Into the system…

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Posts Tagged ‘ward

November 4th: Out of the hospital…

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On November 4th, the 28 day limit on inpatient care was reached with my insurance, so I was to be discharged. I had spent the days prior to my discharge panicking about it, knowing I was no better than I was when I was admitted and worrying that I wouldn’t be safe. I did not want to be discharged. I felt safe on the ward and needed the support. It felt like my safety net was being whipped away before I was ready. I couldn’t comprehend life outside of the ward. It was too scary and daunting.

It was clear I wasn’t ready to leave and Dr G said she’d have ideally kept me in for a few more weeks, but it wasn’t to be. When ward round came around that morning, I was in a state. I couldn’t think straight, was shaking and could barely talk. Her words washed over me and I couldn’t comprehend leaving. I was disappointed that she didn’t seem to acknowledge my fear. I know she told me about what support was available to me afterwards, but it didn’t feel like enough to calm my fears. I was terrified.

Later, I met with the therapy coordinator, J and this was a big help in preparing me to leave. He managed to calm me down a little and helped me to accept that I would be leaving. We looked at the options for day care and talked about the things I could do to get extra support on the outside. Eventually we settled on a programme and I had time to pack and get ready to leave before my last therapy session.

I was sad about leaving. Although most people that I had made friends with had been discharged ahead of me, there were still people I knew I’d miss when I left. I didn’t really want to say goodbyes, so it was kinda convenient that my departure coincided with dinner and everyone was in the restaurant. We took my stuff through to the car and then I got ready to go.

It was very weird being free to leave, after spending the previous four weeks being escorted everywhere by a nurse. I had taken some leave whilst I was on the ward, so it wasn’t a completely new phenomena, but it was still quite strange. It left me in a daze and this was kinda how it felt for the next few days really. It’s weird when being at home feels like a strange experience, but that was how it was. I’m still getting used to it really.

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Monday, 17th November 2008 at 7:42 pm

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.

Exhaustion…

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I’ve just got back from day care and all I want to do is curl up and sleep. I have a stupid cold coming on and am emotionally and physically drained. After my afternoon group, I was going to go down to the ward, but I realised I didn’t want to because if I did I wouldn’t want to leave again! I know I need to move on from that being a safe place and get used to being at home again, but it’s hard. I just wanted to hide away.

I’m physically exhausted as I have to walk back a couple miles to catch the bus home and I’m feeling rubbish with this cold. The alternative to a long walk is waiting a few hours for my other half to finish work and come pick me up. That or pay for a taxi I guess. Not ideal. I’m unable to drive at the moment due to my medication.

Anyway, I’m going to hide in my bed for an hour or two. We have visitors this weekend, arriving in a couple hours. I don’t know how I’m going to cope. Too tired.

Written by intothesystem

Friday, 7th November 2008 at 6:09 pm

Into the community…

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So I was discharged on Tuesday, following four weeks as an inpatient on a private acute psychiatric ward. I was not ready to be discharged, but my insurance had a 28 day inpatient limit, so there wasn’t much choice. I certainly can’t afford to self-fund!

So I’ve returned to the community and so far it feels a bit strange, but I’ve been okay. If I’d been chucked out on Monday there might have been a different story. My mood was on the floor, suicide the only thing I could think about. The same horrid scenario replayed over and over in my head, blocking out all my thoughts and stressing me out. I couldn’t comprehend leaving the ward in that state. Luckily, my mood picked up around Tuesday lunchtime and I’ve been “okay” since. Still low, still struggling to think, but not too bad. For once, my mood shifted at the right time!

In terms of where I am now. I’m still not formally diagnosed; this episode of illness just has the vague description of “depressive episode”. Whilst I was in hospital, I had two short periods of hypomania, demonstrating the clear shifts of mood I’ve been experiencing for most of this year, but this still hasn’t been enough to solicit a diagnosis. My psychiatrist is hedging her bets a little. She believes I do suffer from a mood disorder, but she is not being more specific than that. She said that the predominant picture is one of depression, but that this is complicated by the fact I do have obvious shifts of mood, suggesting that perhaps my diagnosis lies within the bipolar rather than unipolar spectrum. She is still uncertain though and won’t commit to this. She also added that my condition appears to be somewhat complex, due to added complications with my personality (perfectionism, passivity, workaholic). I suspect she is weighing up the decision to slap on a personality disorder diagnosis or two. I’m sure my symptoms could be moulded to satisfy one if she deemed fit. This lack of diagnosis is both frustrating and a relief. I am glad she isn’t rushing into things. I’m glad she hasn’t just wheeled out a diagnosis of borderline personality disorder because I self harm and have been difficult to treat. Yet, at the same time I wish she wasn’t being so vague. I want to know if I need to accept this is a chronic condition that I will be dealing with for the rest of my life. I suspect that it is, but I can maintain a state of denial until she confirms this for me. I want to know what it is I’m facing.

My current medication regime is as follows:
8am: 225mg Venlafaxine (Effexor XL) & 50mg Quetiapine (Seroquel).
4pm: 50mg Quetiapine
10pm: 250mg Quetiapine

So far, I am unsure how much it is helping or not. I suspect the Quetiapine is helping with my sleep. The drowsiness kicks in fairly soon after taking my nightly dose and although I am still waking fairly frequently and not feeling all that rested, I am definitely getting more than before. I think it is also helping to level me out a bit. My mood isn’t spiking as much as before, but just seems to swing between varying degrees of lowness, instead of going from very low to a little high. I started on a tiny dose, but almost every time I see her she adds more!

I do not know if the Venlafaxine is helping. My mood is predominantly low at the moment and the suicidal ideation is still around fairly often (which I guess could actually be the fault of the Venlafaxine – it has a reputation for increasing suicidal thoughts), so I suspect not, but then if I wasn’t on it would things be different? I wonder what her next move will be with this. She has upped my dose a few times to get to this point, but I suspect she won’t up it again.

I start day care tomorrow, attending Mondays, Wednesdays and Fridays for the next six weeks. I will be continuing with some of the groups that I attended as an inpatient and starting some new ones. I am looking forward to some of them, but apprehensive too. Therapy is hard work and often makes you feel worse, not better.

Tomorrow, I have group CBT and Expressive Therapy. I am still to be converted on the CBT front. I’m not sure CBT is all that helpful to me, but the group is quite good as there are two therapists, which ensures everyone gets some individual support. Expressive therapy is a bit like going to playgroup and is different every week. We may be painting, playing games, doing role plays, singing or whatever, but it’s usually quite fun. A bit of light relief for a Friday afternoon anyway.

It will be really good to see people again. I should get to see some of the people who were inpatients at the same time as me, as well as the day patients I’ve met in group. You find that you make close friends easily when you are in a hospital environment or group therapy situation. You learn things about people that you’d never share in the outside world and become intimate friends very quickly. The empathy between patients is something that’s hard to find elsewhere. The only other place I’ve really experienced it is in this blogging community. It’s not just between the general psychiatry patients (depression & anxiety) either. Even the addiction and eating disorder patients have that sense of shared experience and empathy. I do miss the fact I could just walk into the lounge and there would always be someone you could talk to that would really understand. I think so far, that is the hardest thing about being in the outside world.

Generally I think I should be safe over the next few days assuming my mood stays roughly like this. I’ve got a friend coming over this afternoon so that should be good. Although my bloke is out this evening I think I’ll be okay. It’s a bit weird being on my own after 4 weeks of almost constant supervision, but so far I’ve not been too worried. Tomorrow I am in day care, which I am looking forward to, although I’m a little worried about how I’ll feel when I go home after a day at the hospital. Therapy can be draining and it might leave me feeling weird without the safety net of the ward to go back to afterwards. The weekend brings visiting friends and bonfire night, so I should be suitably distracted throughout and Monday brings a return to day care and a review with my psychiatrist. I dread the review a little as I am terrible at getting my needs across, but I will try and prepare a little beforehand.

I’m not sure that “being safe” should be all I’m aiming for, but it is all it feels I can aim for at the moment. I guess I should be pleased that I can feel safe. It is an improvement. A couple of days ago I really didn’t think I’d be safe in this outside world and so far I have been. I am still uncertain though and still don’t trust myself completely. I think I do generally feel as if I may be existing for existence’s sake. That doesn’t make things easy. I get close to giving up more often than I probably should, but it is incredibly draining just going through life for, what feels like, the sake of it. I just have to keep telling myself it will be worth it. I just have to get through this period of crapness and hope for things to change. Not easy though.

Anyway, I have written enough for now. I will update on the weeks before my admission sometime soon, although I don’t really know where to start. It has been a crazy few months.