the D card

Today was the day. It finally happened.

I finally pulled the D card. You know. The D card.

No, no, not that D card. Ew, gutter brain.

The doctor card.

Even though I graduated this past May with my FNP degree and started into my DNP program in August, I chose to continue working as an RN mostly because this affords me the time to work full time while having 4 days off to work on my doctor degree and to study for my certification exam. And I really like having full medical insurance. I’m a pretty sick little dudette.

Still, officially, I am both an RN and NP. This isn’t generally an issue because at work, my duties are to be the RN. Take orders from MDs, DOs, and NPs and make sure they are implemented and executed appropriately and thoughtfully. Once I get an NP job, my responsibilities will change.

But that doesn’t change the fact that my knowledge base has definitely expanded to diagnosing and treating patients with the mindset of a physician or practitioner. This is particularly useful when something is wrong with the patient and I know what needs to be done… but I just can’t do it until the overseeing physician gives me the actual order. But at least I can prep it all beforehand instead of scrambling for it after.

But the issue is that as an RN, people only see you as an RN. They don’t only rightly assume you don’t have as indepth of a knowledge as aphysician (or practitioner, for that matter), but they also wrongly assume you know nothing. There have been many situations where a patient or family has argued about a decision I made (the patient is unable to breathe, so instead of letting him eat, like the family wants, I get him on a BiPAP machine) or an explanation I gave (water and medication going into the lungs can cause pneumonia; it’s not just sugar), only to have the doctor repeat the same exact thing before they accept it.

Take into additional consideration that I look like I’m 22 when I’m almost 31, and now people think I’m too young to really know anything. I had a family member just today ask me a question, and as I began to answer, she looked incredulously at my specifically-colored nursing scrubs, cut me off, and asked, “Wait, you’re a nurse?”

Gee, thanks. What’s that supposed to mean? You old cow. Psh. At least I look YOUNG for my age, not the other way around like someone we know… *grumble grumble mutter grumble* I’m joking. Mildly.

It can be a battle, one that I’ve had to learn to fight every working day. It doesn’t help at all when I’m trying to do something, but the family thinks I’m too young.

So today, I took care of a patient whose daughter was very demanding, rude, and disrespectful. Every question she asked was asked at least 3 times in the same conversation. If I began to answer a question, she would cut me off with another question before I was even 5 words in. After wasting a precious half hour answering her repetitive questions (and getting cut off every time), when I would finally get to tend to my other patients, I would find her stalking the halls and bombarding my coworkers with the same questions.

Let me give a quick transcript of what happened, adapted to a very common and generic scenario (obviously got HIPAA reasons).

Some Family Member: What do you mean he can’t eat? Why not? He’s hungry and sick. He needs to eat or he won’t get better!

Me: Yes, I understand that, but we can’t let him eat right now because he failed his swallow evaluation. Every time he swallows, some food goes into his lungs.

SFM: Well, you can’t just starve him! He hasn’t eaten since breakfast this morning! Why can’t he eat?! And how do you even know that???

M: (resisting the strong urge to say that I hadn’t eaten since 5PM the day before because it’s always too busy to take a breakfast break, especially when I have to wake up at 4:30 AM and my lunchtime won’t be until approximately 4 PM today)

M: I know because he coughs almost after every swallow. I watched him struggle to swallow a pea-sized bit of food. If the food goes into his lungs, he’ll end up with pneumonia. If this is a chronic swallowing issue and we let him eat, he’ll just get pneumonia over and over. We tried it with nectar-thick, honey-thick, and pureed food. He coughed with all of them.

SMF: Well then, you’re just going to let him starve? Seriously?

M: Once he passes his swallow evaluation, he can eat again. If he’s choking, then he shouldn’t be eating. It isn’t at all safe.

SFM: Okay, then are you going to start him on fluids? He’s going to starve and get weaker!

M: It has been literally less than 3 hours since he last ate something. Not eating for any period less than 24 hours doesn’t affect a person as much as you might think. Last night, he went over 14 hours after dinner* without eating and he woke up in the morning perfectly fine. But if tomorrow, he is unable to eat, then we can ask the doctor to start him on fluids. (*Our dinner trays tend to arrive a bit earlier than what’s typical.)

Some SMFs will grumble and others will accept this.

-fin scenario-

There is a very large fear of not eating that people tend to have, which is understandable but not necessarily completely logical. This isn’t simply because after dinner, we may not eat until breakfast the next morning (or lunch at 4 PM if you’re me on a working day) and still be fine, but also because it is much more dangerous to eat and get very sick than it is to stop the cause and have a small fast. Eating is very important… until it becomes the cause of your problems.

ANYWAY, back to my story. So a more specific version of this conversation happened with this daughter. Each time she asked, it would be 30 minutes of her asking me the same questions, my answering her questions while getting cut off, then get going back to one of the questions she cut me off from earlier, her aggressively waving juice and water cups in my face, or telling me why he was coughing and how it had nothing to do with food (“It’s allergies!” “He has a sore throat!” “He’s got phlegm in his lungs!” “It’s the pneumonia!” “He wasn’t properly awake!” “He’s congested!” “Was he even sitting all the way upright?” “His throat is just dry!” “You know he has acid reflux/asthma, right?” …I tell you, I’ve heard it all. Someone hit me with some other ones!)

Six different times, she dragged me into the same conversation, same questions, same aggressively cutting me off, same repetition. Six times, I was dragged into 30 minutes of unnecessary conversation that was already explained by the speech therapist and corroborated by other RNs. Five times that she stopped one of my coworkers in the hallway to ask them questions about a patient they don’t know. A total of 3+ hours (of the 6 or so that she had been there) that she was occupying and taking away from my other sicker patients. All because she needed to ask me the same questions, tell me the same things, and come up with more illogical reasons as to why  we clearly didn’t evaluate him properly.

But the final straw was at approximately a half hour before change of shift, when I still had to check on one patient, administer medications to another, and get ready to tell the incoming RN about my patients. She used a beeping machine to lure one of my coworkers into the room, only to bombard her with a slew of questions I had already answered more than 20 times before. I stepped in because this was my patient, not my coworker’s. She had things to do, too. This was extremely inappropriate of the daughter.

As she raised the same questions again, she frantically told me, “Listen! Listen to how congested his cough sounds!”

I interjected: “Yes. He’s aspirating and has pneumonia. A con-.”

She cuts me off. “Well CLEARLY that’s why he was choking on his food! How can you expect him to swallow properly with all that phlegm in his lungs? I can’t swallow when I’m congested either.”

Me? I’m baffled. A little lost for words. This is almost as good as the guy who tried to tell me that water and pills in the lung can’t cause an infection; only sugar can. Almost. Where the hell do people come up with this stuff? “Um… No. The phlegm is in his lungs. Food goes down his esophagus. They are two completely different areas. The phlegm deep inside his lungs is not going to keep the epiglottis open. That isn’t how it works. Also If you have trouble swallowing when you’re congested, you might want to see a speech therapist, too.”

She sighs loudly and rolls her eyes. “No, you need to take it out. Go in there and take it out!”

Me: “You… want me to go down his throat and into his lungs and… suck out the phlegm?”

She nods emphatically. “Yes!”

I stare at her. “No. No, absolutely not. He is perfectly capable of coughing up the phlegm on his own. He did it many times today. I am not going to force a plastic tube down his throat when he can -.”

She gets angrier. “No, you HAVE to get it out! And then he’ll be fine! Then he can eat!”

Me: “There is no harm in waiting for the speech therapist to evaluate him again tomorrow. But it isn’t happening today. I’m not go-.”

She snorts. “I never said do it now. When did I say that?”

I ignore her statement. She said it several times today. She asked my coworker about it before I stepped in. If that’s the case, then why is she making a big deal about getting his phlegm out so he can eat? But I don’t say that. I’m tired.

She continues. “He just needs to get it out and get tested with the thickened liquids.”

This time, I sigh. “I’ve already told you, we tried nectar thick, honey thick, and pureed. He co-.”

She spins around, grabs the containers of honey thick water and juice and waves them at me. “THESE! He needs these! They need to test him wi-.”

I throw my hands out in front of me and sharply cut her off. “No. You are going to stop cutting me off and let me finish what I have to say. I have explained to you at least 20 times over 6 individual conversations that we tried those. He coughed. With every swallow, he coughed. We tried puree, which is thicker. He coughed. Nothing worked. For the last time, we used those and he coughed incessantly. It. Didn’t. Work. Taking out his phlegm is not going to make his aspirating better because that isn’t the cause. That isn’t how this works.”

She immediately starts up the minute I finish my sentence. “No, I KNOW how it works! My mother was doctor so I know how it works! You don’t know because you’re not a doctor! My moth-!””

I feel the blood rush to my face as my fatigue and frustration boiled over into anger. The events of the day run though my mind. All day, she needlessly wasted my time, bothered my coworkers, tried to manipulate people to get what she wanted, was consistently rude, repeatedly cut me off from answering her questions, only to ask the questions another 50 times, disregarded everything I said, all in front of several other family members, and now she’s looking down on and disrespecting us because we are “only” RNs and her mother was a doctor, so that makes her more knowledgeable than us? Did she think, by declaring her mother was a doctor, that would give absolute credibility to her vague made-up nonsensical excuses and we would meekly accept it because as RNs, we don’t know anything? Doctors know everything, but a simple RN wouldn’t know that she’s pulling shit out of her ass to get what she wants. When she insisted that her father needed fluids or else he would starve, I told her that he didn’t need it just because he’s not eating for less than one day. He wouldn’t starve from that. Instead, she went to the doctor and whined about how dehydrated he was and how dry his lips and tongue were… but failed to mention that he had been on the BiPAP for over 12 hours that day and is an open-mouth breather. Because she knew that saying, “He’s going to starve” was not going to get him the fluids she desperately wanted, she instead said “dehydrated” because that’ll get fluids for sure.

And now, she’s trying to pull a half-assed lie over me, thinking that I’d be cowed by the fact that her mother is supposedly a doctor, something that she never had mentioned in the however many times they had been inpatients?

No. I wasn’t having it. She had been rude and difficult all day. But the frustration that had been building refused to let her disrespect me just because she thought I was a child nurse.

I cut her off with one short sentence:

“I am too.”

All conversations cease. The family members who were chatting on the couch stop and stare. She opens and closes her mouth like a goldish. “W…what? You are?” She looks at me in disbelief. Not surprising. I don’t even look old enough to be an RN, let alone look like I should be diagnosing patients and prescribing medications. Granted, not a lot of people know what NPs are and there really isn’t a term for it in other countries. It all translates to “doctor”, but I am not about to get into the nitty gritty details of the difference in the medical model versus the nursing model. All she needs to understand is that I am also someone with intimate and extensive knowledge of the human body; who diagnose and prescribe, give orders, and lead the medical care of a patient. And that just because I am an RN does not mean she has any right to take me for a fool. No RN should.

“I am. So understand that right now, you have 2 choices. You can either continue to make excuses for why he failed his evaluation and should be allowed to eat and possibly worsen his condition. Or you can be more concerned about the infection ravaging his body and put off eating for one more day, for his own safety. What is your choice? Is it more important for you that he eats? Or that we make sure eating isn’t the cause?”

Her demeanor has changed. Whereas all day, she stood in front of my, always standing to talk at someone, she is now sitting in the chair, not making eye contact. Her hands are neatly folded in her lap, and her voice is calmer, softer, and interestingly, more respectful.

“Absolutely, I want him to get better first. If eating is possibly making him sick, then waiting until tomorrow is much safer. And you’re right, he is getting the fluids, and the other doctor said it had vitamins in it, so he should be fine. They will come to test him tomorrow, won’t they?”

I assure her they will. And without another word, I leave the room. I’m feeling all sorts of emotions. Exhaustion. Elation. Pride. Fear. Embarrassment. Thoughtful.

It was a rollercoaster. My coworker who heard the majority of the exchange looked shocked and impressed. I could tell why; I felt exactly the same.

Exhaustion because i’m not generally a confrontational person. If a family or patient’s wants or doesn’t want something, my mentality is, “You have every right to accept or refuse act treatment I offer you. If you refuse, I’m not going to waste my time trying to argue with you. All I’ll do is reiterate the costs and benefits and ask if you’re sure.” The only times this doesn’t hold is if it is a treatment that is crucial or detrimental. Then I will push, but if the patient doesn’t want to take his multivitamin, why force him?

Elation and pride because I rarely stand up for myself. I don’t let people walk all over me, but I tend to choose my battles very carefully. But today, I stood up for myself. I made a point. I showed her not to judge a book by its cover because she was so wrong. I showed her that my coworkers and I are not just dumb nurses. We’re smart, intuitive, creative, and quite knowledgeable. Even if she continues to be manipulative, she’ll at least know that RNs are not to be trifled with anymore.

Fear because I don’t know what kind of backlash I might get. In essence, I pulled rank in a place where that rank really had no place to be. I didn’t use it, but it made a point. Would I be told I crossed a line?

Embarrassment because once I graduated with my NP, I told myself I would never use it while working as an RN. It’s free knowledge amongst my coworkers that I am an NP and currently getting my doctor in nursing practice, but I rarely share it with my patients because it isn’t in my job description. So I told myself, no matter how disrespectful or condescending someone was, if it came to it, I would back off and leave it to the doctors to clarify misunderstandings. My skills in effectively educating patients would be developted as an RN when I’m working as an RN, and an NP when I’m working as an NP. But today, I got pushed beyond a point I’ve ever imagined. Worse yet, someone witnessed it. I was a little mortified.

And finally, thoughtful because I said I am a doctor. In one sense, I am not a doctor. I am neither an MD, DO, nor a DNP. So in English terminology, I am specifically an NP. There is no “Doctor” in my official title. Not yet, anyway. But I am someone who can evaluate a person and diagnose him; come up with a treatment course; prescribe antibiotics; and head a medical team. I am a doctor, a person who specializes in the art of healing. I can doctor people. But I am not yet a Doctor.

Dr. Pandemonium, DNP, still has at least 2 more years before she can debut.

MDs, DOs , NPs. We’re all so similar and yet so very different. It’s no wonder that sometimes, the lines can blur.

Today, I pulled the D card.

And, yes, it felt amazing.

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Coming out

Major depression ruins everything. Whoever first thought that MDD was the perfect way to get attention clearly did not understand the implications of such a disease. Yes. A disease. Just like having diabetes or cancer or even a broken leg, MDD is a disease. Unfortunately, the lack of immediate tangible evidence makes it difficult for people to grasp what it really does.

In those fancy commercials about MDD and general anxiety disorders, they always show that lonely person with the furrowed brow, looking out the window with increasing trepidation. In movies and TV shows, they’re depicted as the quiet odd one, or the ones that are holed up inside. They’re slightly disheveled, blank, shy, timid. And then… *BAM* “Take this medication and you’ll be this happy person running through the fields of wildflowers, chasing after your dog or children or spouse or WHO CARES?!? YOU’LL BE SO HAPPY.”

As if.

But seriously. Who decided MDD was a good way to get attention? Didn’t that fool realize that he or she would be stigmatized forever? Or that people would just think he or she was crazy and weird?

Take it from me, you don’t want people to know you have MDD. Not because it wouldn’t help explain a lot. MDD usually comes with some kind of anxiety, so it might explain why you have no motivation to see people or go out, and when you did, you’re not only battling the hermit feeling, you’re also agonizing over looking rude. 

The problem is that normal people – even most people – don’t get it. You can tell someone about your MDD and it kind of doesn’t do anything. If anything, it sort of backfires.

When I told one of my exes that I had MDD, he literally attributed every negative mood I had to it, regardless of the cause. 

I’m mad that he left me crying by myself?

“Are you having another episode?”

He screws around all day and then when he finally sees me at 9PM, he tells me 15 minutes later that he has to go to study?

“Are you depressed again?”

No, you donkeyhat, I’m mad that you’re an inconsiderate piece of shell that clearly does not give a poop about me.

And then there’s the other ex who knew and understood that I have MDD, but took everything VERY personally.

I’m so depressed, I don’t want to see anyone? 

“I can’t tell if you care about me.”

I’m quiet at a party?

“You’re being kind of rude.”

Or, if you’re in the lucky group that’s not really experienced with this,

“She’s just using this as an excuse/for attention.”

No, no, trust me. There are much better and favorable ways to get attention. Easier, too. Like really, I could run for mayor of my city. Or post a video of myself singing and dancing (pretty horrendously). 

Which is why this is so difficult to share and I’m sharing this anonymously.

My last ex, bless his heart, asked me why I didn’t share my blog with more people or his friends. I don’t think he understands the stigma and the whispers and condescending “I know better” looks that people give when they hear someone has depression.

And honestly, if he couldn’t understand it and he was going through it with me, how could I possibly share it with others and expect them to understand?

You’re asking for a lot there, buddy. I’d need a miracle for that, and I don’t think even a miracle could cure me.

ugh, insomnia

In an effort to get my sleeping pattern back on track, I’ve been taking a sleeping pill almost every night before I have to wake up early – early being sometime before 9AM. This translates to taking something 5 or 6 times a week – 3 times for 3 work days, and 2 times for 2 clinic days, and MAYBE if I decided to do something stupid and schedule an appointment before 10AM.

One of the odd side effects of MDD (are you guys sick and tired of hearing about this yet?) is that you’re either exhausted and sleep all day, have insufferable insomnia, or you’re exhausted but you have insomnia. I suffer from all three, at differing times of my life. A couple of months ago, I was falling asleep at 4AM and waking up at 7 or 8AM, not really tired or sleepy, but not well-rested either. I was on summer “break” (for all of 2 weeks), so the lack of sleep didn’t bother me much. And since my work days were spread out, it wasn’t that difficult to sleep at 4AM for 3 days and then actually wake up at 4AM the next day. This was a pattern that went on for quite a number of weeks.

Last week, I discovered that past me decided to screw me over and scheduled me to work 3 days in a row. Note: I have not done this in quite some time and I try to avoid it at all costs. For those of you who work 5 days a week, I admire you. I know many of you 9-to-5-ers look at us nurses and go, “You guys are so lucky! You get 4 days off!”

The reality is, we get 4 days off, but not always in a row, and it usually takes a good 12 hours to recover from a day of work. If you work a 3-in-a-row shift, it can take you a day-and-a-half to recover, if at all. You really don’t get 4 days off. Sometimes, I think I might prefer the 5 days of work from 9-5 instead of this insane 3 days of work 7-7:30 – if you’re lucky enough to get out on time.  So, really, nothing to envy here.

So anyway, I worked 3 days in a row, and each night, I went to sleep hoping I’d get called off, and each morning, I’d wake up groaning at 4:30AM realizing that I still had to go in. The first day, I woke up and laid there in a groggy haze, wondering if this was all worth it (It was. I got up and went to work because I need the job). But I realized that having fell asleep at 1:30AM was not going to help me at all. After 12.5 hours of keeping people alive, turning patients 2 to 3x my weight, and trying to fit 300 things into one work day, I came home and just sat in my chair and decided, “I really need to fall asleep sooner.”

So I dug into my stash of sleeping pills that I haven’t taken in quite a while and I took one.

I haven’t really needed to take any sleeping pills for a while because I haven’t been as mentally exhausted as I had been for the past 2 months. Yes, I’m busy out of my mind and I feel like if I stop, I’ll panic, wondering if I forgot something. But these past 2 months have been something else entirely. The reason I don’t really take them is

1) Half of them work insanely well, but they make me loopy

2) Of the ones that make me loopy, half of them force me to sleep 8 hours, while the others let me sleep for 4~6 and I’ll feel fine

3) I’m running out of the 4~6 hour ones, and I’m too busy to go to the doctor.

But desperate times call for desperate measures. So I started taking the other half, the ones that don’t really work as well. These are called Lunesta. They make me fall asleep, but unlike my Ambiens, Lunesta takes an hour or so to work. Ambien knocks me out in 15 minutes.

The other problem with Lunesta is that it makes me groggy. I’ve tried melatonin, Zzzquil, other OTC sleep aids, and they all make me feel super lightheaded and dizzy the next morning, like I’m fighting to keep my soul in my body.

So here I am today, my third day taking Lunesta, and I feel like my head is about to fall off my shoulders. I can’t turn too fast because my head will spin. The coffee probably doesn’t help, but I need coffee because I’m tired.

See, I don’t even know why I’m telling you guys all this. That’s how loopy I am right now.

Now I’m playing gibberish peek-a-boo with a 15-month-old baby who keeps running into the office and going, “NYAH!!!!” while trying to hide behind the door jam.

Silly girl, doesn’t she realize I can see her poofy tulle skirt?

Introversion

When you see an introverted person, you might see someone who is aloof, quiet, reserved, awkward, unresponsive – not such good stuff.

I am an undeniable introvert. Unfortunately, people often mistake that for being shy, because the official definition of an introvert includes being shy. But that’s not necessarily true. You don’t have to be shy to be an introvert. Because I am not shy, and I am not quiet.

One time, I was over at my ex boyfriend’s place. I had been pretty tired, so I fell asleep and woke up in a daze 2 hours later to the sounds of people hanging out (a usual occurrence at his place). I could hear his rather loud, very extroverted sister chatting and singing in the kitchen.

Here’s the thing with me: sometimes, when I’m tired, I don’t want to talk. It’s like using your muscles after working out all day – they’re sore, and you kind of don’t want to move. Here’s the other problem: my voice is generally quite small. Even if I’m shouting, 5 out of 10 times, someone will need me to repeat myself. So usually, I stick with gestures when I’m tired. I’ll do my wide awkward smile or wave at people.

So when I got out to the living room, I muttered a small hello to the people around me and waved. Unfortunately, everyone was so absorbed in their phones and laptops that no one saw me.

At this point, my ex’s sister was pretty much singing at the top of her lungs while banging pots and pans around. I said hi to her as well, but I don’t know if she didn’t hear me or if she just was ignoring me or was too absorbed in her singing. I couldn’t tell. Either way, I just shrugged and slipped out the door.

So later that night, after I got home, she messaged me on Facebook, asking me why I didn’t say hi. I told her I did, but she was singing and I don’t think she heard me, and she had also been chattering away to her friend she was cooking with. I also told her that I was really tired and it’s hard to raise my voice when it feels like my chest is caving in.

Her response was, “Oh, you’re always welcome here! Don’t be a mouse!”

I just laughed and didn’t respond anymore. The thing is that I’ve fallen victim to this stereotype many many times.

Yes, I am introverted. I am probably one of the most introverted people you will ever meet. I like spending time by myself. I literally have 4 friends whom I see regularly, and for the most part I’m okay with that. It can get difficult when i’m not doing well, but that’s a completely different story. I have the classic symptom of having a limited social battery – if I’m around people for a long time, I will become physically fatigued. If I go to a party where I’m standing around and eating and chatting with people who are around, I need to go home and sleep a solid 10 hours to recuperate. After 3 full days of work in a row, I don’t want to interact with anyone because I’m so drained. Being around people is very draining

I don’t like talking any more than I should. It’s one of the reasons I hate chit-chat. I don’t understand talking mindlessly for hours. This was something I had to get over very quickly as a nurse. The majority of the population my hospital serves is the elderly white or Hispanic population, and let me tell you, old Caucasian people LOVE to talk. I had to learn quick how to make small talk, and I think that drains me more than working to keep everyone alive.

And I don’t have a need to announce myself or my intentions everywhere I go. I browse social media often (mostly FB and IG), but I rarely pose, unless it’s something abstract or if I’m doing something special with my friends. But it’s rather rare.

But I’m not quiet and I’m not shy. I’m not afraid to tell people things as they are, particularly if I think it has merit. I can be loud, crack witty (I think) jokes, and dance like a crazy person. I’ve talked down particularly aggressive patients, without raising my tone or cursing. I’m not afraid to demand a wrong be right.

There was a time when I was shy… almost painfully so. I didn’t know how to defend myself. People manipulated me, used me. They played pranks on me, bullied me, and said horrible things to me to my face. They played with my emotions, doing whatever they could to embarrass me, simply because they knew I wouldn’t defend myself. People ran me over so hard that I had permanent emotional scars that, to this day, are visible.

But these days I’m not.

People, I want you to understand one thing: being an introvert doesn’t mean being shy. I might not talk much, but I will stand up to you if you cross a line. I may not speak up often, but if I think there’s merit to it, I will talk for hours. I can stand up in front of 100 people and give a presentation, no problem. And I can dance like I don’t care.

Don’t think that just because I’m introverted that I’m shy. Those are two completely separate entities.

Now, insecurity? That’s a different story for a different time.

Today is one of those days.

I woke up in a sort of haze this morning. It was still fairly dark and kind of foggy outside. I have not had to get up this early in 4 days because I didn’t have work, so going from sleeping at 5am to waking up at 5am was probably not so great for me. But insomnia is a normal part of me when I’m in an episode.

I had been waiting for this aspect of my depression to manifest for weeks now. Usually, in an episode, I’ll first experience some kind of overwhelming sleepiness and fatigue that doesn’t go away no matter how much or little I sleep. All I want to do is stay in bed and not move. Showering becomes overrated, and I only shower because it’s probably not great for me to get close to patients and reek of BO and stale sweat. Even then, I push it to as late as I can, usually 11:30 at night.

With the fatigue comes the inevitable thoughts. Since my body can’t move, my mind moves for it. Once they start, it’s so hard to stop. It starts a mental cycle of self-loathing and sadness that consumes all of my thoughts.

As the thoughts make their way to the forefront of my mind, I begin to suffer from insomnia because, really, how do you fall asleep when the voices in your head are telling you what a shitty, insignificant, miserable little thing you are. It’s sad because this isn’t even from other people; this is my own mind telling me this. You can run away from others or shut them down, but how do you shut down your own head?

After enough self-destroying, I lose my motivation. During a “typical” episode, I can usually keep a smile slapped on my face or adopt a cheery attitude that dampens the sadness. It’s there, but just out of sight enough for me to keep  smiling. Sometimes, I even forget about it until I’m alone, during which time the facade falls apart. You know in movies or shows when someone is smiling, but then their smile fades as they turn away? I always thought that was so corny until I realized how often I did that.

But after prolonged self-bashing, things are different. I become physically incapable of smiling. Instead, my face turns dark and stormy. I already have pretty bad RBF, but when I can’t spontaneously make a smile when someone looks at me, people start wondering what’s wrong with me, if I don’t like them, or maybe I’m just really rude. When someone talks to me, my replies are short and curt, not because I’m angry (at them, anyway) but because I know that if I open my mouth, there’s a good chance I’ll start crying out screaming.

The worst part of it all is that I’m fully aware. What does that mean? Of course I’m aware, I’m a very with-it person.

What I mean is that while my body has gone under the control of my own toxic thoughts, another part of me is screaming at… well, me. This screaming voice is saying, “What are you doing? Why are you being like this? Everyone is going to think something is wrong. You have to snap out of it! Come on, you know it’s just your depression, for God’s sake, don’t let it win! Stop being so weak! Everyone’s staring at you! You’ve officially become a freak show, good job. You’re so fucking disappointing, you know that? God, you’re worthless.”

Well. That escalated quickly.

The point is that I’m constantly trying to snap myself out of it, but I can just no longer smile. I can’t be happy or friendly. That person is trapped deep into the corner of my mind. All the while, my mind is also going crazy trying to logic myself out of it.

Today is one of those days. My smiles, if I have any, are strained into a small grimace. I know that people are looking when they think I’m not. I can’t fake any joy or happiness. I look angry and upset and I hate it.

Why can’t I just smile? Why can’t I just say something nice? It’s not that hard to smile, right? I don’t want people to think badly of me. I know I’m not a rude person. This is never

But it is. It’s hard to smile when I’m in this state. It becomes almost impossible.

I’m aware that this is something I need to work on. I have been, I swear. The only thing I can do is remind myself over and over to smile, to push down those terrible thoughts that keep me from being able to separate the internal from the external.

All I ask is that you know and don’t take it personally. That while I’m snapping at you, I’m hating myself for not being able to control myself. That while I’m quiet and sullen in the corner, I want more than anything to be enjoying the situation like you are. That while I look at you with fire in my eyes, I do really love you and want to be around you and God, do I wish I could be normal and part of the group and with you. I wish I didn’t snap at you, that I could greet you with an easy smile. The fire in my eyes isn’t directed at you, it’s meant for me.

I wish I were different.

But I’m not. This is who I am. Always broken, always misunderstood, too depressed and withdrawn to even apologize because I hate myself so much.

This is who I am. And I’m sorry if you catch me on one of those days.

 

Grummy, Parp, Whimble

Let me tell you a story about Grummy, Parp, and Whimble.

When an episode begins, my mind usually splits into three entities: Grummy, Parp, and Whimble. Without fail, these three characters form very distinct personas of each aspect of my depression.

Parp is the child you might see in the foster care system – beaten down one too many times. Parp feels worthless. No one loves or cares for him. He doesn’t understand why no one wants him. He thinks he’s a good boy, and he tries not to hurt anyone, but it doesn’t seem to matter. Parp doesn’t matter.

Grummy is the school bully. He’s big and strong, both brawn and brains. He knows that he can beat Parp down and say the things that will hurt him the most. It doesn’t matter whether they’re true or not. Grummy knows that Parp will accept them without a fight.

Whimble is the voice of reason, my residual logic that most becomes overrun when I’m in an episode. Whimble is almost an out-of-body entity, who is able to step away and see things from the outside.

When I fall into an episode, my mind forms these three distinct characters, and it’s always the same. Parp begins to remember how useless and worthless he is. He curls up in the corner and cries as he remembers that no one wants him and that he’s so small, he barely makes an impression. No one really knows he exists.

Then Grummy comes along and sees Parp in the corner, and he begins to do his thing. He kicks and beats Parp, affirming that Parp is worthless, a waste of space, useless, and unloved. Grummy tells Parp that he’s better off dead, no one would miss him, and everyone would be better off without him. The more Grummy beats him down, the smaller Parp feels.

Whimble always makes an appearance, and to be honest, she always makes it worse. Whimble comes to Parp when Grummy is taking a break and tries to tell Parp to snap out of it. Whimble knows that Parp is worth so much more, that Grummy is lying, and seriously, you’re making us look bad! You’re coming off as rude to these people! Everyone thinks you’re mad at them! Come on, snap out of it, you know just as well as I do that this is just your emotions getting the best of you! Please!

Unfortunately, this just makes Parp feel worse. He begins to loathe himself for being unable to fight off Grummy. He hates himself for being so weak, for being unable to control himself. He hates himself for not being able to pull on a smile. He hates himself for being on the verge of tears no matter what happens.

It’s hard to break out of. Eventually, Parp and Whimble will work together to overpower Grummy, and peace is temporarily restored. But just like any person who has been bullied, the scars are still there. Parp still remembers those feelings of worthlessness at the peripheries of his emotions and Grummy knows it.

Grummy is just waiting for the right moment with Whimble’s defenses are down.

And when that happens… Well… then a new episode beings.

there are no words

When I’m not feeling well, my symptoms usually manifest in one of two ways – my stomach and my heart. My heart usually begins to overwork, as though it needs to pump harder to get blood to the rest of my body. In fact, it pumps so hard, I can feel my entire body pulsating along with it.

My stomach – or rather the processes associated with my stomach – go completely out of control. Everything I eat becomes a trigger for nausea that can only be relieved with vomiting. I usually force myself to throw up because if I don’t, I’ll be in bed, so dizzy and nauseous that I’m unable to move. Food feels like it’s stuck in my throat and no matter how much water I drink, the feeling doesn’t go away.

So when I don’t feel well, one of the first things that happen is I stop eating. Part of it is that I’m simply too nauseated to keep anything in and at that point, why even bother trying since I’m just going to throw it up after an hour of misery anyway. The other part is fear because I know how miserable I’m going to be.

Unfortunately.

This also means I stop taking any of my pills because 1) I only get enough for exactly one dose a day and 2) if I throw that up, either I’m going to be short or I’m going to pay more for lopsided pills/month.

Okay, I know how bad that is. Considering that the stuff I take is very relevant to my well-being, I realize the implications of being non-compliant. I’ve written three entire research papers (and read way too many related studies and articles), so I’m competently-versed in the forthcoming issues. I don’t need a lecture on that.

So where am I going with this?

A few weeks ago, after one particular night of no sleep (I just couldn’t sleep, I don’t know why), I went to school in a complete haze. I could feel my heart pounding so I knew my body was spiraling downward. And then, of course, the nausea hit. The thing with being nauseous and vomiting is your body needs food to get better. But when you’re throwing up everything you eat, you can’t get that nutrition, so you simply get worse. It’s a terrible cycle.

During that time, a span of 3 or 4 days, I stopped taking my medication. Now, some of my meds are not very important. My allergies have very specific triggers (peaches, anyone?) so as long as I avoid them, I’m pretty good. Others are preventative (ovarian cysts, anyone?) and really, it’s my choice to take them. But then there are the essentials. Unlike my allergy meds – which I really take very sporadically, maybe once a week – my depression meds are not supposed to be stopped cold turkey. Especially with the dose I’m taking. There’s all these warnings and teachings and blah blah blah that says to not stop abruptly because you’ll suffer from withdrawal. This stuff is no joke.

At the time, though, I was too miserable being sick, hungry, nauseous and dizzy to notice whether or not my body was suffering from withdrawal. I didn’t seem any more moody because, let’s face it, I was sick! Who doesn’t get a little miserable when she’s sick?

But even after I got better, I refrained from starting my meds again.

Why? Why, why, why would I not take them again since without them, I not only get very “low”, I also run the risk of spontaneous suicidal actions? (Erm, side note, I don’t have my gun anymore. I gave it to someone for safe-keeping because I wasn’t sure how safe I was around it.)

Well, that’s not true. Once I felt better enough to eat regularly (i.e. once and a half a day), I took half my regular dose. I didn’t want to take the full dose because I didn’t want to turn into the poor wild animals in Over the Hedge after they had their first taste of Doritos.

But, oh my God. One of the particularly difficult side effects of my anti-depressants is that they make me extremely sleepy. I am already very sleep-deprived. For as far back as I can remember, I can count the number of times I’ve gotten restful sleep on my fingers. My first all-nighter was in the first grade. That’s how bad my sleep is.

So with my first half-dose since getting better, I was so tired that even with a solid 8 hours of sleep, I could barely focus on the road as I drove to school. I felt like I was sitting in a room filled with steam. I felt like everything was cloudy. I felt like someone had hit me with horse tranquilizers. I’m lucky to be alive.

Add to that that I was entering the final three weeks of school. I had six major exams, four papers, three presentations and 10 kids that I saw regularly on a weekly basis. I couldn’t afford to sleep 12 hours a day and expect to pass my classes and keep my job. So I made a choice. I would power through without my meds and once all this was over, start up on it like a good kid.

It took me another week to get over the side effects of the half dose. All I did that weekend was sleep. I slept for hours because I couldn’t stay awake. Because it began to get dangerous for me to drive when I had narcoleptic tendencies.

I have another week of school left. Three more exams, one more paper. But already, I feel my mood hitting an all-time low. I’ve become a ticking time bomb, exploding at the tiniest things. I’ve become lethargic. Everything is boring or pointless. Things that I breezed over before now frustrate me greatly. I’ve become enthralled by the new cuts and bruises that have appeared on my body from not paying attention to where I’m walking or what I’m carrying.

And then there are the thoughts. Those thoughts. I hate those thoughts. But I like them, too. They’re an evil sort of comfort, evil because it’s obviously about dying, but comforting because it’s a familiar entity.

Yesterday, I thought to myself that I couldn’t wait for this week to be over so that I could start on my meds again and become happy. But I spent a lot of time thinking today and I wondered which me was the true me. Is it the smiley, happy, giggly, joking girl with the support of medication? Or is it the silent, stone-faced, frustrated, lonely girl who lives in the shadows?

I know that darker version of me is difficult to love and to be around. But what if that’s the real me? What if the happy version is just a facade? Am I asking people to love a version of me that isn’t real? If so, then what? Should I be looking for someone who loves me even as the dark, terrible monster that I am? Or do I continue to hide behind drugs and be the girl that people can love easily?

People stray away from me when I revert back to my darker version. Even the ones who know about my disease simply disappear when they start seeing the signs. Should I still consider them as friends and loved ones? Or should I say, “Fuck you, I’m going to find someone who loves me for me, even at my darkest moments”? Is that even plausible?

I want people to love me for me. I think I’ve always wanted that, but when the two versions of me are so drastically different, when one is so much easier to be around than the other, it’s similarly easy to see why people choose one over the other.

Somehow, though, I feel like I’m lying to myself when I think someone cares for me when I’m happy and lovable. Somehow, that seems like an ironic lie because that still means no one loves me for me.

Or do they?

Why is this even important? Who cares?

Because everyone just wants to be accepted. Everyone just wants to know that the important things aren’t lies. Because I’m human and that’s important to me, too. And, hey, aren’t we all told that we need to be loved for who we really are? Or is that not realistic for someone like me?