Micro Managing

I consider myself blessed to have been able to remain mentally well without medication for while now but this doesn’t mean it’s all plain sailing. There are blips. Last week was a ‘near blip’ and although upon reflection it was a bit of a worry it is also a boost to my confidence that I was able to manage it. Now please don’t mistake the message in this blog, I am not anti medication; absolutely not, at times medication has been absolutely necessary and has saved my life, in fact Thursday evening last week it was medication which helped me avoid a bigger blip. This blog post is about me explaining how I manage on a day to day basis to stay well (or well-ish!), I know it likely won’t always be like that but I also know from experience that the correct medication works really well for me to aid my journey to remission.

Looking back on last week I am able to see how I caught my mood in the absolute nick of time and that even one day later and I may not have been able to recognise how damaging the effects could be. Let me put into context how I think I came close to a blip… Two weeks ago I worked Tuesday through to Friday which were busy in the way an acute ward is the always busy but actually were lovely shifts where I felt good about the amount of time I actually got to spend with patients that week. I was asked to do some overtime on the Saturday which is something I deliberately rarely do as I am very aware of my need for rest days with low stimulation but was swayed by the thought of weekend enhancement plus overtime rate so agreed.

I then had Sunday off but was out of the house all day as I went to 9.30 service at church followed by visiting family and then a teatime family bible study group with my daughter before rushing home to cook a meal and prepare school uniforms and homework for the week ahead. I then went into a run of shifts Monday to Thursday but my shorter shift also became a long day when I agreed to more overtime due to the high clinical activity on the ward. On the Friday at the end of that first week I was on a late shift but went to meet my sponsor at church to share my recently written moral inventory which lists all events in my life, with a balance of good and bad things, and begins to consider the impact those events have had on my life. Those of you who follow my blog will recognise that this wasn’t an easy task for me and likely had an impact on my mood even if subconsciously as it involved opening lots of boxes which I rarely open these days. I just tried to fit too much into a short period of time, I ought to have known better.

So by the end of that run of shifts I had worked 9 shifts within 10 days and five of them had been long days where I leave the house at 6am and get home at 10pm and the second week of shifts were clinically very busy. My threshold for handling stress is high, I cope remarkably well so I don’t think it was this which nearly tipped me over it was the high levels of activity each day which in turn meant I struggled to switch off and slow down my thinking at night. My ‘busy brain’ led to very little sleep which to begin with was annoying as I felt understandably very tired. By Wednesday of the second week I had become aware that I need to take action to ensure I got some sleep and that looking at the laptop screen or watching TV when I got in was a bad idea so instead I decided to do some cooking when I got home to try and not over stimulate my brain.   I still didn’t sleep much that night but by Thursday this wasn’t an issue as I didn’t feel particularly tired any more. At that point major alarm bells should have rang but nope I was just glad not to be yawning.
On Thursday I wasn’t co-ordinating the shift so went out for several hours with a patient to an appointment elsewhere and when I returned I was very aware that I had a lot of paperwork to do from meetings etc that I hadn’t managed to write up from earlier that week since it had been so hectic. I started to do this paperwork and found myself struggling to concentrate, the ward is always loud and like most ward nurses I usually find it easy to block out the noise and carry on typing. I was third qualified nurse on shift so was able to take myself next door to the managers empty office to work through my list in a quieter environment which allowed me to get it done. I had an awareness from past experience that if my thoughts were going so quickly there was a possibility that my speech had begun to speed up to match this and I could feel my leg beginning to bounce with irritable energy so the excuse of getting my paperwork done was beneficial in keeping me out of the way.

As I left the ward just after half eight that evening my husband was waiting outside for me with our daughter in the car, I hopped in closed the door and turned the radio up. I was free to sing along as loudly as I liked and sing I did!

On Thursday evening the temptation to ignore the part of my brain telling me to take action was so strong. I felt energised, not tired at all. I felt good about myself and my capabilities which is very different to the internal monologue of inadequacy I usually run, to be free of that was energising in itself.
Deep down I knew that I have too much to lose and that I needed to act before things got out of hand so I made the decision to take some medication which I keep in for emergencies having not taken regular meds for a couple of years now. This is something I do so rarely, maybe once a year but something I have discussed in depth with my doctor in the past who is happy for me to manage in this way. The medication on a simple level just slowed down my thoughts and allowed me to get some sleep. Tiredness and lack of sleep has a huge impact on my mood so by Friday morning my brain had slowed enough for me to be able to hold a coherent conversation after some restful sleep but I knew I still ‘wasn’t right’ if that makes sense?

I met my friend and sponsor from church for coffee on Friday morning and we talked about how sharing my inventory the previous week had left me feeling. We talked about the impact the week had on me generally but I felt able to concentrate on and follow the conversation better than I would have done a mere 24 hours earlier. I ought to have gone home at this point for a quiet afternoon but the lure of the city centre being so close was strong and I found myself immersing myself in the hustle and bustle of of the city. I didn’t spend a lot but what I did buy was frivolous considering where in the month we are in relation to payday! I happened to pass the theatre so called in to see if there were tickets left for that evening but it was a sell out, one pair left for the following day but they were considerably more expensive than I would usually pay however I had gone in for theatre tickets and theatre tickets I left with.

I medicated again on Friday evening when I realised I was thinking a little fast again after an afternoon in town and managed to sleep for a second night in a row, my body was obviously exhausted as I slept longer than usual which did me the world of good. On Saturday I felt more ‘normal’, I went for lunch with my eight year old and then off to the theatre with the tickets I bought the day before. We had a lovely day and I went to bed without medication sleeping for around 7 hours. By Sunday I felt fine and I returned to work on Monday without issue after my three days off.

I am very aware that for a couple of weeks I need to make a conscious effort not to accept any extra hours if they are offered and not to make arrangements for my days off, life needs to be sedate for a while as I am still probably fairly vulnerable to slip back to where I found myself at the end of last week where I struggled to keep up with my own thoughts. I have become better at recognising these fluctuations in mood over the years and manage them sooner despite the overwhelming temptation to ignore them and enjoy the ride. I have far too much to lose.

On my last discharge summary from hospital it states “There is not an absolutely clear cut picture of purely depressive symptoms” and that “We have used the term bipolar spectrum to describe this to her” stating that this needed further investigation in the community but given how I am able to manage my symptoms for the most part I have consciously avoided following this up. I no longer have involvement with secondary mental health services and given how may hoops employers make you jump through with even a history of unipolar depression and how much I have already lost to stigma I have chosen not to seek out formalising the bipolar diagnosis. What difference will a label make other than them ticking the non concordance box when they will likely insist on regular meds which at present I don’t need. When I was first asked if I had ever experienced mania I remember repeatedly telling them no absolutely not as I had this idea that mania was something I had seen only in extremes on TV but as I got to know my key nurse and she asked me more and more about different periods of my life I realised that the team kept coming back to the subject and were trying to educate me that my periods of heightened mood were not just a standard response to being in remission to depression but were periods of elation. I can certainly see in hindsight and with the benefit of my nurse training that since my late teens there have been distinct periods where my mood was markedly disturbed, I nearly married someone I had known for six weeks once, another time I threw a dinner party every night for three weeks, I even went as far as a setting up a bridal boutique business! My tutor at uni made me miss an entire placement as she felt I was edging into a period of elevated mood, it was at this point when I knew I had too much to lose and have micro managed since then given that I refused lithium when it was offered due to the amount of monitoring it needs and how poor my venous access is.

At least I came through this little blip without any additional piercings or tattoos and without breaking a toothbrush… which I have been known to do on a couple of occasions as when I feel like that I was to feel everything and feel it to excess so even tooth brushing has led to disaster and a couple of snapped toothbrushes. I want music louder, jokes funnier and teeth brushed harder lol!

I’m fairly sure that working in mental health I won’t be able to keep my mood fluctuations without a label forever as someone will have a friendly word in my ear. Now that I am blessed to work somewhere where I am not just tolerated but celebrated I’m ok with that for the most part. I have really good insight into my mental health and know that although I noticed the changes those I work with didn’t, I was working with very experienced nurses at the end of last week and know they would have told me if that had any concerns. I am in no doubt that my professionalism was never in question. I am aware that if I choose to have another child which is something I am thinking of at present then this is the most vulnerable time for a significant relapse of either elation or depressive symptoms but that support would be readily available for this.

For now my plan is to just carry on the way I was before, this is something I have accepted will happen occasionally and I will continue to micro manage and medicate when required. I still consider myself in remission, mental illness just has a way of reminding you it is still there loitering in the background ready to pounce, I’m better at fighting back these days though.

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