Monday, November 26, 2012

A day in the life of bipolar

Today was a very rough day. I don't think you would have known it to look at me, or talk to me. But I was struggling all day to maintain the mask of normalcy, so I thought I would describe my trek through my own private Gulag.

Monday, 5:45am: After having difficulty falling asleep despite a very long stint on the acupressure torture mat, I wake up from a dream in which Bina and her husband were running a yeshiva for rabbinical students, many of whom were using marijuana.

I was also approached, earlier in the dream, by a former co-worker (two jobs ago, before I became a social worker) who wanted me to come back to the agency. I didn't want to, but I made an appointment to meet with him, which ended up being at his home and not the office, and then his kids were running around so we couldn't really talk.

I don't know why Bina and Asher didn't know their students were using marijuana. I was debating whether to tell them when the alarm went off.

5:55am: I don't want to go to work. I feel sad. I have gone through another bad bout of crushing on Dr. Dashing.

[Side note: Two appointments ago, I went in very angry about my crush on him and the fact that went I first went to the hospital, they couldn't treat me because they were out of supplies, post-hurricane. I was mad that they didn't call me to reschedule. I was also mad that I sat for fifteen minutes in the reception area before the receptionist from the urology practice (pain management receptionist couldn't make it in due to the transit closure) called to let him know I was there. So he could tell me that they had no supplies.

[The next day, when I finally went in for treatment, I was furious, but I didn't want to show it. So I didn't talk to him. Didn't look at him either. I didn't want to see any judgement about my uncontrolled anger in his eyes. Usually I chat to him about this and that, and I don't shy away from eye contact. My avoidance made him very uncomfortable; he asked if I was "out of it." I told him I was fine, just very angry. Emphasizing that I wasn't angry at him -- although technically that wasn't true -- and didn't want to take it out on him. (Which was true.)

[Last appointment, Dr. Dashing was very friendly, telling me about his Thanksgiving plans with his family and trying to engage me throughout the treatment. Totally let his shields down, which have been up since the week he called me twice. I thought he was being friendly because he was romantically interested, which led to a wonderfully rich fantasy life on Saturday, but a psychoanalytic friend pointed out on Sunday that maybe Dr. Dashing just didn't want me to be as angry and avoidant as I'd been at the previous appointment. This of course made perfect sense, so on Sunday, I became sad, and I woke up sad on Monday.]

6:00am: How am I going to manage at work all day when I feel so forlorn? Well, I don't have to do a group. I just need to review some treatment plan problems with counselors. That's my primary function at work: "developing" the counselors' documentation skills. Progress notes and treatment plans. I also consult with them on complicated cases, involving psychiatric problems, domestic violence, child welfare entanglements, and the like. Clinical supervision.

6:10am: I don't have a lot of sick days, and I've already used two on my defective knees since August. I can't call in sick. I have to go in.

6:42am: I sign in. Where am I going to sit today? I don't have an office. I can usually sit in the chart room of one of the clinics, which has a computer and telephone, but I can't see patients there. Often a counselor is out, so I can use his or her office. But every morning it's a scramble. Most mornings this doesn't phase me. Today I just want to sit down and check my email and not talk to anyone.

6:45am: I have to say hi to everyone whose office I pass or they will wonder. One counselor calls out to me. What does he want? Is there a problem? I'm not up for complicated problem-solving. Mindless paperwork might take my mind off my anxiety. Fortunately, he says I can work with him tomorrow on his MSW application. Which I promised to do. Which I'm happy to do -- just not right now.

7:00am: I'm in the chart room. Counselors pass in and out. I smile and say hello. Inside I'm crying, inside I'm dying, but I pretend to feel normal. I start looking through my folders, seeing which counselors I need to meet with to discuss treatment plans. There are more plans in the bin for me to review and sign. Meaningless paperwork, take me away!

8:30am: Reviewed seven treatment plans with one of the counselors. Reviewed two treatment plans with another.

What do the counselors really think of me? Some of them act so nice, I am suspicious they are trying to manipulate me. They can't possibly like me as much as they seem to; they must be pretending, but I don't know what they think they're going to get out of it. This makes me paranoid as well as sad.

9:45am: Ouch. I went to see one of the more volatile counselors. She did not want to talk to me. Not my fault; she's been having a rough few days, I know that. But she turned on me like a wounded grizzly bear when I suggested she make a minor change to some screening paperwork. Which the clinic manager had flagged as defective.

Even thinking about the conversation we had, almost 12 hours later, is kicking up the anxiety again. Right after the exchange, I was shaking. For hours. Even after she apologized and hugged me and told me it wasn't my fault and she'd do anything I asked her to do. I couldn't recover.

11:20am: Time for lunch. I went outside and did some comparison shopping, trying to calm myself down. Bought a new pillow and a tuna sandwich and a bottle of juice. Maybe this will soothe me.

1:30pm: Nope. Still stressed and anxious. A counselor calls me to ask if I can meet with her and a patient tomorrow. I agree; the patient has an open child welfare case and wants my help. Five minutes later, another counselor pages me. Can I meet with her and a patient tomorrow concerning domestic violence issues? Sure.  It mystifies me that all these people think I'm a competent professional, when inside I'm screaming and clawing at the air, like I'm suspended by a single thread over the Grand Canyon.

2:00pm: Hanging on by my fingernails. Just one more hour. Another counselor comes into the chart room, and we talk about one of his patients. Who has bipolar disorder. Ironic.

3:00pm: On my way home. Still wound up too tight. I'm going to make myself a nice green smoothie, which I try to do every day. I bought apples and greens at the farmers market yesterday.

4:00pm: I can't finish the smoothie. I'm not hungry. Yes, I'm that anxious. I post a tweet:

2 kinds of anxiety: 1) makes you eat, 2) makes you unable to eat. No idea why or how each strikes at any given time.

5:50pm: Watching last night's episode of "Dexter" doesn't exactly soothe the anxiety. What was I thinking? I will take a Vitamin K tonight. I have to run a group tomorrow; I can't be impaired.

Yesterday a friend said he didn't think I'm disabled, because I live independently and I work. He doesn't understand how much energy it takes to maintain both. More the job than the apartment; I'm a terrible housekeeper. But I've been fired from almost every job I've ever had, and I blame the bipolar.

I look normal, most of the time. Except when I won't make eye contact or can't get out of bed. But I'm not normal. And I'm sick of always pretending to be.
Copyright (c) "Ayelet Survivor"

Sunday, November 25, 2012

This is your date on Percocet

I had a date recently; a friend set me up. I wasn't enthused, because he seemed weird in the first phone call, on a Sunday afternoon.

"I'm walking up Columbus in the 80s," he said. "Where do you live?"

As it happens, near Columbus in the 80s. Which I told him.

"How would you like to go for a walk right now?" he asked.

When at home I'm almost always mostly undressed. I'm not spontaneous on my best days, so the suggestion was unwelcome. I wasn't in the mood to get dressed and go out, and certainly not with a guy who looked pretty hideous in his LinkedIn profile photo (the friend who set us up suggested I Google him). Also, the Rules state that you're not supposed to be immediately available all the time; men should get used to asking in advance to spend time with you, since if your time is limited they will perceive it as more valuable. Or something like that.

"I can't, really," I said. "I'm recovering from a pretty serious knee injury, so I can't really go for long walks right now. I also have some things I need to do later." We continued speaking; I think he found a bench and sat down. He seemed to ask a lot of questions. I suppose if I'd been attracted to his picture I would have been flattered, but the barrage struck me as somewhat intrusive.

"Tell me," he said, "what is the most important insight you have gained from your own individual therapy?"

Excuse me? In the dictionary under "inappropriate" that question is listed verbatim. "That's not something I feel comfortable talking about with you just yet," I said.

"I was going to tell you what mine was," he said, sounding disappointed.

Tempted though I was to call off the date, I got dressed three days later. I didn't bother wearing red, or curling my eyelashes, or going to the usual trouble I take with my appearance. I just wanted the date to be over. My knees were a little sore, so I took a Percocet as a precaution; I didn't want to be in pain and cranky on the date.

That was a mistake. First of all, he was more attractive than his picture. Second, he was very manly in the way he vetoed my suggestion that we walk 10 blocks to the restaurant and hailed a cab. So already I was starting to like him a little. But something went wrong.

The awful thing is, I have no idea what I did or said that turned him off me so much. He asked me if I wanted a glass of wine; I declined, citing the Percocet.

"How does it affect you when you take it?" he asked.

"It doesn't," I said blithely. He must have thought I lied, because the conversation -- from what I can remember -- gradually degenerated into rambling Ayelet monologues about politics, synagogues in Riverdale, and I'm not sure what else. He probably thought he was on a date with Blanche DuBois. A horribly offensive Blanche DuBois who has absolutely zero insight or self-control, and who won't answer a normal person's questions like a normal person would.

Of course, I'm not a normal person. But my disability wasn't the cause of this debacle. I actually wished I could have had a second chance to go on the date sober. It's funny -- as soon as I couldn't have him, I wanted him. Human nature, I suppose.
Copyright (c) "Ayelet Survivor"

Thursday, November 15, 2012

When is an accident not an accident?

Last week I posted about the work I do in my clinics. And the extra work they added by shuttling in two displaced counselors from the hospital's detox and rehab wards. On a good day my job is stressful; when I have to babysit two people, one of whom doesn't know much about methadone and the other of whom doesn't know much about methadone and WILL NOT STOP TALKING, it's extra stressful.

I was proud that despite the extra-extra stress, I was not, as my clients would say, "poppin' off" at anyone. I kept my tone low and respectful. I told the talky counselor, apologetically, that I needed some quiet so I could finish writing my notes. Dr. R commended me for not getting into fights with any co-workers despite my stress level. (We had a phone session because I forgot I had an appointment with him. I put it on my calendar and got an email reminder that morning, but by the end of the day I was so fried that I forgot the appointment and went home. Stress can make you absentminded.)

Then  I slipped on a wet floor and banged my knee.

That would seem like a random accident. But earlier that day, the custodian, mopping one section of the clinic, told me to watch out and not slip.

"I'm not an old lady yet," I scoffed. "Besides, I have good insurance."

Famous last words. A few hours later, after he mopped another section of the floor, I slipped on it and landed hard on my right knee, which is the worse of the two. Initially I thought I was fine and planned to just go to Employee Health the next morning and file an accident report. But I woke up in serious pain. Not the worst I've felt, but bad enough that I really couldn't see running from clinic to clinic all day.

After consulting with my union rep, I went to see my primary care physician, Dr. Cool, and I called Dr. Dashing. Neither thought it was serious -- just a bruise. I rested Friday and the weekend and went to Employee Health Monday morning instead. And then I went back to work with the two extra counselors, my 16 regulars, and 812 patients, because we've had a lot of admissions since I last counted them.

Today things slowed down a bit, and I had some time to think. Was my slip last really an accident? Or was my subconscious conniving to secure me an extra day of rest after an incredibly stressful week of going the extra light-year?

The administration is very respectful of my knee injuries, I think because they're a little afraid I might sue them for starting work at the hospital with sore knees but after three months of a killer commute, being diagnosed with the onset of osteoarthritis. So I'm never afraid to call in sick over my knees. I don't abuse the privilege, but I refuse to suffer any more.

I think they also don't hassle me about calling in sick because they are grateful for my work at the clinics. Everyone except the sociopathic counselor is very happy with me. I'm not imagining this; just today both charge nurses, from both clinics, separately told me how happy they are with my work. The managers tell me they're happy, 15 out of 16 counselors tell me they're happy, and the temporarily displaced administrator tells me everyone's happy. They know that if I call in sick, I'm really sick.

My psychoanalyst friend Joey calls non-analysts "Muggles." I like this term, since I view psychoanalysis as akin to wizardry, whereas I am an evidence-based behavioral clinician. But I do think there's something to the notion of subconscious drives influencing our behaviors. We often react to people not by what they do but by whom they remind us of, which is known as "transference." And not all of our behavior is rationally based. Emotionally driven behavior might have subconscious origins. (Was I angry at Dr. R? Did I really not feel like talking about my feelings?)

I have to remember that as frazzled as I feel sometimes, it's better than the years I spent between college and going to graduate school, when I kept outgrowing my jobs and feeling like I wasn't living up to my potential. I have a career. I have expertise. Four years after social work school, even though I messed up trying to start a dual diagnosis program at my old job, I am supervising 16 people. I harp on that number because I'm proud. My professional accomplishments are impressive, and almost all of the people I work with really like me. After the spectacular crash-and-burn at my last job, I'm flying, and not flying too high.

So I'm grateful for the stress, because it means my job matters and I'm doing it. Just like I'm grateful for the excessive heat in the airless, windowless clinics, because more than two weeks after Hurricane Sandy many people don't have heat or power at all. As the security guard in one of the clinics likes to say, "I'm too blessed to be stressed."
Copyright (c) "Ayelet Survivor"

Monday, November 12, 2012

For once, I agree with karma

Just found out that the horrible people who tormented and fired me from my last place of employment just lost a big contract. They let Princess Crybaby manage it. He failed. Dismally. So did the pompous twit who "supervised" me.

I am not a big person. I am gleeful. They tortured me, and now they're being punished.
Copyright (c) "Ayelet Survivor"

Thursday, November 08, 2012

Aromatherapeutic Ayelet

I am happy to report that with the exception of one person, every person in both clinics loves me. Well, likes me at least, and most like me a lot. The one exception -- how can I put this delicately? She has a personality disorder. That's not just my opinion -- I spoke to several people about her when she started projecting hostility and telling lies to and about me. They all agreed that it's her, not me. We haven't decided what kind of personality disorder it is, but I know she has a history of violence. She was actually fired for assaulting a co-worker and a patient. But, as a union delegate of many years' standing, she fought her way back into the clinic.

I've already told the clinic manager that I have 800 patients and she's not going to be the 801st. We shall see how this plays out.

But my co-workers are especially happy with me because I made a bunch of aromatherapy sachets and distributed them around the clinic. I initially made them for the counselors, because due to Hurricane Sandy, we've been really swamped. Actually, swamped with patients because weren't swamped with water -- patients from other clinics in our program and from other programs came to us to be medicated. I missed work for two days because public transit was suspended, but the three days that week that I worked were extremely hectic.

I also got two extra counselors to supervise. The hospital converted its rehab and detox floors into temporary beds for patients evacuated from other hospitals. I went to bed on November 5 with 16 counselors to supervise, and woke up on November 6 with 18 -- got an email from the clinical director saying that the rehab and detox counselors were being temporarily placed in the methadone clinics. They're very nice, but I was a little taken aback and stressed, because I had to orient them to the treatment modality,  organize their workload, and lead them around the labyrinthine clinics because they kept getting lost.

So everyone's been a bit frazzled, and as usual, it lands hardest on the counselors. I decided I'd try for a little morale boost and made some aromatherapy sachets for everyone. It's really easy, or I wouldn't be able to do it. You just take some mesh or gauzy fabric (I bought a sheer chiffon poncho from Marshall's, but you could also go to a craft store) and cut it into squares. Take two cotton balls. Put a few drops of essential oil on one and press the other against it. Wrap the fabric around the balls, twist the end of the fabric, tie it up with ribbon or string, and voilĂ ! Just take a whiff for an instant aromatherapy break. A micro-vacation, I called it.

I made them in lavender, peppermint, and jasmine, and everyone loved them:

  • "The clinic smells like a spa!"
  • "Oh, this peppermint clears up my sinuses!"
  • (assistant clinic manager) "How come only counselors get a sachet? I want a sachet!" (He got one.)
  • (in a blissful, dreamy tone) "Ayelet, I am sooooooo relaxed right now from this lavender..."

"If I didn't know better, I'd think you were high," I joked.

It doesn't hurt that one of the bigwigs from administration is in the clinic two days a week and thinks I'm great. She even asked me to make sure she got one of the sachets, and when I brought it to her, she was on the phone with her boss, saying that the social worker made sachets and everyone just loves 'em.

I don't have to perform the administrative functions of a supervisor, like making sure counselors meet their deadlines and make their quotas, and I'm not involved in any kind of citation or discipline. But I am learning a great deal about being an effective clinical supervisor, which is excellent experience.

Being exposed to so many people has me worried sometimes, though. These are clinicians. I really don't want them to figure out that I have bipolar disorder. So I'm monitoring my mood and anger very closely. Maybe too closely. This week has been a bad sleep week; as soon as the time changes, my sleep is disrupted. I've resumed nightly torture on the acupressure mat, which is helping, but for a few hectic days -- like the day I woke up with two extra counselors -- I was operating on very little sleep, and I was afraid I'd lose it or make a scene and everyone would wonder why I was so unstable.

But maybe I'm worrying too much. This afternoon I got a call from another clinic in the network. Their social worker was out sick, and a patient came into the clinic not feeling very well and threatened to harm himself. Alarmed, the clinic manager called me and gave me the counselor's number. I called the counselor, who was covering for another counselor and didn't have the patient's chart. So I talked to the patient briefly. Without going into detail, I was able to determine that the patient was not at risk -- he was in withdrawal and hadn't received his methadone dose yet. I told the counselor to send the patient to the medicating station, then called the clinic manager to tell her he just needed to be medicated.

"Why hasn't he been medicated yet?" she asked.

"I don't know," I said. "It's not my clinic."

For some reason this really set me off. I don't know if it was fatigue from insomnia, or feeling rattled from so many unexpected changes hitting me in such close succession. So I went into the secretaries' office and said, "Can you believe what that clinic manager said??" And vented a little bit. Then I calmed down and went to the break room to have my lunch. And after I'd eaten, I started thinking, "I shouldn't have lost it in the secretaries' office. How embarrassing. What must they think of me?"

One of the nurses came in for lunch and we started talking. I told her what happened, and as I was describing my little flip-out, the secretary, Tanya, walked in.

"Remember, Tanya?" I said, laughing in an attempt to appear blasé . "I totally lost it!"

Realization dawned on her face. "I forgot about that," she said. "I remember that earlier, when that other clinic manager called looking for you just as you walked into the office to get something from the printer, I thought, 'She's going to live a long time!'"

Apparently there's a folk belief that if you walk into a room when someone is talking about you, you're going to live a long time. Which is funny, because later that same day I walked into the clinic manager's office and he and the administration honcho were talking about me. Not just about me; about the work I'm organizing for the displaced counselors.

So I guess I'm going to live a very long time. I hope I'm not in physical and emotional agony for much of it. And I guess I don't appear as loony as I fear I do.
Copyright (c) "Ayelet Survivor"