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Posts Tagged ‘relapse’

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 possibly did something a little foolhardy last week. I’d been thinking a great deal on the last interaction I had with the person from my church whom I (misguidedly) confided in, when I was at my illest last year year, who subsequently broke my confidence (apparently I was suicidal enough to justify that, whilst leaving me alone, knowing that she was going to do that was absolutely fine…..cue dangerous situation) and made it incredibly difficult to both access the help I needed, and also go back to my church at all. We haven’t spoken since – although I sent thank-you emails after a sermon she gave to the students, she didn’t reply. It’s been pretty awkward. I don’t feel bitter or angry about it (though some of my friends would still quite happily lynch her) – but it felt so unclosed that I needed to do something.

So – I wrote her a letter, basically apologising for putting her in a difficult situation, but also asking that if she finds herself confronted with someone in a similar situation again, that she acts differently, as if someone is serious enough that you need to get someone else involved – they shouldn’t be left alone, and also that if she’s going to volunteer for being a pastoral support to someone, that she honours that by answering emails and actually getting back to them when they need it. We’re all learning – I am learning, you, reader, are learning, and she is learning – but there are some places where acting incorrectly puts someone else in danger, and I think people need to know where they’ve gone wrong so they can do better the next time. Last year was a mess, and no one knows that more than myself. To move forward though, we have to repair what’s gone before as best we can, we have to put the protections in place to prevent history repeating itself. We are all learning. I also said that I still pray for her, and that I am sure God will use her and her faith.

I’m not sure at all what I expected back – maybe just a short note saying that next time, she would better know what to do when faced with someone in crisis, maybe even an apology if I’m perfectly honest. I got a one-line email informing she’d received the letter and no other comment. Harsh? Possibly. There’s not much grace, there.

In some ways, this demonstrates well that I am better off with her having absolutely no involvement in my life, faith, illness, or recovery. It also shows that as I knew, we are very different people, and that I am glad for that, because I wouldn’t want to be like she is. When I first met her, I thought she had such a good faith and was such a ‘good Christian’. Now, I am not so sure. I’m nowhere near perfect, but I am not short on compassion (possibly over-imbued with it, at times) and I am not ashamed to admit mistakes and learn from them. Her reaction says a lot about her, I think. I hope that she does learn something, from our encounter – and sometimes I think that maybe that was God’s plan from it, that something good could come from my deep despair, that someone could benefit from my deep depression.

In other news, I saw the GP again on Tuesday and after hearing (and seeing my panda eyes) that I’ve literally not slept since starting the sertraline, she gave me some zopiclone (non-addictive sleeping tablets) to try. I was pretty wary of them, but after trying one, slept so much better and felt so much more alert the next day, that I think it’s ok to use them to get me through the adjustment period on the new medication. I’m still feeling very nauseous and am generally very flat, but I’m hoping that if I sleep  better (ie at all), things will improve.

I also met with the organiser of the paeds module this week as mostly due to said lack of sleep, I’ve just not been performing that well and have struggled to get everything ticked off. He was so lovely it took me by surprise – everyone else from the medical school has made me feel like a slacker, or a problem, or a weakling, but he was so kind, and knowing that I don’t need to panic quite so much about everything makes a huge difference. Hearing someone say ‘it’s not your fault, well done for getting things in place, and let’s see what we can do to make this easier’ was something I needed to hear. I’m so thankful for him.

So – it’s been a mixed week of blessings (at last, a lovely GP who listens and acts), the paeds guy, and some of my friends, who have been wonderful – and this not-quite-closure of the letter and its response. I feel like I did right though, by writing, even if the response wasn’t quite what I expected.

thanks, guys.

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Glimmers of hope

I’ve done five days on the new drug now, and the good news is that although I’m feeling continually nauseous and extremely jittery (I literally startle at every sudden noise in the vicinity)  it’s not making me as dangerously unwell, as my first drug trial did. This gives me hope that this might be a solution.

On Wednesday, we got the scores back for our junior doctor job applications (in a nutshell, you get scored across various domains including ability to write 200 word answers to questions about team work/communication etc, and then choose job options depending on score, with higher ranking candidates getting preference. Jobs which include paediatrics, emergency medicine, neurosurgery are higher ranking, as are jobs in popular hospitals). I’d panicked a bit about this as I dropped some academic marks due to last year – but I got a high enough score that I can essentially apply for whatever I like and be likely to get it, as my score is above the minimum needed for every job in my area. I’m so excited about this – looking at the options and realising that in a year, one of them will be mine, is amazing. It means I can go for programmes with neurosurgery and paeds, it means I can avoid jobs I don’t really want to do in the first year (vascular surgery, urology – urgh) and it means I can stay in my city, where my roots are, for another two years. It kind of feels like a sign that after everything, I’ve come through. It was a good week, to hear this, with all the anxiety over medication.

It’s been quite a rough week as I’ve felt so ill, but also rather lovely as I’ve been on the neonates unit, and despite feeling pretty unconnected to a lot of things at the moment, small, sick babies make me remember why I’m in medical school. I want to look after them. And it reminds me how amazing medicine is, that a baby born at 24 weeks (four months early), can survive, sometimes with minimal problems (though sadly often not). It reminds me of my faith, as Jesus was not so different to the newborns I checked over this week, dependant on his mother, just as we are supposed to be dependant on God. It reminds me of hope, imaging what these babies will grow up to be – the leaders of out future, the workers who will improve the world.

There’s still a lot I need to sort out, as although I’ve managed to physically go to placement, getting everything signed off has been a bit much when I’m feeling jittery and unwell enough that I’m not really that on the ball. This could prove problematic with el medical school. Despite feeding back about my GP app as instructed, the Dragon also hasn’t replied – though she often doesn’t, it still annoys me when that’s her job, and I have questions I need answers to. My mood is still very low, and the sertraline is messing with my sleep a lot so I’m continually exhausted, and not able to do more than an hour or so of anything academic before getting fatigued. I think the best description is that I feel ‘sickly’ – weak, wobbly, and queasy. There’s also a lot of small print stuff to sort for my elective – but I am feeling that little bit better, now that there’s more of an action plan in place.

Sometimes, it’s so easy to feel as though God, in whatever guise you find him, has turned from you. It’s so easy to feel adrift and off the rails, and misguided. This week I’ve really felt that inspite of how difficult these last few weeks have been, both in terms of how I’ve been feeling, but also interms of long-term decisions and fallout, that God has come through for me – I have a high score that will get me a job I love (hopefully), I have a plan to get me through the next few weeks, and I have some brilliant friends who drop their own lives for me when I need them. I would like to feel a bit more on the ball, though!

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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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It’s becoming increasingly clear that  at the moment, I’m just not ‘quite right’. I’m feeling a lot more apathetic and tearful, and just can’t quite be bothered with a lot of things. I’m struggling to work productively and find myself crying a lot more than I have for some time. I find myself thinking about things I haven’t thought of since my last ‘fall’. I can’t sing at church either, which seems to be quite a good signpost for things not being right.

In short, I think I’ve officially lost the race against depression again.

This isn’t really that surprising – after all, I’ve had a good five months of recovery after the last and worst dip, but doing these things cold with no medication, is not the best way. And no matter how much I argue that it was ‘best for me’ and ‘the only way I could manage’, it probably wasn’t. I should have pushed to be put on something that didn’t make me so suicidal.  I should have had more courage. I should have realised that like everything on this earth, depression isn’t something you can beat using your own willpower alone. Apathy is my greatest enemy, at times.

The defining moment was realising that my thoughts are getting progressively more negative and dangerous, and although I suppose it’s a good thing that I recognise that they’re coming from an illness which has a solution, and not myself, I’m pretty devastated. I feel like I’ve failed. I feel like I’ve lost the war, at last.

The thing is, I’m afraid to try medication again. I’m going to Nepal for my elective in January, to work in hospitals there, for two months, so there’s not much time to play with drugs and doses. Last time, no one, let alone myself, quite made the connection between how ill I was, and fluoxetine. This was one time when being the eternal perseverer, did not have a good outcome for me. I can’t feel like that again. I’m terrified of feeling like that again – but I’m not sure I have any options left. I feel like a total hypocrite after spending so much time convincing my flatmate to try them, but it feels inevitable. I’m also not really looking forward to going back to the doctors after spectacularly failing to refer myself to the psychiatrist/renew prescriptions/do what patients are supposed to do. It feels like this is all my fault, and that if I’d been just a little less brick-headed, just a little less obstinate, or, dare I say, it, just a little less depressed and incapable, this fall back might not have happened.

I’ve not got much time to play with as I’ve got two essays that need writing in the next fortnight, and there’s a lot to learn in paediatrics too – so I know that I need to act quickly. I know I need to stand up to this and stop thinking I can do it on my own. I know I need to accede the point and then start again from the beginning. It’s like a dreadful homecoming, an unwanted baseline. It makes me wonder if this pattern is going to be all I know, now, of a few months rising and then, repeatedly, falling back and losing everything I managed to salvage. This is a house I don’t want to be in, a party I don’t want to crash, and yet, here I am. I’m stuck  inside the walls again. I’m looking for God in this, and not really finding him.

So – let’s see what happens. I hope all my readers are having a better week than I am.

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‘Now listen, you who say, “Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.” Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes.

First of all  – I’ve calmed down a bit from my last post – sorry for the ire, I’ve decided not to edit it as this blog is meant to be above all things, honest.

I had my last day on geriatrics today (exam tomorrow – eeek) and got my feedback on performance etc – and did fairly well though I am very aware of areas I really need to improve. If I pass everything (and am given a job), it’s exactly a year before I hit the wards as a junior doctor. It sounds like a long time, but there’s a lot to fit in.

I was taking lots of bloods earlier (old people with awful veins and lots of confusion are good to practise on – if you can get blood out of them, you can get it out of a stone….) and was speaking with one patient who I’ve spent quite a bit of time with. She said she thought she was getting depressed after being in hospital so long, and feels as though she’s got to the end of everything. We had quite a long chat and I switched into ‘psychiatry mode’ and asked all the questions I knew the consultant would want to hear about, and then used the screening questionnaire with her and reported back. It made me feel quite emotional (not that this is hard to achieve) – she had an episode of depression when she was close to the age I am now, and then a few more over the years, but has been fine for over a decade. It makes me wonder again  what my future holds. It also led to an interesting discussion with the consultant as he seemed to think that I’d be of the opinion that it’s normal for longterm patients to be clinically depressed – which to be fair, is perhaps what a lot of people might assume – but not me. Depression can be understandable, even reasonable, in come circumstances – but it’s not ‘normal’. No one is ‘meant’ to be depressed. Everyone deserves to have it looked into, and treated if possible and appropriate.

Sometimes, I start thinking about it, and see in my minds eye myself in a year, struggling in my first job, or in ten years, crying and crying with postnatal depression after my first child is born, in fifteen years, as they start to grow and the job-family balance gets harder to manage, in twenty years, when my (future) marriage hits the rocks or someone gets diagnosed with a horrible disease, in forty years, when people start to die, in sixty years, when I am stuck on a geriatric ward, unable to get back home, aware that the end is approaching.  I wonder how many more years I will lose to rainclouds, to sadness. I wonder if this sense of a horizon steadily gaining ground on me will ever leave me – if I will ever lose that sense of perpetually looking over my shoulder to see if the shadow of depression has followed me home. The solution to this is probably to stop thinking – but that’s difficult. Easier said, than done. I looked at this lady, and it was sort of like seeing the future – will it be me, someday, saying, yes, I’ve had depression since my early twenties, yes, I think, I know, it’s back once more?

Unfortunately, I have no silver ball or magic mirror. I don’t have the gift of prophecy, and am a little uncertain about those who claim to own it. I don’t know what the future holds. At times, I would quite appreciate God sending me a calendar with everything filled in for the next seventy years. Or a blackberry, that would also work and is easier to fit in a pocket. Either way – it’s not going to happen. I don’t know what will happen tomorrow, yet alone in year, or a decade. You can schedule and plan with the best of them, but life’s uncertainty and penchance for surprises when you least expect them, will catch up eventually.

I guess what this comes down to, once again, is faith – faith that God will protect me from a relapse, or guide me through it once again, faith that if and when I slide downhill, I will have learnt enough this first time round, to manage quicker, and better. Faith that God is bigger than me, and bigger than depression, and faith that he is more good, and loving, and powerful than I will ever know. This week has had its challenges – but at least this time, when faced with adversity, I spoke up and spoke out and didn’t just run away immediately. I’ve moved forward. I am different to who I was, a year ago, and I’m learning all the time, how to find my path and stick to it. My faith is so clearly stronger than it was a year ago – it made it, tattered, and torn, through last year. It stayed with me, through all darkness and deadness and suspicion. It’s been weighed and found adequate. It’s here to stay, even if it has to fight for its place from time to time. It’s here to stay, even if it’s still just a mustard seed.

Well, if all else fails, one of my patients told me today that I’d do well down a coal mine (he actually worked in the mines near where I grew up, and is currently delerious with an infection and still thinks he’s down them….) as ‘you need pretty girls down in the dark to light the place up’. This cheered me up quite a bit although as he’s registered blind and I’m no model – and certainly not a luminous one – it’s not exactly accurate. Not quite the career I had in mind, but you can’t beat an octogenarian for putting on the charm offensive at every turn….I’m going to miss medicine of the elderly!

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