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Posts Tagged ‘counselling’

I had my last counselling session with L today. It’s been almost a year since I first met her, almost a year of our weekly meetings, almost a year of my tears and frustrations and setbacks.

Given my track record for people letting me down when I tried to trust them as a youngster, or the bad attitudes I got from people who either knew about my dad’s drinking, or just expressed a general opinion towards alcohol misuse, and coming from a family so emotionally desolate it could be the Sahara, it’s no wonder that I was so afraid of trying to open up. It’s no wonder, I found counselling such a challenge.

Sticking with it, is possibly the biggest proof I will ever have of my tenacity and determination. I never missed a session, even when it was the last thing I wanted to go and do. I’ve had a year of being totally drained on a weekly basis, and then having to go and try to live normally in the spaces in between, until the next strike. It’s the hardest thing I’ve had to do – a year of finding bravery. I’ve managed to purge a few of my demons and get some light into the parts of me that were pretty disordered and dusty. I’ve learned to accept and give my issues with alcohol a name, and because of that, because I’ve come to terms with having different thresholds and boundaries for dealing with it compared to a lot of people, it’s that bit easier – I don’t need to drive myself half crazy with it, anymore.

I’ve said before that I have a feeling that had L and I met on other terms, we would have got on very well. I’m going to miss her, in a lot of ways. Having a constant person in my life over the last year, has been a lifeline, even if that was really mostly because she’s so nice I didn’t want to upset her by failing to turn up, or worse. I have her some homemade shortbread and a thankyou card today, and was shocked when she looked genuinely sad and said she’d thought about getting something for me, but wasn’t sure about protocol – I was pretty touched. I think she’s sometime more open and puts herself on more of an ‘equal par’ with me than a counsellor probably should – but I also like that she’s been that bit more interactive than a more experienced person might have been – I always quite like it when she got visibly angry about the med school lot being rubbish, or something going wrong.

I never thought that when I finished with L, I’d be back in the middle of depression. All of this, is pretty bad timing, with me going away in January. But even in spite of feeling flat and low and empty, even in spite of being jittery on meds and exhausted from not sleeping, and anxious about my workload and all the rest, having untangled myself that little bit this year, makes it so much easier – I’m on more solid ground, I’m not coming from this emotional poverty, this inner warfare, that plagued me for so long. I’m thinking straighter, more able to formulate and follow a management plan.

It’s been a strange year, so marked by a struggle to get through that other landmarks sometimes went uncelebrated. Academically, I beat a lot of odds – I passed and passed well, when no student in my situation had done so for several years. I got a high enough score that I can get a job I will hopefully love. I delivered my first baby, fed my first lonely newborn, saw my first death, compressed my first chest in hospital. I preached my first sermon and learned about the power of the church community to heal, as well as do harm. I stitched my first scalp and sited my first cannula. I went on my first roadtrip, with two good friends and one grandma. I came close to losing my faith, and yet all it did was grow stronger and knit itself even closer to me than it had been before. I learned to talk about my past and issues and to find a voice that had been lost for years. I learned how to begin to heal. I learned how to let God, heal me. L was there through all of that – and I thank God for her, every day. With counselling ending for the time being, and the letter/email last week, I kind of feel that although I’m in this new phase of depression, last year is over and a new phase has began. I think this phase will be better.

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I had my GP appointment yesterday, with a new doctor I’ve never met, but who is meant to be ‘good at mental health stuff’ who I was hoping would make me feel more like a person with a problem, than the problem itself which was a bit of an issue last year with stereotypicalgrumpymiddleagedmaleGP.

It’s been one of the hardest weeks I’ve had for a while, though some of the worst things aren’t really suitable for public writing – but believe me when I say that last week was a struggle. I kind of feel like someone’s flicked my ‘off switch’ and I just can’t get it back on – like I’m stuck back where I was, stuck in apathy and exhaustion and endeavour, and unable to climb out. This is not who I am. This is not who I am, at all.

I told the GP that after a few months of almostifnotquiterecovery, I think, or know that I’ve relapsed, and she did a good job of asking for once all the questions you’re supposed to ask someone in that situation, and seemed nice. She agrees that I need to try medication again, and also agreed to let me try another SSRI, so I am now on sertraline, starting this morning, with another appointment to check in next week, and when I need to decide if I need or want to be referred to psychiatry.

I’m feeling pretty dented – but I know that I’m sliding down so fast that I needed to do something whilst I still had enough insight to book and turn up for an appointment. And I’m afraid of what the next week or so will bring, whether this new drug will just push me further over an edge like the last one did, whether I’m really going to lose my grip and ruin things. I’ve emailed the Dragon again to get her up to speed and am starting to accept that I’m going to be entering another phase of endless meetings and trials – but I am also hoping so much, hanging on, so much, to this new tablet working and taking this black mood away. It kind of feels like a last resort, though I know that’s just my messy head talking. I’ve got to be stable before I go to Nepal though, or try to sit finals, or start my first job. I’ve got to be stable.

It also made me a bit sad when this GP was asking a lot of questions about why my family know nothing about last year, or this year for that matter, and why it is that my relationship isn’t as strong as it could be, and why I’m single at the moment. I can’t help where I come from. And yes, sometimes I’m pretty jealous of people of my age with very supportive families, or who are fortunate enough to have found the person they want to spend the rest of their lives with. But my family has its problems, which I manage by finding support in other places, and depression doesn’t really help you find a partner either. She made me feel quite alone, particularly as things with my flatmates are pretty difficult this week. It’s taken almost a year of counselling for me to accept that all the patterns I grew up with put me off trusting people quickly, or wanting to have close relationships that had the power to harm as much as heal, when things go wrong. And I am learning, and getting better at letting people in, and have strengthened some fantastic friendships because of that – but I don’t really need reminding about my lack or roots, this week.

Anyway – at least things are a bit more in place now, I can plan a little easier what’s going to happen. I’m not in limbo any more. I’m a patient again.

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Still

The last few days have felt both frighteningly familiar, and brand-new, all at once. On the one hand, it seems like every day brings more confirmation that I’m ill again, and yes, I am afraid of being back here, of falling down again. I am afraid.

However, now that I’ve accepted my lapse, and done the practical things (doctors app, seeing ‘the dragon’ today), I’m in a bit of a stalemate  now. Unlike this time last year, when I wasn’t really willing to accept just how bad I was, this time, I’m putting things in place. It’s almost out of my hands now – until I’ve seen the doctor and talked things through, all I can do is keep going and hope for the best. That’s not saying I’m giving up and spending a week with my head under a blanket – but just that there’s not much more I can actively do, now, aside from try to keep things ticking over.

I met L after meeting the dragon today (the phrase ‘glutton for punishment’, comes to mind) and am feeling pretty bulldozered by it. She seemed to start panicking when I told her I knew I was going downhill again, and said maybe I should see someone else – which is ridiculous as I’ve only got a few more weeks till we break for Christmas, after which I’m going to Nepal – and I didn’t really know what to say to that, apart from feeling pretty cross and upset as I wasn’t quite expecting that reaction. I sort of rely on her to NOT panic and be calm – and it threw me off. It’s the first time I’ve felt angry with her. And then she started going on about church healing rooms and suggesting I think about it – which also confused me as I’m really not one for asking for people I know to pray for me, let alone strangers, and to be honest, it sounded like a last resort – as though I’m in need of a last resort. It’s nothing to do with my faith in God not being strong enough, to find healing in these places – it’s that (as she knows) people have inflicted quite a lot of damage by using prayer to say things they had no right or reason to say, and I don’t trust other people with my faith, especially when I’m vulnerable. Not at the moment. And what I needed was for someone who has heard my reasons for fearing medication, to encourage me and tell me that I’ve done right in making these appointments and gearing myself up to try them again. I didn’t need that decision glossing over and marginalising. Her suggestion was so completely out of my range that it makes me wonder if she’s been listening at all, these last few months. Feeling like a lost cause, is never a good thing.

And yes, it’s just this latest drop that making me feel as though the rest of my life is going to characterised by many more troughs than peaks, and yes, it’s just this depression that makes me feel so relentlessly unable to fathom how I’ll manage that – but it’s how I feel, today. It’s how I was feeling after seeing the dragon and being up since 6am after a sleepless night. It’s how I was feeling after finding church on Sunday more painful than its been for such a long time. It’s how I was feeling, as I realised how much I’m playing for at the moment.

I know, that mulling over things isn’t going to help and that there is no gain in regretting past decisions or thinking over mistakes I made – but if I can’t rock up at counselling after a crap week with a pretty big realisation, and cry and say that I don’t know where to go from here, and how I’ll get through another period as black as last year if it comes my way, where can I say that? I have acted to sort this out as quickly as possible, but that doesn’t mean that my mood hasn’t plummeted, and it doesn’t mean that I’m not devastated at the moment by this latest change.

I’m not sure what I’ll do next week. Part of me doesn’t want to see L again. Part of knows that I probably need someone keeping an eye one me. It’s hard, sometimes.

Thanks to all who’ve been thinking and praying for me. It helps.

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I realise I’ve not written too much about my counselling with L of late – mostly just because other things seem to have subsumed them, or my posts haven’t gone up soon after a session.

It still seems odd as the longer I know (as much as you can ‘know’ your counsellor, anyway), the more it seems that if we’d met in other circumstances, we’d probably have got on very well. It’s like that Thomas Hardy poem, ‘the man he killed’ – except unlike in the Boer war, bloodshed is very much frowned upon in therapeutic circles…. The concept is the same though – in other times, in other places, on different terms, our relationship might have been more equal, more balanced. I’ve thought a bit this week about how I’m now past the mid-point in counselling as once I leave for two months in a Nepalese hospital in January, L and I will probably never meet again. I also had an email this week from an old teacher at school, which has also made me think a great deal, as she was the first person I ever told about my dad’s drinking, after I came into school one morning after sitting overnight in A and E, and just completely broke down. She was the first person who listened to me – and when I refused point blank to try any form of counselling, she didn’t push me, and supported me through my final years of school by giving me books (she was a very stoic English teacher and very much subscribed to ‘reading through the pain’ – as do I) and generally being lovely. She also never breathed a word to my parents, which must have been a hard decision to make, but one I am eternally grateful for.

I was sixteen, then. It took another seven years for me to get myself into a counsellors office and capable of staying there. Growing up in a substance misusing household changes your perception of risk, gain, and potential for harm. For me, the risks of opening up were just to great, for too long. I’d lived under the shadow of a tabboo topic and couldn’t break it. There was too much at stake, and too many ways that it threatened to push me over the edge. By the time I had no choice but to go, I was already as far over that edge, that I could go. And it’s taken more courage, each week, every week, than I can often describe.

Yesterday, I hadn’t been thinking too much about what to talk about, but then had an extra half hour to waste as I headed over as I got away early from the childrens hospital, and as I was walking, realised that I’ve felt pretty flat recently. And yes, I’ve been busy and harrassed, and busy again – but I’ve also been a little numb, a little flat, in a way that being busy and somewhat misguidedly listening to the latest deathcab for cutie album,  just doesn’t quite explain (everyone has a band they should have outgrown, but never will – deathcab are mine). I was already crying, by the time I got there. I was already crying, and wasn’t even that sure why. It’s that feeling of mourning something, that I can’t quite shake off, that feeling of being without something, of being tired out and work out and desperate for some relief from the heavy days and all of their requests. I can cry in front of L, now. It does get easier.

Part of it is that I’m over-reacting a bit about a meeting I’m chairing next week for the medical school mentoring scheme that I set up (it’s going very well, which is nice) – and asked for a member of the medical school’s pastoral care counsel to come along to speak to us. The person they allocated is a psychiatrist that the student support person (aka ‘the dragon’, for longterm readers) told about my depression, without my consent, when I took myself off medication and went more than a bit haywire. And although I should be able to say that he’s a psychiatrist and this is what he does for a living, and that he probably won’t remember me by name alone anyway, I’m also terrified that he will and will say something, and I’ll start crying. I’m fed up of feeling as though every single time I feel like I’m getting past all of this stuff, something jerks me back. I’m fed up of feeling like I’m tattooed for life. I’m fed up of feeling as though I will always be judged first on my history of depression, before anything else comes into play.

L was pretty good about all of this, and I do find that I trust her opinion, which after six months, is a good thing. Counselling still leaves me exhausted though – it’s not as simple as being a release, or an outlet. It wears me out. Sometimes everything just feels so dramatic and difficult. Simplicity is a wonderful, enviable thing.

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First off, my ‘date’ yesterday afternoon was really rather nice. I think I’d like to see him again.  I’ll stop before this gets too schmalzy.

Some things this week have been tough, though. I know I am prone to a lot of introspection, but I think that this week with all the other things going on (job application: finally submitted!) has led to me thinking more than ever about mental health, and my own path through it. More specifically, after seeing pretty quickly that 30% of beds on accident/emergency are perpetually filled by overdoses, self-injurers and suicide attempts, it’s made me question what made me, to put it bluntly, manage to hold on when I was at my lowest. I don’t always know the answer to that. I don’t know what separates me, from the people who come in to the ER and sadly never leave. I don’t know why I was brought out, and they were not. I do not know. Sometimes, I think it’s mostly because I was too scared that if I tried anything, I’d end up being treated in this same ER, with my peers on placement peeking at me round a curtain. It was the potential for shame, that kept me alive.

But on the other hand, I’m kind of struggling with having a flatmate (and best friend) who is now being started on treatment for mid-grade depression. I encouraged her to go back to the doctor’s this week for follow-up and afterwards,  and was trying to explain that she shouldn’t assume that her medication won’t work just because mine didn’t, but just ended up frustrated. I think part of it is that when I really really needed someone to hold my hand through things, there was no one quite up to the job. I know I asked her, at one point, to phone and make an appointment with the psychiatrist I’d been referred to for me, as I just couldn’t face it, and I needed her to go and fetch the number, and do it, there and then and take that task from me. I needed her to do it and give me a date and a time, and make sure I went. I couldn’t face it myself. No one rang for me, and so I never went. No one encouraged me to go back and see another doctor, or keep taking medication. With depression, you sometimes need someone to take charge and just force your hand; I think they were unsure or afraid or doing that; perhaps it seemed too difficult. I fought my way out of last year without medication or psychiatric input, or anything much, really, and am still reeling from it. I’m still not back to where I was. I don’t know if I’ll ever get there.

And I want so badly for this first, low dose to work for her. I want her to be one of the ‘miracle cures’. I’m praying for it. But I also am just so bogged down with wondering why it did not work for me, why I was less worthy, or deserving, or able of mending myself. I ended up on three times the starting dose, and it was never right. I’m helping guide her through it, but that small part of me is angry that I had no-one who knew enough, or was confident enough, to tell me, show me, how to get through depression. My flatmates were not medical and did not know. I know it doesn’t mean at all that they didn’t care – but sometimes, caring isn’t quite enough. Sometimes you need action and motion. It’s hard. Sometimes, I feel like I’m always leading the way or teaching from my experiences, but having to learn the hard way myself – and I know that’s partly because I hardly make things easy, but by the same token, last year, there were all these people I was having to go and talk to, and to be honest, none of them really did much for me. They didn’t return my emails, or check in. They didn’t chase me up or ask my tutors to keep an eye out. They just looked awkward when I cried at them and promptly forgot me.

And it makes me angry when she says things about counselling not ‘being for her’, as though you have to be a bit self-indulgent or attention-seeking to benefit from it. It makes me feel fobbed off – I’m not sure anyone who has not ‘done counselling’ knows how hard it is, or how much effort and courage it takes to go, every single week. I’m not sure she realises that it’s no easy option. It’s been the most painful experience of my life. Perhaps it’s my fault for never telling anyone that I get there fifteen minutes early so I have time to coax myself through the door, or that it still makes me cry myself to sleep every single week, and leaves me drained – but I don’t appreciate feeling as though I’m a weakling for trying it. I’m a stoic, in many ways. Counselling has gone against all of my instincts and taken away any feeling of safety and privacy I had. It’s not for the faint-hearted.

I guess, in ‘mental health’ terms, this week has just been ‘extremely triggering’. I’m not sure I’d really appreciated stuff like triggers before. I’m on the nightshift this weekend, and spending twelve hours at a time surrounded by drunk people, is wearing me down. However, this time in a week I will have a week’s holiday to look forward to, and I really can’t wait to have a few days away from the city and medicine, where I don’t have to think about all of this.

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Life is pretty busy at the moment – I’m doing anaesthetics this week so working for as long as there’s operations going on, essentially, and trying to sort my job application at the same time. Anaesthetics isn’t for me – I’d rather be the surgeon doing the cutting than the anaesthetist enabling them to operate – but it is interesting. I intubated my first patient this week, and am enjoying getting to learn more and more practical skills – I feel like I’m finally really learning the ‘tools of the trade’. And I’m not going to lie – helping them put a tracheostomy tube in was pretty AWESOME. I’ve written before that I love medicine, but it’s things like this that really make me rejoice and thank God for guiding clever clogs through the centuries – we can keep someone alive. We can breathe for someone. When you need it, someone will literally breathe for you. That’s pretty amazing.

Counselling on Monday was pretty rough; she’d not had time to read back through everything so I didn’t get feedback, despite being a complete bag of nerves all week over it. So, I have another week to wait. Part of it is that although she’s pretty much duty-bound to do the whole unconditional positive approach or whatever, I don’t really believe it. I’m still, even now, as ever, set to this stance of incredible negativity, which only gets worse when I’m a bit emotional as I am at the moment. I’m half expecting her to tell me I’m a hopeless case and that I’ll never achieve that all elusive balance. I’m half expecting her to tell me I’m wasting everyone’s time and just need to get over myself.

I’m so tired at the moment, which is not that surprising as I’m doing long hospital days, followed by a few hours of studying, and then repeating ad infinitum, but I am just feeling so very drained. It’s tough with F and her pathway through possible depression at the moment, particularly as I’m the only student on my block and literally go all day without seeing any peers, and then come home to a fairly grim flat. I’m feeling a bit shut off at the moment. I’ve just got too much in my head at the moment. Between my job application (due in a week on Friday) and everything else, I’m just feeling stretched. I’m also feeling a lot more anxious than usual which is starting to worry me (ironically) – whether it’s just that I’ve had some pretty harsh clinical tutors recently who have really dinted my confidence is hard to say, but I’m not enjoying the whole racing heart, light-headed thing. I need to be working at the top of my game. Strangely, I’m very good in actual high stress situations – I can get cannulas in quickly and helped resuscitate someone today – it’s just there in the background, more of a confidence in the small things problem, as when I actually really need to step up, I can. I’m putting it down to a stressful few weeks, and am hoping that once my application is done, I’ll breathe easy again.

One thing I’ve thought about this last week is that my prayer journal has changed in the last while, for the better. Every Sunday, I write at the top of my notes things that I’ve done that week, and things I need to pray for in the coming week. For most of last year, there were big lists of bad things that were happening, and long lists of stuff I was worried or scared of, and not very many positives. Now, although I still worry about counselling and don’t enjoy the meetings at the med school I have to go to, finally the list is becoming more positive, more reflective of who I am. This week, a student going to Londond for next year asked if he could start a branch of my visiting programme down there, which is fantastic, and tonight is the AGM for the neurology interest group I chair, which has done a good job this last year. I’m advertising the medical school mentoring scheme, which is my new pet project, tomorrow to the second years, and have a wedding to go to on Saturday; all good things that remind me that although I lost a great deal last year, I am slowly regaining it back and am still the person I always was. It’s good to feel that the balance is finally tipping back to normal, even though I know I still have a few miles to go. These things keep me going. They keep me breathing.

I’ve written before that I struggle with keeping my ‘busy-ness at bay’ – but sometimes, I am so grateful for it, as it reminds me that I make a difference and make a change to how things are around me. I need that anchoring at times. It helps me focus on what I’m doing and why. When I spend a Sunday visiting one of my old folks in hospital, part of the joy is that I know their family is feeling that bit easier as they aren’t spending another day alone. They breathe easier. Similarly, my mentoring scheme will help younger students who are battling with academics and their own issues – it will help them breathe easier. This is all what I want to do – as a medic, I want to, obviously, ventilate with the best of them and get people through crippling illnesses. But as a Christian, my goal is more simple. I want to lighten loads and lend a hand and find solutions. I want the world to breathe a little easier. I want things to hurt a little less.

We all need help to breathe, sometimes.

 

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I’ve been on the intensive care unit this last week. It’s been a mixed experience as I’ve enjoyed learning about the specialty, and am always amazed with what medicine can do, even after studying it for six years. It also reminds me of God, as despite years of geniuses beavering away, science has still not fully worked out how to do as good a job as our kidneys, hearts and lungs so of keeping us all alive. Technology is no match for divine design – but it does come in handy when things go wrong!

It’s also been hard, as by pure coincidence, all of the patients I was allocated to died – which although is obviously quite a common outcome, was still just bad luck, really. This too, is a part of life and a part of the profession I am entering, but it doesn’t make it any easier to listen to the sound of pure grieving from behind a curtain once the machines have been turned off and the chaplain has left the family to mourn. I was listening and thinking that there are certain sounds you know that by choice, you would never hear again, and the sound of a mother crying for her dead (adult) child, is definitely one of them – but this is something I am going to be a part of for the rest of my working life. It was the sound of a heart breaking, of hope, breaking. It was the sound of a life changing. It was the sound of something coming to a close.

ITU is a great equaliser, in many ways. Humans are bloody fragile. We may be marvellous products of creation and evolution, but that doesn’t change the fact that when you’re sedated, intubated, ventilated, and dialysed, there is something so vulnerable about every last one of us. I never got to speak with any of my charges this week as they were all incapable of communicating, whether due to sedation or ventilation – but I felt like I got to know them, nonetheless. I met their families. I occasionally caught their facial expressions and eyes. It makes me sad when at times it seemed they were being treated like  a pile of failing organs, not a person – but I can also understand that at the end of the day, this is probably what long-term staff must do, in order to do their jobs. When my patients died, the process of turning off everything and removing all the tubes seemed like a strange ritual, brutal, final. I found myself mourning people I had never truly met. I found myself crying (in the changing rooms, anyway) for men and women I did not know and never would. It’s been an emotional week. I’m looking forward to getting back to a specialty where I actually get to talk to my patients; I’ve missed it, this week.

When I got my first offer of a place at medical school, aged seventeen, I went to a bookstore and used some hard-earned babysitting money to buy some medical books. The ones that stand out are the memoirs of a junior doctor which at the time scared the living daylights out of me, and a medical history book about the most significant advances of the last century. One of these was the invention of manual ventilation, which was first trialled in a big group in Copenhagen in the 1930’s, when there was a huge polio epidemic that pretty much wiped out the cities children. Medical students from all over Europe travelled there to sit at a child’s bedside and manually ventilate them with a bag and mask, for days on end, until their respiratory muscles recovered enough to let them breathe on their own. How amazing is that? At the time, the thought that someone not far from my stage, had sat and squeezed a bag to save a life, made a huge impact. It’s still one of my favourite ‘medical anecdotes’.  I love the fact that we can keep people alive who even twenty years ago, would have died. I love that we can give another chance and get people through to recovery. I feel so priviledged that I get the chance to learn how to do things like this. Even if I was a little bit terrified when they asked me to fiddle with the ventilator settings.

Tomorrow I’ve got counselling and will be getting the feedback from L about how I’m doing and what I need to focus on to ‘move forward’. Frankly, I’m pretty scared. I had keyed myself up for asking for a quick run-down last week, but not quite anticipated an indepth analysis that I’d have to wait a week for. I have a feeling it’s going to be pretty painful. I’m feeling fragile enough right now that I’m not sure how I’ll cope with it, to be honest. Tomorrow is also the day my job application opens so I’ve got two weeks of misery until it’s submitted. I’m still a bit sore that I didn’t get the chance for an academic job due to last year, and am  really feeling the stress at the moment, between placement, impending exams, problems with my flatmate (see last post), counselling, church stuff and ongoing issues with student finance (who have got to be the most annoying organisation in history). All in all, I’m feeling pretty fragile. Last week was the first one where I’ve cried every day, for quite a while. I’m just a bit drained at the moment. But, in three weeks, my job application will be done and so will my exams. Two more hurdles over.

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