Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Wednesday, February 28, 2007

So very sad

Depression has hit. In force. It's been hitting for a while now, but the last few days have been worse. Today I literally felt it worsening minute to minute, much like it feels when you are getting a cold and you know when you wake up you're going to wish you hadn't.

I had to ask the doctor for help. I hate that. I hate that I still can't make it long enough to not talk to her (email) between appointments.

I hate that suddenly I feel like nothing I do is right and that everyone hates me. I know that probably these thoughts aren't true, but countering them takes so much energy it's too much to bother.

I've become certain that I'm not very good at my job. I keep fighting to be able to do this job and truthfully it wears me out and I can't meet basic criteria so why on earth would I consider myself good at it?

For now I'm going to bed. Sleep at least is a vacation from feeling bad. Hopefully more meds coming soon.

Tuesday, February 27, 2007


Sometimes it should be easy to post and it just isn't.

Right now I'm feeling sad. I'm tired and I'm sad. In fact, I'm plain old depressed. Hating it, but there it is.

I'd much rather talk about it if there was a why. Without a why it just is this interminable disease and one more reminder that I cannot make it go away just because I say so.

I wish I could talk. I wish I knew what to say. Instead I merely want to sleep.

Three more days until weekend.

Thursday, February 22, 2007

Therapy should be easy

It seems like sitting in a comfortable chair and talking should be easy. Especially since I usually am just talking about my own life, something I'm pretty familiar with and honest with myself about.

It's not.

I don't talk a ton about therapy because I'm just not comfortable with that; the details of what goes on there seem to invasive. But it is part of my life, and it will be for a very long time. Sometimes it is weekly, but there's always the possibility I'll need more, and it still seems to be about monthly I need an extra visit.

Sometimes it is hard work because I have to face things I don't like, or learn to do things that are just plain hard. This summer I worked very hard to learn to let go and cry. That's a lesson I probably could use some revisiting right now, as I'm stressed and feeling like the tears will start at any moment and not stop. Sometimes the concepts are just painful, like learning that not only do my moods and behaviors show, but that at least this person is capable of reading a lot of it better than I can. Sometimes it is hard because it feels like it is absolutely overwhelming and that I am doing absolutely everything wrong in my whole life and how do I fix THAT?. Sometimes I want it to just stop, or for it to just be easy. I could make it easy, I could pick a therapist who was more about helping me feel better about my life, but I've agreed to do it this way, the way where I'm supposed to work hard and learn to manage things better. The thing is that there are days and weeks when I wish I had made the other decision. Sometimes I just want to hear that it's ok, that I'm doing well, that I'm superwoman for handling this disease the way I do. I don't even care if it's TRUE, I want to hear it.

Sometimes I wonder what he thinks after he is with me. I wonder if he dreads each encounter. I wonder how boring it is to have to listen to the ups and downs over and over, and if he feels like if I'd just listen I wouldn't have these problems. Sometimes I'm sure that I'm the most frustrating patient ever.

Not long ago I said something about not wanting to be treated "like a psych patient". By this I meant that the assumption that I do certain things for manipulative or other negative reasons when in fact I have valid reasons and the other causes wouldn't be considered if it weren't for my diagnosis really annoys me. He reminded me that I am indeed a psych patient. True, but I still have been left wondering if that means I act manipulative and whatever else was at stake all the time. I certainly don't think those are issues for me. But what do I know?

It was a lot easier when I was in the stage where I'd met some goals. Now I'm in some odd middle stage where I need new ones, and because I don't feel I'm going anywhere I feel I'm failing.

Master of science with a failure in therapy about myself. That's irony for you.

Tuesday, February 20, 2007

When you do everything right but all that matters is money

One of the hardest parts of working for me has always been my "productivity number". I'm mentioned this before, but in case you don't memorize the details of my life, what this is the percentage of the time I'm paid for that is billable. It is supposed to be 85%. This is not particularly realistic for anyone since we do massive amounts of paperwork that is not billable, and many things comes up during the day that need to be taken care of. Checking people to see if they need therapy services, walking place to place, setting up/cleaning up, all those things take time.

In my case it is just impossible to want this consistently because I can't do paperwork at the same rate as other people. To best meet the requirement you need to write while you treat and I can't do that. Some days I can't smoothly proceed through an evaluation as it is, and I've done thousands of them, the same basic thing each time. I am also more affected by noise, etc than other people are, and nothing really can help that but giving me a quiet place to work. At one place I share a tiny (and I mean TINY) office with 5 people, and at the other I work at a desk in the treatment gym. The word gym should say it all in terms of noise. Additionally my work is affected by how tired I am (and one must realize when considering how tired that can be that I take ENORMOUS doses of sedatives daily. I've now surpassed a huge dose and moved beyond that, and that's one of 3 sedatives. But the sedation is not a cure-all; when I'm depressed it can feel like far too much, but it can't be reduced during those times because that just makes me cycle as I need this much sedation for mood stability. When I'm not depressed it can be not enough sedation, which means I have to add Ativan during the day, which makes me even more tired and out of it. On top of these things my atttention span has been affected severely, and a lot of paperwork is harder for me because I mess it up if I'm not extraordinarily careful. To top THAT off I have visual problems. My pupils are extremely dilated from meds, which means that I get a lot of glare and am susceptible to eyestrain. I have lazy eye, so I don't track well, and this makes me mess up paperwork even more.

Four years ago I had no problems with my previous employer. They were kind about the whole thing and I never put it into writing. Over time the numbers increased and they started pushing. Every company around started pushing, and some will dock pay, etc. if you don't meet the standards. Just in the last few years the normal requirement has increased from about 75% to 85%. Some places want upwards of 90%.

Therefore when I took this job I had it in writing that I cannot be held to normal productivity standards. They acted like they couldn't really give in on this, but the truth is they have to and they know it. So after a while nobody said much about it, although I am obsessive about it because I feel like I'm constantly on the verge of getting in trouble over a number.

And then today happened. Today I got a lovely note, left in a public place, telling me that every DAY that I'm not at 80% I have to account for it. It has always been that it was every week that mattered. Last week I was 79% and would have been higher except for something she was aware of. One day that was low was low because I was doing paperwork from the preceding two days, which were during the blizzard. I'm really upset about this.

Last week I worked 43 hours. I drove in some really bad conditions to make sure that patients were seen so we got paid the most possible. Thanks to the weather I had to work 5 days even though I should have had only 4 and a vacation day. I was sick the whole week with a cold. I made a LOT of money for the company. I know this because every 15 minute evaluation I do makes about 3 times what I'm paid per hour, and I did a lot of evaluations. I constantly seek new patients and find them for all 3 therapies. I effectively treat my patients.

I'm not sure why it is so hard for people to understand that the ADA accomodations I have are not just favors I get. (This is exactly what co-workers think, I've heard so many times people tell me I should be grateful they "let" me do this or that when truthfully they have absolutely no choice). I especially am angry when it is managers who are supposedly trained.

This is the point of some of my vocational rehabilitation services. But every time I get a note like that and never get a note that says good job I feel more and more like it's pointless, that I can never do a good job beccause I can never have good numbers.

That pretty much sums up my day. I ran constantly and then wound up feeling like I'm terrible at everything because I can't find a way to force myself to not have problems that just will never go away.

Friday, February 16, 2007


Insurance stinks. As a healthcare professional you get used to that fact pretty quickly as you spend a lot of your time fighting with it, complying with it even when it is against what you want/need, rolling your eyes, etc. I deal mainly with Medicare and Medicaid, and between the two of them there are enough rules to make anyone confused on a daily basis, and they change all the time. All kinds of things make no sense, like there are times when it is better to be on Medicaid than to have money of your own or private insurance. Actually that's often true. Unless you need other things, in which case forget it. Or Medicare sets one chunk of amounts we are paid for services and Medicaid sets another. Medicaid's payments are so low that it actually costs my company money for me to treat a Medicaid patient.

However, one benefit of working in this field and of there being a high need for therapists, is that we generally have really good insurance. Just like everyone it's gotten worse and worse, and just in the last 3 years mine has significantly gotten worse, except that it improved in some ways because for a while my insurance did not cover mental health, including psychiatrists, until a $10000 mental health deductible was met. That's not a typo, and that would be a more than average hospital stay for psychiatric treatment paid out of pocket before a dime was paid. At that time I paid everything left after the doctor took off the negotiated fee chunk. That left me paying $45/month. At that time I also paid about $200/month for prescriptions and I was taking 7 meds, nearly all of which were not generics. One prescription alone would have cost $1000/month and it was covered except for $15 of co-pay.

For the last few years I had a little bit of coverage for counseling (They paid about 70% of 15 visits). The psychiatrist was $25/visit. Generics were $10 and name brand meds were $15. Labs were covered at least 80% (for a while 90%). My meds cost around $200/month and I really don't know how many I was on at an average because I've had many changes.

When I took this job my insurance was just about the same as my previous job. There were a few things that were slightly more expensive, but the out of pocket deduction was far less, and the changes were miniscule. Then this year they altered the plan. The out of pocket deduction was only changed a tiny bit, but the co-pays suddenly are ridiculous. Each psychiatrist visit is $50. That is monthly. I have such minimal counseling coverage that the center recommended not using it and going on the no-insurance, high need program they have. The meds are the worst part. Generics are $15 and name brands are suddenly $40. One of my meds my doctor had to fight for approval for, and even with that I have to pay $60 per month. My out of pocket med costs, despite being on less medication than ever before, is currently at as much as it was with the maximum number of meds I've been on.

I'm also constantly fighting with my insurance. Before vacation I had to fight with them because they could not comprehend that if the number of pills I took per day of a given prescription doubled then I would need to fill the script early at the new dose. They tried to charge me $300 for a refill. It took 3 phone calls to fix that one.

This makes me afraid of what is to come. I am feeling really good on this current medication strategy, but what happens when that changes? What if I need 7 or 10 meds again, and if I do what if they are brand names? I'm very fortunate right now that I've done very well on a very old antidepressant that is very cheap for a long time, but I do well tenuously; the dose I take now may well make me manic soon, and 6 weeks ago a teeny amount less had me quite depressed.

Sometimes I wonder what would happen if we didn't have insurance at all. Not the whole socialized medicine thing, but if healthcare were just another industry, something everyone used, like deodorant manufacturing or something. I wonder if trying to make it manageable just makes it worse.

What we have now just doesn't work.

Still here

I'm just not writing much. I'm STILL sick. I'm finally off to get antibiotics this morning after my doctor had to cancel my original appointment thanks to the snowstorm of the decade. I'm very tired, and work has been kind of horrible since I went back since I have to do basically 2 weeks of work this week. Tomorrow I have to work and go to the psychiatrist so that's another very full day. My mood is kind of weird, I think because of not feeling good for so long and being tired.

I'll be back soon.

Wednesday, February 14, 2007

What I do for you

I've always been a little sad that I didn't have a picture on here, but there is no way to be anonymous with a picture. That, and I didn't have a digital camera nor understanding of how to work one.

Well, this has all changed now. I am now addicted. However, posting this has NOT been easy. I would suspect this is about 4 hours of work you're looking at. If it weren't for sickness and snow this would never have happened.

Some anyway, representational art. That's me.

Monday, February 12, 2007

I'm Back

Back from illness followed by vacation with ongoing illness. Not much to say tonight, but that's why I've not been talking, and I will say more in the next day or so. I have a post started about something I really want to say, so hopefully I can finish that soon. Also lots of updates on my journey with vocational rehabilitation services.

For now I need to wash off airplane germs, try to bribe my cats into forgiving me for leaving, and work on adjusting to the climate change. To put it mildly it's a bit colder here.....

Wednesday, February 07, 2007

My hero died

During last's week's mania and concurrent lack of tv and internet I was a little shut off from the world. I didn't realize that one of my heroes died.

I've never been into horse racing, but for whatever reason was watching the Preakness last spring when Barbaro was so horribly injured. That was at the time I was at my very sickest, and I latched onto his story of hope as he overcame the odds time and again. I felt a strong connection to that horse, and I have stalked the UPenn Veterinary Clinic website for updates.

I knew during the week before my disconnection from reality that he was getting worse. I truly thought he'd be ok though; he was so tough. It was only tonight that I learned instead his pain became too great for him to bear.

I'm sadder than I can express. I see death or dying daily. I've seen it happen many ways, and I firmly believe death is a graceful thing.

Yet I will mourn the loss of another young could have been.


I'm trying to figure out remote blogging as I'll be on vacation in about 12
hours.....Let's see if this works.

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Sunday, February 04, 2007

Manic thoughts

I've often tried to explain what manic thinking is like. It sort of defies explanation though, which is one of the more frustrating parts of my life. It's just so fast, and so far beyond what I can control. Sometimes it amounts to nothing more than embarrassing myself because my mind gets so far ahead of a conversation that I say something that would be quite funny (and I find it so) if only it weren't 5 steps ahead of everyone else. Other times it is forgetting things or have so much difficulty concentrating on things that I have to copy and re-copy my paperwork 3 times to get it right.

Tonight I topped many previous experiences. I ran a whole load of clothes with lots of soap and disinfectant because I've been exposed to some ugly bugs. The only problem is I forgot the clothes......

Sometimes I amaze myself.....

Saturday, February 03, 2007

A whole week plus

That was some week. I have had so much to say too. I guess it was ok because I had little time to say it, but I really missed this thing. It was really neat though to come back and check my statistics and discover that my referrals have been increasing rapidly.

Anyway, the cable thing was annoying. Enough about that or I'll vent for about 3 hours. Five days without internet or tv is a long, long time.

The good news: I was approved for services through vocational rehab. I will meet with someone about providing education/mediation services with my company this week, and then soon I'll meet with the computer person about getting a laptop. I am so very excited about this. However, being and staying excited has been a process. To accept services I signed something about how I have a significant disability that negatively impacts my ability to obtain or maintain a job.

At first this seemed like a "duh" statement. Then I realized that it actually was something much, much bigger, a sign of how far I have come in this last year. I have spent so long focusing on being "high functioning" that I haven't let myself accept the reality of how hard many very normal things are. It's not until now that I am accepting that my disability is something that impacts every single day of my life in a negative way, even when I am doing fine.

It's been odd because I've had to figure out new definitions for old ideas. I knew long ago that my version of this is considered severe. I had trouble with putting "severe" and "functional" together, and so it took this last year of being not very functional at all for me to understand that even severe has it's own levels. At my best I am severely affected because I am severely socially isolated, unable to independently do things I need to do, etc. At my worst I become so severe that I can't do anything at all.

So now I have come to terms with having a "real" disability (perhaps; I've thought I understood this before), and am looking forward to getting the assistance. Just yesterday I did a ton of re-copying things because of mistakes, and one day in the last week I copied the same page 3 times which just makes me want to cry because it is such a waste.

I met with my psychiatrist a week ago and she decided that trileptal wasn't doing very much for me. So we are trying an extremely high dose of depakote, which I've been on very successfully for years but have pretty much maxed out remotely normal dosing. That now seems to be going ok but it has been rocky. I was pretty manicky most of the week. That is slowing now, and I will have a blood draw early this week to see if I can handle any more.

On top of all this, and with the mania requiring an extra counseling appointment to help calm down, I'm trying to get ready for vacation which starts Wednesday night. I have no idea how I'm going to get it all together. I've been sneaking in shopping as time allows and still anticipate throwing things into a suitcase at the last minute. I had a scary moment when I was shopping the other night; I left counseling and went to the pet store. Somehow I dropped my wallet while loading the car. I didn't realize this until I was at the mall to buy sneakers. (I finally get to wear regular width shoes again after years of swollen feet from lithium!) Thankfully it was still laying there when I went back.

Now I am "enjoying" the cold. It is positively frigid here tonight and I imagine my heating bill is doubling as I type. One problem with working in nursing homes is that you tend to get acclimated to the high temperatures the elderly prefer and then cold weather outside work feels even colder. This is really bad though.

So I think it's time to curl with with some hot chocolate and ponder life.