Job update

Hello? Is anybody out there? Is anyone still listening?

Apologies for the radio silence over the last few months. It wasn’t for lack of ideas and thoughts to share, but more for lack of motivation and follow through. It’s been a long, cold winter for me! How about you?

The run-down of this winter is coming in instalments, because a lot has happened despite the long cold. First off, and the main event, an update on work.

I quit my old job in August, yep the same one that I started in April, and moved on to another job. I’ve never “given up” so soon! But it was a good move, probably the best career move I’ve ever made despite quitting being seen generally as a negative thing. Four months in community pharmacy, and I’m done! It wasn’t the community, it was the pharmacy, more specifically the management of the pharmacy, and more especially the owner/manager/slacker/ingrate/greedy pig/jerk. I’ve done that fight in a job once, and it changed the course of my mental health for life! This time, I knew enough not to stay, and I’m proud of that! It shows that I learnt something that first time around, and that’s a victory. As soon as I realised that the situation wasn’t going to change (another thing I’m proud of recognising this time around) and that my initiative was unappreciated, I started planning my departure.

And karma smiled. Well I don’t believe in karma, or the universe, or fate. But everything fell into place like it would if you did believe in one or the other of those things. I monitored the regular SEEK pharmacist job alerts that I’d signed up to receive before this job, as well as the Society of Hospital Pharmacists job register. I was still searching for my escape route (you know, never leave a job until you’ve got another job), when I got a call from Slade Pharmacy at Epworth Private Hospital in Richmond asking if I would like to interview for a casual position! Ah yes! I would definitely like to interview for a job with flexible hours in a hospital, albeit the dispensary! Especially since you called me; is this a dream come true? So why did they call me? Turns out that when I interviewed for them last year and didn’t get the job, they said “can we keep your resume on file?” and meant it! How about that? I thought it was just a line that everyone says when you don’t get a job as a consolation that maybe in the future there’ll be something there for you. But this time there’s an actual consolation prize in form of a job! Amazing.

So, interview, check. Job offer, check. Give notice that I’m leaving, check. Get obnoxious response from boss, check. Leave job feeling even better about my decision to leave, check. His response when I said I was leaving? “That’s a relief. Return the keys. Retail is not for you”! Sorry. You’re wrong. Retail pharmacy is for me, in fact during uni days I worked in retail pharmacy for 3 years and had a great time. But you’re right, the way you mis-manage it, it’s not for me. Ciao!

Usually when someone is looking for work, changing jobs, planning a career or whatnot, they consult their own needs and maybe that of a partner or family member. It comes down to what you want from a job, where you want to work, what you want to do in your job and that’s it. That’s true for me too, but in my case, there are a few other factors that contribute as well.

Number one: how will this job affect my health? That’s always the first consideration nowadays. Do you ever even think about this when considering a job? I certainly never did before I got sick. Could I work fulltime, could I manage the stress, how would I manage my workload? I never even thought about these as issues, I never thought about it period. I just knew inside myself that I would manage whatever came to me. I never doubted being able to do whatever job I got. I didn’t understand there being any option but doing the job well and going home to rest before going back the next day. Until the last year of my first job led to my physical health falling apart, and my mental health beginning to deteriorate. My second job was endlessly fulfilling but my mental health was already on the way out and too far gone for me to hold my head together, so I had to bow out. Ever since then I’ve been returning to work and thinking about what I can physically and mentally manage in a job.

Number two: what do my doctors think? Their opinion isn’t the end of the matter, but it has a lot of weight and sometimes it does decide the issue. My psychiatrist for instance has an old-school understanding of what hospital pharmacists do, but a very up-to-date understanding of how my previous jobs have affected my mental health. His current stipulation has been no hospitals, which of course I’ve found very challenging to accept! Hospitals are my place, I’m sure of it, but the politics of my first and third hospital jobs have been tough on my health for different reasons. So, I did what he suggested and tried retail pharmacy. I wasn’t very enthusiastic at first, but I tried to see it as a challenge, as a chance to update and broaden my drug knowledge and expand my mind with a different type of practice. But unfortunately, I found a great job in a terrible environment. I tried hard to make it work, but it began to drag me down after a couple of months and my psychiatrist could see that clearly, once referring to my ex-boss as Frankenstein’s brother, and another time as a peasant which amused me greatly! But still, when I broached my new job at Slade Pharmacy with him, I went cautiously and emphasised the words dispensary, retail, community pharmacy, and minimised the word hospital. But as it turns out, that first job as a casual dispensary pharmacist starting in September was easy to sell. Meanwhile my GP is supportive of anything that I want to put my hand to, even recommending I just not work for a while longer if it suited me. But getting back to work has always been a driving force with me, for better or for worse.

A week into my casual dispensary role, I heard someone dropping the words job and emergency department!! Wait!! What?? My favourite ever job so far! On offer right here? Where I already have a job? Ears pricked, senses heightened, on full alert I went into action finding out as much as I could. As soon as possible I interviewed for and was then offered later that week a role in the emergency department, 2 weeks into my casual dispensary position. I was more hesitant in telling my psychiatrist about that. I used words like part time, structured, working with another pharmacist, dedicated time, no involvement with the main hospital. But it went over easily. He saw how the community pharmacy thing went; we tried that. So now this is a new thing that I wanna try, and we’ll watch and wait this time.

The third and last factor is a third party checking in on the progress of my work. I’m receiving income protection payments from an insurer, and they check in on me every month. There’s a lot of filling in of forms by myself and my GP, supplying payslips when I’m working, and periodic check ins with a “rehabilitation consultant” who keeps tabs on my work and my health, and a case manager who keeps tabs generally. They do keep the pressure on to remain in paid work, of course, and they aim to get me back to full time work, something that I’m by no means convinced is possible. When I wasn’t happy in that retail job, I did experience some pressure from them to keep going rather than quit, but I was sure I was doing the right thing, and now in hindsight they agree. It’s just another little something in the mix that complicates my plans for what work I want to do and how I want to do it.

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I’m back…

[Started on December 9th]

“I’m back, baby doll…”

-one of favourite quotes from How I Met Your Mother

I’m baa-ack. It’s been a month, apparently. It felt a lot longer! I only know this fact of it being a month since I was here from opening my blog today for the first time since … so it tells me … the 9th of November.

Wow.

And during that time I actually thought up zero topics, had zero inclination to write anything and was pretty much happy to climb into a hole and be a hermit for the rest of my natural life. But the light has broken through and here I am.

It’s been a very full month. I’m trying. A trip away to Werribee, days out of the house doing stuff, hanging out with girlfriends, some actual real live housework. There were, surprisingly, some pretty great times.

And then there were days when I wore my pajamas until 5pm and only left my bed to eat. But you know, looking for the upside!!

There was one amazing week where I thought I’d finally broken through the depression glass ceiling into what normal life could be like, and I loved it! So did my GP: ‘Imagine if this is how life could be from now on? That would be f*@%*^# awesome’. His words, not mine! Just to clarify. But yes, why yes, yes it would.

Sadly for me and anyone my life bumps up against, it was mania.

Oh mania, you heartbreaking devil you. You get us so excited and hopeful and relieved and let us sniff “normal” for 5 minutes, before depression overcomes us again and we all sink back into the swamp!

Normal, or a bit more overdone than normal; either way, it’s a nice change from blergh, uff and erk!

But it wasn’t devastating when mania went this time. Well not as devastating. This time. I’m getting more resilient gradually.

[Updated from here in later December but the computer wiped all my additions and made me so angry I gave up on it! Then I vowed to complete it on January 9th but when the date came around I was staying in a motel without WIFI…ahh the horrors of modern life! So here I am, Feb 9th…and finally I’m back! And saving my draft after every word!!]

Thankfully, bit by bit, episode by episode, high by low by high by low I am taking it less personally, getting less excited and less distraught when my brain chemistry flicks the switch and lands me somewhere I wasn’t prepared for.

So says my mouth, and my head. So I wish, so I hope. And maybe sometimes that’s the case, that I’m less wrung out over it. Maybe.

But actually now that I’m slipping down the slidey slope again I find myself not so okay with that. I don’t want to go down there again. I don’t want to be like that again. But it seems that I’m not being consulted in the matter of what goes on in my own head.

Ironic, isn’t it? My own head, taken hostage by chemicals. Chemicals that don’t even have brains or thinking power or motives – but they pack quite the punch! We’re doing all we can to oppose them but it’s turning out to be more of a war than just a battle.

I’ve been told over that I have tricky brain chemistry. At first I thought it was one of those placating remarks all doctors make to help ease you through the rough period between the diagnosis of depression and the onset of full medication effect, which can be up to 6 or 8 weeks at times in some people.

Although I guess I didn’t hear it said first until I was trying the 5th antidepressant; but I definitely needed to hear something at that point to convince me that I should still hold hope that this one would work! My doctor told me that every time an antidepressant didn’t work, we were one step closer to finding the one that would; we were one step closer to getting better; the depression was one step closer to showing us how it was working and what we could do to oppose it.

That’s a lot of talking for a chemical to do!

Time and experience have unfortunately proved the fact to be true. I have tricky brain chemistry. It’s difficult for the medications that we have available to match the chemicals that are lacking from, but should be in, my brain keeping me from becoming anxious, depressed, manic or a swinging monkey between all three moods!

I’d love to be one of those people who gets diagnosed with depression, gets prescribed whatever antidepressant their doctor has on their mind that week, tolerates it well and after a year or so with successful treatment and other supports, undertakes a careful withdrawal of their medication under supervision of their doctor and continues on with their life drug/medication free. Not trivialising their sufferings, just envious of their rapid and successful long term improvement and freedom from medications.

Of course that doesn’t happen in bipolar disorder; only in depression. Bipolar is not a condition that remits; it’s a life sentence. It’s not going anywhere, and it’s quite unlikely that I’ll ever be free from taking medicines.

But it’s the dream, isn’t it? To be medication free, drug free, not drug dependant; isn’t that the dream of any person tied to medication?

As a pharmacist I have to ask every person/patient I deal with if they take medications. Apparently this is the most annoying question that a person could possibly ever ask! Or maybe I’m just asking it wrong; that’s always a possibility.

When I was working, a distant memory just now, I’d get 50 people a day saying “I’m not the kind of person that takes medication”, “I’m not the type of person who takes tablets”, “I’m not some kind of druggie”! Or my personal pet favourite hate: “I don’t like taking pills”.

Really? Well who does like taking pills? And what exactly is the type of person that would take medications? I guess having to take medications to get by makes me more sensitive to these types of comments spoken from ignorant minds. It’s obvious that they’ve just never given the issue more than a seconds thought, or they’re basing it on inappropriate pill popping they’ve seen on TV.

But just a suggestion, if you ever come across me actually working as a pharmacist in the indeterminate future, please just answer no or pass me a printed list of all your meds with doses, thank you so kindly!

 Moving on.

Tricky chemistry, multiple antidepressants, additional diagnosis of bipolar on top of depression and anxiety.

The diagnosis of bipolar disorder, after the initial shock and rejection of the idea as stupid and crazy (oh the irony of calling it crazy!), was actually not that surprising, looking at it rationally. The failure of antidepressants to work or to work fully is actually an indicator of bipolar disorder, which I knew somewhere in my mind from when I studied mental illness as half of my post graduate studies. Another irony!

What if I’d had the clarity of thought to see it that way back when? To look inside my brain in a rational, systematic, logical manner. But that’s not how mental illness works. It takes a regular brain and clouds it with so much doubt, fear, hurt, pain, sadness, hopelessness etc that you just can’t see.

I’d go to my doctor and say, I was so bleak and black yesterday I nearly couldn’t stand it. And he’d say, how many Valium did you take?

Valium. Brand name of diazepam, used in my case as a sedative and anxiolytic, remover of anxiety and worry.

And every time he said it, it would be such a revelation to me: oohhhh! RIght! I should have taken a Valium! That would have made me feel better. Of course, how did I not think of that? I say every time because there were quite a few times he had to say that to me!! And I’m a pharmacist! Turns out being a good pharmacist doesn’t always extend to yourself! Luckily my husband is happy to jump in and now whenever I’m complaining of my mood he puts on his doctor voice and asks me, did you take a Valium??

I had this sanctioned stash of tablets capable of taking a stressed-to-the-eyeballs or suicidal girl and transforming her into a warm, fuzzy, calm girl ready to take a nice comfy little sleep to get her through the hours until her chemistry improved or she crawled into the doctor’s office, totally empty and out of ideas and ready for the next injection of hope, help and medication changes.

I had it. I still have it. 13 months later! I think I’m getting better at remembering how to render psychiatric first aid to myself when the complicated muddle of meds I’m on just isn’t cutting it, or the depression is just a bit too strong, or the mania is making my limbs dance a jig of agitiation. Or everything is just all too much and the circuit breaker has to be activated to prevent the whole place from burning down! Metaphorically, not literally.

 Because there are still those days. Bleak days. Blank days. Flittering days. Storm in a teacup days. Meltdown days. Frustrating days. Agitated days.

There are less of them. They come less often. They do less damage. They don’t get full control of me. But they do come. They’ll always come.

The key, as they always say, is management. So here we are, my and my team, managing. We’re managing. And that’s pretty great!

Thank you for taking the time to read my great big long shambles and hope to chat again soon x

Voices

 

I’m friends with the monster that’s under my bed

Get along with the voices inside of my head

You’re trying to save me, stop holding your breath

And you think I’m crazy, yeah, you think I’m crazy

Well, that’s nothing

-Monsters by Eminem feat. Rihanna

 

I love this song called Monsters by Eminem with Rihanna and always sing along when it comes on the radio while I’m driving. The chorus mainly, I’m not skilled enough to rap along with Eminem! “I’m friends with the monster that’s under my bed”. To be friends with whatever our own particular monster is; what a great goal to have!

To accept that I have a monster in my life, to accept that it isn’t going away and can’t be gotten rid of, to accept that it will always be right there lurking under the bed is one of the biggest parts of reaching remission with mental health disorders. Acceptance is key.

That’s what I’ve been told by my therapists and I really do think that this is true. I’ve seen enough patients with mental illness, mostly schizophrenia and sometimes bipolar disorder, and every now and then depression, anxiety or panic disorders who do not believe that they are unwell to know that believing the diagnosis and accepting the need for treatment is the biggest advantage you can have on your side. From then on out, having a good relationship with your doctor, having faith in the treatments given and doing what you can for yourself are added bonuses towards successfully managing your condition.

Fighting against the diagnosis, disbelieving the doctors, resisting the label, not wanting to accept the idea of illness takes so much emotional energy, so much mental energy and makes you prey to so much more time exposed to the condition that is ravaging you. It can also make your condition harder to treat once you finally succumb to the idea of needing help as it has had so much more time to get a strong grasp in your mind and the symptoms may be a lot more advanced. You wouldn’t do this to your body if you had diabetes, leave your body exposed to high levels of blood sugar damaging your blood vessels and nerve endings while your organs starve for sugar. So why do it do your mind?

Because at the end of the day, mental illnesses like diabetes or thyroid disorders or heart disease are conditions that are not curable, in the sense that they never go away but can be well managed. Bipolar disorder doesn’t just pop up then vanish away again. But it can be managed away to the extent that it no longer controls your life and so that people around you have no idea about your condition, and maybe you even forget that you have this monster.

Here’s to becoming friends with whatever it is that scares the pants off us! To becoming friends with our monsters.

 

[ I ] Get along with the voices inside of my head”

 

I don’t have voices inside of my head.

That sounds like a statement of denial, but it isn’t. I’m just telling you a fact about me. Trust me; I’ve been thoroughly checked for voices! By my GP, my psychologist, two psychiatrists and a number of nurses. And myself, just to quintuple-check.

I mean that I don’t have voices in the sense that most people expect voices. I don’t have auditory hallucinations such as people can have if they suffer from schizophrenia, psychosis, some forms of bipolar or delirium. I don’t hear people who aren’t physically present telling me things, commanding me to perform certain actions or speaking to me through objects like the radio or TV.

But I’ve come to learn about other types of voices that can be just as damaging. The inner voice. Everyone has one, to whatever extent they allow it to be heard in their own mind. The little voice that chats away in the background carrying along beliefs, ideas, thoughts, judgements, criticism and hopes and dreams. And sometimes not only one voice. There’s my inner voice that carries the weight of history, experience, self esteem and knows me well. There’s the inner voice which is other people’s beliefs projecting as their voice and most importantly, my new inner voice!

One of the things I’ve been trying hard to work on during my recovery is to change my inner voice, or develop a new inner voice. Depression and anxiety can both have a large self critical and other people critical component. When my current voice criticises or judges or makes snide remarks, I try to correct it. Not with judgement, or criticism, or rudeness. If I took that approach, my new voice would be as difficult as my current voice!

So when my old inner voice sparks up a thought train that I don’t want to follow, my attempt is to gently override it with a better thought, or kindly redirect it. When a critical thought comes to mind, I try to tell it, no that’s not how I want to think about people anymore, and then I try to impose a better thought onto that thought to overcome it.

Maybe the idea pops into my head that that girl over there is fat. But that’s not how I want to think about other people, and I have to bear in mind that I myself can be classed as fat, so instead of thinking those thoughts about her and me, I’ll think about her beautiful hair and her lovely smile. Which will make me smile, and enjoy these nicer thoughts 🙂

It is not easy! It takes a lot of hard work to get along with the voices inside of my head! Being friends with the monsters is much easier for me! I don’t know if everyone has the same difficulty, but it’s taken me a lot of work to get to where I am and there’s still a way to go. I know consciously exactly how I want my mind to be, but it doesn’t change just for me wanting it to! It takes practice and repetition and solid thinking!

But at least I’m on the way to getting along with my voices, a little progress is better than no progress!

Saturday Shoutout

I have hedged around this and hinted at in and mentioned it obliquely but it’s time for some straight speaking about an important part of my life.

My peeps.

Specifically, my psychologist, my psychiatrist and my GP.

My support crew.

Without them, I don’t know where I would be. Literally and figuratively. Would I be in a psychiatry ward in a hospital? Would I be in rehab? Would I be doing a lot worse than am I now? Would I be a vegetable in bed? They have stood by me, held me up, dealt with me, kick-started me, bucked me up and saved my life.

I don’t say this lightly.

They saved my life! They’re that important.

Everything I say here has what to me is an obvious unwritten addendum: as well as my husband. He is the most important person in my life and has been my most supportive friend through every hill and valley, through every new discovery and every boring pushing-on day, through every heartache and excitement. He is so critical in my life but there are times in life when you need to call in the experts!

And these times have been the last year!

My aim today is to give a shout out to my current team because I truly do owe my life to these people. There are other people who have also been hugely helpful to me and I acknowledge them mentally; they might get a write up another day.

Starting with my local doctor, my general practitioner or GP, Dr Richard Young.

I came to see him accidentally after a false start with the GP that I used to see back when I was at uni. She charged a fortune and didn’t give me any confidence that she knew what she was doing. In fact she said to me, I’ll ask my colleagues and check some textbooks; can you come back next week? Well no I couldn’t wait a week, I needed help now! I complained to a colleague at work that I didn’t know where to start looking for a good GP and that I wanted to find one close to work.and who didn’t cost me so much and she handed me a business card for this doctor. I rate this as the best recommendation I have ever had and am always so thankful to her for this!

I didn’t tell this colleague why I needed to see a doctor and yet she gave me a recommendation for a doctor with a special interest in mental health, and who sees many patients with depression and anxiety. That was lucky number one. Lucky number two was the location of the clinic, within a 5 minute walk from work! Could anything be more perfect? I could easily slip away from work in my lunch break, between discharges, after ward rounds etc for my 15 minute appointment. And lucky amazing number three is bulk billing for mental health patients! That is, no fee to pay for each visit! Thank you infinity for this amazing policy that has benefited me and my husband so much!

Richard is a young enough doctor to have passion for his job in spades, old enough to have experience and knowledge and confidence, and has bedside manner and compassion like you dream of in a doctor!

His knowledge of the health system is unsurpassed. I have attended many different GPs in my old clinic last year as well as here, and have never experienced such thorough care! I have cervical migraines; I get Medicare subsidised visits to a physiotherapist. I’m gaining weight on medication; I get some of those visits changed to see a dietician. I have deficiencies; I get treated. I have risk factors; I see the practice nurse to develop a care plan for how I will reduce my risk factors. I have depression/anxiety and need help managing my symptoms; I get ten Medicare subsidised visits to a psychologist, and when I use them all up, I get more! We need help managing the medications; I get Medicare subsidised visits to the psychiatrist. And most importantly, when I’m suicidal he doesn’t let me go home; he sends me straight to the hospital where I can be cared for and a new plan can be made for my treatment.

You get the picture: this doctor is amazing! There is nothing I have that he can’t fix me up with the appropriate health professional or service!

After 8 months of seeing Richard once a week every week I have no complaints! I have had to wait on occasion, I have had to be rushed through on occasion but I have proved abundantly that when I have acute and severe needs, I will be given as much time and attention as I need and be cared for exactly how I need. How I want not always; but always how I need. I think you do need to give credit where it is due and understand the limitations of the medical system and within those limits I have been wonderfully and carefully looked after!

I would absolutely recommend Richard to anyone!

It is due to Richard’s amazing insight and care that I was first given a referral to see a psychologist. Unfortunately the first lady I saw did not connect with me at all, and in fact I left worse than I arrived!! Crying going down the steps is not the right way to go. So Richard promptly organised for me to be assigned another psychologist and I have loved her since the first meeting!

Patty Sabbagh from the Nexus Psychology group is her name and place.

She has seen me through all kinds of scenarios. Happy, sad, suicidal, excited about life, demotivated, purposeful and everything in between are the ways that I have turned up at her door and she has adapted and given me real help and hope and a new way on from every problem! She has helped me to deal with all kinds of issues, she is so resourceful and like a good friend. Sometimes I have gone and its just been a good chat with an understanding fellow human that I needed, and she has been a listening ear, a shoulder to cry on and a clever therapist able to give me a better way to fight on. A mother, a friend, a support; all labels I could give her and more!

She listens and considers and recommends the best approach. Sometimes talking about it really does solve the problem, sometimes a new way of looking or thinking about an issue is needed, sometimes there is need for meditation, or mindfulness, or cognitive behavioural therapy. Whatever is needed, this talented psychologist and counselor has the remedy!

Anyone in trouble needing someone to help would be well advised to seek the help of Patty from Nexus Psychology or one of her colleagues.

Lastly my newest support crew member, and one who has changed my life. Another big statement but well deserved! My psychiatrist, Dr Ian Katz.

He entered later in the picture because I initially saw a psychiatrist as part of my outpatient follow up from being in the emergency department of the local hospital. He was the one who suggested cautiously that bipolar was indeed a possibility and who first started me on a mood stabiliser. However his role is to see patients in the short term then send them back to their GP to be managed. Which is what happened.

My GP and I went along with the plan for Seroquel and for a while we seemed to be winning. Then that started to fall apart and my GP gave me the referral for Dr Katz. He picked up the pieces, made a sensible picture out of it all and gave me a ‘wait and watch’ directive and asked me to come back in a few weeks. I returned with a history of the most manic-like state that had happened to me so far coupled with a long period of depression and the diagnosis of bipolar was complete. He prescribed lithium, one of the best things that has happened to me in a long time, and things have been improving ever since! He calls it “the game changer”; I call it a life changer!!

I have been so impressed with Dr Katz because of his huge capacity to listen, and hear all the information then process it in a logical and helpful manner. He will then set out a considered, clinically sound plan and make everything clear and easy for me, the patient. That takes a huge lot of knowledge, skill, patience, kindness and clinical experience to attain and I think there are very few other clinicians like him. In addition, his commitment to his work amazes me. I have had appointments at 6.45pm, 8pm and 9pm!! Thank you for that!

I have a very high respect for his opinion and his directions and am just so grateful to him for being the one to really turn my life around!

So there you have it. The three most important people in my life just now, besides my husband. Three people who have left a permanent impression on my mind, and my heart really. Conditions like bipolar absolutely need to have this three pronged approach, which in the past was not such a priority but I would not give up either one of these three for anything! Each has a separate but vital role, and each one contributes in a different way to my overall mental and physical health.

I don’t think I could step into any of their shoes, even assuming I had the appropriate training. They each have some strength of character to do what they do that is beyond my understanding but its so important to me that they continue to do what they do.

I don’t know when they take holidays, I don’t know how their families cope with their dedication to their jobs but I know that without them I wouldn’t know where to go or who to turn to and I am forever grateful to them, and everyone like them who works for us, the patients.

Alone

Today I want to make a shout out to anyone and everyone who is battling mental illness alone.

Kudos to you! You are amazing! You are so much stronger than you realise! I don’t know how you do it but keep it up; you are an inspiration to me!

I don’t believe that I would still be here if I had gone through this alone. So many times in so many ways I have relied on all of the amazing people around me.

My husband of course being number one. He has been dealing with me for eleven years! Ten of those years I was undiagnosed with mental illness, and I’m not sure how much of my illness I had over that time but he has dealt with all of me and stuck by me and been my best friend, my biggest supporter, the most amazing listener, and just through and through amazing. I shudder to think of some of the things I put him through: hysterics, tantrums, intense nagging, doom and gloom, worry about everything and everyone, panic attacks, tears over anything and everything, and some pretty crazy manic episodes!!

My friends have probably been subject to some not so nice days with me too. Sorry about that! But their support has always helped me in every scenario and I wouldn’t be without any of them!

My team. My GP who is available all day any time Monday to Friday at short notice and without an appointment. My sweet psychologist who will fit me in any time Monday to Saturday and who calls every now and then just to see how I’m going. My relatively new psychiatrist who has given me his mobile number to call any time! That’s pretty amazing! The local CATT team who are only a phone call away. The workplace counselling number that I can call 24 hours a day. Lifeline, Helpline, Suicide Callback line and all the other fantastic services that can be called from anywhere anytime and are truly fabulous!

My colleagues. I don’t see them much but when I do they are so friendly and concerned and encouraging that it really touches my heart and I want to get better so that I can get back to work and pay them back for all their kindness.

Family too, everyone in their own way doing what they can to help me keep going.

I’m so glad for each and every person who has helped me keep on going and made me keep trying and made me want to keep living and fighting!

I might not have thanked you face to face, I might not have let you know how awesome you are but I know it and one day I hope I can show you how important you are!

The price of good health

Here’s my thing about the current mental health system. I know everyone has a different “thing”; this is mine at the moment.

Despite really needing them, I have exhausted the maximum number of Medicare-subsidised psychologist appointments that I am entitled to in a calendar year. I ran out in April. 4 months into the year!! Leaving me in the unenviable position of having to pay $145 per one hour session weekly with no Medicare rebate of $85 if I want to keep seeing my counsellor and improving my mental health. Not a great encouragement to continue therapy.

$145 is a lot of money for someone who has been off work for 100 days and ran out of sick leave after four and a half weeks! But this is not just about me, it’s about every patient who is getting treatment for mental illness. It’s a lot of money to anyone! So I tried to go without my psychologist session,then I tried spacing them out to two weeks or three weeks. Didn’t work terribly well or please my doctor or psychiatrist! Or me for that matter.

Luckily for me, in a freak moment of paranoia in 2010 I signed up for income protection insurance after a work colleague was diagnosed with cancer and couldn’t get insurance. Because of this I am getting a kind of substitute wage. So I am doing 10 tonnes of paperwork every month for the insurance company to pay me a benefit in arrears. So far I’ve had one payment. It was a great payment, but it was once! But there are a lot of people out there in the world who wouldn’t have been prepared to pay $85 per month for the last 4 years for the sake of an insurance payout that might never be needed. Thank goodness I did pay for it, though!!! It cost me but I am getting the benefit now.

In the case of people without income protection insurance they would be doing 10 tonnes of paperwork for Centrelink disability or sickness benefit or health care card or something else similar! For a lot less money probably. The government doesn’t match your current wage.

In an effort to address this problem with paying $145 out-of-pocket each week, I changed my insurance over in April so that I now pay a lot more per month for better psychologist and psychiatrist and inpatient psychiatry cover. Again, not something a lot of people would be prepared or able to do. Unfortunately I then had to wait two months to be able to use it! And I only get $250 worth of psychologist cover, not even two sessions!! Not quite worth it for that part.

Luckily, there is another benefit of income protection insurance that I was not aware of; in their portfolio of helping me they have agreed to fund 10 sessions!! Thank goodness!! And they have offered to put me through a meditation course, which I was already thinking of doing, so there’s a few perks to having paid privately for this insurance. But like I say, how many people could or would pay for this? How many people develop mental illness, which never comes in a planned way or at a convenient time, and have to make the choice between paying a huge amount  of money or go without treatment?

So this is the reason why there are crazy and hurting and needing-help people walking the streets; the private system is expensive!

And you can’t get admitted in the public system unless things are diabolically bad! They refused to admit me when I was suicidal and didn’t think I could keep going. I begged them to!! They would not do it. They just kept saying it would do me more harm than good. I kept begging. They kept refusing. They won. I got sent home. It wasn’t nice!!

They asked me if I had private insurance. Yes, yes I do. Well we’ll look for a private hospital bed for you. Okay sounds great, I just need to have someone look after me. Well we’ve called your insurance company and you will be $2500 out of pocket up front plus $400 per day. We don’t know how long you will need to be in hospital. Ummm, okay, maybe not! That’s a whopping lot of money! I know you can’t put a price on your health, but that’s a large pile of money that could be put to some other large life investment! Another reason for upgrading my insurance.

Now that I’ve served my waiting period of two months, I can get private hospital admission for only a few hundred dollars out of pocket. Will I need it? Maybe not, but I’d rather know that I can get it if the need arises because not being able to access it last time left me feeling even more desperate when I didn’t think it was possible!! But it’s a toss up, spend over a hundred a month to save a couple of thousand…how long til it adds up to that much anyway? But I have a plan to reduce my insurance if I don’t use it this year.

So instead of a hospital admission, the community psychiatric team came and visited me or called me once a day for 10 days until the new medication had kicked in and I started to see life in a more hopeful light. I have to say they were amazing and helped me so much. And I continued to see my usual GP and psychologist in that time, as well as a psychiatrist in training at the local office.

Which brings me to another point. I have been seeing a doctor once a week since last November. After the worst episode of suicidal thoughts and desperation I saw my GP twice a week for a couple of months, then went back to weekly. We’ve planned to stretch it out to fortnightly but we’ve never quite gotten there due to either a relapse or medication change.

The first doctor I saw charged me $73 per session. This is pretty standard. My current GP who I’ve been seeing since December usually charges $70 per session but bulk bills me because I’m a mental health patient and he doesn’t want mental health patients to not see him because they are worried about the cost. Which is a very important consideration!! And it actually does make all the difference! I know I can go in and see him anytime and I don’t worry about the cost, when I would otherwise consider that before booking an appointment.

Imagine $70 at least once a week since December. That’s 6 months. 23 weeks. If I had had to pay $70 per session I would be at least $1600 out of pocket!! Again, a lot of money for someone who hasn’t worked for 3 of those months. Or anyone, for that matter!! The Government has put in place a medical safety net so that if you have medical costs over a certain amount you can get a benefit at tax time. But you have to spend even more than this before you get the benefit, as I understand it. You really have to spend a fortune to get any help or subsidy.

Bulk billing is one of the greatest inventions but it relies on doctors being willing to take a Government-determined payment for their services rather than the larger fee that they could justifiably charge. That takes a dedicated and altruistic physician, and I’m so glad for every doctor that offers bulk billing! You are the hope of the sick and poor!!

Doctors that don’t bulk bill are private (non-hospital) psychiatrists. Which is understandable because they invest more than 10 years of their post-high school life to achieving the knowledge and expertise to work in that position. My psychiatrist charges $315 for the first consultation and $215 for subsequent appointments! Understanding this the Government rebates $221 for the first appointment and $113 for the second appointment. Not bad but still a fair amount of money to pay on a regular basis.

Then of course there are the medications. Lithium, venlafaxine, quetiapine. Diazepam for emergencies when I’m really anxious. Pantoprazole for gastric upset on lithium and venlafaxine. Levlen to avoid becoming pregnant on lithium and quetiapine. Cholecalciferol for reduced vitamin D from spending the last 3 months mostly indoors. Tooth mousse for increased cavities on quetiapine due to dry mouth. Anti-perspirant for over-heating and increased sweating on venlafaxine. High protein diet for iron deficiency. Low cholesterol diet for high cholesterol due to eating badly and quetiapine. Calorie restriction for increased appetite due to quetiapine and lithium and venlafaxine. Altogether it comes to about $150 per month for meds. There is also a prescription safety net, but this only comes into play after you have about 60 scripts dispensed in a calendar year. I’ll come in just under this so no safety net for me.

So that’s my whinge for today. From my position I feel lucky for the investment I made in insurance years ago, and I’m glad that I now have better insurance for the present and I’m glad that I’m in a position to afford these things. I’m not wealthy but I’m comfortable, and I feel for those people who really don’t have the money to get the treatment that they so badly need. Should we be subsidising treatment more than we do? Should people be made to have better insurance? Who pays for all of this? It’s not really an answerable dilemma, but I’d like to be more thankful that I’ve been able to get the treatment that I needed at times when I’ve really needed it!! Maybe not as much as I wanted but enough to keep me safe and pushing on.

And as I always say to my patients, I need to thank my stars that I was born in Australia not America. If I lived in America I would have had to pay for all of this and pay for it dearly! I’d probably have taken out a $20,000 personal loan by now or have completely used up our life savings.

Health. When it’s good, you don’t even think about it; it’s just there and we all take it for granted. We expect our bodies and minds to work in a predictable manner. We feel let down when they don’t work to our plans despite it being quite the miracle that all the intricate functions of our bodies work smoothly without a hitch.

But I’d like to take more time to be thankful for the days when my health comes to me easily! When it doesn’t take doctor’s visits, hospital admissions, psychologists, psychiatrists, medications, time off work to achieve a type of health. When I wake up and I’m just well! It really is a miracle and I want to appreciate it.

Suicide *warning: the following material may be very disturbing*

Author’s note: I wrote this piece two weeks ago. Then while re-reading it prior to publishing I had some reservations. My personal editor (aka my husband) also had some reservations about how it would affect other people so we decided to wait a while and see if we really wanted to publish this.

I’ve decided that I do want to write publicly about this issue. I apologise if it is disturbing, or frightening, or confrontational, or triggers emotions that are hard to deal with.

I can write about this issue openly now that I am past these horror days and now that I feel reasonably confident that I won’t experience them again, at least nowhere near the depths that I did sink to before. Thanks to an antidepressant and two mood stabilisers, and a team of psychologist, psychiatrist, very accessible and caring GP, fabulous husband and great friends!!

But I do feel that the population of the world fortunate enough never to plunge to these awful depths should have some understanding of the suffering that is out and about in the world, walking around trying to contain their sorrow and hurt. My favourite saying comes to mind:

“Always be kind. Every person you meet is fighting a battle you know nothing about.”

lease PLEASE remember that however impossible it feels, severe depression can be survived. It doesn’t feel like but just ask for help and let someone in! Tell your partner, your friend, your family, your colleague, a local doctor or go to the local emergency department. Tell someone; don’t suffer alone!! You know the numbers:

Lifeline: 13 11 14

Suicide Callback Service: 1300 659 467

Men’s Line Australia: 1300 789 978

Kids Helpline: 1800 55 1800

Employee Assistance Program (employees of public hospitals): 1300 361 008

beyond blue: 1300 22 4636

Suicide Line (Victoria only): 1300 651 251

Suicide Prevention Foundation: 1300 465 366

So here we go!

Suicide. Death by one’s self.

We don’t talk about it enough.

It’s taboo. It’s avoided, ignored, swept out of sight.

There can be sense of shame about it. Some consider it selfish.

In some places and in some era’s it is and has been illegal.

Some insurance companies won’t pay out life insurance policies if a death is determined to be a suicide.

Yet, along the death spectrum a ways, people campaign for euthanasia, the right to kill oneself if life becomes physically unbearable.

What about when life becomes emotionally unbearable? Mentally unbearable? Somehow people never consider the rights of a person suffering in this way.

But this is a dreadful, terrible, awful way to suffer.

Why are we sympathetic to cancer patients with terminal illness suffering physical agony but don’t give the same thought to mentally ill people suffering emotional agony without relief?

And to some people there seems to be or is no end in sight; treatments that don’t work or take too much time to work, emotional turmoil with no relief, desperation. What then?

Personally, I don’t believe suicide is right. Morally, that is. I believe what the Bible says: thou shall not kill, including oneself.

But it was a whole different story when I found myself in the grips of severe depression and assailed with suicidal thoughts.

Suicidal wasn’t about self-harm and ending my life. Initially.

It was about feeling terribly awful in the midst of my perfect life, so awful that I didn’t know if I could survive, if I would ever feel good or well again and I just wanted a break!

It was about dragging myself through the motions every day and wondering if I would ever feel like every physical step wasn’t a tiresome chore. It was about emotionally forcing myself through the duties of the day, pasting a smile on my face and coping when I felt like crawling into bed and never coming out.

I wanted an escape, to step into a time warp that would take me out of my life for as long as it took for the depression to go away. Then I could just step back into my life and take off where I’d left off, minus the awful distress.

I wanted the escape, but didn’t know how to get it. I was on two antidepressants, an unusual combination and a bit risky. But that was what it took to get me feeling better and sleeping. To start with, but then I started having odd thoughts as my mood took a steep dive downwards, the first time I experienced what I would later find out was a mood swing.

What would happen if I just stepped out in front of the bus? If I just took one step out…

Would it hurt? Would I just die or would I be injured and gain nothing but more pain?

I’ve always been against the idea of committing suicide by using another person driving a vehicle. I’ve called it selfish. I’ve called it unfair and sympathised with train, bus, truck and car drivers used in this awful way.

Is this karma? To be wondering whether I would actually take that step? To be thinking not about the awfulness that the driver would experience, but to be wondering if I could be that person? Wondering if it would solve my problems? If it would just take everything away so I didn’t have to try to deal with it day by day by day.

I’ve always been nervous about people standing close to the edge at train stations. I’ve always been half-prepared to see something so awful that it would damage me for life.

But then nothing happened and this mental disease arrived, bit by bit. Maybe it was the anxiety in me the whole time, all these years worrying and thinking about such things.

This was my thought process, back then, before I went to hospital.

I could never jump in front of a train. I’ve read ‘Dear Miffy’ by John Marsden. I know what happens when a jump in front of a train is misjudged! I don’t want to be in a wheelchair or completely dependant on someone else.

I don’t think I would jump in front of a car; too small, more likely to end up alive and well with a couple of broken bones. So that’s out.

So that leaves a bus.

Or an overdose. But I know that the medications that I’m taking are relatively safe in overdose. They won’t kill me. I’ll maybe sleep for a while then wake up back where I started. With the added stigma of having tried to kill myself!

I don’t want that for me, but mostly I don’t want that for my husband. I don’t want to leave him with the bill, so to speak. He doesn’t deserve a life of questioning what went wrong, where could he have done something or done it differently, of blame. He doesn’t deserve any of that. No one deserves that. So I came to this: I can’t do any of those things. I have to keep on going, to keep trying, to keep fighting. Because I can’t do that to him. But it’s so hard!

Another day I got to thinking again: what if I just jumped off these rocks into the crash of waves breaking? Would it hurt? How long would it take? Would someone rescue me? Would it just be easy and instant?

What about sharps? One of my horrors is paper cuts to my eyelids, no idea why! But I’m always super careful around knives and I hate blades, which is why I now wax instead of shave; I’ve cut myself enough times as a total accident to give away shaving! And our knife set is new and super sharp, but I don’t think I could ever do that.

I don’t have a gun and I wouldn’t know what to do with it.

What about painkillers? I don’t have any above supermarket strength and I know they don’t work in overdose, it’s just long slow painful illness of liver failure that can take forever and is a terrible idea. Or bleeding, also slow and awful, not at all a solution.

I’m not great with heights, I just know I could never make myself jump.

So, all out of ideas.

And that’s how I came to be in my doctor’s office at midday on a Monday, bawling my eyes out.

The doctor asked me, have you had any suicidal thoughts? Yes, I sobbed.

Do you have a plan to harm yourself? No, because I can’t think of a way that would work! Sobbing harder and harder.

If I let you go, can you promise me that you won’t hurt yourself? I don’t know, I think so but I’m not sure, I feel so terrible! Sobbing, and sobbing, and sobbing!

A terrible, awful point for me in such despair and not even able to come up with a good way out. Still believing that it’s wrong, but needing so badly some relief! Just a few hours off, just a day of rest from the hurt and chaos in my mind!

Which I did get, later. I took a Valium on the way to the hospital, they gave me another one in the emergency department a few hours later. I slept then, for a few hours. That was just what I needed. But then I woke up and they wouldn’t keep me. As desperate and at the end of my rope as I was, they sent me home.

With 2 temazepam, double the usual dose of this sleeping pill. Which gave me another 8 hours of absence until I could come to terms with going on, dealing with a new day, another battle, keeping on keeping on. Until they could send members from the outpatient psychiatry team to visit and help me.

And then they started the long path to bring me back to today.

Starting new medications, changing doses, scrapping that one, starting another one, altering, fiddling, trying and failing and trying again in the long haul to now, a better day.

Today it is 77 days since I was in the emergency department of my local hospital (author’s note: written two weeks ago). Not the hospital I work at, another one near home. I could never have gone in that state to work and shown any of my colleagues the face under my usual coping face.

77 days. None of them spent working. All of them spent here at home. Making tiny steps of progress, going backward, coming forward, a couple steps one way, another few the other way, teetering backward and forward on the scale from deep depression to hypomania and somehow, at long last, feeling like I’ve settled in the middle around a place that I could call home, somewhere around about “normal”.

My husband in fact thinks maybe I’m better than “normal”. He sees now that maybe I’ve never been as good as I am now.

Sure I still get tired, and have the odd afternoon nap. But I’m more productive, I’m more energetic, I’m more engaged, I’m enjoying life, I’m driving a bit, I’m shopping a bit, I’m doing the dishes occasionally, the laundry sometimes, making the bed some days, hosting visitors rarely, doing day trips every now and then, actually living my life 🙂

We know there will still be days that are further toward one end of the scale or the other. The aim of all the treatment is to not go so far toward either end. My personal goal is to never ever in my whole entire life get anywhere near as deeply depressed as I have been. I don’t ever want to see the shape or colour of that place ever again!!

But we’re living life, and enjoying life! That’s something to be deeply grateful for every day. We’re alive, and relatively well, and life is good! Well, better anyway. That’s something.

I want to live life to the fullest. It’s a cliche, but that’s what I want. My aim is to enjoy every day that I can enjoy because depression is not ruling my life with it’s inability to enjoy pleasure, or it’s sadness, and hopelessness, and pointlessness.

Now ruling my life is just…life. Just life. Getting less complicated, more predictable, more fun! Yes, it takes an solid dose of antidepressant and a good going dose of two mood stabilisers/anti-psychotics. It takes weekly visits with my GP and psychologist, and fortnightly visit to my psychiatrist. It takes good doses of friends and hobbies and enjoyable activities. Who cares? What works, works and I have no argument against that!

Link: how to talk about suicide