Change

I have some big news! HUGE news! We’re moving cities!

What?? Yep we’re moving interstate! Not what we thought we’d be doing for the rest of the year!

Why?? My husband has been chosen by his workplace for a project. It involves tailoring and implementing his workplace’s software, and the customer wants him on site to help smooth the whole process.

Where? We’re moving to Canberra!

When?? Well apparently his start date is still Monday 12th September, as it was set a couple of weeks ago when the project came up. Yep, as in next Monday!! It seems that that is still going ahead, despite the fact that his workplace still haven’t organized our accommodation at all!! They are meant to be covering our moving costs etc, but right now it feels like what move?! Are we really moving? In a week? Like next weekend??

How long? The project is meant to be for 3 months, but you know projects…we’ll see. We might still be up there in February!

So! Once the shock subsided, I think we like this idea! I think we like it a lot. So many new things to be experienced.

Of course the list of down sides can be significant: missing friends and family, feeling displaced or lonely, far from my doctors/support network, leaving my stuff behind etc. But let’s leave all that til it happens. Right now, the opportunities are spilling out in front.

It’s going to be exciting!

What better time to be an unemployed pharmacist with no job ties? Talk about silver linings! This has to be a pretty big one. No taking leave, or a leave of absence. No having to quit a job I like. I can just up and go at a moment’s notice; which as it turns out is just as well, since it might come down to that!

I’m going to be a tourist in a new city with unlimited time to check out all the fun places it has. I’m smiling spontaneously and getting a buzz just thinking about the endless possibilities, the sights I might see and the people I might meet. And I’m off the hook about jobs! It is a relief. I’m unlikely to fall across a short term part time job while I’m up there so free time! Like last time when I was off work, when I was still sick enough to not need to think about returning to work, but well enough for short daytime adventures. Like an organ concert, a blogging class, a river cruise, taking the tourist bus or the city circle tourist tram around the city, a couple of hours at the zoo or wildlife park, sketching in the botanic gardens…I had so many hobbies and attempts at hobbies and really tried to get around the city as much as I could for free or cheap.

Remember this, self, remember the excitement when your anxiety about not knowing when you’re leaving for this new city, when you need to be packed up by, where you’re going to be living, what you need to take, how you’ll get around, if you’ll miss home, if you’ll find new friends, if you’ll….argh!! The big ol’ IF!!

I don’t deal as well with change these days, not like I used to. I tend to get anxious and become stressed about the unknowns in life which I would have sailed right through before I got sick. I need more notice, more time to think and consider the options, and I’m generally just more of a pain in the butt about the details! I need details!! Ask my poor long suffering husband! I have to be reminded, and reminded that things will work out just fine and not to get bogged down in the minutiae of a situation. Just breathe, and things will be fine. Of course they usually are just fine, but my brain doesn’t keep a record of all the times things have been just fine. It still goes straight to the what ifs.

And now I’m feeling thoughtful and pondering after that little detour, instead of happy and anticipatory of the future! Annoying. Let’s get this back on track: excitement, happiness, adventure!

I started a list of things to do once I get there, whenever that turns out to be. A reminder of all that I can look forward to, and a prompt for me to get out of the house once I get there and make the most of my time.

I’ve looked up places to go bird watching and practice my photography. I’ve ordered some tourist brochures for all the typical things to do. I’ve thought of a couple of friends I have up there, as well as my brother and sister in law. I’ve started checking out women’s bike riding groups and places to go riding. I’ve planned visits from people who may not yet be aware that they are coming to stay! I’ve chatted to some people who live an easy weekend away from where we’ll be living. Actually there’s so much to look forward to if you put your mind to it. Which I try to do these days.

I’m still writing my packing list and checking it twice. But since nothing has been happening about accommodation and no new information has come up, I’ve sort of put the packing thing off until I know for sure there’s a furnished house with our name on it that I can direct my things to. I had my initial freak out about which knives we must take and which tea towels were essential, but a Valium and a good night’s sleep mostly calmed my heart rate and thinking speed down to normal levels about that, and I’ve only been a normal level of anxious since. Well I think so anyway.

I will miss being close to my doctors. I think that will be the hardest thing. I don’t want to find new doctors; I’ll stay with the ones that I have. That probably means a couple of trips back for my psychiatrist, and I’m not sure what I’ll do about GP appointments. I know I can always call them on the phone so that’s reassuring. I’ll need to get new scripts for everything before I go. I just have to remember that I’m only a phone call away, rather than thinking of it being a 6 hour car ride away! Or however long the flight is. But nothing is impossible really. Just have to think of another way around it.

All of this shows, I think you’ll agree, that I’m going pretty well right now. Being able to see the positives, the blessings, the advantages, is not something you can force while you’re unwell, however much other people try to get you in the frame of mind. It comes with time, and with health. I’m grateful to have been able to take this enormous change so calmly, for me, and so positively. It could have thrown me well off kilter and returned my to bed for days. I’m glad that’s not the case.

So, all things being well, I’m off Canberra to have a fun and adventurous time for a couple of months, and I’ll certainly be filling you in on my life living above the blue line!

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!!