Birthday Cheer: Hard To Be Cheerful When You’re On A Cancer Unit

It’s my 24th birthday tomorrow. There was a time 7 months ago when I didn’t think I’d see my birthday, then again at the time I don’t really think I did want to see my birthday. Now I am not so sure. I still have days where I wish I was dead and that the attempts had worked, but then I have other days where I am prepared to give life a go and see if it can throw anything nice at me for this year!

As my birthday occurs in mid-June I always see it as the mid-point of the year and therefore give myself time to evaluate the year I have had so far on my birthday. This year however, will be different. I am not going to look at the last 6 months, I think it is fair to say that we all know that the events of 2009 haven’t been great. The New Year started badly and so far hasn’t improved that much.

I saw Jane and Dr Mc yesterday. I was perfectly honest with Dr Mc and said that I felt my mood had been slipping over the past few days. He decided that adding an antidepressant to the valproate would be a good idea. He asked me if I had  any suggestions. Of course I lept to the idea of venlafaxine, for the weight loss reasons, but when we rationalised the last few antidepressants I have been on it does seem the best bet. Reboxetine didn’t have much effect on me until the dose was increased and then it sent me manic, duloxetine was the one I was on at the end of last year (and made 3 suicide attempts on and ended up hospitalised), me and the SSRIs don’t agree (everytime the dose is changed I have a mood swing) and I am still deemed too much of a risk to be given a tricyclic. Therefore I am back on venlafaxine, at a ridiculously low dose of 75mg/day.

Jane was very helpful and helped me to realise that I need to let all the people who I promised favours to when I was manic down gently. I hadn’t realised how much I had taken on when I was manic, and of course now I am not then I don’t have the energy to complete all the favours I offered so am going to have to bite the bullet and let them all down. She was as positive as ever and reassured me that I was coping admirably, even though I disagreed with her on this front.

I’m currently sitting on the Teenage Cancer Trust unit (they treat up to 25 year olds) and will be until Friday afternoon. What a way to spend your birthday – being pumped full of cytotoxic drugs that make you feel sick. Mind you, they also make me feel very drunk without the actual alcohol, so it’s all swings and roundabouts! My sister got me both the Ashes to Ashes soundtracks for my birthday, so I have some great 80s cheese to listen to which is always a relief!

Ruth

Divided They Stand: How The NHS And Private Sector Cannot Work In Tandem

I got my care plan through the post from the CPA meeting that was held whilst I was in the Priory. I already had the Priory’s copy as my named nurse and I went through and wrote it up whilst I was still an inpatient. The copy I got through the post was my NHS version, a little late admittedly, and unsigned by me.

There are huge discrepancies between the two. Dr Mc and the Priory have listed me with a diagnosis of bipolar affective disorder with emotionally unstable (borderline) traits. The NHS say that my diagnoses (most significant first) are emotionally unstable personality disorder and bipolar affective disorder. In fact Allison has written in the CPA review “Ruth had been anxious to obtain a diagnosis of bipolar affective disorder as opposed to Borderline Personality Disorder. Dr Mc reiterated a diagnosis of bipolar affective disorder with emotionally unstable traits”.

Traits are just that. Things in my personality that mean I am emotionally unstable at times but not enough to fulfil the criteria for a personality disorder. Allison has been doubting Dr Mc’s diagnosis since day one, this is one of the reasons that I have found it so hard to grasp the fact that I actually do have bipolar (told to me by Dr Mc, Jane, all the nurses at the Priory and my GP) rather than just seeing myself as a hopeless personality disorder case. Allison has written in the review that I should consider the NHS group therapy programme for BPD, even though at the review Dr Mc and the therapy team at the Priory thought it was an inherently bad idea.

I still do not know where I stand. I know I was admitted into hospital before Christmas with severe depression and Dr Mc said I had bipolar 2. This was then reviewed and changed to bipolar 1 when I went manic and had hallucinations. I was admitted last time due to mania, which Dr Mc and Allison both agreed I had. Now I know that Allison isn’t denying the fact I have bipolar, although I do think that she does doubt the diagnosis and has only written it down because Dr Mc told her that was what is wrong with me, but she seems obsessed by giving me a full BPD diagnosis rather than allowing it just to be traits, as Dr Mc wants.

The NHS and the Priory are getting worse at keeping in touch with each other. Last time I saw Dr Mc he had received a phone call from Allison less than an hour after I had seen her because she was concerned about one thing or another and decided that it was a matter of safety so he needed to know. This was over a week ago. Now Allison seems to want to get me to do the liaising between the two of them and when I saw her on Friday told me to tell him a couple of things from her. I felt like saying that if she could go behind my back to inform him of things that I had already agreed I would tell him (she clearly just didn’t trust me) why should I act like the gobetween now?

I have no idea why I see Allison really. The Priory give me most of the support via Dr Mc and Jane and the NHS just seems to be getting in the way. When I rang the CMHT a few days ago to speak with Allison, as she is listed as my first point of telephone contact, and she wasn’t there, instead of the duty worker speaking with me (as he should have done) he decided to look at my notes and tell my that I should just ring the Priory. The crisis team refused to assist me after my discharge because I was discharged by the Priory and it was up to them to sort out aftercare, which they are doing in the form of daypatient care, but that still leaves the weekend. I know I can phone the ward at the Priory day or night and someone will talk with me, but the staff on the ward are there for the inpatients. It should be the Community Mental Health Team that deals with problems in the community, hence the name.

I need to keep seeing Allison as I do not know how much longer my parents will be able to fund the Priory, particularly daycare, and so keeping in with the NHS trust means that when I need them fulltime they will already be there, rather than me having to wait weeks/months to be re-referred to the NHS. However, at present I feel she is detrimental to my recovery as she is always very hesitant about what I can and cannot do or am capable of. The Priory support me massively and are keen to see me do things and lead a ‘normal’ life, but Allison always has her doubts, and she voices them. I am not saying that the Priory is the be all and end all, god it has it’s own little brand of politics that is difficult to fathom at first and hugely irritating when grasped, but they seem to be a lot more focused on making me well, rather than keeping me in the unwell mould.

I have also crashed down from my (hypo)mania. It was slow and steady and I could feel it coming. First I went hypomanic, then I had a period of relative normality where I was on an even level and quite happy, then I could feel the signs of depression creeping up on me. The wanting to stay in bed and perpetually tired. The not caring about what I wear or washing my hair. The comfort eating (when I am mild-moderately depressed I eat a lot, when I am severely depressed I stop eating) and craving for chocolate and carbohydrate. The apathy towards whatever I am doing and nonchalent attitud as to whether it is completed to a good standard or not.

I am nowhere near severely depressed but I am depressed and if current trends are anything to go by it will continue to slide. I see Dr Mc and Jane on Tuesday so will mention it to both of them. I don’t know if Dr Mc will put me back on an antidepressant. I desperately want venlafaxine so I can shift the weight I’ve gained, but then I shouldn’t be picking my possible treatments on account of me liking the side effects. Part of me wants to get through it with no antidepressants, or indeed medication at all, but then part of me knows I should accept whatever help is given to me.

In better news, I haven’t self-harmed for 2 weeks – the last time I self-harmed was when I was an inpatient. I haven’t actually even wanted to cut/burn myself so there must be some improvement somewhere. I want that feeling to last, this is why I’m scared of the depression creeping back in.

Ruth

Creature Comforts: Back Home In My Own Surroundings

I am finally back at home after pleading with Dr Mc that I was safe to be discharged today and didn’t need to be kept in over the weekend. I was going to be discharged earlier this week but after an overnight leave, and ignoring everyone’s advice about not driving whilst in this state, I drove my car and crashed it. Luckily I didn’t cause anyone or anything else any damage, as apparently my insurance is invalidated as I am driving whilst having a medical condition (mania) that I have not informed the DVLA about. If I do inform the DVLA, then my licence will be revoked and not reissued for eithe r3 or 6 months, depending on when I am stable, and then it will probably be assessed annually. Luckily no one has informed the DVLA, and as my car isn’t exactly in a good state at the moment, I won’t be driving for a while.

The valproate has been increased again, but although it has taken the top edge off my mood it hasn’t capped it like everyone had hoped it would. My thoughts are now racing around my head at about 200mph rather than 500mph, I can sit in a chair and only move my feet and hands, rather than jiggling my whole body around. It is little differences like that which have enabled me to be discharged though, so I guess I should be grateful.

This post isn’t going to make any sense, I can’t keep my thought process on writing it for long enough. I guess the basics are that I’m home, I’m now classed as hypomanic, I crashed my car, I self-harmed and ended up in A&E again on Saturday, I have made myself turn over a new leaf and be accepting and welcoming of the help the Priory are giving me as I do not know how much longer my parents can fund it, I see Allison on Monday and Dr Mc again on Tuesday and I only have to keep myself on the straight and narrow for the next couple of days.

Ruth

In The Words Of Simon & Garfunkel: I Wish I Was Homeward Bound

After my not so little escapade last weekend I didn’t manage to get discharged on Tuesday, despite my pleadings and grovelling to Dr Mc. I was kept as an inpatient and had my CPA meeting on Wednesday. This was a, well, interesting affair.

Around the little table, in a room that I never even knew existed, was Dr Mc, G (the assistant psychologist who was covering for Jane who was off on annual leave), me, my Mum, K (my named nurse) and Allison. Dr Mc, K and Allison seemed mainly concerned with my lack of insight, risk taking behaviour, clear elevation in mood and compliance with medication. G wanted to know if I was stable enough to be engaging in therapies or if I should wait until the meds had worked into my system so that I was mentally stable and less likely to do something stupid following a particularly bad group/session. My Mum, having been somewhat kept out of the loop, wanted to know what the bloody hell was going on and I just wanted to know when I was going to be discharged.

Dr Mc suggested that the antidepressant be stopped immediately, that I was to be weaned off the lamotrigine and onto a higher, but more in the range of therapeutic, dose of valproate. K suggested that I would benefit from having more one-to-one time with a member of the nursing staff in order to prevent repeats of the weekends behaviour by engaging me in discussion about my mood and behaviour. Allison seemed to be in agreement with this but was also concerned as to what the input from the Priory would be upon my discharge as she said that she couldn’t shoulder all the responsibility of me in the community. G said that she would incorporate me into certain groups but not groups where my energy and somewhat tactless remarks would be unhelpful, and she would find me more active groups, such as art therapy, to help me channel my energies. My Mum sat there and said she couldn’t cope with me for much longer, she didn’t know how much longer they could keep funding me and kept saying it was all so unfair. And me? Well little me sat in the corner, fidgeting and every time I was asked a question suffixing it with ’so when will I be discharged?’.

I am still in the Priory. I am still manic and bordering on the completely insane. My Mum took me out for a coffee earlier this afternoon, only I wasn’t allowed a coffee, or a Coke, or anything sugary or caffeinated, so I had a fizzy water. All I can see ahead of me is a random section of time with me being in here, the funding clock ticking (as the NHS trust won’t fund the Priory, despite the fact they have had to admit that the care they offered me at the end of last year was ‘unacceptable’ and they have handled the situations leading to my admissions ‘to an unsatisfactory standard’) and Dr Mc trying different drugs out on me like a guinea pig until one sticks. Jane assured me that valproate doesn’t cause weight gain, as she has had patients treated with it in the past and they haven’t noticed any significant change. I think they are all saying this just to make me take the sodding tablets. It’s a ploy. Tell Ruth they won’t make her gain weight and she’ll take them. Well I’m not that flipping gullible, I mean there is a reason for the fact my mood hasn’t entirely calmed down yet, and it might have a large part to do with refusing to take olanzapine, risperidone or quetiapine as an anti-psychotic.

I’ve self-harmed again as well. This time, on Bank Holiday morning, the on call medical officer decided it was too severe for him to deal with so I ended up in the local A&E with a nurse from the Priory who didn’t take her namebadge off for the whole time. You can imagine that a lot of people were giving me strange looks. The triage nurse applied a wet dressing to both arms so this made the wounds look worse than they were because the blood seeped through and went all over them. Imagine slightly demented, lunatic, fidgeting, impatient patient with both arms in bandages with blood seeping through with Priory mental health nurse calmly sitting beside aforementioned lunatic trying to get her to sit down, quieten down and stop fidgeting. Get the picture? Well the other patients in A&E didn’t like it.

The SHO I saw dealt with the wounds and suggested I needed to see the crisis team. Bearing in mind that the Priory nurse wouldn’t leave me unattended at any point throughout my admission, she was there for triage, the suturing, mental state assessment by the SHO, I found this hilarious, and decided to laugh at the idea. The SHO was adamant that I needed to have a psychiatric evaluation, despite Priory nurse saying I was currently a Priory inpatient and that she was an RMN and that my psych was assessing me on the Tuesday morning. Baby SHO went off to speak to his consultant and returned, tail between legs, to say that this time he thought I could get away with being discharged without an assessment. I have to give Priory nurse some credit, she kept a straight face throughout and didn’t laugh until we were back into the car!

Since then I’ve attended some groups, walked round the grounds supervised, gone out with my Mum a couple of times, been isolated from the patient who got me involved in the alcohol scandal of Sunday (as of Wednesday he had disappeared and no one would say where to – I suspect the more acute, acute ward if you get my drift – they don’t like to call it an intensive care unit here) and been a complete nutcase. The patients who were in before, when I was last in, are back off leave, and the day patients are back; most of whom I know, fairly well and we are creating slight mayhem.

Together the lunatics will conquer the asylum!

Ruth

The Crazy Girl Is At It Again: Only This Time She Got Caught

I am in trouble with the nurse in charge, and I mean BIG trouble. As is another patient, although I do not accept all responsibility as it was not my idea, I just stupidly went along with it all.

I was having a weird day to start with. Early-ish this morning I wanted to go outside and walk around the grounds. The grounds here are beautiful and it’s been a glorious day, all sunny and everything. I knew a walk in the sunshine would do me good and burn off some excess energy. I asked one of the nurses if I could go for a walk and she said that she would love to let me go but I would have to be accompanied and unfortunately they were short staffed today as one of the nursing assistants was off ill. In essence I was told that I couldn’t go. That didn’t stop me though and about half an hour later I walked out of the front door.

The Priory has always amazed me in the fact that they always keep the front door open from 8am until 8pm. I can see the logic in this on weekdays as there is a receptionist present and it is the door in which day and outpatients use to arrive, but I never could understand the logic of it at weekends. If you want a cigarette after 8pm then you have to be let out of the door that leads up to the therapy department, which is coded, however, pre-8pm? Go ahead, walk out, no one at the weekend will see you go.

That was the philosophy I took and so I walked out figuring that as they were short staffed no one would really miss me. There have been 2 full-time RMNs, one agency RMN and 2 NAs on today. One patient has been on one-to-one obs so that means there has really only been 1 NA to complete the obs, the nurses never really do it, they tend to sit in the office and fill in paperwork or walk around every so often to ensure no one is kicking off or sit in the lounge and make it look as if they are working and being sociable whilst watching repeats of the Jeremy Kyle show on Freeview. I thought I could go out, have a brisk walk round and be back before anyone noticed, despite the fact I am on 15 minute obs.

So I open the front door, walk outside and smell the freedom of fresh air. I walk past the smoking hut and go onto the grass where the next thing I know is the male full-time RMN and the male agency RMN bundling on top of me and rugby tackling me to the ground. What do I do? Well, instead of being sensible and giving in whilst being frogmarched back to the ward I decide to fight back. It’s laughable, me at all of my 5′ 4″ trying to wrestle with two blokes restraining me! Anyway, they got me back to the ward where the nurse in charge gave me a bollocking as she had already told me I couldn’t go out and so I sat in my room, and in a very mature fashion, sulked.

A few hours, and a lot of sulking later, my head was spinning with thoughts, so much so that I couldn’t really focus on anything. I was hearing command hallucinations telling me that my head would straighten out if I cut myself. That if I self-harmed then I would slow down, be in control, my head would feel normal again and I wouldn’t be feeling so charged up. I cut myself with a razor blade I had hidden in the back of my phone, the same place in which I had smuggled the one I used earlier this year, and the same place they never checked when I was admitted. The nurse in charge came to talk to me about my skipping lunch and found me with what I thought to be quite superficial wounds all over my arms. She called the doctor and spoke with me about it until he arrived. I told her about my head spinning and the voices and how I felt so out of control and that I thought if I cut then I would be back in control. The doctor arrived and sutured a couple of the cuts and put dressings on the rest.

If that wasn’t enough, one of the other patients, invited me out for a cigarette (even though I don’t smoke anymore) and we cleared it with the nursing staff. He then procured a bottle of vodka out of a bush and we sat outside for about 2 and a half hours getting slowly drunk with the staff thinking we were drinking orange squash. When we both went inside we went straight to our rooms. I don’t know what he did, slept it off I suppose, but I ended up having a phone conversation with someone telling me I have no insight, was being selfish (as in only thinking about myself and having some of the best care in the country and just feeling pissed off about it) and was stupid for getting drunk on the meds I am on. I threw up whilst on the phone and threw up twice after we stopped talking. The NA realised I was vomiting and called the nurse in charge to come and assess me, she instantly realised I was drunk, breathalised me and gave me a complete and utter dressing down. She also called Dr Mc to inform him of my actions today, so any plan I had of being discharged on Tuesday I think I have just blown.

I now have to sit in the lounge all evening until the night staff come on duty at 7:30pm and then until they give me my meds at 10pm whereupon I will be observed until I have fallen asleep and then on strict 15 minute obs. The only saving grace is that they haven’t rung my parents about it. I guess I am beginning to accept I am manic, especially after talking with the nurse in charge about an hour and a half ago when I said I was just having fun and she told me I was being utterly irresponsible, lacking in insight, convinced I am invincible and nothing will happen to me and ‘as high as a kite’.

The strange thing is, I quite like being manic, even if I have been bollocked more times then I care to recall today.

Ruth

Going Crazy In The Nut House: Maybe I Shouldn’t Be In Here

We all know I am crazy and that crazy people end up in loony bins at some point or another.

We also know that a lack of insight or medication incompliance is a more than likely reason to land yourself in hospital.

I also know that I have both of the above and am manic (although that does show some insight, I just don’t have insight into how I am manic, I just know I am because I have been told it by so many people).

The thing is, I don’t think I should be in here. I am pissing the staff off by asking to go out for a walk, or to go to the art room to do something or by constantly tidying up and annoying other patients into doing things. I am also annoying the depressed patients, who quite frankly are just lolling around in front of the TV, and I can’t blame them because 6 or so months ago I was one of them, because I want them to do something, anything with me.

I took the first dose of Epilim (sodium valproate) last night. Apparently it is slightly chemically different from Depakote, which is what I thought it was at first. I also got given haliperidol at about 9pm to shut me up and to calm me down. K, my named nurse, was working today and we had a chat and a wander around the grounds and she was telling me how different I was now from New Year and how she would be nursing/looking after me in a different way. She tried to get me to see that I should be in hospital, but I’m still not agreeing with her.

We made a pact that I will stay over the Bank Holiday weekend, mainly because Dr Mc isn’t back at work ’till Tuesday and then review the situation. I have a CPA meeting on Wednesday with Dr Mc, K, Allison, G (the assistant psychologist) and my Mum, but I see no reason why this cannot be conducted as an outpatient. In short, come 9am Tuesday morning when Dr Mc arrives into work I will be trying to self-discharge.

This place is driving me crazier than I was at home, mainly because of the lack of stimuli and the fact that everyone is annoyed by my incessant energy and eagerness to do things. If I get too high, like last night then I am deemed in a mood that is a danger to myself and others so am sedated.

I debated running away but I guess the fall out isn’t worth it, and I promised K I would stay until Monday.

Ruth

Gazing Into A Crystal Ball: How People Can Read Me Like A Book

I saw Allison and Dr Mc today. Both concluded I am manic. Allison was worried about the events of the weekend and that I appeared to believe I am invincible and cannot concentrate on anything. Dr Mc was concerned that I’m not taking the valproate (for fear of weight gain) and that I will come to a point where my mood gets me into trouble.

I didn’t say much in my appointments. Well, I said a lot but it was all pretty incoherent and rather off topic. However, they both managed to ascertain my mood without me even saying anything. I’m obviously easy to read.

Dr Mc has admitted me, to ensure that I start taking the valproate and to try to get my mood stable. At present I should be discharged next Friday (I’m using my mobile to post this). I’m not happy about this, but it’s my own stupidity that has got me here.

Most of the people who were here when I was last in have gone, or are on Bank Holiday leave. I feel very isolated and bored. I keep trying to do things as I can’t sit still but all I get threatened with is being sedated unless I calm down. My named nurse is the same as last time, although she wasn’t on today but is here tomorrow.

All I seem to do is yo-yo in mood and in and out of hospital. I still haven’t got put on venlafaxine, in fact Dr Mc has reduced the dose of the reboxetine yet again, because of the mania. I want to lose weight. He didn’t seem to grasp that the reason I hadn’t taken the valproate was because of the weight gain. All I have heard since I arrived here is everyone telling me I look well. Well, no offence but if I look that well, why the fuck did people realise that I’m not well and put me in here.

A rather stroppy, beligerent and flying off the ceiling Ruth

I Am What I Am: Accepting My Diagnosis

I saw Dr Mc on Friday and he concluded that I was in a hypomanic state that he was concerned would escalate into pure, unadulterated mania. I told him I was just happy for once and cheerful. He told me that happy people don’t sit for half an hour constantly moving around, fiddling with their rings/bracelet, staring out of the window and saying “oh look a plane” and talking so much that he couldn’t get a word in edgeways. He has decided to cut the dose of the reboxetine in half as he thinks the increased dose caused the mood swing and has added sodium valproate into the cocktail.

I didn’t start taking the valproate until last night. Mainly because all the research I could find on it told me it would cause an increased appetite and weight gain, something which regular readers will know I am battling with already. However, I spoke with a good friend online yesterday and told him that I had been prescribed it and what could he tell me about it (this friend knows about these sorts of things). He told me this (and I quote as I can remember not as a paraphrase) “it is the second in line mood stabiliser used for bipolar” after questioning he concluded that lithium was the first line drug used.

This made me realise that I am actually bipolar. Before I just thought people were saying it as they knew how I’d react if they told me I was borderline. In fact, saying that, I probably would react in a borderline way if they told me I had BPD, but then I still do have borderline traits. I have for so long, since I was officially diagnosed in the Priory at Christmas, fought against the diagnosis. I have claimed it to be wrong, that there is nothing wrong with me, that I may be on the bipolar spectrum but don’t fit the criteria for full blown Bipolar 1, in short I have used many, many excuses to try and escape the reality of the truth.

I don’t know why I was trying to escape the truth. After all, I’d rather have an accurate diagnosis than some wishy-washy guesses of what might, or might not, be wrong with me. I jsut never thought I had a ‘proper’ mental illness. Not one that you can put under the ’severe’ category when the professionals categorise them. I always just thought I was a bit crazy, lost touch with reality a few times, self-harmed, had issues with eating and was terminally depressed. My Mum however, as soon as she read the criteria for bipolar told me that was my diagnosis, and this was before I was admitted.

I saw Jane today and told her about my horrendous spending over the past 10 days or so. I recently opened a new bank account, which is the main one I am now using, forgetting that my old current account was in the red, to the tune of £500. Now I know I should have paid this off before Christmas, when I had money and decided not to be using that account anymore, but me being me I didn’t. Anyway, last night I got a phonecall from said bank requesting I repaid the overdraft back, in full. They gave me two options; pay by monthly installments (with an interest rate) or pay the amount in full. I opted to pay the amont in full. Very sensible you might all think, and I put it on my debit card, where I thought there was £500 or so pounds. It would take me to the wire, but I thought I’d still be in the black. Of course, my life being my life, paying off one overdraft has taken me into the overdraft of my current account, so I am officially penniless. This didn’t stop me spending money like nothing on Earth today though, I just used my credit card instead. One of these days I’ll learn, or hopefully the mood stabilisers will kick in before my credit rating falls through the floor.

We also spoke about my eating and drinking. I got totally and utterly trashed over the weekend with a couple of friends. I went out late on Friday night and was at least 30 sheets to the wind when I crashed out on my friend’s floor having rung the parents at some ungodly hour to assure them that I was still alive and not in the morgue. I then sheepishly went home on Saturday to be invited out again Saturday night, whereupon I got very drunk again, and did some very silly things, which I am not proud of and at the moments am not sure I wish to divulge into (mainly because I don’t want to accept they happened).

My drinking of other fluids is atrocious though and she is concerned that I am neglecting myself by not eating (this is a conscious effort to lose the blubber I have acquired) and not drinking enough fluids. I’m not deliberately becoming dehydrated, it’s just I am so busy with other things and busy with being busy that I forget to drink. I’m constantly on the go at the moment and remembering to have a glass of water is not a top priority.

She is going to contact my GP and Allison about the ’self-neglect’ which I am disputing is self-neglect at all. I see Allison on Friday and I doubt she is going to be overly joyed at Jane’s news, but then she doesn’t seem overly joyed with anything I do at present. I see Dr Mc again on Friday as well, hopefully I can try and keep a lid on things this time and be a little less bouncy so he doesn’t think I’m hypomanic/manic. I am still trying to get put back on venlafaxine, but it’s not having much effect. I think maybe I’ll try appealing to his better nature this time (if he has one) rather than being ‘lippy’ (his words about how I was in the appointment) like I was last time.

Ruth

Round In Circles: I Can’t Get A Straight Answer

I saw Allison yesterday and I was in a very irritable yet agitated mood. It was lucky that we sat in the interview room as it has no windows I could stare out of, unlike when I saw my therapist and I was like “oh look, a plane” about every 5 minutes. Instead I just sat fiddling with my rings and twisting my foot round and round. She gave me a pen to fill in some stuff and a couldn’t stop clicking it. I’m wondering if I am on the way up, after all it is a week since I started taking the anti-depressants again (at the recommended higher dose) and the only anti-depressant that doesn’t send me sky-high when the dose is increased is venlafaxine. Unfortunately, despite the claim of weight loss as a side effect of reboxetine, I am not one of the ‘common people’ it affects. God damn it.

Allison and I talked about the case review at the GP’s surgery and how she became involved. She apparently is still worried about me as I still pose a high suicide risk. In fact, that reminds me that she still hasn’t given me my dressing gown cord back when she said she would in the following appointment from when she took it off me, and it must be over a month that she’s had it now. We spoke about the cancer and how I realise that I have no effect on the course it will take. I pointed out to her that although I haven’t been compliant with my mental health treatment I have been consistently compliant with the cancer treatment; going for chemo, radiotherapy, attending appointments etc. I am doing as much as I can to recover and to get into remission but unfortuantely it is an illness that will take it’s own course and no one can prevent it from doing what it feels like. It is curable and they can try and halt the spread, but ultimately it has the upper hand.

When I said this to her she looked shocked and asked if I had realised that it could kill me, and what my thoughts on that were. I explained the above to her and said it was miles apart from mental health where you can take some responsibility for your recovery in engaging with talking therapies and exercising etc. She said that I was taking an ostrich approach to it (i.e. sticking my head in the sand) and this is why there was a case review about me. Apparently I am a suicide/self-harm risk (which I proved by ending up in A&E just the other day), I am not necessarily entirely stable in my moods yet (could be because I have only just re-started taking the tablets – a fact she is aware of) and I am being flippant when it comes to serious matters.

I told her, in no uncertain terms, that they didn’t seem reasonable enough excuses to hold a meeting behind my back which I only found out about with a call from the crisis team (and every person in that room at that time knew my view on involving the crisis team in my life) and not being able to pick up a repeat prescription, whereupon I couldn’t get an answer out of my GP.

I also asked why the idea of consulting Dr Mc before my appointment was not mentioned to me earlier as I had a right to put my case forward before I have to see him in person (this afternoon). Yet again, she couldn’t think of a reasonable answer. I felt like I was going round in circles, trying to get a straight answer and being fobbed off with the same crap that everyone has been mentioning in a risk assessment since I was discharged in February.

I am still quite angry, yet can sort of see their viewpoint of me being a danger to myself and because I span the NHS and the private sector it is often difficult for the two to communicate (despite the advent of emails and fax machines they still are in their 2 little boxes and inevitably I act as the go-between telling my GP and Allison what Jane and Dr Mc have been suggesting/doing and vice versa).

I have to see Dr Mc this afternoon and I can feel myself going quite high. The hallucinations are back despite being on an anti-psychotic and I know he will suggest a different mood stabiliser. I am quite happy with the lamotrigine, the medication I want changing desperately in the reboxetine in favour of venlafaxine. Not because it is a better anti-depressant, although in some ways it is as it stopped the complete mood swings (it just left me in a complete depressed state, although I hasten to add that the suicide attempts took place whilst I was on duloxetine), but because when I was on it I weighed at least 2 stone less.

No matter what I try, staving myself, eating healthily, purging food after I have eaten it, taking as much exercise as I can (difficult with a leg that is just out of plaster and lungs that mean I get breathless easily) I cannot shift this weight. I cannot buy the OTC drug Alli (orlistat) because I have lost a little weight and my BMI isn’t 28 or above. I have toyed with the idea of amphetamine based diet pills, or ones that contain caffeine/guarana but then last time I ingested a lot of caffeine I went totally manic.I want venlafaxine and I want it now. I found an old prescription for it in my drawer but unfortunately it is nearly a year old so they won’t dispense anything from it now. I know it sounds like I am being petty but my weight means a lot to me and at the moment it is constantly praying on my mind, every second or every day.

I guess I just have to wait and see what Dr Mc says this afternoon. I bet he says that he wants to give the reboxetine a bit more of a chance to kick in and that the mood stabiliser needs reviewing. In fact if I was a monetary gambling girl then I would put money on it.

Ruth

Resigned To The Inevitable: How I Should Be A Hysterical Banshee

I am still angry at certain people for making decisions behind my back, over my head, whichever way you want to put it. In short without talking with me.

My oncology consultant contacted my GP informing her that he thought I was reacting badly to the treatment and that my mental state was clearly unstable. My GP then held a review meeting with Allison and another GP in the practice who I used to see (who is a partner in the practice). The minutes from this meeting were sent to Dr Mc and the crisis team. The crisis team then rang me requesting an appointment to assess me. I told them I didn’t need to see them.

I went to pick up my prescription yesterday to be told that a repeat hadn’t been issued as I needed to talk with my GP. I couldn’t get an appointment until today, meaning I had no tablets this morning. I asked my GP what had happened and she told me that the oncology consultant was worried I was obsessing with death and dying as from the conversations he has had with me I haven’t seemed that bothered about the ultimate consequence of the cancer.

This then sparked a case review at the surgery, in which the other GP was involved in as my GP isn’t a partner, whereupon they decided to drag Allison into it and ring Jane who suggested sending the minutes to Dr Mc as a matter of urgency as I see him on Friday.

Yes, the idea of dying from cancer doesn’t bother me. A year ago it did, but that was just when it was a tumour in my leg that they were going to treat with chemo and then operate on. Since then it spread to one lung and is now in both lungs, although it is very mild in one lung. I am now possibly facing the fact that I have terminal cancer as lung cancer is notoriously difficult to treat. I get the impression though that if I was breaking down hysterically then the oncology consultant would have still contacted my GP. Or maybe I should be acting like some hysterical banshee, screaming and shouting and crying all over the place. Trouble is, that isn’t going to cure the cancer and for once I am taking a pragmatic approach to it all.

I don’t know what Allison will say tomorrow when I see her, or Dr Mc when I see him on Friday. I do know however, that I will be consulting Allison as to why I wasn’t involved in any of this and the first thing I knew about it was the crisis team ringing me and my prescription not being dispensed. I’m sure that as a mental patient I’m not meant to question things or doubt professionals but this issue has annoyed me so much. In fact it has annoyed me more than some stupid overly stressed A&E registrar saying he’ll refuse to treat me again.

I did self-harm today and I ended up in A&E whereupon they did treat me. I got a lovely SHO who had only just rotated into A&E at the beginning of the month and she chatted to me whilst she spent ages carefully suturing me back together. Turns out she has already completed rotations this year in elderly medicine and plastic surgery so her sewing skills are amazing. She accepted I didn’t need to see the self-harm or crisis team, and I explained to her, in brief what had happened and why I definitely didn’t need to involve the crisis team. She told me that she had a friend at medical school who self-harmed but is now perfectly happy in her job and has stopped. She said she wished that one day I could stop and look back on the times as a learning curve. I ended up crying whilst talking to her and she didn’t patronise me or tell me that I was unstable or force me into a psych assessment, she just sat for an extra 15 minutes after she had finished suturing to make sure I was OK enough to leave the department and wasn’t going to go home and do it again.

It’s professionals like that who restore my faith in the medical profession when all the others at the moment have left me out of discussions about my care, one girl not much older than me involved me in decisions about treatment and took time to care.

Ruth