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Before I post this week’s missive I just want to say a huge thank you to each and every one of you who stopped by my little blog last week and read my disturbed thoughts. I was very much of two minds whether to post anything so personal and dark, but you all were so faithful in reading what I wrote, and those who contacted me were so kind that you restored my faith in writing the whole ugly truth. I love you all, and watching the stats rise was such an enormous encouragement to me! THANK YOU!

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Back

Written late April 2016 after my latest work contract ended; updated 20th June 2016.

“I worked my a*& off to get back, really back; harder than I’ve worked at anything my whole life. ” – Detective Marcus Bell, Elementary

…”because there’s nothing like getting back for getting better” – current WorkSafe Victoria Return To Work campaign

Getting back; it’s what everyone recommends for getting better. I resisted it for a long while in my original sick leave but in the end I found that it was true! Occupation, purpose, time consuming work; it all helps to develop an inner feeling of being better, getting  back to normal.

But, as my deepest darkest suspicions have been humming a tune all along, it’s not enough. I’m not enough. My efforts are not enough. It was a dark moment! Or two…

There have been tears, and more tears; it was so disappointing!

More doubt, more undermining of my confidence that was fickle at best, more breaking through my denial of recovery to let the truth of ongoing illness in. Then there are moments of resolution, mostly led by my husband’s sensible, problem solving , kind voice where I decide actually I will be okay; I’ll be okay, I’ll figure it out.

It’s not what I want; I think that’s obvious. If I could do anything to change it I would. I tried to see if there wasn’t any way around this decision to relieve me of my job by not renewing my contract. I spoke with the powers that be reminding them of my loyalty, commitment, long term intentions and proximity, for goodness sake, if nothing else! But I can’t fight my way out of this. Maybe I have to let it be.

Oh that so does not sit well with me. But a good friend reminds me that maybe that’s the point; maybe this is a long term play for my strength of character not a short term game for my own convenience! Ahhhh…it’s hard to swallow but maybe I need that.

So here’s the situation: the workplace I was working in when I got sick doesn’t have any obligation to me, to rehabilitate me. I was working there on a one year contract when I got sick at the half way point, and wasn’t able to return to work for any more than two mornings a week in the last 6 weeks of the contract. And that was just a desperate scramble to try to be okay enough to stay on there. I was utterly unable physically, and not even slightly ready mentally to apply for a new full time contract, the only way that I could’ve stayed on. So the contract, and with it, the obligation, ended and I went back to bed. Not what I wanted, but I couldn’t do anything about it; I just wasn’t in a state to change things. It was what it was.

So then, after another 9 months at home, I started back at work with a short term contract at the next place that would take me. They also have no obligation to me, other than to offer the same support that they would offer any other employee. They took me on when I was returning to work; they knew that, and made some allowance. But it’s not their fault, not their duty. No special exemption or workplace mentors; no keeping a place for  while me while I convalesce and struggle to get back into the swing of things. You have to compete with every other well person and that’s just how it is. And when it’s over, it’s over!

Done                     3rd May 2016

I’m overwhelmed, I’m in dismay,

The job I had, the work, the pay

It did me good, it helped me stay

Above the blue line, come what may.

 

Now it’s over, my sad reply,

Tears of hurt and loss I cry,

Feeling useless, have to sigh

For fear of dark days once again nigh.

 

It did me good, it kept me busy,

Filled my days and weeks, and nearly

Convinced me that I was now surely

“Better”, “fixed”; was I silly?

 

Silly to be believe in “health” so easily,

Of usefulness, I thought sincerely

That all was good, I did feel truly

That this was it, “I’m better, really”.

 

The routine and the structure, see,

Work and occupation the key,

Helped me build life, ABC,

From sickness to health; 1, 2, 3!.

 

I got me carried away, and planned

To stay and work, but now that’s canned!

“I have no hours for you ma’am”,

It’s over; nothing to be gained.

 

You’re done here! Well it hit me hard,

I did not see it coming, barred

From that which made my life less marred,

It feels unfair, am I so tarred?

 

By that which has my brain entangled,

Bipolar, why have you now mangled

This, above all else was dangled

Hope, that by work I’d disentangle.

 

Please let me stay, I love it here,

The colleagues; the task; the jolly cheer,

And to my home it is so near,

Please let me stay, just anywhere.

 

I’ll type the scripts, talk on the phone,

Check the work that others have done,

I’ll smile, be nice, work with anyone,

Please, please, please don’t say I’m done!

 

 

 

Sunday Summary

Dear friends,

It has been a busy week! For me, I mean; probably not what you would call a busy week. I didn’t work at all, I didn’t get many chores done, and the most I did daily was get out of the house for an hour or two. That’s busy, for me.

I’m so happy that it worked out to be that way!

When I finished work three and a half weeks ago I was worried that the naturally “depressed state I was in about finishing work, together with my ongoing lethargy and tiredness, would result in me becoming a bed bound vegetable again.

Well again isn’t fair; I’ve never ever not gotten up at one point or another during the day. But with no definite reason to get up in the morning, my lack of motivation to get up unless there’s someone waiting on me, and the general listlessness of having no set purpose, I thought that there was a fair chance of me lounging around all day.

And it turned out to be that way for a few days. With nothing planned, with accumulated tiredness from keeping up with my shifts at work for six weeks when they consumed about the last ounce of my energy, and no reason why not to get up, I had some pretty massive sleep ins.

Until I missed my tablets one Sunday night! This happened in spite of the careful routine that I have built into my days after I had previous missed doses to prevent the same thing from happening again. Obviously there’s still a loop hole somewhere that I haven’t found but I’m working on it.

My routine is to weekly make up a medicine box with all the medications that I need to take both in the morning and at night. My pharmacist brain cross-checks the directions on the bottles and boxes with the number of tablets I put into each slot and then double check that I haven’t missed anything by comparing what I’ve packed with my complete list of medicines printed on the bottom of the box. My triple check is when I take each group of tablets and I count again to make sure I have it right.

I set this medicine box right next to my bed on my bedside table so that I should see it when I get up and when I go to bed; this should give me a visual prompt to take my tablets. But I don’t trust this system so I have set a morning and evening medication alarm in my phone. This can only be snoozed three times so I also have a medicines app that generates a reminder at 7am and 9pm for me to take my tablets. This can be snoozed to infinity I think, but the fact that I missed a dose makes me wonder if it actually does have a limit to being snoozed. I’m looking into this.

So the missed dose. You wouldn’t think it would make that much difference; it’s only one dose right? But it does make a difference, at least for me at this point while we’re still fine tuning the medications. Most times when I miss my tablets I end up getting upset over some little thing or teary for not much reason or get in a fight with my hubby! Poor hubby, he has to bear the brunt of everything! I think this reaction has been when I’ve missed my morning dose, which means I miss my antidepressant and my morning lithium dose.

This time I missed my evening dose. That means my evening lithium and my other sedating mood stabiliser. I’ve only ever done this once before. It’s never fun, because it means there’s nothing putting me to sleep! This time was terrible! I’m sure I had a maximum of 4 hours sleep but who knows. When you’re tossing and turning and can’t sleep and want to sleep, time loses all meaning! Poor hubby again, every time I tossed or turned he turned! But I physically couldn’t bear the sensation of lying still! It was awful! I just had to move and move and move and move!! I woke at 5am and tried to exist as quietly as possible til hubby was ready to get up. Then, so out of my recent character that it was laughable, I jumped out of bed fresh as a daisy at just after 7am and left the house before hubby! I was in my runners and leggings and I was off!

Compared to my recent sluggish, only-move-if-I-have-to, and even then moving snail’s pace, I was striding off to the park like I haven’t since I don’t know when, and paced out two laps! It was ridiculous to me even as I was doing it! But it was a fabulous feeling! I could move as fast as I physically wanted to for a change, instead of how fast I physically could through mud bearing heavy weights!!

Incredible! And so friends, this is mania. Or a sub form of it. You won’t see me like it often, unfortunately or fortunately, but you’ll know it when you see it. I’ll be smiling at all and sundry, grinning, laughing, putting out a decent amount of physical effort, having a great day! I’ll be chatting flat out, possibly jumping topics or getting distracted. I’ll be super effective and get many tasks done. I’ll be physically active and able to do a lot more activity than usual.

It’s a feeling that is addictive actually, I never want it to end…to start with! By the end of the day I was pretty sick of it actually because I could hardly sit still or rest, and was just feeling irritable, agitated and like I couldn’t possible tolerate having another night like that. By then the frustration tears were pretty close to the surface, but let me tell you I achieved a great days work! All three loads of washing done, some of it off the line and folded! The kitchen was sparkling clean; I’d cleaned the grout and the stubborn grease on the splash back. Lots of jobs attended to, a family visit where I chatted away like a…like a crazy person! Chat chat chat chat chat chat chat!

But I was glad to put it away. Not glad to go back to lethargy and anergy (absence of energy), but after all it’s a balance. You can’t have everything, so you have to decide on the most important things. Which is not being a whirling dervish, but a calm reasonable person not prone to snap decisions and excess!

My short point at the end of that long explanation was that it broke my bed rest habit and got me out into the sunshine, and the outside world. I watched the ducks paddle, saw the swallows come out to swoop and feed, found a magpie nest without getting swooped and in fact saw the magpie partner watching from on high at a distance. And remembered that I liked the outside and wanted to be out there, not inside all day.

Add to this a pep talk from my psychiatrist AND my GP in the same week about just getting outside, no agenda, no pressure, no panic about how I was feeling, just enjoyment…and the message was clear! Just enjoy it.

So I have enjoyed it! What a glorious week it has been!

Monday started slowly, but a late afternoon trip to Blackburn Lake Sanctuary yielded a fabulous hour of the new Musk Lorikeets ( see earlier post) plus an added hour of delightful favourites. Then a sleepover with our great friends and delightful bubba!

I just love love love this gorgeous Galah eating wattle photo!

I just love love love this gorgeous Galah eating wattle photo!

This is the cutest Noisy Miner sequence I've ever had - mother catches moth, baby screams for it, baby gets moth, mother leaves :) eucalypt

This is the cutest Noisy Miner sequence I’ve ever had – mother catches moth, baby screams for it, baby gets moth, mother leaves 🙂

Tuesday didn’t work out how I had thought it would, but a picnic on the banks of the Yarra river in delightful Warburton with several girlfriends and their cute kids is a pretty fine day if you ask me! In addition I got to see two lots of adorable ducklings and a fun Kookaburra.

Cute cute cute! Discovering the innocent joys of crawling up and down stairs, green grass

Cute cute cute! Discovering the innocent joys of crawling up and down stairs

More cute! Fluffy Wood Duck ducklings huddling on a rock in the Yarra River at Warburton

More cute! Fluffy Wood Duck ducklings huddling on a rock in the Yarra River at Warburton

Wednesday morning was a return to Blackburn Lake Sanctuary, the top end this time for some variety of bushland and birds. What a day it ended up with a Kookabura flinging a metre long snake around and many cute tiny birds that were hard to capture.

The fabulous post and rail fence that completely encircles my favourite Blackburn Lake Sanctuary

The fabulous post and rail fence that completely encircles my favourite Blackburn Lake Sanctuary

I spotted this Laughing Kookaburra and stopped for photos, didn't realise it was in the process of killing a snake!

I spotted this Laughing Kookaburra and stopped for photos, didn’t realise it was in the process of killing a snake!

I just love being in the Sanctuary - so pretty and lovely

I just love being in the Sanctuary – so pretty and lovely

Thursday, oh Thursday! This was a bucket list day with a girlfriend and it was amazing! Glorious day, two brand new birds that I’d never seen before, loads of flowers, a couple of moths and some damsel flies! Some amazing scenery, the awesome Kuranga native nursery, Birdsland reserve and a flash trip through the Dandenongs (see previous post).

Friday was appointment day and catch up with my old work mates day and getting my favourite bacon and egg sandwich and eating it in the gorgeous Fawkner Park. A picnic above Yarra Boulevard with my fabulous hubby and some new photo ops over the city as the sun set…wow! Can you beat that for a way to see out the work week?

The great outline of Melbourne city backlit by a cloud sunset, blue sky,

The great outline of Melbourne city backlit by a cloud sunset

The brilliant sunshine, the silhouette of a pretty tree and Melbourne - I love you

The brilliant sunshine, the silhouette of a pretty tree and Melbourne – I love you

Saturday was another girlfriend catch up and was great fun finding plover babies and getting swooped relentlessly by their parents! Then we went on a Loch Ness Monster hunt all around the Blackburn Lake and still aren’t sure exactly what was doing so much flashing and splashing and swimming…tbc, duln duln duulllln! We got a fabulous shot of a Spotted Pardalote by the path and had a great lunch at Gourmet Girl – what an awesome catch up! Over tea cooked by sensational hubby we heard and saw two Striated Thornbills in our minimal garden! I think they’re building a nest! Excitement!!

Mummy Masked Lapwing with tiny weeny baby - these must be very new because the plovers have been docile until this week; now they are savage!

Mummy Masked Lapwing with tiny weeny baby – these must be very new because the plovers have been docile until this week; now they are savage!

Not a clear shot but the beautiful front of a Spotted Pardalote

Not a clear shot but the beautiful front of a Spotted Pardalote

Sunday is rest day and I’m glad for that, but boy I am so glad for every bit of excitement and interest that has sprinkled my week and made it actually fun! And thanks to all my wonderful people who are there every day giving me a hand along, and making my life more amazing!

Funny side story. After looking back at the week in the detail above, it made me remember all the good things and I mentioned to hubby that I’d had an amazing week. His response was fascinating: “Really? Maybe the last couple of days have been okay but I thought you had a bad week.”

To which I, in the mood of putting all the good bits together and seeing them in clear focus and forgetting the rest, replied: “Really? But I’ve done all these amazing things.” So we had a chat and here’s another perspective moment – what’s in focus is really clear and the rest in lost in fog.

My hubby was remembering coming home to me still lost in my afternoon nap, to me not able to get my thoughts together enough for our weeknight Bible study, to him making dinner from scratch every single night of the week, to me as a blob instead of an enthusiastic lover, to me struggling to get enthusiastic about any physical activity; basically to him carrying the load of the relationship, the housework, being the bread winner and the carer for this weighty gal.

So yes, if you look at all the cool bits it was a great week. If you look at all the failures it would bring you to tears. If you see all that hubby did to get us both through the week, you like me would have overwhelming admiration for this great fella without whom I don’t know what awful state I would be in!

So my motivation for this new week is trying to even out the load for my good man, and continuing to have great days!

So tell me…?

Something that I’ve found out along this journey with me, my head and I is that questions are really important.

It was that question that has become an advocate for helping others with mental health concerns that first triggered my understanding of the need for questions; R U OK?

I’ve always been interested in mental health and I saw this group pushing people to understand and use the question R U Ok? to start talking to others about what’s going on, what’s wrong, what’s troubling you, what’re your concerns? I thought it was a great idea and I bookmarked it in my head to use someday if I saw someone having a hard time.

I wasn’t sure that it would be effective but I planned to give it a go anyway; nothing ventured, nothing gained, right?

But then, before I had a chance to use it to help another person, someone asked me, and I burst into tears!! Just like that! That is how powerful the question is and how right on target it is to really hit the spot when someone is down, anxious, fearful, despairing etc.

I didn’t think it would work. But I walked into a doctor’s room to get some routine results, she asked ‘are you okay?’ and it turns out I wasn’t, to a severe degree which I had not even realised up until that moment.

When she said, ‘how are you?’, as I walked in the door I said fine. That question is just too automatic and we are too programmed into a standard response that doesn’t really give an answer. We know when we ask it that it’s more for form than for really enquiring into someone’s health. It has become a greeting more than a query. Not to say that it can’t be used as a question; some people can inject that something extra that shows that they genuinely are enquiring about your health, but usually that’s not the case.

But there is something unique, direct and unusual about the question ‘are you okay?’ that hits a nerve, that registers with a person as an actual question and that demonstrates some extra kind of care and interest on behalf of the asker.

Questions are so important in mental health.

We can’t lay open a wound, or show an obvious dislocation, or contusion, or register a positive blood culture, or low blood level as evidence of our condition.

We may not look ill, or sick, or injured to other people.

All the evidence of our ailment is locked inside our heads.

It is literally all in our minds, but not in the way that that saying is usually used, to suggest that it’s a figment of our imagination!

There is nothing imagined or exaggerated or fictitious about any mental illness.

However there is a level of difficulty for anyone treating a mental illness, be it doctors, nurses, psychiatrists, psycholgists, counsellors or any other health professionals.

To diagnose a mental illness, as with any other condition, a set of diagnostic criteria must be met. But none of those criteria are obvious when a patient walks in the door.

The diagnoser (doctor or psychiatrist) must be able to draw out the information that they need to make a diagnosis by asking questions. They need to ask a lot of questions. Questions designed to gather information, to confirm suspicions, to determine signs and symptoms of the condition.

They have to be very skilled in asking questions AND in listening to the answers for clues about what is going on with the patient.

It takes time! Sometimes a lot of time. Sometimes questions are asked over and over. There is a purpose to that; it is to gather the right information so that the right diagnosis is made and the right treatment given. It might seem repetitive but every question fills a useful part of the overall picture. It’s not a sign of incompetence on the part of the person asking the questions; its a part of their professional skill.

Patients most often don’t know what is going on with them. I’m a health professional with a clinical understanding of mental illness but I still didn’t recognise mental illness in myself. I just thought I was stressed at work. The fact that I was constantly obsessing over work all day and night, that I couldn’t sleep, that I was being clingy and petty and being a huge strain on my husband with my concerns and fears and anxiety didn’t occur to me to be an excessive reaction. So I can’t even imagine how patients with no prior knowledge of mental illness feel when they start to suffer from symptoms.

They might be scared, afraid, stressed, anxious, overwhelmed, confused, in denial or fearful of what the diagnosis will mean and what treatment will be prescribed. So the doctor also has to tread carefully around the person’s soft or sore spots but still trod and poke enough to get what they need to do their job.

In any emotional state a person has more difficulty remembering and recalling, trouble giving an accurate history, limited ability in listening and responding, and struggles with taking in information. This is one of the reasons why questions need to be repeated; to be sure that the right answer has been given. It’s also why seeing multiple doctors on different occasions can be useful in building a clearer picture of what is going on.

Often a patient may not be diagnosed immediately, because of these factors. It may be considered in the patient’s best interests to allow them time to go away and calm down, to give more thought to the history of symptoms that they have experienced, and then to bring them back and ask further questions. Of course it isn’t safe for all patients to be sent away; some need to be kept for their own safety, some need to have treatment started immediately. For those who are sent home to return late, maybe the same questions will be asked all over again, and although it seems tedious to the patient, it is all for the purpose of gathering as much information as possible so that the best outcome can be achieved for every patient.

So, questions.

Tell me what’s been going on?

How have you been feeling?

When did this start?

Who have you already seen about this?

What treatments have you tried?

Has anyone in your family experienced any mental illness?

How long have these symptoms been going on for?

How severe are your symptoms?

What symptom is the most difficult for you?

What has brought you here today?

How are you today?

Compared to then, how are you now?

What do you think has triggered these symptoms?

What has happened that might have caused this?

What do you know about your condition?

What do you know about the treatment for this condition?

What’s the worst symptom that you are experiencing?

How are you coping?

Are you experiencing any side effects?

Give me a run down on how the last week has been for you?

How often do you shower?

How often have you been getting out of the house?

Are you finding enjoyment in life?

How has your motivation been?

What have you been getting up to?

Have you been hearing or seeing things that don’t exist?

Has anyone been speaking to you through other objects?

Are you suicidal?

Have you had thoughts of harming yourself or others?

Do you have a plan to harm yourself?

Have you had suicidal thoughts?

Have you had thoughts that are frightening to you?

How has your sleep been?

Tell me what you are afraid of?

Do you ever have periods of great energy when you can achieve a lot? Or when you don’t need sleep?

When are you not anxious? Are there any places where you feel comfortable?

What things make you anxious? What things trigger a panic attack?

There sure are a lot of questions that can be asked!! And this is probably the tip of the iceberg really, these are just the questions that I can remember from the health professionals that I saw. I’m sure there are many others for other mental health disorders.

And yet, the most important question is whichever one you ask to the person that you see struggling. It really doesn’t matter what it is. It can be r u ok?, how ya doing?, what’s up with you?, how are things?, how have you been going lately?.

As long as you take the courageous step of asking and listening, you will be doing the right thing. Go you!!