this sooner. Or maybe I can believe it, after all, I’m still surprised and a bit doubtful that 50mg can make that much of a difference.

My GP was away for the whole of last week. She told me on Monday when I saw her that she had gone to Vietnam. Unfortunately last week was when I needed to see her to get my prescription for a month’s worth of Pristiq. I resorted to taking 150mg instead of my usual 200mg for a whole week, even so, by the time my appointment rolled around I only had three 100mg tablets left.

It’s made me realise that the Pristiq perhaps is working. I wasn’t sure before. I learnt, yet again, messing with your meds is not a good idea. Though I wouldn’t have if I’d had enough in the first place. I also learnt that when you’re directed to swallow the tablets whole and not split or chew them, there’s probably a really good reason why. Ha, who could’ve known…

Now I’m torn as to what to say at my upcoming psychiatrist appointment. Do I say the Pristiq is to some extent working and I want to stay on it? But then, what would be the point of attending a psychiatrist appointment? May as well just keep collecting the same scripts from my GP.

 

What’s happening re: my mental health care?

Went to see Dr L today for a follow up from last week’s appointment. It seems as though her and my psychiatrist had a lovely tête-à-tête on the phone about me. Nothing was brought up by Dr L today about me having an earlier appointment with my psychiatrist before January 20th, when my next appointment is meant to be. Either Dr T can’t fit me in, doesn’t think I need to see her or doesn’t want to see me. Meh.

Tidbits of information I was given about the aforementioned phone conversation between them is that Dr T told Dr L I:

  • tend to self harm more when I’m stressed;
  • have been warned before about the legal issues of stealing medications from my old workplace to OD on, especially as a student health professional
  • may benefit more from attending ASC (public outpatient mental health service) where they have psychiatrists and psychologists, rather than just seeing one psychiatrist.

Dr L also wrote a letter for me to give to the hospital psychologist I’m seeing:

At this point I’m not sure what’s happening in regards to my mental health care. I don’t know if Dr T is suggesting I see a different psychiatrist instead of her, I don’t know if I will get referred to ASC, I don’t know if/when the youth counselling service the hospital has referred me to will take me on. I’m not even meant to be seeing D, the hospital psychologist, as he’s really only meant to work with inpatients. I’m just lucky allowances have been made for me to continue seeing him as an outpatient until another psychologist is able to work with me.

Long term therapy

“Do you think you’ll always need psychological input?” we were asked during one of the hospital group sessions. The discussion was based around  the Better Access scheme limiting us to ten sessions with a psychologist per year. We paused. “You’d hope not,” another patient finally answered.

Are there actually people who completely rid themselves of psychological and/or psychiatric services and manage to stay well though? Not needing to see a psychologist, take medication, see a psychiatrist or be hospitalised again? I’m not asking this rhetorically, I actually want to know. Is it just that I don’t know enough people? Or are those who get and stay well a rarity?

Sometimes it seems as though my answer to the original question posed is “Yes”. I was told by my GP this week I’d probably need ‘long term therapy’. Which in itself, isn’t a statement that fazes me much anymore. I’ve been told the same by at least two psychiatrists.  Except that I’ve been in therapy for the past three years. How much more ‘long term therapy’ could I possibly need before I’m considered recovered? Surely three years is plenty long enough?

GP Appointment

I visited my GP today asking for scripts for the Pristiq and Seroquel. She didn’t provide them to me. Instead, she rang up Dr T’s office requesting an ‘urgent appointment’ for me as I haven’t seen her since August and don’t have an appointment until January. ‘Urgent appointment’? But I’m fineeeeee. I’ve been doing okay since discharge; I’m still seeing the hospital psychologist until the youth counselling agency picks me up, I’ve gotten through my exams and even managed to pass all my first year units.

GP had a conversation with the secretary in which she was told I had ‘missed a few appointments’. Missed a few appointments? I called up and cancelled two for legitimate reasons! Once when I had uni stuff on, and once because I was in the psych ward. I was told by GP that I must give these appointments priority over uni, going out with friends, and basically everything else. GP told the secretary, “She’s asking for these antipsychotics and I don’t feel comfortable giving them to her.” It doesn’t help either that it seems the hospital didn’t send the discharge letter through to my GP and so she has no documentation of what medication I’m on. The only correspondence she has received is from the Emergency Department, detailing my overdose/s.

And so, I’ve been told she is waiting for Dr T to call her back to see if I can get in to see her. I will then be notified of whether she can or not, and if not, GP will provide me enough meds to tide me over until I see Dr T. I’m feeling rather apprehensive about seeing Dr T again, terrified of how she’ll react and what she will say of my most recent overdoses and subsequent hospitalisation and worried about whether she’s willing to continue prescribing me the Seroquel or not.