Tag Archives: nurse practitioner

My Schpiel

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New clients view me with a mixture of distrust and curiosity. I am usually introduced to them by a case worker who gives little information about me or about what I do. Initially, I am seen as part of the system.

I have to break through any figurative walls quickly and carefully to reach a level playing field where I can teach the skills I’ve learned. Passing along what has helped me is my whole reason for working. Giving the tools that help me stay well and not relapse into crisis is what being a Certified Peer Specialist is all about. It’s my job.

In training, I was coached on how to introduce myself. I was given the Five Key Concepts and directed to use them when I meet a new client or group. Those concepts are

  • Hope
  • Personal Responsibility
  • Education
  • Self-Advocacy
  • Support

My introductory pitch to a new person is important. It will determine how we are going to interact. Once the mood is set, it is difficult to change it. I have to be vigilant in my own recovery and follow my own WRAP daily to be ready for these precious meetings. They are precious. Each meeting and each session and each client is a gift to my recovery. I heal freely sharing what I was taught.

My schpiel or pitch is conducted completely using “I” statements. It’s my story. It’s never exactly the same, but it meanders along an outline something like what follows:

When I was diagnosed with a mental illness 12 years ago, I was devastated. I felt like I’d hit a brick wall with no possibility of going around or over it. I lost my job, the respect of my family and many friends, and my self-respect. I felt utterly worthless. My life as it had been was over, and I felt damaged. What’s worse was I felt abandoned by society as a whole. I was an outcast.

I had many dark times. There were days when I had no energy to get out of bed except for the most rudimentary needs. There was a time I wouldn’t leave my apartment for days. I despaired that things would never improve.

I had no hope. Darkness swallowed me.

Luck put a group of loving friends in my life. They listened to my complaints and distracted me with silly card games and other activities. They dragged me into the sunshine when all I wanted was to stay locked behind my door. I also had a kind prescribing psychiatric nurse practitioners and at other times good psychiatrists. I have been extremely lucky to be in therapy with a highly regarded psychologist. All these people gave me a few tools to get through each day.

They showed me that hope was possible. Trying different combinations of medicine gave me ideas that I could improve. Getting out to socialize even in simple settings like the coffee shop was a labor for me, but I did it regardless of my internal desires. I began to exercise. I clung to my friends. I renewed my interest in meditation or guided visualization. I began to see how taking care of my most basic needs was an act of self-love.

Hope rekindled in me. It was slow, and over the course of years, I realized that I had a stake in making me feel better. I was miserable, and I wanted not to be. Those little daily tasks like taking my medicine, socializing, exercising, and meditating became a mantra of sorts. I saw that I had to take some responsibility if I wanted to feel good.

I also had a lot to learn. I was fortunate growing up to have an older sister who worked in the mental health field. I knew a lot about the importance of taking medicine each day. I heard about her experiences with patients, and I knew I did not want to be sick. I wanted good mental health, and I had to educate myself on my illness. Living with the Internet, this process was much easier than just a few years ago. I had a wealth of information at my fingertips, and I used it.

I began using the new information I’d gleaned from the Internet and books and sundry other resources to talk to my healthcare providers about my treatment. I became an active participant. Looking my psychiatrist in the face and stating plainly that I wanted help with a particular problem altered my life. I was a force in my own decision making. I was not a pawn of any system.

Finally, I permitted myself to have a group of supporters who have my best needs at heart. Today, I have an excellent prescribing nurse practitioner, and we work closely together on my medication needs and talk openly about events in my life. I have a top-notch therapist that I’ve known for over twenty years. I have a case worker who is one of my greatest cheerleaders. I have loving children. I have friends who truly love and support me in my endeavors.

I have a new lease on life.

The above is a broad example of my schpiel or introduction. It’s tailored for each setting and each new client, but it’s my joyous responsibility to follow the Five Key Concepts and model them in my life.

If there is anything I would like to emphasize it is regaining hope. Without it, I was lost. I cannot say enough how thrilled I am to do the work I do, to live the life I have, and to practice my own recovery. Today, I am hope-full.

Coping with Anxiety

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Yesterday was not an easy one for me. It was busy with emails flying about and doctor appointments and phone calls. The emails were unfortunately very confrontational, and they caused me a lot of anxiety.

Over the years of therapy I’ve been grateful to have, I’ve come to recognize negative emotions in my body right from the very beginning. For me, they start in my stomach. When I feel it churning or burning, I know that I’m experiencing anxiety or fear. When my chest tightens, then I’ve already missed the early warning signs, and the situation grew. If my face muscles clench or I have a headache, then things are out of control.

Thankfully yesterday, I caught my emotions while they were still in my stomach. It was extremely unpleasant, and I was relieved to have two appointments with health professionals. I saw my psychiatric prescribing nurse practitioner and my psychologist. Both are very competent women with many years in their fields, and I trust them fully.

The nurse practitioner and I had a good opportunity to discuss the situation, and she had some great feedback. She suggested that I begin to disengage from the volunteer organization that I spend so much time and energy giving to. She didn’t tell me to quit, but to let others in the group step up and do much of the work. I have been doing this since the beginning of the year, and I’m continuing it.

My psychologist had even more concrete ideas about easing the trouble causing my upset stomach. I had been insulted by one conversaion, and she suggested I write a very short note to the friend who had hurt me. I did that. I wrote clearly that my feelings were hurt. I did not write in anger. I did not express any either. I stated simply what words hurt me. Just discussing the idea of writing the note eased my churning stomach. Actually doing it and hitting the send button on my computer gave me more satisfaction. Later, I received a simple and heartfelt apology. All was well.

My psychologist paid me a great compliment. When I began counseling with her many years ago, it would take us many sessions to dig up my emotions. Yesterday, I entered her office and immediately explained my upset stomach and what was causing it. We came to a good conclusion, and I followed through. All that was accomplished in one sitting.

I have learned to pay attention to my body. It doesn’t lie to me. If something is wrong in my environment or with a situation that I can’t put my finger on, I can trust the sensations my body is giving me. I did not learn this overnight. It took many years, and I am still perfecting it. I will always be a work in progress.

Anxiety is awful. It robs us of clear thinking and overall enjoyment of life. Causes of anxiety are as numerous as grains of sand on the beach. I used to be terribly frightened to drive in parking lots. Life is not simple, and I needed a coping mechanism to allow me to park with minimal fear and greatest safety. I learned to plot my course. I visualized entering the parking lot from the same spot and turning down the same lane each time. My decision was to park in the first available stall regardless of its distance from the store’s entrance.

It worked. I learned to practice this visualizing and planning technique with many other situations in my life. Whatever gave me fear would be met by clear thinking and discussions with caregivers and planning.

I am not alone today. I have people who care about my success at daily living. They help, and I am learning to accept help.

One Nice Thing

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My friend suffering from major depression contacted me after a long quiet spell. Actually, I initiated the communication reaching out to him. We’ve been sending text messages for a number of days now. He doesn’t seem to have the energy to speak on the phone.

I’ve known him for about six or seven years now. I’ve talked to him in times of deep crisis and in happy ones, too. When my internship begins, I am going to strongly urge him to join in the WRAP classes.

A Wellness Recovery Action Plan as taught by certified facilitators has the capacity to alter lives. It changed mine. I cannot stress enough my personal transformation. I walked into the job training a frightened individual who believed he was defined by his illness. I leaped through a stage or two of recovery the first week. My eyes opened. I shed my negative self-talk miraculously.

Recovery works. It really works.

My friend can’t see that as yet, and I do not push. I offer understanding. I have been in the dark pit of despair and made it out with the help of a cadre of supporters. I had family, friends, case workers, a therapist, a psychiatrist, and a psychiatric prescribing nurse practitioner all working to find what would work for me. I believe it allowed me to reach a place of acceptance, opening me to the possibilities of recovery.

My mantra encourages those suffering depression to do just one nice thing for themselves each day. Just one. A simple one.

Many years ago when I was at my lowest, my one nice thing was brushing my teeth. I was incapable of more. Gradually, I was able to exert a bit more energy and add activities to my list each day, but I began slowly.

It’s important for people with mental illness to practice loving acts of self-care. We, who often feel the opposite, are worthy. I am worth it.

Feeling Surreal

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Can time be experienced as more than simple aging and decay?

Can time be experienced as more than simple aging and decay?

I wrote recently how my negative self-talk had stopped. I’m happy to report there’s been no resurgence. I won’t call this permanent, but there’s a sea change in my head. I glow.

My psychiatric nurse practitioner took one look at me yesterday and noticed. I’m beaming.

I have been studying for my job training classes. They hoisted an enormous 3-ring binder on us bursting at the seams with information, and we will be tested on it at the end of the training. There will be a written and an oral test. I’m concentrating on the present. I’m studying and retaining as much as possible. The test isn’t today.

Where did this patience come from? When did this ability to live here now appear?

I can honestly say I awoke after the training and realized I had a head clear of the negative bombardment I’d known all my life. I’m questioning when these qualities I’ve seen in others came to me.

I’ll be going for another week of training in a matter of days, and I am truly excited. One of the next lessons will be about battling negative self-talk. Ha! It appears that all I needed was to write a WRAP, and – poof! – they were gone.

Overbearing Emotions

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It’s a sad day for many. A massacre occurred at an elementary school in Connecticut in the U.S. Many small children lost their lives, and many brave adults did, too. As soon as I heard, I shut off the news on my computer and limited my intake. I am sensitive to these tragedies, and they have a way of needling into my thoughts and taking center stage.

Despite the measures, I wept for a long while and felt anguish and helplessness. My mind returned again and again to the unbearable loss.

Thankfully, I had an appointment scheduled with my psychiatric nurse practitioner, so I knew I would have an opportunity to discuss my emotions regarding the horrifying news. I arrived early and asked if she’d heard the story. She had.

***

I don’t trust my emotions. I’m unable at times to distinguish how I feel, if anything at all. I’m fighting back tears as I write this, and I don’t know what the tears are for or why I’m fighting.

***

The nurse informed me that people with a mental illness like mine will often repress emotions. “Little incidents,” she said, “that I wouldn’t even spend a split second thinking about become mountainous obstacles in the lives of my bipolar, depressed, and schizophrenic patients.” Due to this, we often shut emotions off only to have them resurface in odd ways.

I found myself pacing my little house several days this past week. On several occasions, I wandered back and forth along a worn path from room to room. When it dawned on me I was walking aimlessly, I didn’t stop. I tried to remember what my thoughts were while pacing, but it was no good. The thoughts had vanished. My memory was faulty. The nurse informed me this was a classic example of repression.

My sleep has been troubled, too. I wake after a few hours and then can’t get back to sleep until several more hours pass.

And there are the dreams. One I call “The Actor’s Nightmare,” in which I find myself on a bare stage where someone is just about to raise the curtain. I don’t know my lines. There is no set. I’m wearing no costume. There are no props or even other performers. No one else is backstage with me, but I can hear people in front of the curtain talking to the audience announcing the beginning of the show. I can’t get their attention to tell them about the emptiness they’re about to expose the audience to. I find a kind of bag full of papers that I begin to fling about so that I can take the empty bag on as a prop.

Emptiness. Lack of control.

There’s the dream of which I only remember the ending. I have lit a cigarette lighter, and I’m inhaling the flame to burn away the rotten parts of me. My lungs are engulfed by the blaze. I have a desperate need to burn what is unworthy.

Self-loathing.

I saw my therapist yesterday, and we discussed the dreams. We talked more about the sexual healing I’ve been working on. She mentioned love.

“How far back do you have to go to an age when you know you were loved?”

“The cradle,” I replied.

She displayed no surprise, but I was. My answer was quick and certain, so we spent time imagining caring for a “baby me.” I held the baby close. I cooed to him. I rocked him. I cuddled him.

We went through the steps of changing a messy diaper, and I got to express love in all circumstances with a baby’s needs.

***

Healing is slow.

***

I cried today for the lost children in Connecticut. My heart aches now for them, but then my heart aches much of the time. I sent out a prayer to whatever it was that set this universe whirling, asking for healing and solace for their families and me.

Getting Help and Preventing Suicide

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Please, let me reassure regular readers I am not suicidal.

As it states in the tiny “about” paragraph on this blog, I am merely here to share my experience, strength, and hope as it relates to living with bipolar disorder.

That being said, readers can search here and find times when I have been suicidal, and there were times before I started this blog when I was suicidal and others I have not written about.

I am writing this today to share some resources that helped me in crisis. There may be readers who are searching for help.

First, there is the National Suicide Prevention Lifeline you can call in the US at 800-273-8255. If you search the Internet, your country may have a similar phone assistance program.

Second, there is a little website I stumbled across that helped me: metanoia.org There is an excellent line on that site:

“Suicide is not chosen; it happens when pain exceeds resources for coping with pain.”

I was jolted into remembering my first time to visit the metanoia.org site. I was deeply depressed. All around me was black. I felt like I was in the bottom of a pit so deep and dark that no light shone in. No light. There was not the tiniest glimmer. All I could feel was pain. All I wanted was for it to stop.

Depression is a disease. It is recognized by doctors as such. It is not a moral failing of the sufferer, although that is just how many people internalize their experience with it and how many of those around judge them.

Through many struggling years and patient family, friends, and caregivers, I reached a point where I began to think about helping others. I will start job training in the new year for that, and I’m anxiously awaiting it.

This blog has been both a form of expression for me and a way to reach out to others hurting, too.

I can honestly say that I’ve been very lucky. I’ve had many excellent psychiatrists, psychiatric nurse practitioners, nurses, therapists, and caseworkers over the years.

One thing has stood out for me. I have used them. When I was in crisis, I sought out help, and it was given to me amply.

If you are in crisis, reach out. Extend your hand. Help can be found.

Mania 3

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Sigh.

Here I sit at my computer in the middle of the night when I should be sleeping.

My mind is racing.

Everything I touch is magical, and colors have meaning.

The tapping of the typing speaks to me in secret code.

I’ve been pacing through the rooms of my very small house.

I’ve overeaten.

I sat in front of the TV long enough to run from the lowest channels to the highest.

And then I paced some more.

I’ve taken my medication.

I should be sleepy.

I’m groggy, but I feel agitated.

If you go to the right side of this blog and click the word “mania” in the tag cloud, you’ll find a lot of entries about this subject.

I want to sing. Shout. Dance. But not in a healthy way. I want to flail and thrash.

I had a change in my medication recently. I’ll be calling my psychiatric prescribing nurse practitioner in the morning to ask if it could trigger mania.

I know a lot of people with bipolar disorder who actually look forward to this high, but for me, it’s devastating. I spend money I don’t have. I act out sexually in unhealthy ways. I have delusions. I talk to trees.

I’m angry and anxious.

I feel vulnerable.

I feel sick.

Hospitalization

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I’m fresh out of the hospital where I spent the last four days getting my medication balanced. If you read my previous post, “Manic 2,” you know I was not well. I went to the hospital not long after writing that.

Thoughts of suicide are not healthy. Simply put, they are an indication of something far off kilter. I was just that way, and it was quite awful. I took myself to the emergency room and signed myself into the psychiatric ward. I’m grateful for a friend who suggested it. I’m grateful for my caseworker who suggested it, and I’m even grateful for the anonymous crisis-line worker who suggested it. Yes, I called around looking for answers. I took all their advice and went.

I was able to completely relax knowing I was in a safe place. The atmosphere was healthy and loving. I felt cared for.

Through the data on this site, I can see the searches some people use to find this blog. The question of whether or not to go into the hospital comes up occasionally. I’ve been hospitalized three times now, and I can say without question that it was necessary each time. I have found restoration in the hospital. While I’ve been scared going there each time, on arrival I’ve been relieved. It’s almost like diving. Standing at the back of the board is scary, but taking the plunge is so relaxing and, in the end, invigorating.

For me, hospitalization has proved successful.

My Head is Spinning

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This is just a quick note to report on a medication change. I take gabapentin as a mood stabilizer. The dose I was taking in the morning was making me very light-headed, so the nurse and I decided to reduce it. The result is mania. My mind is racing, and it’s not pleasant at all. I can’t focus. I can’t carry on a conversation. It’s horrid.

Well, I called the nurse practitioner, and we’ve decided to try increasing the dose I take at night to see if that will alleviate the mania while not adding to the light-headed-ness in the mornings.

Fingers crossed.

Stopping One and Starting Another

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I had to stop the lamotrigine. It has some potentially fatal side effects, and I noticed the symptom of one of those within the first week of taking it. I called my prescribing nurse practitioner, and she agreed that I should stop it immediately. She then asked me how my mood was, and I lied saying I was fine. I lied.

I called her back this morning and took responsibility for my words and told her the truth. I’m still manic. I’ve lost my appetite completely. I’m sleeping very little. My mind is racing a mile a minute. I find it difficult to concentrate on anything. Taking care of myself has gone right out the window. I’m still spending money I shouldn’t.

I wanted to buy two shirts off eBay today, but luckily, the phone rang and I forgot about one until the auction was over. I let the other one pass as I engulfed myself in a project. Getting easily distracted can have benefits.

The nurse is prescribing a different mood stabilizer that has fewer side effects. I’ll start that as soon as I can rip myself away from all the distractions I have at home and can go to the store to pick it up.

Ah, euphoria. How I wish you didn’t feel so good and would simply leave me alone.