No Such Thing as a Free Lunch...

Today marks the end of my journey with the Mother and Baby Unit. My doctor saw me as an outpatient for a number of months following my discharge as she wanted to make sure I was doing ok at home. But David is now one, and I have been stable, and it was time to be referred back to my local mental health team.

Today was the day I was to have an appointment with the new Psychiatrist that was going to be taking over my care. I wasn’t looking forward to it. Due to the experiences I had before my hospitalisation I am wary of medical professionals – particularly those in mental health. Would they take me seriously? Would they screw around with my medication? Would they be nice?

Furthermore, my appointment was at my local hospital whose service has not impressed me over the past 18 months. This is the hospital where I was told (in the midst of a mixed psychotic episode) that I didn’t need hospitalisation, only a good night sleep. Indeed it is the very same hospital that I called during my labour with David, only to be told to take a Panadol and have a bath. It’s a good thing that we ignored that advice, because when I arrived we found out I was half way to having a baby, and the contractions were coming quick and strong. Naturally the birth suites were full, and I needed to be transferred to a different hospital, but the doctor was then concerned that I wouldn’t make the ambulance ride. I was told I may have to deliver in the waiting room, with no epidural (“this was not in my birth plan!!!” I couldn’t help thinking ;)). Fortunately for everyone my labour stalled, I was successfully transferred to a different hospital and I even got an epidural. No thanks to my local hospital though. Do I sound resentful? Perhaps a tad ;)

  Anyway. Back to today. I went to the appointment feeling rather stand offish and cross about things. I was on the offense and I wasn’t afraid to let ‘them’ know about it. The doctor called me up by my middle name, which wasn’t a great start. But there was something profoundly kind about this woman, and for the life of me I couldn’t stop myself from telling her everything. To open up to someone so quickly is very unusual for me. I talked and talked so much that when Steven came to pick me up my voice was hoarse. Ok, so admittedly I am still recovering from laryngitis...but you get the idea ;))

At the end of it she asked me how it had been. I was honest with her and told her that I had had deep reservations about coming, I told her about my experience with the other doctor. I explained to her that when I am depressed I don’t tend to show the emotion that other people seem to. I don’t tend to cry or even talk much. I will just state that I feel depressed, and because actions speak louder than words, I didn’t seem to receive the help I needed.

To my surprise she told me that she had dealt with many individuals that show little emotion, and that ‘Depression’ is about far more than feeling sad. She told me it was about an inability to sleep, to concentrate, to make decisions, to engage in life. She assured me that she was taking me seriously, and from her notes from the mother and baby unit and from what I had talked about she felt that I had been to hell and back. She told me how sorry she was that I had been through this, and how sorry she was that their service had let me down.

I think that’s what I really wanted. To tell someone at the hospital what had happened and for them to acknowledge it. I hope that by telling someone, perhaps someone else out there won’t slip through the cracks. Not everyone who needs help wears their heart on their sleeve.

All in all I feel good about the appointment. My new doctor is lovely, and I’m confident that with time I will trust her in the way I trusted my old doctor. To my surprise I was also given a medication voucher for the pharmacy, so I can get all my medications for free! This was a huge relief since we were paying almost $100 a month on pills.

 To be honest with you, although I have had some bad experiences with our mental health service, I’ve had some really good ones too. The hospital and all of my doctor and psychologist appointments have been free of charge. I received free childcare and now free medications. People say there is no such thing as a free lunch...but I guess sometimes there is. And I know I’m grateful for it! :)

Hospital Visit

 I think that when you’re a mum, you just KNOW when your child isn’t well. When there is something more serious than the average cough or cold going on. I think as a parent you have an instinct.

This week I had a suspicion something wasn’t right with David. On Monday I worried when I dropped him off at daycare, and called from the uni to see how he was. When we took him home that night he was frantic. Screaming, writhing, thrashing. Painkillers didn’t seem to work and nothing seemed to settle him. First thing the next morning I took him to my local GP.

My GP was concerned, David was still screeching in pain, and basically inconsolable. Yet at this stage he had no fever, no sore throat, no ear infection, no runny nose, nothing obvious to explain his pain. We spent an hour at the surgery for observation, then were advised to take him to hospital for further investigation.

My mum came with me to the emergency department, where David screamed and thrashed. He was assessed by doctor after doctor. Through tears I watched as my little boy was wrapped in a sheet and pinned down by three nurses, while a consultant unsuccessfully attempted to administer a line and take bloods. Dripping in sweat, writhing in pain, David didn’t take his eyes off me as they pricked him again and again.

The doctors were concerned he had a bowel twist and directed us to go to the city’s specialist children’s hospital to meet with the GI surgical team for a review. We were offered an ambulance transfer but I refused as I didn’t want to be without my mum. Instead we drove home, picked up my husband and went straight to the emergency department.

 At the hospital we were seen by doctor after doctor after doctor. But nobody could tell us what was going on. David was obviously in tremendous pain, but had no other symptoms. An ultrasound ruled out a bowel twist, and suddenly doctors were talking about real nasty pasties. Bone infections, meningitis, lumbar punctures. Of course we were terrified – although David was unwell we hadn’t expected anything like this. For a while, Steven and I couldn’t even say the word. ‘Meningitis’ became ‘that other thing the doctors mentioned...’ 

 Luckily for us David started to improve after taking some painkillers. Although he still had periods of intense crying, he also started having longer periods of calm. Doctors were more relaxed, telling us he had no suspicious symptoms. After a long night where David developed a hoarse voice, cough and wheeze, he was diagnosed with Croup, an ear infection and constipation.

Croup! What a relief! Somehow I couldn’t believe our luck. You see, for the entirety of our stay at the children’s hospital I had seen such dreadfully sick children. I had heard stories that made my heart break. And I had been praying that we were not about to embark on a similar journey. Taking my sad, hoarse little boy home felt like such a gift. My heart goes out to the families who have to leave their children at the hospital. The families that have to deal with heart break every day. We had a scare with a happy ending. Some other families are not so lucky.

I’m not religious but tonight I’ll thank God for my healthy child, and I’ll pray for those who need it.

It's So Much Friendlier With Two

While I was in hospital, my dearest friend Leanne was undergoing chemotherapy for Ovarian Cancer. A horrendous journey that she and her family went through, and although she has finished her chemotherapy (and is now cancer free!!) she still walks the tough road every day while she recovers physically and emotionally from the cancer.

 For the best part of three months Leanne and I were unable to see each other (the longest time we have ever been separated), and although we had conversations on the phone and by text, we weren't able to physically be there for each other. The funny thing is, our friendship and our bond has grown stronger by our experiences. As Leanne put it today “no one out there understands what it was like for us to go through hell this year”. And she’s right – they don’t.

I may not understand what it is like to go through chemotherapy, but I do understand what it is like for no one out there to understand what you are going through. She may not understand what it is like to be bipolar, but she knows how it feels to be depressed and alone. We understand each other in a way that others may not.

  And now, although the fire has been fought, there is still work to be done for both of us. This is something I think a lot of people tend to forget. Just because you have finished chemotherapy does not automatically mean you are cured. Far from it. The body needs time – a lot of time – to recover from the hell it has endured. The mind needs time to process all that it has been through. Likewise, just because you have been discharged from hospital does not mean that everything is suddenly ok. At the moment I feel I am in a constant juggling act, trying to keep on top of my emotional wellbeing.

  But despite the past year, when I get together with Leanne I laugh more than I do with anyone else out there. We have the exact same warped sense of humour that I’m fairly sure nobody out there understands. We bake and we laugh and we watch TV, and yeah we talk about the hard stuff, but we talk about the fun stuff too.

Friends are the family you choose, and I think I have chosen well. Bipolar, and many forms of mental illness, carry such a social stigma. As much as I should be honest and comfortable with what I have been through, when I am faced with someone I’m not sure I trust I find myself telling them that I suffered post natal depression, and conveniently skip over the psychotic, neurotic, manic bits. I don't want to be remembered as 'the crazy one'. But with Leanne and her family (who I trust wholeheartedly), I’m not the one who went crazy, I’m just Rachael. Just like Leanne to me is just Leanne – not the girl with Cancer.

What I am trying to say is that one thing that has helped me on this journey is my friendship with Leanne. The road is much less lonely when you have someone to laugh with, talk with and cry with. Life is so much more enjoyable when you are sent amusing texts and facebook posts (or voicemails that merely say “we’re doomed!” ;)) And as Pooh Bear once proclaimed “it’s so much more friendlier with two!”  

So thank you Leanne for everything you have done for me, and for all the ways you have helped me. I appreciate it more than I can express. Love you lots my sister from another mister :) 

I just wanna feel....

If there is one thing that my GP, child health nurse, psychiatrist and psychologist all seem to agree on, it's that I really didn't express much emotion during my last depressive episode. They all cite this fact as one of the reasons why I slipped through the cracks for so long, and things got as bad as I did before receiving adequate help.

They are probably right. When David was only a few weeks old I visited the child health nurse, talked about David for the majority of the session, only asking for some resources for post natal depression at the very end. "Are you feeling depressed?" the nurse asked, clearly surprised. I told her yes and filled out the Edingburgh scale for her. It was only after seeing my score that she became concerned, urging me to see a GP that very day. I remember her telling me that I didn't look or act like someone who was depressed. I wondered what a depressed person was supposed to look or act like.

Months later, in the midst of a mixed state, I poured my heart out to a community psychiatrist. Telling him how I thought the police were after me, that I was considering drinking toilet cleaner, that I simply couldn't go on. But actions do speak louder than words. It wasn't until I broke down and screamed at him that he believed I had a problem.

My weeks in hospital were a baseline of emotional detachment with occasional blips of insanity which invariably resulted in me being medicated and escorted to my room. I was off or on. I was quiet, off in my own little world. Or I was falling back to earth with a thud, and screaming with the pain of it all.

The thing is, it wasn't that I didn't feel pain, I just didn't know how to express it. How can you express a deep intangible pain? Where do you even begin? "I feel depressed" just doesn't seem to cut it. Because of my attitude, and the way I described how I was feeling, people didn't seem to take me seriously. The more my attempts at asking for help were unsuccessful, the less inclined I became to talk about it. It just seemed like a no-win situation.

At some point in hospital my medication was adjusted so that my pain went away. It was incredible! I didn't feel anxious anymore, I no longer felt depressed. There is so much that you can achieve when you aren't weighed down by depression and insecurities. The best thing was that although my negative emotions were dulled, my positive emotions soared. I feel happy and excited so much more than I used to. I don't know whether that is due to the medication, or simply because there is more room for positivity now my negativity has been dealt with.

But in the recent weeks I became a little concerned. While at first the absence of negativity was freeing, now it felt a little...odd. I never felt upset - even when I had a good reason to be. I never felt stressed - even when I should. On one occasion, shamefully, I even picked an enormous fight with Steven. Just to see if I could feel upset. We fought and shouted he stormed off, and I sat there screwing my face up trying to cry. Nope. Nothing! While Steven fumed in the bedroom, I went back to my book.

This week I talked to my psychiatrist about this, and she reccomended that I reduce some of my medication, particularly since I haven't had any problem with depression. So I cut down my dose and forgot about it. Until last night.

Last night Steven and I had a little argument. Nothing too upsetting. But as he stood outside, talking on the phone I suddenly burst into tears. Now I'm not talking a little sniffle, I'm talking loud, messy, gut wrenching sobs. Alarmed, Steven raced inside and tried to calm me down. But I was unstoppable. I cried about all the things that I never had a chance to deal with while I was on the medication and couldn't feel. I mourned the lost time I felt I had, I cried for what I had been through. I cried for purely selfish reasons. I sobbed and bawled, and GOD it felt good.

What's more, I slept better than I have done in weeks.

Like a storm after a drought the air is clearer now. Although I'm scared I will feel to much again, I'm relieved I can feel something. I guess it's a balancing act, trying to find a steady point between the two poles. And I'll get there. I know I will.

Admission

My admission was precisely that. A public admission that something was horribly wrong. But it took me a long time to get to that stage. I denied it, faked it, hoped that it would just go away on its own. Three medical professionals on five separate occasions recommended hospitalisation. But I shrugged it off, wiped away my tears and convinced them that I was ok. I wasn’t.

They call it a mental illness. But I believe in an inextricable link between the mental and the physical. Just as a physical illness may spawn mental distress, a mental illness can have profoundly physical side effects. In fact, to call it a mental illness surely denies how physical the mental can become. Before my hospitalisation I had shook, vomited, hyperventilated, lost weight and bled. But nothing like what was about to happen.

One day, a few weeks before I was admitted to the mother and baby unit, I was suddenly struck down with the most unbelievable abdominal pain. I managed to stumble into the living room where Steven sat, and cry out ‘something is not right!’ before collapsing. The pain was intense, comparable only to childbirth. I screamed at the top of my lungs. I lost all feeling in my limbs.

I spent four days in hospital in a narcotic haze. Eventually I underwent an investigative surgery, and the usual post operative pain was a blessed relief after the horror of the previous pain. The surgery showed nothing except some pre-existing endometriosis. Nothing ‘physical’ to explain my phantom pain.

I know now that that hospitalisation was the pivotal point in my journey. It was the moment where my body simply shut down, the mental strain having been too much for too long. It was the moment where I realized something was very wrong. I screamed out of physical pain, but also out of mental torment.  What was mental had finally become physical. Becoming physical was the only way I was spurred to seek help.

The problem was that just because I was ready to accept help, didn’t mean I would be offered it. I paid a visit to my GP and psychologist, and they both agreed that I needed urgent assistance. However, despite popular belief, unless you are outwardly behaving in an extreme manner, psychiatric hospitalisation in the public sector is remarkably difficult to achieve. To obtain a referral to the MBU it seemed I had to be first referred to my local mental health service. From there I would be assessed by a community officer, who would determine whether I needed a psychiatric assessment. The psychiatrist, who would be meeting me for the first time, and would only talk to me for an hour, would have complete power over my treatment plan.

I was frustrated by the seemed bureaucracy of it all, but I comforted myself by believing I would be receiving help within days. Instead I was offered an appointment for a weeks time. Now a week may seem like nothing, but by this point I was deep within a mixed state, and I was desperate.

Psychosis had set in and I peered out the windows, sure that the police were after me. I searched Steven’s desk, his belongings for evidence. Evidence of what? I’m not sure. I paced around the house, unable to keep still, forgetting to eat, forgetting to sleep. Steven had locked away anything I could use to hurt myself, so I sat on the bathroom floor staring at the toilet cleaner, wondering if it would do the job. I kept crying to Steven “I can’t do this, I can’t wait a week, I can’t keep going”.  Looking back, I don’t know how I did.

But I didn’t have much of a choice. I could present to the emergency department, but I knew I would be hospitalised in a general psychiatric ward without David. My best option was to wait it out, to get through the days, and to get a referral to the MBU.

Finally the day of my appointment arrived and I sat down in the psychiatrists office prepared to be as open and honest as I could. Calmly, I told him everything that had been happening, all the symptoms I had. I didn’t mince my words, and I didn’t leave anything out. At the end of it all he looked at me and said “I don’t think you need to be hospitalised, Rachael. I think your problems are to do with sleep deprivation, I can prescribe some pills to help you sleep”

  I was stunned. Had he not read the referral from my GP and psychologist, which clearly stated “it is in my opinion that Rachael be hospitalised”. ? Had he not just listened to all the symptoms I had described? I tried to tell him that I didn’t think my problems were to do with sleep, he told me that I was “overriding his professional opinion”. At that moment I realised that if I wanted help for being ‘crazy’, I’d have to stop acting sane. So I let the psychiatrist have it. I raised my voice and argued and cried. Soon enough he was printing out referrals and calling up the hospital. Funny that. Before I left he told me that he thought I would only be in the MBU for a few days, a week tops. Of course ;). 

Finally a few torturous days later I walked into the MBU for an assessment, wondering if they were going to turn me away. I can’t remember what I said, or what my doctor said, or how I acted. All I remember is my doctor standing up and saying “You clearly need to be hospitalised Rachael, we have a bed ready for you down the hall”. After the appointment with the psychiatrist I was so doubtful that I would be admitted to the MBU that I hadn’t even packed a bag. So we needed to go home first and collect some things.

Finally I lay down on the hospital bed. It was the end, or was it the beginning? I had done it, I was safe. I was relieved, scared, and everything in between. But most of all I was exhausted. I went to sleep – for the best part of three days I’m told.

And that’s all I can remember – for the first 3 weeks anyway.

The Dark Side of the Mood

Mania is like a whirlwind romance with someone who is no good for you. At first everything seems wonderful. You giggle, you make plans, you forget to eat because it just feels that good. It’s a sudden ego boost. Before you know what has happened you have eased into it, you have fallen in love with it, you have committed to the high. And once you reach that certain point, you can’t turn back, not without a fight anyway.

I read recently that one of the tell tale signs of mania is a complete denial that anything is wrong (when it is obvious to others around you that there is). I was irate when the doctor told me that she thought I may be experiencing a manic episode. I think part of the problem is the name of it. I mean manic? Really? I was so against the term ‘mania’ when I was in hospital that the nursing staff used to refer to my highs as ‘productivity’ instead. When I was depressed I was incapacitated. When I was ‘productive’ I had ideas, felt creative, completed tasks, and generally just got things done.

And how, I tended to think, is that a bad thing? How is it unhealthy to be productive? How can something that feels good possibly be an illness?

Retrospectively I realise now that I have experienced manic episodes in the past. But of course then I had no idea what they were, and I welcomed them. Now, occasionally I feel a slight twinge of mania wash over me. I feel the euphoria, or the confidence. I become engrossed in a project to the point of obsession. Or I just plain become ‘productive’. In that moment when I realise the rise in my mood I need to make a decision. I can sink into it, encourage the euphoria, and ride the wave. Or  I can attempt to stop it. Remove myself from any risky situations. Calm myself down.

But you have to understand, refusing that mania is like refusing a drink when you are on the cusp of intoxication. Are you going to get drunk tonight? Or are you going to stay sober?

But like many drunken experiences the aftermath of a manic episode often involves embarrassment and regret. And like intoxication, once you reach a certain point it is very difficult to remain in control. Mania, despite its allure, has a dark side.

In hospital I was protected from any kind of physical injury during my manic episode. But even so, I did walk out in front of a car, and was found standing on top of window sills. I was also largely protected from any kind of later humiliation. The staff who dealt with me were accustomed to mania, and my euphoric and antagonistic behaviour was really just another days work for them. Steven was the one who bore the brunt of my mood, and I know that if I were to continue the way I had been our relationship would begin to suffer. There is only so much patience a man can have.

But in the past, where I wasn’t protected by the hospital, my mood placed me in potentially dangerous situations, and hurt the people around me. For me, the euphoria, the creativity, the ideas and the confidence is just not worth that risk. Don’t get me wrong, I’m still happy, I’m still content, and I still allow myself to be so. The manic euphoria is distinctly different from everyday happiness and pleasure, and I’m able to recognise the difference.

So a few weeks ago, when I finished my shopping only to realise I had been singing out loud as I pushed my trolley, instead of giving into the euphoria I went home to bed instead. Then I completed the most mundane everday tasks you can think of. Cleaning the house. Doing the washing. And that night, when Steven and I sat down to watch TV together without fighting over my mood, it was worth it.

I’m sure there will be times where I am unable (or unwilling) to harness my moods in the way I have been recently. The memories of hospitalisation are still fresh in my head, and perhaps in a year or ten years those memories will fade. But I hope I always remember the trade off, the dark side. The dark side of the mood.

Driven to Dissociation

For most of the time I was in hospital, and for many weeks before hand, I experienced a curious sensation that the medical staff referred to as ‘dissociation’. I found dissociation to be a remarkably strange experience and very difficult to explain or describe to people. I could tell you that from a clinical perspective dissociation is an altered state of consciousness where the individual experiences a detachment from reality. But that doesn’t really say much does it? Perhaps I could tell you that my dissociative experience involved distorted vision, and an overwhelming feeling that nothing was real. But that doesn’t describe it well either.

I guess the best way to describe my dissociative experience would be to first imagine you are really really drunk. It’s hard to walk because everything keeps tipping and turning around you. You’re wading through thick mud. Everything is too loud and too bright. The colours hurt your head. You can’t read, because all the letters seem to dance around the page.  Somehow you are behind yourself, watching yourself, like some kind of strange mixed up movie. It feels like a dream. You pick up an object or touch a surface...anything to remind yourself that you are real. Are you real?

At first the dissociation frightened me. I would sit, gripping onto the chair. Willing my vision to steady, telling myself over and over ‘You are REAL Rachael.” But soon enough the abnormal became the normal, and dissociation became merely a part of my everyday experience. I learned how to hold conversations, complete tasks and even care for my baby all the while dipping in and out of reality.

  “Why?” I asked my doctor. As with any psychological state, dissociation can occur for a number of reasons. With me it seemed to be almost a defence mechanism. I was so unwell, so stressed and so unhappy that my mind was literally attempting to shut down for preservation. I began to notice that dissociation often occurred when I was upset, stressed, or tired. Unfortunately for me, given I was at that point a stressed, depressed insomniac, dissociation was a regular occurrence ;)

Of course they taught me strategies to deal with the dissociation, and they did work. But try as I might, I just didn’t seem to be able to prevent the episodes in the first place.

Nevertheless everything has it’s time in the spotlight, and it’s time in the shadows. One day, a few weeks after I was discharged from hospital, I sat down in a noisy crowded cafe and suddenly realised that I hadn’t dissociated in almost a week. I was astonished. The dissociation had disappeared and I hadn’t even realised it was gone!

Now I occasionally get a little tingle of dissociation. Sometimes I’m standing behind myself. Others I’m watching my life like a film. Like a twinge in an old wound, it warns me to slow down and reassess my situation. Am I stressing too much? Am I too overtired?

A demon now tamed, my dissociation watches over me. A lesson now learned, I listen to my mind.