It's been a long long time . . .

Wow. It's been 9 weeks since I last posted. It feels like that long, it feels longer.

The great news is my lack of postage is because I have been out and about, living my life, and enjoying it.

Referring to my last post; I did indeed go back to work on the Monday (Sept 14th) I was only in for two days, as on the Wednesday morning had my third and final appointment with the crisis team psychologist, which I will write about in detail on my next post. Fascinating stuff. Then on Wednesday afternoon I travelled south for my friends wedding. I was the bridesmaid. I'm sure I must of mentioned it before on here. Anyway, yeah, it was a stressful couple of days pre-wedding but the everything was sorted in time for the big day and she had an amazing time, as did I. I got drunk of Champagne which is curious since on the rare occasions prior to this that I've had to have a glass, I've not really liked the taste.

Back into work the following week; only for three days: as Thurs and Fri 24th and 25th Sept were my uni induction days. There is a very small number of us doing the course, all currently employed in the NHS. Nurses, midwife, radiologist, ambulance crew, OT's - a real mixed bag. To me that makes it even better, as there are a lot of different perspectives on the same scenario. There are only a couple of us doing it part time, the rest doing it full time over a year. In hindsight I wish I had done the same but thats a ramble for another time.

The following two weeks I was in uni solidly. The course has 3 research modules where you go off and do your own thing; and 3 taught modules. The taught modules are generally composed of one or two weeks of lectures and then you go off and do your reading and submit essays; so its still massively self directed.

So I spent two weeks in uni, and then I flew to India on October 10th.

Let me tangent off for a minute about holidays. I am ridiculously crap in hot conditions. The last time I had a beach holiday was in the summer of 2002, just before I started university to do my nurse training. I spent a week in Gran Canaria with two mates. I spent the whole time wilting in the heat, whinging that it was too hot, pissing them off and in the end pissing myself off too. I learnt my lesson. No more sun for me. Since then the few holidays I have taken have been spent either in a European city, or whooshing down the alps on my skis. But my friend, the one who just got married, was marrying a guy from an Indian family and so they were also having an Indian wedding. There was no way on the earth I wasn't going to be there, so as soon as she told me I prepared myself for a hot holiday in the Indian Summer.

I went for two weeks. The first week we (me and her man of honour) travelled round the Golden Triangle of North India - Delhi, Jaipur, Agra. Then the second week we flew south for her wedding.

I worked out that the last time I had a two week holiday was 10 years ago, when I went to California with my parents. I was 17 at the time, initially I wasn't going to go as they had planned the trip for their 25th wedding anniversary. But then I got hit by a car and ended up dropping out of my A-Levels, with a plan to start them again the following September. So out of sorrow, they re-invited me, and out of self-pity, I accepted. Sorry, I lose my train of thought. My point is, the second week makes all the difference. Really made it seem like a holiday. I had a fantastic time, truly forgot about work or uni or mentalness; just enjoyed myself. Truly amazing time. Didn't facebook, read a blog, nothing - for two weeks. It was liberating.

So by the time I did return back to work on Monday 26th Oct I had actually had four weeks off! And the previous two weeks before that I had worked a sum total of 5 days. And, got paid for it all!!! It wasn't as bad as I had imagined it to be. The place was much the same, the people were much the same. No one new, on one had left, no dramatic changes; not that I was expecting any.

I am now working 3 days a week, with 2 days study leave and two days off a week. I have been rigid about only working extra bank shifts on the days off or extensions of shifts I am already working; so that I am still having two days a week to do my work for uni. There is a lot of it, but at least its stuff I am interested in. I bough a fancy corner desk and sorted out my wireless, so the office is up and running.

I am still waiting for an appointment with a psychiatrist in the hospital where I am now being treated. The crisis team psychologist also referred me for CBT and I am still waiting for an appointment for this. Thinking about it, its been like 6 weeks now. I have inspired myself to give them a ring and see what the deal is.

My blood sugars are brilliant, well for me. I haven't deliberately omitted insulin or had a (large) sugar binge in over 2 months. I am sleeping well, I am eating well. I am being disturbingly inactive. I didn't go to the gym for two weeks after I came back from India. Combined with the two weeks I was in India; effectively I may just as well have burnt my membership fee that month. I have got a little bigger. And while it does bother me, and I am fully intending to loose it again before Christmas, I took the decision that getting my presentation and essay finished were higher priorities. It was me who went ahead and did not go for a run for a month. Its only now I can see it, but getting onto this course has really boosted my confidence, I feel like while yes, I would like to be thinner, thats for me, to please myself. I feel accepted by my course mates, my friends and my collegues. They don't mind that I am a little bigger. To them I still have the same worth. So I can deal with my size in my own mind for now, because I believe I have done the right thing.

My crap arsed GP's wouldn't give it me my fluoxitine on repeat prescription without seeing a doctor for a medication review; and then wouldn't give me said review for a week and a half; so I had a hideous five days where I went cold turkey from 60mg to no fluoxitine, and got some nasty gastro side effects. Then I recommenced straight away on 60mg and experienced more nasty side effects. Seriously, they were the most rancid smelling burps I have ever known. Attractive. But I seem to be back to normal now. Sorry body.

I am way behind in blog land. The only person I have caught up with since I came back from India is Lola - and much love to you hun.

The rota for December is out. I am working Christmas eve and day; but got new eyars off. I can live with that.

xXx

Utilisation of the NHS at its Finest

Considering I've been off sick from work, I've had somewhat of a busy week.

On MONDAY I went to the GP's. It was my 5th ever visit to this practice since moving house and GP's at the end of January, and I saw my 5th doctor. I told her about ending up in cas last week, now being under the crisis team, and my leg. I didn't even try and start to give her a potted history and she didn't ask. She was helpful though - I explained about needing a referral to my local hospital psychiatry team so I can be seen there in out-patients and she said she would write one. She gave me a prescription for zopiclone. Then we got onto the leg: its a mess. She's put me on flucloxicillin [500mg qds 1/52.] She made me an appointment for wednesday to go back and get it checked, because of being diabetic and delayed wound healing etc etc. She said it might need surgical intervention, by which I assumed she meant incision and drainage.

I phoned my boss. I asked if I could take this week off and come back next week. She said to me "I can't tell you thats its ok to be off sick, but if you need to be off, be off." I have to call and confirm I will be back next week on sunday. I also need a sick note.

I got a phone call from the nurse from the Crisis Team who had been out to see me on Sunday. He said they had made an appointment for me to see their psychologist tomorrow.

So on TUESDAY I apprehensively turned up for said appointment. The mental health trust is different to the acute hospital trust and so despite being on the same site, its in a different buildings separated by bits of gardens and small roads. However, its the same trust as the one DrF works for as there is one huge mental health trust for the city with wards and out patient services at all the hospitals. The last time I had been in the building for the mentally interesting was over the Easter Weekend 2007 when I had a four day stay in the assessment unit. Prior to that I'd been on one of the wards for 6 weeks in may/june 2oo6.

I hadn't realised that all the out patient stuff ran from there as well. It was strange going back. I passed the ward I had been on. It was odd to be able to walk around freely; without a support worker following me and no one ushering me back onto the ward after five minutes. Its not a place I associate with either freedom, or good times.

The psychologist was in my good books after 5 minutes, when he told me he had been through my notes at length. He knew a lot of my history, which saved me a lot of work. He had the dates of all my out patient appointments, like ever. I thought this was fascinating: it transpired I had 55 appointments for CBT over 23 months, for which I attendec 50. This was in 2005/06. I have had 19 appointments with DrF and attended 9. Some were cancellations, some were DNA's. He thought this was hugely significant. I was really surprised because I liked DrF and got on with him really well, so the low attendance rate surprised me.

He said he would like to meet with me 3 times. We made the next two appointments there and then. I found the session quite beneficial. He said a lot of things that hadn't occurred to me before. I don't really want to go into it in too much detail here; but he certainly gave me food for thought. I don't know if he was a consultant or a reg. I reckon he could only have been early 30's at the oldest.

I had managed to secure an appointment with brilliant diabetic nurse for WEDNESDAY. My appointment was for 9am and I didn't leave until 10:30. It was really good to see her. I told her absolutely everything. She asked to see the leg. She thought it was a mess and asked the nurse who specialises in diabetic wounds to take a look. I told them about the fluclox. They gave me a prescription for another weeks worth. I have daily dressings to do on it as well. She said it would be at least 2 months before it healed up fully, and I would be left with a dint and a scar. I have to back next week for them to see it because if the antibiotics aren't working enough I might need IV antibiotics and incision and drainage.

When I think of all the times I have cut, and they have always been superficial and never caused any physical problems. The guilt and shame after the event and the covering up of scabs and the embararssment of scars is another matter altogether of course. But by not cutting my arms and instead burning my leg I thought I was somehow doing a good thing. I wasn't cutting because I was getting better. HA! I hope I have scared myself into neither cutting or burning ever again. I could need surgery. All my own doing.

I was meant to go back to the GP's on wednesday afternoon, but since I had much more faith in the diabetes nurses ability to care for the wound, I didn't go. It was with yet a different doctor again anyway. But it occured to me afterwards I still need to get a sick note. Before monday. Which means I'll have to go tomorrow. Twice in a week. Yikes. The receptionist will recognise me before long.

On THURSDAY, or yesterday as it is now, I had my second session with the psychologist. He said a lot of interesting things. Again. Such as, we don't need to know the 'why' behind a behaviour to change it, which had never occurred to me before. I'm always searching for the why. Why do I use insulin manipulation as a coping mechanism? I always thought if I could work out how where it all stems from I would be able to stop it. He really made me think. Like, I do things every day without consciously knowing why. I do them, because thats just what I do.

He explained to me about how we can learn to separate memory from emotion. So for example, when I remember being in primary school I generally feel happy because I remember it as being a stress free, happy time. But when I remember the summer of 2006, I can't really place an emotion on it. Yet it was clearly an emotionally charged time for me. It was fascinating stuff.

It was a bit depressing though, I found myself falling into my pessamistic mindset. Feeling like a failure for lacking the willpower to stop manipulating insulin. That I am untreatable, that nothing will ever work and I will be like this forever. Which leads to thinking that this isn't how I want the rest of my life to be, and so Whats The Point? and so on and so forth. And once I had got going I ruminated for hours.

We talked about CBT and DBT and psychotherapy and group therapy. He is anxious not to just to throw me at any service and hope that it works. He thinks I need something that challenges me on an intellectual and emotional level, otherwise I will not partake fully and start to see it as failing. I have my final appointment next week.

I really really hope that something beneficial will come of all this.

Randomly, my Mum called me yesterday, apropos of nothing, and asked if I was okay and that she couldn't shake a feeling I had got myself all stressed out and was off sick. The telepathic power of the mothership never ceases to amaze me. So I updated her about seeing psych liason, the crisis team, and the psychologist. I didn't mention the DKA the week before or the ramipril, or the leg. She's coming up to see me tomorrow, or today as it is now, and I can't wait to see her. I've not seen her for 9 weeks, which is a long time for us. We usually see each other every 5-6 weeks. I'm just glad that my arms are scratch free, because that always upsets her.

So thats been my week. I feel bad for using so many services this week: the gp, the diabetic nurse, the psychologist twice. It's quite selfish when you look at it objectively.

I feel a bit in limbo now. I am supposedly back in work on monday, yet really nothing has resolved. I guess I just have to get on with it.

CN

xXx

A+E and the Crisis Team and a new Doctor

After I wrote my last post, I got into bed and cried. And cried and cried and cried. Pathetic I know but I was literally at my wits end. I tried to sleep as well but shockingly enough that wasn't happening.

I was on a day off but I was meant to be on a study day. I watched the minutes go by, knowing I wouldn't get there on time. I thought about getting a taxi. And then I cried some more and decided I wasn't in a good enough state to go.

So bang on 8AM I called Dr F's secretary and OMG, like, oh wow - she actually answered. Success! But the news was bad. It transpires that DrF is no longer my doctor; because they've had 'a change around' and so DrF is only seeing inpatients. She informed my my doctor was now Dr? [so called because I can't rememnber the name. I think it was a woman.] So I asked if I could get an appointment with her; but seemingly she has a different secretary. So DrF's secretary went off and came back and told me one had been made for November and to expect a letter in the post. I asked if the thing about having to have a new doctor was final, like I definately couldn't stay under DrF; but seemingly that is indeed the case.

And then I cried some more. And bang on 8:30AM I called the GP's because by this point I was read to spill my innards to a stranger if it meant they would calm me down (I was kind of hoping for a bit of promazine to be honest) but the receptionist had no appointments until next Thursday. I was managing not to cry down the phone but I think my warbaly voice was giving the game away a little. I had been blatently crying to DrF's secretary. The shame. At least I'm never going to have to speak to her again. So I said to her 'what if its a mental health emergency?' hoping she might panic thinking she had a mentalist at the other end of the line and magically find me an appointment; but she told me to go to cas(ualty).

I spent a good few hours pondering that. I didn't want to waste anybody's time. I wasn't sure I was really ill enough? On the surface, I was fine. I had gone back to work, I had kept myself out of hospital. No-one would know what was going on inside my head. Which was mainly thoughts about potassium. I was thinking about how much I would have to take to induce an arrythmia. And playing a movie in my mind of being struck off the register for stealing potassium supplements from work, and I really don't want that to happen. I realised it boiled down to whether or not I could trust myself not to steal any drugs from work. And as much as I didn't want to openly accept it; at the moment I'm not sure I can. At which point I decided I would go to cas.

So I must of turned up about 3ish. I had showered and washed my hair and moisturised before I went, because I'd been rather neglectful in the personal hygiene department of late, and I didn't want to give them reason to make me stay (they don't look favourably on self neglect. Look clean at all time). I was really really twitchy once I had booked in. I must of changed seats in the waiting room over ten times. I couldn't keep still. I was trying really hard to sit still and keep my mind busy.

I got called in and started pouring everything out to the poor triage nurse, who was like 'I'll go and get the psych liason nurses'. This was new. My hospital (as in, where I work and where I see DrF) has a cas psych liason team; but when I had been once before to this hospital (as in the one round the corner from my new house) they had just had psych house officer on call.

Anyway, I was put in the crazy persons room and met two nurses from liason, a man and a woman. I instantly liked her, she had doc marten boots which were black with daisy's on. He was a nice enough bloke as well. They were just like 'kathryn, slow down' because apparently I had accelerated speech. I must of talked for a good hour and a half. She said a more junior HO might mistake me for being manic but I wasn't, I was just super stressed.

Apparently if you're manic nothing can calm/slow you down; whereas as I spilled everything out and got all my stresses off my chest, I did begin to relax to the point where I was able to sit down and sip a cup of tea.

If being manic is having that 'mega jittery can't keep still can't concentrate on anything for more than a couple of seconds' feeling for an extended period of time I'm grateful it's not something I've ever experienced. No haloperidol in my ass thankyou very much!

They felt the best option was to refer me to the crisis team, so calls were made and I was given their card. They debated about giving me some promazine, but said they'd leave it for now, and that the crisis team can always prescribe it out in the community.

I completely lost it when it came to talking about having to call nice lesser boss to say I would be off sick tomorrow. I just don't want to let her down - I've been so well for so long, everything has been going really well, I've got onto this masters and stuff and I don't want to shatter the illusion. So the liason nurse said she would call for me. I was like 'thats so pathetic, I can't let you do that ' and she was like 'look at the state of you, I'll do it'.

I left feeling quite a bit better; but Thursday night was hellish: stupid mind having stupid intrusive thoughts, and playing movies over and over. I dialled the number of the crisis team card a couple of times but hung up before anyone answered. I called two of my amazing friends. One was on nights so I called her at work. The other, I woke up, at 3 in the morning, and she was equally supportive. It certainly helped my 'I have no friends because I am worthless and why would anyone want to be my friend?' mentality.

I must of nodded off about 5ish but didn't get up til after 9 on friday morning. I had a voicemail from the liason nurse saying she had spoken nice lesser boss. Liason nurse said she had given nice lesser boss the bare minimum - that I was having a visit from their team this afternoon, I wouldn't be on my late shift, and that I would call later. And so I spent the next 3 hrs stressing about having to call later and what I was going to say and what she was going to think and that it was YET ANOTHER episode of sickness.

The crisis team came to see me on Friday afternoon. It seems like a similar set up to the crisis team at my hospital, who I was under for a couple of weeks last year

[for more info see these posts:

http://blogofcrazynurse.blogspot.com/2008/09/being-discharged-and-crisis-team.html

]http://blogofcrazynurse.blogspot.com/2008/09/being-discharged-and-crisis-team-round.html]

They come out and see you in your house and try to prevent hospital admissions. They can see people for up to 6 weeks, and they're all mental health nurses. A man and a women came round. They stayed for a couple of hours; I gave them a basic mental health history and then ranted about why I couldn't stop obsessing about taking rndom tablets and seeing what happened. They said that if I was going to have to have a new doctor at my hospital, why not move my care to the hospital round the corner. Technically I should be there anyway: its nearer to my house, and my GP practice is covered by their services. Makes sense to me, and I like the idea of having my mental health care away from work. So they said they would sort that out. They talked about referring me to their psychology team because it had been over 2 years since I had CBT. I said that was fine. I was much calmer than I had been in A+E. I sort of worried that they probably thought I wasn't ill enough to be under their care.

They arranged to come back on Sunday (as in today) but I was supposed to be working the early on Sunday. I explained to them about having to call nice lesser boss back and how I was stressing about it. They advised I went to see my GP next week and got a sick note for a week or two, and then I didn't have to worry about work. They said they would call me when they got back to the office, by which time I would have spoken to nice lesser boss, and then we could arrange an visit time.

So I called her, and she was so lovely. I know you don't have to say anything, but I told her that I was having some issues, and that it wasn't safe for me to be in work at the moment, but I hadn't wanted to admit that, and that DKA was a more valid reason to be off, hence implying it wasn't exactly an accident. She told me to look after myself over the weekend, and to contact the appropriate people if I needed to. She said she would put me down as sick for Monday and that I should call her on Monday afternoon.

The friend who I had woken up at 3AM invited me to hers for the weekend as her boyf was away so she had the place to myself. On Friday she had 4 of us over and we got a Chinease delivery and she tried different make up on for her impending wedding, which is in 2 weeks. I'm a bridesmaid!

On Saturday she slept in til after midday while I speed red through her book collection. On saturday night we got some Definately Very Dodgy's and watched District 9 and Dorian Grey and I got State Of Play which I never got round to watching at the cinema.

I was really grateful to her: the fact that soemone else was around all the time meant I didn't ruminate over things too much. I managed to sleep as well. Bonus.

She dropped me back off here this morning, and one of the nurses from the crisis team who had been here on Friday came round. I inwardly smiled thinking that now they had established I wasn't going to hurt them, they could come alone. But he refused tea or coffee. Reminded me of my student nurse placements in the community - there were places you knew not to accept a brew, and places deemed safe enough to accept. Clearly he hadn't made his mind up about me yet!

I talked quite openly to him. I feel like I'm just sitting tight, waiting for my thoughts to go away. Then I worry they never will, and that takes me down the whole 'what's the point?' road which only leads to feeling even worse. I'm also obsessing quite a bit about death. Death in general that is, not my own particularly. We talked about distraction mechanisms and using rubber bands instead of cutting, and previous coping strategies.

He said they would contact their psychology team tomorrow, and call me with an appointment. My job is to go to the GP during their open clinic hour (since I know their are no appointments til Thursday) and get a sick note for next week at least. But I also need to go to the GP for another reason: I had put a lighter to my leg on Monday and Tuesday after work and then picked at the scabs, and now one of them is blatently infected. I've got a nice cellulitis on the skin around the scab all red and hot; but more worryingly covering a wider area than the scab and cellulitis, like underneath the scab as it were, I've got a large lump. My friend thought it might be an absess. I don't know much about them, but am already panicking that it might involve IV antibiotics. I seriously hope not.

And thats where I'm up to.

CN

xXx