Posts Tagged ‘Dr G’
A Little Clarification…
My last post, Distressing Diagnosis… was a little on the rushed side and basically unfinished when I posted it. I knew if I didn’t publish it when I did, I wouldn’t get the chance for a while, but I kinda wish I’d held back. I’ve been back and edited it a little, but it still doesn’t say everything.
Edit: (17/03/2010) – I’ve actually ended up reworking this post quite a lot too. I didn’t read it back yesterday and since then I’ve realised it was all over the place and made little sense. It is a little better, but I just find this so hard to write about objectively. I am struggling with it all.
Lets get one thing straight. Dr M isn’t a horrible person or a bully. In many ways she’s actually quite nice and well meaning. She is trying hard to help. I can see that and I appreciate it.
She said she doesn’t want to do anything that will make me worse, and she did agree to remove the diagnosis in my notes when I said it wasn’t helping. I guess I can’t really argue with that. I asked her to change her diagnosis and she agreed to do so. I don’t think she’s changed it in her mind, even if she has on paper, but that is at least something.
She genuinely thinks she is helping and that she is doing the right thing. She keeps saying that she will make me better and that the future is hopeful. She is always very positive and encouraging. Many patients probably really appreciate this approach, but I find it a little too much. I don’t see enough evidence to support her positivity and that can actually be damaging. It makes me lose faith and trust. I find that she can ignore the negative, which means I don’t feel like I am being listened to or taken seriously. Unfortunately she doesn’t seem able to recognise this or she is unwilling to adjust her approach.
She also gives me her time – lots of it. She tries not to rush her appointments and lets them take as long as they need to, even if that means she runs behind fairly often. One of my ward rounds was over 90 minutes long, which when I realised seems pretty incredible. She saw me regularly on the ward in addition to the weekly ward rounds. She is now seeing me fortnightly as an outpatient, as opposed to the huge expanses of time between each CMHT appointment (4 months!). This is a good thing. It is closer to what I was used to in The Priory and a vast improvement on my other NHS experiences. Usually they sit you down and before you know it the appointment is over and nothing seems to have happened.
There are certainly good points to her care so far. I think it probably is an improvement on my other experiences with the NHS, but there are issues and I am finding those hard to deal with. Overall though I don’t think she’s a bad psychiatrist. I am just not sure she is the right doctor for me and I am not sure I am the right patient for her. Things just don’t seem to be working.
I don’t think it helps that we just don’t seem to get on. She was not impressed with my initial request to not be patronised and I think that clouded her opinion of me right from the start. She doesn’t seem to understand my job and why I like it. She doesn’t seem to know how to deal with me questioning her. I have a real sense that she just doesn’t like me for some reason. There was one point that she pretty much said that she couldn’t get on with me in “real life”, although I can’t remember the context now. My bloke tells me that is paranoia, but I remember it because I was shocked at the lack of professionalism and was upset that she didn’t like me.
I know I can’t hold this against her though. People don’t get on with each other and that’s a fact of life. If she doesn’t like me then fair enough. I’m not sure I’d get on with her in “real life” either. It wouldn’t matter though if it didn’t affect our therapeutic relationship. I worry that part of the reason she has diagnosed NPD purely stems from a sense that she doesn’t like me. Is it because she thinks I’m arrogant because I didn’t want to be patronised? Is it because I don’t agree with her opinion? I fear that in many ways it probably is.
It’s always going to be easier to trust and work with someone you get on with and I am finding this hard. It was one of the things I found great about working with Dr G. We got on well and could talk about anything, not just my treatment. It felt a lot more therapeutic and less clinical, which I think is important when dealing with mental illness, which is so entwined with emotion. I miss the way things were with Dr G and I am not used to the change. I don’t see the relationship with Dr M ever being like that. I find it hard to talk to her and hard to trust her. I am meant to tell her how I feel, yet I don’t feel comfortable doing so.
I also struggle with the fact that she doesn’t seem used to dealing with patients who are capable of getting dressed, eating and general functioning. Even if you had just tried to kill yourself, said you felt absolutely terrible and were threatening to do yourself in, if you could get up and about, communicate, eat and drink etc. then you are not really depressed and should be discharged. There seemed to be little acknowledgement of the fact that patients hide how they are feeling and put on a mask. There was a lot of focus on the functional side of depression and little acknowledgement of the emotional side and how patients felt. I wasn’t the only person who noticed this. A few of the more functioning patients felt that they were always being pushed to go home, treated as if they weren’t really ill and made to feel like they were a fraud. One patient was discharged too early a couple of times because she always hid how she felt and seemed “well” but she ended up back in hospital within days. You would have thought they would realise this was a problem. I don’t think this is purely down to Dr M. There were unbelievable bed pressures and the nurses weren’t exactly great at observation, but at the end of the day she makes the decision to discharge.
I wondered if this was because she is used to treating patients who aren’t functioning – those who are catatonic, staying in bed, barely speaking etc. In many ways these patients probably are more severely depressed, but that doesn’t mean they are more “worthy” of being in hospital. Non-functioning patients are a lower risk because they aren’t even capable of hurting themselves, where as a functional patient who is dealing with distressing thoughts needs to be kept safe. There didn’t seem to be much acknowledgement of this. I always felt like I was being told my problems weren’t important and that it didn’t matter how I felt.
Maybe Dr M has a problem working with me and other patients in a similar situation because she just finds it easier to deal with patients that do as they are told and don’t answer back. I guess anyone would find it easier to deal with people that follow blindly and don’t question things, but it is wrong to judge those that aren’t like that. Maybe it is as simple as a power trip. She likes to be in control and feels threatened when that power balance is upset? I don’t know.
It was also a common complaint on the ward that she thinks she’s really in touch and that she knows what you are thinking, but the reality is she’s often a long way off. Sometimes you get this hint that she might actually understand and then she says something else to contradict that five minutes later. It can be quite frustrating because you get this feeling of hope that she is listening and understands and then you get disappointed. You often feel like she is jumping to conclusions or judging you and I find it hard to talk to her. I don’t have this problem with Dr N and I never had it with Dr G. They listen to you and seem to understand what you are trying to say.
I think my feelings towards the NPD diagnosis have made it hard for me to work with her. I am offended and upset by it and I associate her with this distress. It feels like a personal attack and I find that hard to deal with. I don’t want to be considered as narcissistic, arrogant, self-serving etc. I want to be a “nice” person, someone that people can trust and get on with. I read the descriptions of people with NPD and I am scared that anyone could think I was like that. I am disgusted with myself that someone can think I am the horrible person that the NPD diagnosis describes. I can’t handle my thoughts and emotions around this and I need someone to direct those frustrations at. I guess naturally I will direct them at her. As much as her views of me may be misguided, my feelings towards her are skewed because of my feelings around this.
I still don’t think the NPD diagnosis is very accurate (although I do understand to some degree why she may have diagnosed it). I certainly don’t think I meet the criteria and I think she was wrong to diagnose it in the way she did. I really question her judgement and it is going to be hard to work with that in mind.
Personality disorders seem to be her diagnosis of choice and that worries me. She seems to be giving anyone that doesn’t respond well to medication, functions “too” well or who doesn’t fit in the usual boxes, a personality disorder. There was someone on the ward who was diagnosed with Bipolar Disorder many years ago and she had seen multiple psychiatrists who agreed with that diagnosis. Dr M began treating her, quickly questioning depression and suggesting her personality was to blame for her thoughts. There seemed to be no logical reason for this, only the fact that she functioned fairly well and medication had stopped working.
I guess in many ways a PD diagnosis means the emphasis is on the patient to get better and not the doctor. If the patient doesn’t improve the psychiatrist doesn’t need to justify herself in any way. The patient is also fairly powerless because any questioning of the diagnosis could be considered a symptom of the disorder. “I’m the doctor, you’re the mental, now do as you’re told”. It probably helps that there is enough of an overlap between symptoms of a personality disorder, general life experience and other conditions that there will probably always be some evidence you can use to back up your opinion.
A little off topic perhaps, but I do still want a second opinion on the diagnosis, but I don’t know how I go about getting it. With the diagnosis lifted from my notes, I don’t know where I stand. My personality is now “under investigation”, but does that mean she is going to change the way she thinks about me? I doubt it. Do I just wait and see what happens when the therapy referral comes through or do I try and get things clarified now? Presumably there are still mentions of the narcissism on my notes, so will that influence things in future?
I wonder if I should ask about the Affective Disorders clinic in Manchester. A couple of people have suggested it to me and they have someone who focusses on “complex needs”, who may be able to comment more on the relationship between my mood disorder and any personality problems. There’s also the CUPS service in Cardiff, who has a similar service offering second opinions to anyone in the UK with complex mental health issues. The problem with these services is they require referrals from your consultant and I don’t know how to ask her, without sounding like I don’t trust her opinion.
I don’t know.
I still don’t really know what to do or think about it all. In some ways I know I should just try and forget about it now that the problem label has been rewritten, but the therapeutic relationship thing is a problem. I still have to see her every couple of weeks after all and I don’t know how things are going to work.
I guess my conclusion is though that Dr M isn’t all that evil. It’s the NPD diagnosis that’s the problem and it is going to be an elephant in the room for a while I think.
Bombshell…
On Wednesday night Dr M dropped a bombshell and then ran away whilst it detonated.
Contrary to what was said in ward round on Tuesday, “yes, it does sound like a mood disorder. We shall discuss your notes and call you in later to discuss medication”, they are now questioning my diagnosis, saying my picture doesn’t fit with their understanding of Bipolar Disorder. Now, considering this is based on a half hour conversation with me and a couple days of uncharacteristically fast (for me) mood swings, I am concerned.
They said they want me assessed by the clinical psychologist, which may take “many weeks” before they make any decisions. She isn’t sure where I should wait, here or at home, but is concerned about my safety (which to be honest she needs to be! Being in here doesn’t exactly do anything to convince you life is worth it, when you have already given up).
She said she doesn’t want to change my medication as it might influence the assessment. No mention of taking me off my current meds, which could be doing the same!
Then the meeting was over and I was left to handle the fallout alone.
I am a little shocked. They haven’t seen my Priory notes as the CMHT has lost them. I was under the care of The Priory for many months and I think they had enough time to assess me. Not make assumptions based on a short conversation and observations over a couple of days, which have obviously been influenced by an overdose and stress!
I am concerned that the change of tack seems to have come after J spoke to them. What on earth did she say, especially as she didn’t exactly know me or get the full picture as I didn’t trust her?
I can also sense what is coming. A borderline diagnosis is ahead on the tracks and coming at me fast (or slowly as it’s the NHS). I wouldn’t mind if this seemed to fit, but I am fairly familiar with the criteria and nature of the condition. It doesn’t ring true with my experience. I have no fears of abandonment – I am fiercely independent and quite happy to accept someone won’t be in my life any more, e.g. when therapy has ended. I may miss the person or thing, but not object to losing it and will not try to stop them. I do not have stormy and unreliable relationships – I have been with my partner 7 years. We argue like man and wife and our relationship is strained by this episode of illness, but I don’t love him one minute and hate him the next. My mood swings are not generally reactive and *usually* slower than those suggested for BPD. I don’t suddenly want to kill myself after bad news. Yes, I can express frustration or be upset, but not out to a level that is out of the norm or to extremes. I do not act impulsively without considering the consequences. My major suicide attempts have both been a result of a huge amount of thought and planning. In fact, aside from my mood swings I don’t think I am generally a person of extremes. I also have no past trauma, which is often involved with the condition. I could probably half meet maybe 3 or 4 criteria, but never the 5 needed by the DSM or the descriptions given in the ICD. I’m aware I am having to simplify things through lack of space or time – my thumbs will fall off if I write everything I want to, but I think you get the idea.
Also worth noting that borderline PD is one of Dr G’s specialisms and she never mentioned it to me. She tends to be pretty straight with people, so if she thought it was that then surely she would have been able to say so? She also wouldn’t have referred me to Dr P, him being the mood disorder specialist.
I can’t help but feel this is all part and parcel of the way this label can be misused. Don’t fit classic diagnosis, don’t respond to first line medication, female, suicidal and have mood swings. Oh BPD will do. Lets try and put the square peg in the round hole.
Maybe they aren’t thinking Borderline PD, but the mention of psychologists and lack of anything else even remotely close, suggests they are.
I am also frustrated at the lack of desire to do anything whilst waiting for the psychology/therapy assessment. Even if it was BPD, medication can be helpful with treatment and is often following the same kind of strategy as Bipolar II. She may in a couple months time go back to my current diagnosis, make the same changes and in the meantime I have wasted months of my life stuck on this ward. There never seems to be much desire to get you out, unless they suddenly need a bed then you can be out on your ear, recovered or not.
There are a lot of questions and no one has given any answers yet. I wrote a list of the key practical ones and handed it to my nurse to pass on yesterday, but no mention yet. I suspect I will be waiting until ward round next week.
After all this, my bloke went to see Dr N yesterday for his opinion. I thought this would help but it has made me more confused. Apparently Dr N is quite pleased I am being reassessed as he was never convinced by my diagnosis and he even suggested Dr G wasn’t. I had suspected this myself, but when I questioned Dr G on it, she said she agreed with Dr P. My bloke and Dr N apparently discussed borderline PD for a bit too. My bloke also expressed his concerns about rumination (he seems to think if I stop overthinking and forget about my illness I will be okay) and my blog came up. Apparently Dr N didn’t know I was still doing it! Surprised by this as everyone else, including the CMHT knew. I kinda feel left out of my own care again, so am wishing I had been there yesterday, although I know it is not practical.
Since then I have spent a lot of the last day or so pondering all this. I had a visit from Em in the afternoon which was lovely of her and a short break from everything.
My bloke came in the evening. It was his birthday but he wasn’t exactly full of birthday cheer. Em had got me a cake to give him, which we shared some of, but then we spent the rest of the time talking about all this. He has been doing a lot of research, trying to fix everything and find solutions (typical man).
He has been going over the rumination thing and my lack of positive thinking. I know I overthink. I even overthink good things. The problem is I always have and it feels like part of me. Questioning that feels like a direct attack. It may be an exacerbating factor, but it isn’t the only problem and I also don’t know how I could really change this. I can tell myself to stop and distract myself, but the running commentary just carries on and questions me further. I will almost overthink, overthinking. Distraction works to a point, but when I stop I just go into thinking overdrive instead and I can’t distract forever.
He has all these suggestions of how I can get better and things I need to do. Thinking and therapy techniques, supplements, the usuals of exercise etc. Many of these I do try to employ already and it is all well and good to suggest them, but at the end of the day I am: a) unwell and that can make it hard to do anything, especially when I’m in crisis and all logic goes out of the window, b) stuck in here so many of the suggestions are impractical and c) they may help to some degree but none of these things are going to fix things.
It still feels like he basically wants me to buck my ideas up. I was getting frustrated by this. I know he means well and is trying to help, but I wish he was perhaps more sensitive in his approach. He has gone from acting caring and supportively over the last couple days to criticising me again. I do wish things were all as simple as a bit of CBT, some positive thoughts, routine, eating and exercising well and some distraction. Sadly they are not.
Edit: Maybe this is unfair. The conversation was frustrating and I did feel attacked at times, but I am glad he is trying to help. Some of his suggestions were helpful. There are good bits within the bad. I do just find it hard to see them and I don’t know how much I can do right now.
Today looks pretty bleak and pointless. More waiting and the thought of another long weekend ahead is tiresome. I asked about having Nikki, coming to visit so we could have a walk around the grounds, utilities the nurse said I need to get it sanctioned by the doctor. Considering I am not on a section and would be escorted by my partner this seems unfair. I wish I could just walk out and although in theory I can, they are unlikely to let me. A section would probably beckon, if only an assessment one.
I am tempted to ask for some haloperidol! It is the only thing to ever sedate me and although it turns me into a zombie, I’d quite like to sleep away a few days in an antipsychotic-fueled daze right now. It is not practical in the real world, but in here it doesn’t matter. I don’t have any PRN written up as nothing really works.
Anyway this is pretty long and I’m scared it won’t post! I better go. Xx
Discharge…
So it is official. I am being discharged from The Priory by Dr G. I contacted her yesterday about the outcomes of my NHS appointment and her secretary called me back to say she will sort out the discharge paperwork and copy all my notes to send over to the CMHT. I knew it was coming, but it was still a little weird to know the decision has been made and put into action.
I am really going to miss her support. In a couple of days it will be a year since I first met her and a lot has happened in that year. She has been there through everything and has done her best to help. I wouldn’t be here by now if it wasn’t for her. On many an occasion my promise to her to keep going has stopped me acting. I am not going to say I’m grateful for that, because I still wish I wasn’t here, but I am sure my family are grateful.
Mood wise I’ve come back down from last week. Things started to calm down on Friday and by the weekend I was back to numb, monotonous depression. I’m missing the buzz from last week and disappointed that the promise of hypomania hasn’t been fulfilled, but in a way I am glad it is over. Impulsivity is always a real risk when I am wired like that. The flat depression isn’t fun either though. I am so bloody bored of feeling like this. Able to function, but wishing I wasn’t. Stuck in some kinda half-existence, where I go through the motions but feel so little and care even less. In a way it is better to feel worse, because at least then you are feeling something.
Today I was interviewed for local radio. Next week they are focussing on mental health in the run up to World Mental Health day on 10th October. The BBC came to Creative Remedies this afternoon as they want to feature the scheme on one of the shows. I was a little surprised when the staff asked if they could interview me. I had no idea what I was going to say, but managed to get through it and hopefully with a little editing I will sound half-coherent. I’m not quite sure why the outreach team picked me as I’ve not been going for long, but I guess I come across as fairly confident and talkative in sessions, where as a lot of people are quiet and reserved.
The team were asking me about ideas for advertising and improving the scheme. There are a lot of things they could do with it so it will be interesting to see how things go and what suggestions get implemented. They also want to set up a website about the sessions and to have somewhere to display our work. Of course I have experience in that area, so it looks like I’m going to work on that with P, one of the outreach workers. I think the team are quite keen to make use of my skills!
Not much else to report. Life goes on.
Creative Remedies…
So I started at Creative Remedies today in the performing arts group. There was an interesting mix of people and an awful lot of staff. It was the first week after the summer break and there was a new tutor and some new staff so no one seemed to know what was going on at first. We started with singing, which I enjoyed. I’ve sung a lot in the past so felt at home doing the breathing exercises and warm up. This was followed by some movement and yoga stretching, which was far more energetic that I’d expected. I was falling out of my top, so know to wear something with a little more covering next time! Overall the session was okay, but I’m not sure how helpful it is going to be. It kept me distracted for a couple of hours and got me out I guess.
Friday and Saturday were days of cooking. We made some nice platters to take along to the wedding. Pink Swirly Meringues and Mars Bar Cakes on one, Goats Cheese and Red Onion Rolls and Pizza Fingers on another. I also made gingerbread biscuits and my bloke made coleslaw and potato salad with his own mayo. The meringues and mars bar cakes were especially popular. The reception was nice and relaxed. It was lovely to see the brides and there was an impressive buffet. We left fairly early though as we didn’t know many people and we were flagging a little.
Yesterday, my bloke’s mum, sister and boyfriend came up. It was the sister-in-law-to-be’s birthday on Saturday so I made a cake and we had dinner. I always find visits from the in-laws stressful and this was no exception. I was ready to hide by time they left and we had an early night.
Tomorrow I see Dr G. I’m glad. It’s been a while since I’ve seen her and I need input. Things have not been good since I last saw her and I hope she will have some suggestions. We will see anyway.
Disappearing Posts…
Some of you may have noticed that my posts disappeared yesterday for a while. My bloke and I had an argument and in order to hurt me, he signed into here and deleted my blog. Thankfully he had the nouse to back it up first, but I was still upset and felt violated.
I saw Dr N this morning. As always it was good to see him. He always gives me time and is understanding. We talked about various things, including the arguing and anger, work and the CMHT. I got my script and I now have my melatonin so here’s hoping I get a decent nights sleep soon.
He is still keen for me to go back to work, but I just don’t know how I can. I am still as low as I was last May when I was signed off initially. I can’t handle even the smallest thing and I just snap and lash out. I’m worried the stress would tip me over the edge and I’d end up hurting someone or killing myself. Last night I dreamt I was at work and I hit my old boss. It was horrible. I hate that vision of myself and worse, I know it is close to reality. I suspect I wouldn’t last a week, even on part-time hours. I really don’t want to go back before I’m ready, yet I don’t know if I will ever know when I’m ready. The longer I leave it, the harder it is getting.
I am getting frustrated at being left behind and the way this illness has ruined my career. If I’d been well I’d be promoted this September. I am being left behind by my colleagues that started with me. Even worse, people that started after me and who were not as good at their job as me are being promoted ahead of me. I feel like a failure.
I fear returning to work and people’s thoughts about me. I fear the questions about my absence. I fear people’s confusion over why I’ve been in the company over 2 years, but have not been promoted to the next level. I fear people will think I’m useless because of that.
So far I’ve had some fairly negative reactions to my time off from work due to illness and that both upsets and worries me. I feel that I’ve lost people’s respect. What if I can’t find a new project because every manager is too worried about my sickness record? What if they treat me differently?
There is part of me though that is dying to go back. I want to get out of the house and start my life again. I want the freedom and independance that work will give me. I want the social life that work gave me. I want the daily routine. I want a reason to carry on. I’m fed up of this illness ruining my life. I want to go back and be better than ever.
I know that going back would not be the same. I loved my old job, but this wouldn’t be my old job. I will be working on a new project with new people. At first I will not even be on a project, which will be strange and difficult. I don’t want to return to a watered down version. A phased return would be painful for me, even though I know it is for the best. I want an exciting project and want to be in the thick of things. I don’t want to do pointless activities for the sake of it. I don’t want to be stuck in the Manchester office all the time. I don’t want to be learning how to do my job again. I am worried I just won’t be as good at it as I used to be. I am not as sharp and find everything so difficult.
When I went back to my old role for a few days last August, I found it unbearable not being able to do my old job. I found it unbearable knowing that someone else was now in control. I won’t be going back to the same project this time, so maybe that won’t be a problem, but then I’m scared about starting over again with something new.
There are also the small issues of the finance side of things. If I go back my permanent health insurance would be stopped. Initially it is complicated as I won’t be working full hours, but I’d be on some form of pro-rata pay. Also I’m currently applying for ESA. If I tried to go back to work and found I couldn’t manage it, I wouldn’t be eligible to claim again for another 28 weeks. It’s not exactly an incentive to try and go back before you are ready.
I guess we shall see what happens. I am signed off for another 6 weeks or so anyway so won’t be deciding before then. Dr G said yesterday she doesn’t think we can consider it until at least the end of September and I’m not sure I’ll be ready then. I will also have to attend an Occupational Health appointment before they let me back. OH of course might decide that I’m not well enough anyway.
Urgh…
I feel awful. I don’t know why, but my mood has dropped like a stone.
I saw Dr G this afternoon. I didn’t really know what to say to her. I just said that my week had been “more of the same”, but she tried to probe further and wanted me to tell her how I actually felt. For some reason I didn’t feel able to. I was just vague and didn’t know how to explain things. She asked me about my suicidality. All the way there I’d been thinking about how I could still do it at any point if the opportunity presented itself. Suicide was on my mind. Yet when asked, I played things down. I said that the thoughts were still there, but that some of the time they aren’t as strong as they have been. I said that, when only a few minutes before seeing her they were as loud as ever.
I think most people would be surprised at my suicidality, even now. I suspect that most people think I wouldn’t do it now as I’ve managed to resist for so long. I suspect that most people think things are improving and I am on the way to recovery. The reality is though I am kept safe and if I wasn’t, I’d be long gone.
In some ways maybe I am on the way to recovery. Lamotrigine has been the first medication to not make me worse, and maybe with time it will make things better. My concentration has improved a little and I’ve started to read again, something I wondered if I’d ever do again. I am usually not grappling with the most extremes of my mood any more, although I still have my moments. There are enough encouraging signs to give Dr G and others some hope.
The problem is it is not enough and I still feel hopeless. In many ways I’m still as ill as ever. I could give up on these signs of recovery at any point. I could and probably would end it all given the chance. It may not work and then I’d be back to where I was last February, but I’m certainly willing to take that risk. I don’t care that I may get better. At the moment things aren’t good enough to want to survive.
I am still not sleeping – rarely getting more than a few hours. Dr G has decided that it’s worth trying Melatonin (Circadin). I need to see Dr N to get the script. I hope it helps. Anything is worth a try.
We also talked about how we are going to manage things until I see the NHS. I will continue to see Dr G for now, but I will probably have to be passed over following my appointment with Dr B (or her team) in September (if I make it that far :S). Something I am not overly keen on.
I wish all this could be over. *sigh*