Sutures

I’d been experiencing the urge to self harm for a few days, yesterday I ended up giving in. I searched the ward for something I could use, broke a piece of plastic which didn’t really do much. Found a mug, smashed it on the floor and self harmed with that. It’s not what I usually use and did more damage than I’d intended and thought it would. Seeing how much it was gaping panicked me a bit, but once it had stopped bleeding I thought it would be fine. One of the nurses this morning though came up and asked whether I’d cut my leg as someone had seen. I admitted that I had the previous day, and she took the broken fragments of the mug out of my room.

The doctor had a look at the wound and told me they’d stitch it up. “Does it…need stitches?” I asked, not keen on the idea, never having had them before. I was told yes because of how it’s gaping open and reluctantly I agreed. Ended up requiring six stitches, and though the actual suturing didn’t hurt, getting the local anaesthetic injected did.

Despite self harming for about 10 years now I am actually really quite a wuss when it comes to pain and needles and I’m really squeamish. So it’s embarrassing that it was hard for me to tolerate when the doctor was injecting the site with local anaesthetic and halfway through I had to take a break before continuing. The nurses and doctor were really nice about it which makes me feel guilty- I feel like I don’t deserve it and they must be thinking “If you cut yourself on purpose, why are you being a wuss about getting it stitched?!”

It scares me a bit because when people talk about self harm getting worse and/or accidentally going too far, I’ve always thought “I can control how deep it is so that I don’t have to get stitches, I’ve been doing this for years and it hasn’t gotten worse over the years so it’s fine.” And though having to get sutures partly puts me off self harming again because getting the local anaesthetic was a bitch, a part of me doesn’t care and wants to cut even now.

At the goal weight

I’m at the goal weight that was agreed on- 43kg. Originally they wanted me at 46kg, thankfully they’ve lowered it to a weight that is both healthy for me and a number I’m more able to cope with. They want me to maintain the weight for a few days before discharge. Technically I’m now “voluntary” as the Form 6 of the Mental Health Act I was under expired. However when I said I wanted to leave, I was told I wouldn’t be allowed to do so, and that I’d just be formed again if I did. Doesn’t sound very “voluntary” to me. I realised though it’d be better for me to play the game and comply for a week rather than run the risk of being put on a Community Treatment Order when I’m discharged, which could last for up to six months. It’s what I continue to try to tell myself- play the game, not long to go now so don’t screw it up for yourself.

Saw the psych registrar today who told me if I dropped the weight again they may bring me back into hospital which could result in a longer stay and they’ll increase the goal weight even more. Next sentence he’s telling me they want me to continue to see the doctors and the dietitian as an outpatient. I almost laughed and asked him why I’d attend outpatient appointments if it ran the risk of being forced back into hospital? At this stage I’m not sure whether I’ll maintain or lose weight when I go home, but I sure as hell am not coming back here to obtain treatment for anorexia. It makes me so angry to think about the punitive way I was treated here. Taking away my control, insisting on putting in a nasogastric tube without even giving me a chance to eat, taking away my dignity by not even allowing me to walk 3m without a wheelchair, not allowing me any of my clothes and belongings and not even my glasses, being so rigid to the point of ridiculousness in following the “management plan”, confining me to a room on “bed rest”, focusing entirely on weight gain with daily weigh ins, forbidding my friend from being put on the same ward as me even though her doctors were fine with it, taking away the one thing that may lift my mood and take away from being so miserable. I’m not opposed to treatment entirely, just treatment here after this awful experience. On principle I don’t plan on attending any future outpatient appointments here. As for treatment in general, I’m feeling so tired of it all and at the moment it seems futile. I’d seen a clinical psychologist three times during the past couple of weeks, last session however my defences were up, I didn’t talk and told her it was pointless. I’m sick of starting over and over again with countless psychologists and I feel like nothing will work anyway.

I’ve been feeling hopeless about everything and anxious about the future. One of the nurses was saying she’s excited to plan for the future, which I’m envious of, and wish I was too. Instead it just seems bleak with nothing to look forward to and I’m too afraid to think ahead as the future just scares me. When I’m restricting and losing weight it takes away from my emotions and my feelings and now that I don’t have that, the sadness and hopelessness and anxiety is intensified. When I’m eating disordered I can pretend that food and weight are the problems and can delude myself into thinking that if that is solved, everything will be fine. On the surface that’s easy to cure, eat and gain weight and life will be fine and dandy. The reality however is much different- I may be eating and a healthy weight but then I have everything else- the feelings of being alone, hopelessness, feeling I can’t cope with life as well as everyone else, and desperately wanting a way out. That’s much much harder to fix and I can’t even pretend I have a solution to it because for this I really, really don’t.

Struggling with being over 40kg

Since the last post I’ve been transferred from the open ward to the locked ward, then moved back to the open ward where I’ve been for a few days now.

On Monday I was reviewed by the dietitian. I was told my weight had stagnated as it had hovered at 39.2kg for a few days ever since I’d come on to the open ward which was attributed to me “walking around” even though the most walking I was doing was 5m from my room to the lounge room. It’s a ridiculous distance to have to be wheeled in a wheelchair when I can walk, and honestly, walking that short a distance is not going to affect my weight in the slightest. She again reinforced the restrictions of being wheeled around in a wheelchair and having meals in my room as opposed to the dining room with everyone else. I was upset after this review, as I felt I was being blamed for my weight stabilising, and despite me eating most if not all of my three meals and drinking all three Ensures a day, I was still being so restricted. I was already upset, and it was made worse when two nurses came in and started going through my belongings. I can’t stand having my privacy invaded and on two previous occasions when I’ve had my room searched, I’ve ended up restrained and put in the seclusion room. I tried not to completely lose my shit again this time. I took the blade I had in my bag and held it in my hand to try and calm myself down with the knowledge that it was there just in case. Unfortunately the nurse who was specialling me cottoned on after a while that something was up, and came to investigate. She had a glimpse of the blade, which I quickly took in my hand. She tried to get it off me, I wouldn’t let it go, and other nurses were then called and the duress alarm pulled. I was restrained and taken to the seclusion room where the security guards prised the blade out of my hand, I had all my clothes, glasses and jewellery taken off me, and was given an IM injection. After a period spent in the seclusion room I was wheeled out of the open ward where I found myself once again in the locked ward.

The first few days there I wasn’t allowed any of my personal possessions, not even my glasses, as apparently it would pose “too much risk.” On the second night there I got very frustrated at the situation, took myself into a bathroom stall and started hitting out and punching the wall. The nurses heard me banging around, led me out and into my room where I pushed over a chair in anger. I was then escorted to the seclusion room, where I was made to lay down and once again given an IM injection.

Whereas on the open ward they’re a bit more relaxed, the staff on the locked ward were very rigid in following the management plan down to the letter. I was told I couldn’t have honey with my weetbix at breakfast because it’s “not on my management plan”. There was a plum on my dinner tray and I don’t like plums so asked for an apple instead and was told no. And though the point is for me to gain weight, when I asked if I could have a tub of yoghurt or an ice cream, I was also told no. Out of spite I then ate exactly what it said on my meal plan, nothing more, went everywhere in a wheelchair and drank only a minimal amount of water to prove that it wasn’t being in the open ward that was making my weight stagnate and by not allowing me extra food, I wouldn’t gain weight. I did end up dropping 0.2kg and was 39.0kg on Friday morning.

Thankfully on Friday afternoon I was transferred back to the open ward and have been here ever since. Still on a 1:1 special which means it’s been three weeks that I’ve been continuously watched by a nurse. The dietitian added even more to my meal plan which means daily I’m having three full meals, three snacks and 200ml of Ensure Plus three times a day. Eating six times a day feels excessive and surely normal people do not eat this much.

Up until now I’ve been eating and gaining weight quite easily without it being much of a struggle, but these past couple of days I’ve been feeling awful as my weight is now over 40kg. Being under 40kg felt safe, and now that I’m over that number, I feel like I’m fat enough and any more weight gain is unnecessary. Clothes that used to be loose on me now feel tight, and I feel like I need to punish myself by self harming for being such a fat, disgusting pig. But of course I can’t, and I just feel low and I can’t cope with them wanting to be 46kg which would be a BMI of 18.5. I’ve never been that heavy in my life and at that weight I’d either just restrict again to lose it or kill myself. I could go home and eat without trying to restrict at about 40kg, but 46kg? There’s no way I could deal with that and that’s just setting me up to starve and lose weight all over again.

Back in hospital

So I’m back in hospital and have been since 17 December. It seems like everyone saw it coming; my mum, my aunt, my friends, the nurses, even readers of my blog. Everyone except me that is. Huh. Naively I thought if I didn’t have any physical health problems, they wouldn’t form me under the Mental Health Act, and I believed my case manager when she said they wanted to keep me out of hospital. This is a new low for me, one month out before being back in again. Usually I’m able to keep out for at least four months between admissions.

So how did it happen? It started with two of my friends whom were also inpatients last admission voicing their concerns to me. They were concerned I wasn’t eating much and I’d lost weight all over again, and had convinced themselves I was at risk of dropping dead overnight. They asked me to come to the Emergency Department with them, I told them there was no need and that I was fine. After much convincing and my friend saying that she wouldn’t sleep at night worrying about me, and that they couldn’t forgive themselves if they had to attend my funeral, I came with them into the psych triage at A St. I went out of guilt and I was sure whoever I saw would also agree that I’m fine. Spoke to a nurse and a doctor who were happy for me to go home and said they’d talk to L, my community mental health nurse/case manager. The next day I had a visit from my case manager who said that she’d talk to the psych registrar, Dr D, to see if I could get an appointment with her during the week. On Tuesday morning I then got a call from L asking me to come in for an appointment with Dr D that afternoon. I went and drove to my appointment without any inkling whatsoever that I wasn’t going to be able go back home that afternoon. I was told by Dr D they had spoken to the inpatient consultant psychiatrist and that they wanted me to come into hospital. If I didn’t agree, I would be formed under the Mental Health Act. My relatives had to pack my bag for me, come drop it off and drive my car home for me.

The next morning I was reviewed by the doctors and dietitian where I was told I’d be put under a Form 6 under the Mental Health Act, they’d be inserting a nasogastric tube, I’d be put on bed rest, be on a 1:1 nursing special, and whereas last admission they discharged me at a BMI of 16, this time they wanted me at a BMI of 18.5. “What if I eat and or/drink orally?” I asked, desperate to avoid an NG tube. They replied that it’s “Not negotiable.” Obviously I was upset at all I was told, and after the review I tried to abscond from the ward. Unfortunately it was my poorest effort yet, and I didn’t get very far before a nurse and a doctor caught up to me, grabbed me by the arms and forcibly escorted me to the seclusion room of the PICU/locked ward.

It’s there I stayed for six long days. I refused to let them put the NG tube in so I was restrained and injected with midazolam so that they could try and force it up through my nose. The events are a little blurry, but I remember a nurse trying twice to get it in, me trying my best to prevent that from happening, and somehow or other I actually got out of it and thus far no NG tube has been put in. A short time after that, my blood pressure apparently dropped quite low, and a code blue was called. I was pretty out of it by then, but remember having an oxygen mask and getting IV fluids put through.

For the first few days on the locked ward I was confined to my room on bed rest. I found that very hard to handle, with nothing to do except read a book or stare at the wall. Being a PICU, everything is taken off you- phone, iPad, electronic equipment, cords, toiletries, anything breakable, jewellery, bag, keys, wallet, and plates and cutlery were all plastic. I self harmed at one point by using my nails to scratch my arm and using my watch to hit my arm- until I was restrained by nurses and security guards on my bed, and had my watch taken off me.

On Monday when the dietitian and then doctors came to see me I was told I would be allowed to be wheeled in a wheelchair to the lounge room to watch TV- but still not allowed to have my meals in the dining room or participate in OT activities. Though those conditions were a tiny bit better, I was upset that I was still so restricted, and not allowed to even walk 5m to get from A to B. In addition to this, because aforementioned friend was also in the locked ward, staff wanted to prevent us from interacting and we were told we weren’t allowed to talk to each other. At one time when we were both in the lounge room, a nurse told me I had to go back to my room, as we were apparently communicating with each other. That’s when I got pissed off and started arguing- we had not said one word to each other that whole time in the lounge room and it felt so unfair that I was the one kicked out when there’s nothing else I can do. There was one night though where the nurses didn’t care that we were talking to each other, and it really helped my mood to be able to chat and have a laugh with her, other patients and nurses. On the locked ward I was so bored and depressed that I didn’t give a shit any more and actually ate, even extra food like ice cream, chocolate and cheese toasties.

I was moved back up to the open ward on Christmas Eve. After being in such a controlled and restricted environment, it is such a relief to be back on an open ward. It’s much more relaxed, I have all my belongings back, I’ve been having my meals in the dining room and have been to the OT groups of cooking and art. On Christmas Day I had a few hours leave with my relatives, as my parents are overseas at the moment. I was seriously contemplating killing myself if I was still in the locked ward and confined to my room, but as I wasn’t and had been moved to the open ward, I was in a good enough mood that I didn’t bring back to the ward things to harm or kill myself with. It was nice getting away from the hospital, being away from being constantly watched and getting to see my dog, even if I did eat then purge while home.

I’m still on constant 1:1 nursing, and this is the longest that I’ve continuously been specialled. The doctor on duty came to see me today, and it happened to be the doctor I was seeing whilst inpatient at another psych ward during October/November 2011. He remembered me, and joked “You’re always needy!” about me being specialled….again.

Unlike last time in hospital, this time I’ve actually been eating and mostly compliant. I’m trying not to think about it, how much I loathe being controlled, being made to gain weight, eat way more than I’m comfortable with and how fat and disgusting I feel. I’ve been told they want me to be 46kg before discharge but there’s no way I’ll be okay with that. I’ve never been 46kg in my life, the most I’ve ever been is about 43kg, and that’s when I was eating normally and hadn’t purged in months. I’m Asian, 158cm with a small body frame and 46kg is too high, none of my clothes will fit at that weight. Right now I don’t even plan to go home and lose weight all over again, I could probably live with maintaining at around 40kg which would be high enough so that I don’t get scheduled under the Mental Health Act, but I’d rather kill myself than be 46kg. If necessary, I believe I do have the means to do so properly. When I came into hospital I was 34.8kg, just 11 days later I was 39.0 kg this morning. I’ve been told they expect a gain of about 1kg a week, and in less than two weeks I’ve already gained 4.2kg. On one hand that gets me out faster. On the other hand it proves to me that this amount of food is way too much for me, I’m always bloated and I’m ballooning with how much I’m eating.

The need for public inpatient eating disorder treatment

Today I attended a forum for consumers and carers to discuss the 10 Year Mental Health Services Plan, facilitated by the state Mental Health Commission. The four categories discussed were bed based services, community clinical services, community support services and prevention & promotion. There has been talk of this already, but one of the points I raised under bed based services was the need for a specialised inpatient eating disorders program for adults. Currently in my state there’s an inpatient eating disorders program at the children’s’ hospital for those under 16 years old, and for adults there’s one at a private hospital which is only accessible for those with private health insurance. In the public mental health system this is non existent, so you either get put in a general acute mental health unit or you get nothing.

This is problematic for a number of reasons. As we all know, the number of beds in psych wards are limited, and there’s almost always greater demand than there are beds available. Most beds are occupied by those who are suicidal, have psychotic or affective disorders. Even those who are suicidal sometimes get turned away. So if you have an eating disorder, unless you’re quite underweight or physically compromised, there’s slim chance you’ll get inpatient help for it. It seems as though EDs being treated in acute psych wards are so rare that nurses were quoted saying to me “Last time we had an eating disorder patient here….” It’s hard enough to eat and recover with supervision and inpatient care, I imagine it would be even harder to do so on an outpatient basis. It just doesn’t seem fair that it’s so hard to get that help if you’re in the public system.

Then there’s the care for when you are an inpatient. It’s better than nothing. But there are also many reasons why an acute psych unit isn’t appropriate. I get that it’s hard to cater for everyone, but often groups weren’t all that relevant. I know that at the private ED program, the groups offered are actually somewhat relevant to those with EDs. The focus while I was inpatient was all on just food and weight and there was nothing to help with the psychological side of it.

There were some staff members who did seem to have experience and knowledge of EDs, but then there were others who did not. I got nurses from one extreme, who told me I’d eventually be dead if I didn’t come to hospital, to the other extreme who asked me “Why are they so worried about you anyway?” and told me “I thought you’d be home by now.” I got the feeling some nurses wondered why I was in hospital and didn’t think I needed to be there. There were nurses who didn’t seem to get that it’s not that easy and would tell me “Just eat and put on the weight so you’ll get to go home, simple,” as if there wasn’t a battle going on in my head when it comes to doing so. When I was caught exercising and told to stop by the nurse, “Put on the weight so you can get out of hospital, then when you get home you can do what you want.” Lol, kinda defeats the purpose of being in hospital, but ooookay then.

There was even one nurse who asked me how I managed to lose weight on more than one occasion. Eventually I asked her “Why would you ask someone with an eating disorder that?” There was a particular conversation I remember she was having with my friend on the ward and myself. The nurse was talking about being envious that Asians are all so slim and and asked me how it is that Asians do stay slim and what they eat to do so. “Rice,” I answered. She laughed and said no, she’d probably gain weight if she ate rice. This conversation was upsetting to me as I feel like I’m meant to be thin because I’m Asian. Because I’m Asian, even at my lowest weight, by Asian standards it’s not even considered skinny- just average. And if I gain weight and go back to my highest weight of ~43kg, it’ll be considered fat for an Asian.

Then there are aspects that I, or rather my ED, likes that some staff aren’t experienced. Times when my Ensure Plus has ended up down the drain rather than down my oesophagus and into my stomach when I haven’t been watched or watched closely enough. Times when I’ve managed to hide and/or throw food in the bin. When at a mealtime a nurse has said, “I’m meant to watch you eat but I won’t, just makes sure you have everything you’re meant to have.” Lol, sure I will. It seems like some don’t realise how sneaky eating disorders can actually be. Before I got caught out, I managed to go a few times to weigh in wearing multiple items of clothing and hiding extra weights on me. A friend who’s been through the private eating disorders program couldn’t believe I’d gotten away with that- it seems that over there where they specifically treat EDs, they’re a lot more clued in to the tricks that people with EDs use. One morning when I’d been up early, I blatantly had two cups of coffee before weigh in and didn’t hide it, and they didn’t pick up on it or say anything and weighed me as usual.

One advantage I will say though of not being in a specialised eating disorders program is that I was the only one in the ward at the time being treated for an eating disorder. I worry that if I were to attend an eating disorder program, I’d be triggered by patients who were thinner than me, or who ate less than me. When you’re the only one in the place who has an ED, there is far less competition for who can be the thinnest, who can be the sickest, who can eat the least.

Cancelled the appointments

I was meant to have an appointment with the inpatient psych registrar on Thursday and dietitian on Friday. I cancelled both and didn’t attend either. I talked briefly to one of the nurses on the ward yesterday when I was visiting a friend, and she reckons something will happen if you don’t go to appointments. I disagree. I’ve done it before and cancelled the follow up appointment with a psychiatrist after being discharged from hospital and it was fine. Besides, I am only one of many clients who attend the mental health service, I’m sure they all have better things to do than bother with someone who’s stated she doesn’t want help, when there are people who do.

It’s been over a week now that I’ve been out of hospital, and I’ve pretty much gone back to doing what I was doing before being admitted. Although, whereas before I wasn’t purging regularly any more, this week I’ve already done so four times. A few years ago when I was regularly purging I only managed to gain weight instead of losing, and I’m afraid of doing so again. I have lost a bit of weight since coming home, and weighed in at 37.2 kg this morning. It doesn’t feel like even nearly enough though.

I don’t feel sick enough to want to recover yet. Looking back, I wasn’t even that thin at my lowest weight. I know I can’t go on like this forever. But maybe if I got down to say, 30 kg, then I’ll stop.

Home 7 weeks later, 5kg heavier

It’s been seven long weeks, and I’ve finally been discharged from hospital. I came in weighing 34.6 kg, and left at 39.4 kg this morning. Which would be 5 kg had it not been for my methods of artificially increasing my weight before weigh ins. Weighed myself without clothes on once I arrived home- my scales told me 38.3 kg.

Had a family meeting before discharge in the morning, with those present being my mum, the consultant psychiatrist, intern doctor, dietitian, nurse, and of course myself. What came out if it is they want me to maintain and not lose weight obviously, and for me to remain in contact with mental health services. I have an outpatient appointment with the psych registrar on the team next week, however, I don’t intend to go. I may be more inclined if the appointment was with someone I liked or at least feel neutral towards, but I don’t and see no value in going to see someone I can’t and won’t talk to. With having an appointment to see a dietitian I also feel it would be pointless, as I could have the most elaborate meal plan in the world, but it won’t do much good if I can’t and won’t follow it.

I’ve never been one to fast though- at least I do eat. I’ve never gone more than a day without eating anything. Just that what I do eat tends to be small amounts of fruit, vegetables, and a few things in between. Found myself falling straight back into old habits as soon as I got home. Chewing and spitting a whole lot of food. Not being able to allow myself to eat certain foods and feeling guilty at what I do eat, telling myself I didn’t need it.

It’s such a push-pull internal tug-of-war. When I think about being able to eat what I want without guilt and ruminating over it afterwards, without always thinking about food and worrying about what the numbers on the same tell me, it sounds so nice. But getting there feels so out of reach, something that belongs in the “too hard” basket. The alternative is to keep on doing what I’ve been doing- restricting what I eat and pushing myself to drive the numbers on the scale lower and lower with each passing day. In some ways it’s easier than recovery, in other ways it’s just as hard.