Into the system…

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Posts Tagged ‘crisis team

Discharged…

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So I was discharged on Friday.

I think my reason for discharge was more down to the fact they don’t know how to help me, than me being any better. The current bed shortage probably had something to do with it too. They are struggling for beds and suddenly they are trying to send us all home.

My consultant suggested that staying any longer would not be good for me. The longer I stay on the ward, the harder it will be for me to leave. You get used to the routine, doing nothing all day. You really can’t help but become institutionalised, living in the safe bubble of the ward. The real world gets stranger and scarier by the day. I was getting more and more scared about leaving. It was an easier life in there and I could just about cope with existing. Being home has been a shock to the system and I realise now how much I’d settled into inpatient life.

It feels pretty risky to discharge me. I know I can’t stay in there forever, but I don’t feel particularly safe. I felt safer on the ward, although in reality I probably wasn’t. I wasn’t on escort during my last week and I could have gone out and done something, but of course it’s the evenings and nights I find most difficult and I was always kept safe then. My consultant didn’t seem to be taking the risk very seriously. She seems pretty convinced I don’t mean it when I say I still want to kill myself.

I nearly didn’t get to come home last week. It was agreed that we would meet with my new care co-ordinator on Thursday, so they could work on a care plan before I was discharged. Unfortunately she wasn’t in work for some reason and my consultant was reluctant to let me go without a CPA. By this point I’d accepted I was leaving on Friday and I didn’t want things to change at the last minute, so I managed to convince her to let me go anyway. We agreed that I would be placed under the crisis team until my care co-ordinator sees me this week. They’re not visiting me, but I’m on the list so if I call they can respond quicker. The likelihood of me making the call, even if things are bad, would be slim, but it was enough to satisfy my consultant.

Then on Friday they closed the ward due to an infection outbreak. Probably Norovirus, a stomach bug had broken out. Patients and staff we dropping like flies and the decision was made to close the ward. No one in, no one out. There were doubts over whether or not I’d be able to leave, but permission was sought and I was allowed to go. I felt fated to never leave.

I also had chest/upper abdomen pain, which was pretty bad on Friday morning. At first I just assumed indigestion, but when it still hadn’t gone away by the second day I was starting to worry. I knew I should bring it up with the ward doctor, but with the stomach bug running wild, I knew I wouldn’t be able to leave if I showed any sign of being ill. I decided to keep quiet, but as the pain got worse on Saturday I was starting to regret it. Managed to get through until today and saw Dr N. He said it could be related to the Reboxetine and has given me some meds that should help. We shall see.

At first, it was a nice novelty to be home though. Not getting woken up at 7am, by a noisy nurse shouting “Good Morning”. Food that isn’t lumpy and grey. A doggy to give cuddles. Internet access and my normal phone. Being able to go out without planning it. It all made a nice change. I even got breakfast in bed delivered to me for valentines day (aww).

Sadly though, the novelty is wearing off and reality setting in. I feel pretty awful at the moment. Nothing has changed. I’m grumpy and anxious. The smallest thing is making me snap. I went to Creative Remedies and instead of making me feel better, I felt worse. I just wish everything would go away.

Anyway I have to stop writing. I want to try and write about my time on the ward, but not sure I’ll get much chance. I wrote a lot in my diaries, so I hope I can use some of it for a few entries.

Hope everyone is okay. Let me know your news! xx

Written by intothesystem

Tuesday, 16th February 2010 at 12:56 pm

Back in time…

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It felt very strange to see DP again yesterday. It was like going back in time.

On my way there I was trying to remember what he looked like, but all that came to mind was the fact he was bald. When I got to the therapy centre, it took me a minute or two to recognise the building. It kinda made me realise how fuzzy my memory is of last year. I still blame ECT.

Memories started to come back though. Silly things like waiting in the kitchen until he was ready, taking off your shoes (both of us without undoing them!) and the blue sofas lined up against the wall.

We didn’t dwell on the paperwork. CORE outcome measure form and a couple of consent forms and that was it. A pleasant contrast to last week’s 50 minute form filling marathon!

Then of course he turned to me and asked me to start. I knew he would sit there in silence for the full hour if necessary, so it didn’t take me long to get going. I had taken notes with me, hoping I could update him on the last 18 months quickly without having to say anything. Sadly he wanted me to talk over things myself. I kinda knew that was coming.

I went over the main points. Last summer, The Priory, February’s overdose, ECT, Bipolar diagnosis and since. All the stuff I’ve been over a million times now. I can’t really remember, but I don’t think he said much at this point. He never did say much. I think he was a little shocked though.

The conversation moved onto what use the sessions are going to be. He seemed doubtful as to whether there was any point in working together for only four sessions. I explained the theory – that it would give me a little support in the interim and help me identify areas to work on long-term, but I am not sure he agreed. I am wondering if he just doesn’t want to work with me again. I am worried that I might have scared him off. I don’t know. I feel quite paranoid about it all.

We talked about how things are now. He asked what the current situation was care-wise, family-wise etc. I filled in some gaps. We talked about my mood too and that being what it is at the moment we got onto the question of self-harm and suicide. I think he was a little concerned and possibly a little panicked. I do wonder if he is used to dealing with this, but then surely most people in therapy have considered such things?

He pointed out that my risk level means I am a “red flag” client and he will need to talk to the EAP about whether or not we should continue. I remembered this from last time. I was a red flag last year and I’m not sure there has been a time since when that status would have been lifted. I am wondering if he is using this as a way to escape me. The other EAP therapist didn’t bring it up, but nothing has changed really when it comes to risk levels. I pointed out that the EAP were aware of my situation when they took me on this time and I hope that means it won’t be a problem, but he said he still wanted to talk to them.

He asked me about a verbal contract too. He wanted me to give my assurance that I won’t do anything to harm myself whilst I am seeing him for therapy. A repeat of the request from the EAP counsellor really. I struggled to give it, not because I have plans to do anything, but for other reasons. I think part of the reason is not wanting the added guilt. The guilt I get from wanting to break those assurances, because the suicidal thoughts are still so strong. I feel bad for even having the thoughts. I guess my reluctance is also to do with the fact I don’t trust myself any more and don’t see the point if I can break my promise. I had given my assurance to people I wouldn’t act when I made the attempt back in February and it wasn’t enough. I have assured myself enough times that I shouldn’t act, yet it wasn’t enough in the end. There have been other times though that making a promise to someone has been enough to make me think more than twice, so maybe it is worth it.

Towards the end we talked about next steps.

He thinks I should be getting more NHS support at the moment. I think he may be right, but I wonder what support there is. What point is there in the crisis team? I’m perpetually in crisis and I don’t think it would be helpful. What point is there in contacting the CMHT or asking for a urgent psych appointment? Useless social worker, J is on holiday and Dr D didn’t know what to do with me when I saw him last month anyway. What point is there in bothering Dr N any more than I already do? He has nothing more to offer me.

As we finished up, DP told me to email or text if I need to, which I am grateful for. I guess the fact he offered that option shows he cares and is trying to help. He certainly didn’t have to.

Overall the session was hard work and quite strange, but I left feeling relieved. I think it was helpful. I don’t know though. It is hard to tell.

In other news, today I had a phone call from the therapist I saw last week wondering where I was. The EAP had forgotten to contact him to say I wouldn’t be seeing him again. I wish I’d cancelled myself now, but I just didn’t know what to say. I feel bad that he was waiting for me. I hope the EAP pay him for the mix-up!

Written by intothesystem

Thursday, 10th December 2009 at 10:05 pm

Tiresome…

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Another week has passed and I’ve not written again. I don’t know where all the time goes.

On Monday someone came from Birmingham University to interview me for Mood Disorder research. It didn’t take as long as I thought it would, but that may be because I was hardly verbose. I just generally ended up saying “yep” to every question. There were questions about your family situation and stuff. Then there was a series of questions about depressive symptoms, all of which I have experienced at some point or another. She recorded that part of the interview and the following part about mania. There were questions about agitated depression and dysphoric mania too, both of which I’ve experienced and most of my depressions are agitated.

There was a section on psychotic features, most of which didn’t apply, but there were some things mentioned that I’ve experienced and never really considered psychosis before. Those dissociative experiences and weird feelings where the world don’t quite feel right were given air time. There are times when I lose all sense of size and relativity. Paranoia too, but I guess everyone experiences that at times.

There were questions about medication and treatment. I realise now that I forgot a load of drugs that I had been on. I don’t know if it’s worth emailing to let them know. It felt weird when there were questions about hospitalisation and ECT and it made me realise just how ill I have been.

Her list of symptoms and questions made me realise that I can’t deny having Bipolar Disorder. I had experienced pretty much everything mentioned for both depression and mania (although generally not as severe on the manic side). I sometimes wonder if I’m actually just plain depressed as I spend so much more time on that side of the coin, but I can’t deny that I’ve been manic or at least hypomanic plenty of times too. More so, it made me realise that I am really quite severely ill. I often think because I have Bipolar II disorder, rather than I, it means I’m not that bad, but I guess that isn’t really the case. I’ve been lucky to have not had any real psychotic experiences and severe manic episodes, but my depressions are pretty much as severe as they get and I’ve been through a lot treatment-wise too.

At the end the girl tried to take my blood, but failed. I have really terrible veins. Small and deep. She’s given me a pack to take to my GP so they can take it instead. I wonder if they ever will find a gene or two that causes all of this.

Afterwards I completed the questionnaires she left me. Millions of ticky, or rather crossy, boxes. A lot of personality type questions about honesty, social anxiety and esteem. A section on events proceeding first experiences of illness, which for me was pretty much uneventful. No bereavements, abuse etc during my childhood.

Tuesday was fairly dull, except my father popped in for a couple of hours. He was in the area for a trade show so came over for dinner in the evening. We went to the new Fish and Chips in Alty and then came home and had cake. Good food and it was nice to see him for a wee while.

On Wednesday I saw Dr N for my fortnightly visit. I was pretty honest with him about how the past couple of weeks have been. Things have gone steeply downhill since a month ago and he was concerned. We talked about self harm and suicide again. We also talked about my social worker and seeing the NHS psychiatrist. He warned me that the NHS psych will probably try and get me to try an anti-depressant again especially considering the drop in mood over the past couple of weeks. He made some comment about “that’s all they [NHS psychiatrists]  seem to do”, which amused me. I’m worried about this though. I don’t think it is a good idea considering how bad things were when I was on them, but then I wonder because things have not exactly been great without.

I forgot to take the blood pack with me, so he’s going to do it next week when I’ve seen Dr G. No doubt I will have a meds increase to sort out as well.

This morning I had a visit from J, my social worker. It was a long one and I found it tiring. I tried to be honest with her too, talking about the increase in suicidal thoughts and the agitated anger outbursts that have been happening for a while. It was shaming to talk about wanting to hurt people and myself. I felt uncomfortable and was fidgeting a lot. She was pushing for info though and I felt obliged to supply.

I was alarmed when she mentioned the crisis team and hospital. I managed to calm her down and say that I’ve managed to keep myself safe over the past couple of weeks and I think I will be able to going forward, but even still. She agreed with me in the end and said she will not take action, but she kept reiterating the fact we could get the crisis team out. I don’t trust the crisis team and I certainly don’t want to go through the NHS inpatient experience again. I don’t want to put my family through that either. I am scared that my bloke will be shocked it was even considered. I have not really let on that things have been much worse in the past fortnight. I have to phone her or ALERT if things get worse again, although I still don’t have their number so not sure how to do that.

She wanted us to talk about what her role was and what I want her to do for me. I didn’t really have an answer as I find her a little useless and wonder what the point of her appointmesnts is. I was keen for her to liase with other services and make referrals for me though. We discussed other things out there, especially therapy. She is getting me on the list but warned me it will be an incredibly long wait, even just for an assessment. She also suggested Beating The Blues in the interim, but it’s more CBT and I’m not sure Kate had much positive to say about it. I start Creative Remedies next week and Positive Thoughts in a couple of weeks so we shall see how those go. She also suggested I tried the Day Centre in Warrington. I’ve been once before, but was too scared to talk to anyone there and left after 5 minutes reading the notice boards. She suggested she took me in and introduced me, which may be better. I said I will see how Creative Remedies go first and then decide.

There was a lot of boring stuff about setting expectations for recovery and doing things to help. It was a repetition of much of what she’s said before and got quite tiresome. She talked a lot about my work and how if I am ever to go back things will have to be different. We talked about the competitive nature of the company and she seemed appalled at the way things work and shocked that I accepted it. I think she really wanted me to consider leaving and working elsewhere, but didn’t dare say as much. I know things will have to be different, but I am not sure I want them to be so different I leave my job. We will have to see.

This afternoon I need to get down to some serious baking. My friends who get married tomorrow have asked for contributions to the buffet and bar instead of traditional wedding presents. Hopefully I can knock up some yummy contributions and everything goes well.

Hope everyone out there is okay. Take care folks xx

September/October: Meet the Shrink…

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Late September: Referral to Psychiatrist

I returned to Dr N shortly after my trip to A&E. I was embarrassed about my previous visit to him and quite apprehensive, but it was okay. He was lovely as ever and showed his concern. He apologised for sending me to A&E, but pointed out he had to. He was concerned that I could have taken something else and not be telling him, so needed to get things checked out. I explained what had happened in A&E and following, with the crisis team. He was pretty shocked and disappointed that they hadn’t offered me more support or a proper assessment.

I questioned him on the borderline thing and he kinda avoided the question, horrified that the A&E department had been stupid enough to show me the letter, but did suggest that he wasn’t attempting to make a psychiatric diagnosis, more trying to assure I got the right attention in A&E. I wasn’t really happy with his response, but nevermind. He’s since redeemed himself.

Anyway, I asked him what other options there were and reminded him of my health insurance. In the end we agreed that a referral to a private psychiatrist was probably the best option and he arranged to do this.

When I saw him again, he explained he was referring me to Dr G and had written the letter. When I got to see the referral letter I was a little horrified. It was hard to see everything in black and white, honest and accurate as it was.

The referral process was quick and I managed to get a cancellation. An appointment was booked for October 2nd.

October 2nd: See Consultant Psychiatrist, Dr G.

I was absolutely terrified before my appointment. So terrified, I managed to miss the turning on my drive there and took a while to realise I was going in the wrong direction. I was not really in the right frame of mind to be driving. I got there safely though and was pointed in the direction of a waiting area. She was running quite late, although no one thought to tell me, so I sat there nervously looking at the clock, worrying I’d been forgotten or was in the wrong place. Eventually she came down to find me and led me up to her consulting room.

I was relieved to see there wasn’t a couch. I was terrified I’d have to sit on the cliché psychiatrist’s couch. No one prepares you for what it is going to be like, so I was relying on Hollywood’s interpretation of the psychiatrist for clues. I sat in a small, blue armchair and she began. She explained that the session would take around an hour and that she wanted to go over some of the things discussed in the referral letter and gather an overall history. Then she left it to me to talk.

I am not good at talking. I find it very difficult to open up, but I knew I had to if I wanted to make the most of her expertise. So I went through things. I probably forgot stuff. I was very nervous and didn’t know what to say, but we got there. Afterwards, she wanted to lay out the options for how to proceed. We discussed medication and Quetiapine (Seroquel) was brought up as a possibility. Then she dropped the bombshell. She thought I should come in as an inpatient. I was completely shocked by this and did not know how to react. I had not expected it. She did say if staying as an inpatient wasn’t an option, day care would be the second best thing, but she really wanted me to stay. I couldn’t really think straight after this. I was worried about what my other half would think and terrified at the prospect of being admitted.

At the end of the appointment, she showed me down to the ward and the woman in admissions showed me around. I think they wanted me to see that it was more like a Travelodge than a hospital and were trying to put me at ease. There were no beds available so they explained I would be put on a waiting list and it was up to me if I accepted and came in.

A million thoughts were racing through my head after this. I was worried about what my partner would think. I was anxious about the argument that was likely to follow when I told him. I was worried it was all an overreaction. I worried that maybe I’d been exaggerating things to make them seem worse than they were, yet at the same time I was glad to be taken seriously for the first time. I was cynical and thought that she probably just wanted to make the most money she could from me. Mostly I was just plain scared. I didn’t know what to expect and also knew that if I was to be admitted I would need to tell my parents.

An argument did follow and it took a while for my partner to come around to the idea. He didn’t want me to go in at all. I’m not sure he had realistic visions of what it might be like and seemed to worry it would make me worse. I also suspect he didn’t want me to go because he’d miss me and he was probably worried about not having me around to look after the house too! He did say that he wouldn’t want to visit me there and considered going away for a few days, but in the end he didn’t.

I also went and saw Dr N to get his advice. He agreed that I should be admitted and was glad that I was finally getting some support. He told me he’d have wanted me admitted to the local NHS unit if he thought it would do me any good, but said that it was so terrible it would probably do more harm. I think that’s a sad reflection on NHS mental health services. He also told me he’d been a ward doctor at a Priory hospital for a while, so knew what it was like and thought it would be beneficial. We talked about the benefits of staying over day care, such as not having to drive to and from the hospital after a challenging day of therapy. He really helped me to make up my mind and I made the decision to be admitted.

September: Caffeine Crisis…

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September 16th: Caffeine Overdose

A week on from the bridge I was a mess. I had spent the week trying to stop myself from hurting myself and I knew that I couldn’t withhold it much longer. The day before, I’d bought a packet of caffeine tablets. I don’t know why. Overnight I had gone over and over the urge to overdose and by morning I couldn’t stand it any longer. I took all of the caffeine tablets, 32 in all. I was surprised at how easy it was. I just swilled them down with a can of Diet Coke. I didn’t care what it did to me. I just wanted to shut up the noise in my head. I guess I knew that it wouldn’t kill me, but I wanted to make myself ill. I wanted to hurt myself. I wonder now if I took the caffeine to stop myself taking the paracetamol or fluoxetine or whatever else I could find. I wonder if I did it to stop myself from going to the bridge. I don’t know if there was some form of self-preservation happening.

The caffeine made me incredibly agitated. Shortly after swallowing the pills I was shaking and couldn’t keep still so I decided to go for a walk, hoping it would use some of my excess energy. I walked towards the village not knowing where I was going or what I was doing. My head was spinning. I felt drunk, dizzy and full of energy. When I arrived at the village I thought about seeing Dr N, but when I got the surgery I was too scared to go in and ask to see him. Instead, I kept walking. I sat down on a bench and texted a friend, then walked back to the surgery, but Dr N had left for his rounds. I gave up and walked home. By the time I got home I was feeling awful. I had terrible stomach cramps, was shaking and my head was pounding. In the end I just lay down in bed and stayed there. When my partner came home I just told him I was feeling poorly.

The night was long and painful. I was awake all night, the nausea unbearable. I kept heaving, but nothing was coming up. My head was spinning and pounding. My heart was pounding. I thought I was dying.

September 17th: A&E

In the morning I was still feeling terrible. My partner was concerned; of course, he did not know that I had brought the pain upon myself. I rang the surgery and made an appointment with Dr N. I was agitated beyond belief, feeling terribly sick and barely able to talk as I walked into his office. I was shaking terribly. I didn’t know how to tell him. I was so ashamed and embarrassed. In the end I managed to spit it out and explained what had happened. He was concerned and didn’t know how to react. He checked my blood pressure and kept asking me if I was going to be safe if he sent me home. I didn’t know how to answer. He decided to send me to A&E, gave them a call and wrote me a referral letter to take with me. He wanted me to call my partner and get him to take me, but I was too scared. I opted for a taxi.

I arrived at the hospital and handed the receptionist the letter. They took it from me and handed it to one of the nurses and then it was handed back. The letter was now open and I could read it. I was shocked to see what it said. Dr N’s differential included not just depression, but “? Personality Disorder”, which one would assume referred to the possibility that I had Borderline PD. I was quite angry. I hadn’t expected that, as it had not been mentioned before, but I also kinda knew that by self-harming in this way I had opened myself up to it. I sat in the corner and banged my head against the wall in frustration. Eventually I was called through, but a mix up meant I was left to sit in the cubicle on my own waiting for a nurse. One nurse saw my letter and said “oh you’re that one” and then ignored me. Eventually a nurse came and asked me some questions. She then found another nurse to take me through to majors.

I was shocked by what happened next. I was led to a cubicle and she instructed me to change into the gown and to get onto the bed when I was ready. I remember her asking me why I did it, but I didn’t know how to respond. She noticed my engagement ring and told me “see, that’s something to live for”. I thought she was an idiot. She obviously has no idea what it’s like. She attached me to the monitor and took my blood pressure and temperature, then left me. I proceeded to spend the next couple of hours feeling terrible, trying to work out what they were going to do with me. I was terrified. Everyone that came over and saw my notes seemed to flinch and wander away. I sneaked a peak at them myself and saw “DSH” in big letters at the top. I wondered if that was the reason why I was ignored. Eventually a doctor came and took some blood from me and asked me further questions. I was scared of him and didn’t know how to answer. He smelled too. Eventually he finished his interrogation and left me again. More waiting and being ignored followed. After what felt like forever, a nice nurse came and explained what was going to happen. I was to be moved to the CDU ward within A&E, to wait for the blood test results and a psychiatrist.

Shortly after I had been moved, my partner arrived. I was shocked to see him, as I hadn’t told him where I was. I found out that he’d been worried that he hadn’t heard from me and at lunchtime he had began a search. In the end the doctor’s surgery had told him I’d gone to A&E. When he arrived he was angry at me for not telling him the truth. He told me I was silly and kept asking me questions about what I had done and why. I just wanted to be left alone. I didn’t know how to respond. He kept asking me questions, in between hugging me and telling me things would be okay. I didn’t know what to say. I was starting to feel a little better by mid-afternoon. The nurse in CDU was lovely and the only one to really treat me like a human being. I was brought food, but it was inedible.

Eventually, I was deemed medically fit and the psych team were able to assess me. This was horrible. I was uncomfortable with the MHP. She asked me plenty of questions, but didn’t seem to want to listen to my answers. My answers didn’t seem to be what she wanted to hear. She didn’t seem to understand why I was there and I got the impression she just thought I was silly and pathetic. She was confused as I didn’t seem to fit her boxes. I think she just wanted to send me home, but realised I wasn’t happy about that. In the end she called the on-duty psychiatrist and he came. He didn’t ask me any questions about what had happened and just asked me what I wanted to happen next. He gave me the choice of going home and pretending nothing had happened, going home and having the crisis team visit or being admitted. I was scared of hospital, so I chose the crisis team. I was discharged after some frantic form filling.

September 18th: Crisis Team

The crisis team were hopeless. They turned up late and then proceeded to perform some bizarre good-cop-bad-cop routine, whilst they tried to find out what had happened prior to me tipping up in A&E. They asked me various questions but I didn’t know what to say to them. I made light of everything as I didn’t know how else to approach the situation. In the end I was deemed sane enough not to warrant their attention. They wanted me to wait for the mental health team assessment that I had been on the waiting list for forever. They seemed frustrated that they couldn’t just stick me in a suitable box and in the end they just discharged me back to my GP.