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Posts Tagged ‘work’

It seems to go faster every year. As a child I always heard adults saying that and equated it to being old. Does this mean I’m old now? Regardless, where am I in life right now?

I am not seeing anyone from my treatment team. E (therapist) suggested a break at the end of September. I had initially kept an appointment in late October to check in after that. I canceled it. I stopped seeing my dietitian and physician too. Honestly, I feel more settled than I have in a long time. I still have eating disorder behaviors, I still worry about weight and calories, but I no longer have this pull between doing what the eating disorder wants and what my team wanted to hear. I have a new normal and I no longer have the nagging in the back of my head that it isn’t right or the exhausting struggle to change.

I have completed all the work for my MPH although I’m still waiting to see if I passed my [pass/fail] practicum to officially graduate. I would be lying if I didn’t say that I still have a lot of anxiety about not passing and therefore not graduating.

Next semester I will be taking one class for several reasons:
1) The hospital (my primary job that supplies benefits) will pay for me to take up to 4 credits of a “work-related” class
2) There is a class next semester in the college of public health that I have been wanting to take.
3) My job at Student Health is officially classified as a student job, so to keep it I have to be taking at least one class.

I interviewed for the medical school at my current university just before Thanksgiving. I haven’t heard anything more. It is by far my first choice school but since this is my fourth time applying I’m not particularly optimistic. I have two interviews at osteopathic medical schools next week. In many ways osteopathic medicine seems to be a better fit for me. It has a greater focus on primary care, prevention, alternative medicine, and caring for the whole person. But I hate moving and the closest osteopathic schools are 2 and 3 hours from where I currently live ūüė¶ Not to mention M absolutely refuses to move or go to one of the places (currently my 3rd choice). And allopathic (MD) school rejections have been starting to come in. It’s somewhat depressing. Additionally, osteopathic schools have a much faster turnaround time so in a month I will almost definitely have decisions from both of next week’s interviews.

On the home front. My house is a mess and it drives me nuts, but I’m completely overwhelmed about where to start with cleaning and decluttering. I have been shelling out some money for a new dog trainer. Zef had been having increasing behavior and aggression problems. It was getting to the point where I was avoiding walking him and dreaded just taking him outside briefly for the bathroom. And when I did take him on a longer walk or run my shoulder would hurt for a day or two after. This trainer was recommended to me by my academic advisor. The trainer has raised Australian shepherd for years. She comes to my house and works with Zef and I in our natural environment. She has come 3 times in about a month and a half and although progress is slow, there has been significant progress.

I’m sure there’s more, but that seems to be enough for now.

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Frustrated

Yesterday was the first day of a six-day stretch at work. Doing a one-to-one. As a general rule, I am not a fan of 1:1s. I have trouble sitting for eight hours and I find them to be more mentally exhausting than working the floor. When I work the floor I have brief minutes of downtime when I step behind the nurse’s station. Working a 1:1 I don’t have that option. 8 1/2 hours, with a 30 minute break. I constantly have to be mentally alert.

Yesterday’s’s 1:1 started out ok. My patient wandered up and down the unit so I wasn’t sitting for long stretches. I had to be closely watching that tubes didn’t get pulled, but that’s not all bad. What did bother me was having another patient dumped on me that continually untied his restraints and spent several hours cursing at me because I wouldn’t let him get up (he wasn’t able to walk on his own). Both patients were incredibly confused and, in their ramblings, increased the other’s agitation. While dealing with one, the other pulled out a tube. Yes I was frustrated. I felt like a huge failure. The whole reason I was there was to keep that from happening. All my coworkers were very understanding and didn’t call me a failure at all. They understood that it only takes a second to pull something out and there’s very little someone can do once the patients is intent on that. But I continued to blame myself.

And another thing that wasn’t okay? Not getting a break. I managed to slip to the bathroom twice while the nurse was giving meds, but that was it. The only thing I had eaten all day was an english muffin. I grabbed coffee and diet coke on my bathroom breaks. But I had nothing else. I was absolutely starving. I was surprised by that, but even though I don’t eat very much I spread it out so I’m never that hungry. I felt physically ill. My stomach was upset, I was irritable, I had a headache, and I was exhausted–physically and mentally. I picked up some cold-case chinese food from hy-vee, but I felt so sick that I couldn’t bring myself to eat it. It’s still in my fridge…unopened.

Know what else is irritating? I have less than 3 hours left on my shift and I still haven’t had a break (I’m sitting on another 1:1). All I ate this morning was some yogurt. I’ve had my coffee, but I haven’t even been able to get my diet coke yet. I came in today with a fresh outlook, trying to not let last night hinder tonight. But I’m starting to get upset. I really hope the whole weekend doesn’t go this way.

But I keep trying to have a good mindset. Someone will remember me, someone will respond to my request for a break…

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When I experience guilt, I really experience guilt. If I feel that I have done the tiniest thing wrong I am immediately overcome with an intense feeling of guilt. ¬†But that’s not the worst part.

The worst part is the sudden anxiety/guilt attacks that occur for the next few days.

It’s essentially a panic attack, I have this intense¬†foreboding¬†that something¬†terrible¬†will happen if I don’t fix it immediately. But usually I don’t know exactly what it is. If I think back and try to come up with a trigger for the anxiety (which I do with most panic attacks) I don’t come up with anything. Instead I just come up with guilt. Reminders brought on by an¬†unconscious¬†thought crossing my mind. And BAM. Guilt attack. I have to fix my wrong.

Problem is, most of the time I didn’t actually do anything wrong. I just perceive it as wrong. Or I think that someone else will think it is wrong. And I can’t fix it. But I still feel guilty.

It’s debilitating. Honestly. I live in fear of doing something that awakens my guilt. It keeps me from taking risks because I’m afraid of making a mistake. It keeps me from trying new things. It gives me intense anxiety about getting pulled to another unit at work because on a different unit I don’t know every tiny little detail of each rule and therefore I’m less prepared to ward off a mistake. I don’t have the best chance at performing *perfect* work, which means that there’s a larger chance I’ll miss something. And feel guilt. Even when the other people on the floor forgive me because I don’t usually work there.

So often I want to ask doctors questions about their work and how they chose to go into what¬†specialty¬†they are in. But unless I have a complete set of questions worked up in my head I won’t do it because I’m afraid of sounding stupid and¬†embarrassing¬†myself, which causes more guilt.

And the guilt renews itself each time I see a person associated with the situation.

This perpetuates the eating disorder.

This is what is holding back my life.

And I don’t know how to stop it.

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Sometimes I wonder how my work in psych is affecting my future work as a physician. One might say that I could simply look at psychiatrists that have been practicing for a couple of years to see how they change, but my role in their care is very different from that of a physician.

I’m the one they curse at when dinner is late. I’m the one holding their hand while a new IV is put in. I’m the one that makes them remove their own clothing and put on a hospital gown when they are admitted. I’m the one who sees the faces of their family members as they enter the locked unit. I’m the one who gets hit. I hear their insistence that they’ve learned their lesson. And I hear the same plea on their next admission.

So yes, my perspective has changed.

One of the best things that has changed about it is the realization that I can’t change people. I can facilitate and support that change, create a good environment within the hospital to further help that change, but ultimately the patient is the only one who can make that change. And my powers are even more limited than that–once they leave the controlled climate of an inpatient unit, I can’t promise that their home environment will be conducive to the change.

I am not one of the bright-eyed students who crumbles at the first “failure.”

But I also see the darker side of people. I am not the innocent person who takes anyone’s words at face value. I listen carefully, I read body language, and I fact check to see if the patient is being truthful before I trust what they tell me. I’m not sure if this is a bad thing or just neutral. On one hand I don’t automatically trust patients, but on the other hand I don’t label it as a lie until I’ve checked into it further.

What else?

I shrink away from a raised hand. I get really nervous when a patient stands in a doorway and I have no way out. I don’t take insults and curses personally. I can calmly listen to a manic rant that rips at my character and continue on with life. I have become a decent mediator. I am unfazed at any display of anger or intimidation. I can stand my ground.

I have great sympathy for the families who are torn by their loved one’s illness. I have sympathy for the patients who don’t get better. Sympathy for the ones who can’t seem to cope with life in non-destructive ways.

And I take great joy in watching someone leave as a different person and hoping (for their health) that we don’t meet again.

I think this experience is good. I will have a different perspective than most physicians. I will know that what they tell me in the 10 min I see them on rounds is not the whole story, I will have an appreciation for the people who spend every hour working with them.

I will realize that sometimes I will fail, but I will take even more joy in the success of a patient because of it.

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So much has changed in my life recently! Or if it hasn’t changed yet, it has recently gained large potential for a near-future change.

1. I cut back my work hours at the hospital.

This was a really hard choice. One one hand I was spending 40 hours/week at work and only 10 hours (or less) on school. I was making it, but since the discovery that I really love grad school and love what I am doing, I want to get the most out of the experience and that wasn’t happening with all the work I was doing. My supervisor was really good about the decision and I am down to 24 hrs/week starting next week!

I tend to count my worth by how many hours of work I do in a given week (and I typically don’t count school work) so I equated cutting back work hours with being a failure at life. And there are always financial considerations–but the job really didn’t make a huge difference there. I already had to take out some student loans to cover tuition because I didn’t earn enough for that in addition to my living expenses. (yes, considering the job requires absolutely no degree, it pays decently, but I could get a better paying job that better utilizes my knowledge) Now the job will cover living expenses and that’s it.

And although I love my job, it is physically and emotionally demanding. Even with a healthy degree of separation from the patients (which happens to be one of my few talents), psychiatric work takes a toll on a person. Although I never take the beatings (verbal or physical) personally, one can only take so much abuse. After a while of cursing, and accusations, and manipulations, and altered perceptions, and hitting, and biting, it becomes rather difficult for me to bite my tongue and turn the other cheek. And yet, I have to. Plus, working with people who are also medically sick means I have to put forth quite a bit of physical effort and that is not ideal at this time either.

Basically some work=good for keeping a healthy balance with school. Too little work=an unhealthy obsession with school. Too much work=way too much stress.

2. I was invited for a medical school interview at the university I am currently attending.

Not much to say about that. It’s a good thing. It’s happening at the end of October.

3. I am in conversation with a research team about a different job.

With a psychiatric researcher with a lot of neat projects going on.

The initial offer was hourly (read: no benefits) so my initial desire was to just pick up some hours in addition to my hospital work. But it’s possible that it could be made into a graduate assistantship….which means it could include benefits and a tuition scholarship. I’m meeting with the research team Thursday. Stay tuned.

Oh, and at the end of the email she wrote “with your background and experience we would love to have you involved.” A compliment! It did make me rather happy.

In other news:

I have cut back on exercise. I am dealing with it moderately well, Zephyr is not. He is becoming neurotic. He has always had this obsession with lights (and I mean that in clinical, not colloquial terms). Every shadow or ray of sunlight prompts him into his “light hunting” stance and he stares at it intently and then dances around pouncing on it, wiggling his tail, and sometimes escalating into barking. Within the past week it has become unbearable. I can’t open a three-ring binder, turn a lamp on, read my book before bed, open the door to an unlit room, keep the blinds open at night, keep the blinds open during the day….and more. Last night I completely darkened my room, with the blackout curtains I use to sleep after night shifts, and he was still up until 3 ¬†dancing around on the bed chasing some invisible light on the wall. He awoke at 6:30 to start it again and is still at it 3 hours later. This means I got 3 1/2 hours of sleep. And I seriously want to strangle the dog…but I can’t, because I know it’s not his fault. It’s definitely gotten worse since he’s getting less exercise with me. So I have a few things to work on here. I need to wear him down somehow: whether it is running with him (despite the ban from my therapist), making frequent trips to the grassy space outside for tennis balls and frisbees, or going to the dog park. I need to get him some more mental stimulation–with all the work I’ve been doing this has fallen by the wayside and I will start scheduling training in our days. And we just need to deal with the anxiety issues more.

I am still freaking out about weight.

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I suspected it would happen eventually. And it did. Two weeks ago.

I got pulled to the eating disorder unit.

I don’t even have that much to say about it. But apparently it affected me.

They were all so thin. Much thinner than I am (or so I tell myself). A couple had had seizures from electrolyte imbalances. Many were committed.

Part of my job was “Eating Disorder Observation.” All eating disorder patients are automatically required to be on “standard” observation…which means that they must spend all of their waking time in the unit dayroom (or in groups when those are occurring). ¬†After reaching a certain behavior level they may be considered for a different observation (meals + 2 hours or meals + 1 hour). A nursing assistant is required to be in the dayroom with them at all times–to “redirect.” Basically make sure they sit down at all times (and tell them to sit if they attempt to stand, walk, stretch, etc), don’t talk about food or weight, don’t jiggle their legs, sit on prescribed cushions/recliners if they have them.

I got to be that NA for a while. Oh joy. How can I stop them from jiggling their legs when I never stop it myself? How can I force them to sit down if I can’t do it myself?

But first let me say that on my unit, although it is a psych unit we also have very medically sick people, and I spend most of my shift in constant motion. So being pulled after 4 hours of that was a cataclysmic change. I sat on a 1:1 and read my book for a while, then sat on observation. And after 10 minutes or so I found myself reading the bulletin boards, wandering the halls within eyesight of the dayroom, looking at the whiteboard, re-reading all the bulletin boards, and generally just standing/pacing the whole time. damn. So I sat back down. And 5 minutes later was back at it. Even after all the patients had gone to bed I stood while I talked with the other NAs. One even told me to “sit down, relax a bit!” Was it that obvious?

I didn’t think it affected me. And while I was working it didn’t really sink it because my head was in “work” mode. I work from my¬†doctor brain.

And then I left work. And immediately I was analyzing all the foods in my fridge. Why do I enjoy eating greek yogurt? It has so much fat and protein. And the peanut butter and nutella in my cupboard….It doesn’t matter that I don’t touch the jars, just the fact that I have such foods is a disgrace.

And it gave me a chance to tell myself that I don’t really have a problem. I’m not thin enough to be committed. It doesn’t matter that I’ve lost x lbs in the past year. It doesn’t matter that I have an actual-active-diagnosis of anorexia. My blood labs are always fine, I won’t have a seizure. Look at me, in grad school and working a full-time job, if I were really sick I wouldn’t be able to do that.

And it made me sad. I’m so miserable. I want help but I’m too afraid to ask because I’m afraid that I’m not “sick enough” to need it and I will be rejected. And now that I work in the psych department it makes the patient/provider roles all confusing. I’ve managed them very well up until now, because in the beginning I convinced most of them that I was doing better. But yesterday I saw K—- in the cafeteria during lunch time. I was doing schoolwork and not eating. She usually will talk to me a bit, but today was a stiff hello and a sad look. She can see it–the weight loss and skipping lunch.

I’m afraid that everyone will know that I have an eating disorder. I’m afraid my competency at work will be questioned.

I’m afraid someone will force me into treatment.

I’m afraid that no one will convince me to get treatment.

I am afraid of living like this forever.

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Alphabet

It starts with the name of the hospital…

U—

Continues to divisions…

BHS, MSS, ISS, IP, OP

And to sections of the physical building…

BT, JPP, JCP, RCP, PFP

On to units…

MICU and PICU and NICU and SICU and PACU. Along with the CVICU and CPICU. and ETC and ECT. CDS, PHP, PPH, EDO, OR,

There are tests and procedures…

EEG, ECG, EKG. MRI, CT, CBC, WBC, ABG. PET, UA,

Diagnoses/Diseases

MDD, BPD, MI, PE, CVA, BSI, PTSD, ICB, SDH, CVD, CHF, AN, BN, EDNOS, BED, MRSA, VRE, DVT.

And people…

RN, MSN, MD, MPH, PhD, BSN, MA, MS, BA, BS, DO, PAC. PT, RT, AT, and OT. RTR, NM, ANM, APN, ARNP. NA and PNA. NF, HO. CNA, CMA, LPN, DDS, OD, JD. LMHC, LMSW, LISW.

And others…

AC, HS, TED, SCD, IV, AB, BID, TID, QID, BM, I/O, S/S, T/K, BPM, BM, BP. BMI, GAF, WD,

The above don’t even begin to break the surface of the letters I now speak in, not to mention the inordinate amount of shortened words and phrases I use and hear.

I am definitely well on my way to being fluent in the language of jargon.

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