Figures

I was so upset with Dr. Mind and expected an awkward session.  Instead we had the best session we've had in a long time.  I hadn't realized how intense it has been.  Today we just talked.  There wasn't a lot of fighting to deal with anything, there were no tears, and we talked about things relevant to now but also we just talked.  We've done sessions like that occasionally for years because the normal (ish) socialization is good for me both to practice and to just experience.  Since at least January we have not had a single session that wasn't intense, at least that I can remember.  So today was actually nice.  I did briefly tell him what I felt the truth was related to his statements last week and he accepted that.  There was not a big confrontation about how upset I was last week and I really, really needed that.  I am taking it to mean both of us weren't right last week.

My new apartment plans are done and I've chosen cabinets and I think paint colors except for the bathroom and I'm close on it.  We played a game of "let's reduce costs" today so we cut out a couple of windows, a small cabinet, etc.  My sister is going to give me their fridge so they can have a bigger one as they become a family of 4, and that's really a nice gift since it's a very nice fridge but small for their purposes.  It's one of the freezer on bottom ones and to me it will seem enormous.  The apartment is bigger than we thought initially, 600 square feet and there is a nice little deck as well.  I am probably no longer welcome in Sherwin Williams; I have collected a LOT of paint samples of late.  They have these neat things that I'm using where there are about 15 color choices that are put together so every one of them matches all the others.  It works nicely.  Next up is financing on my mom's end.  I have the weird thing of having excellent credit but such a low income that I couldn't get a $50 loan.  A few year ago I had not good credit but a lot of income.  I'm so glad that I worked hard to fix my credit the last several years I was working.

Anyway, I'm doing battle with another migraine and I think I need to get away from the screen.  All the things I thought would be rotten with menopause have not been that bad and the things that I never expected like migraines really frustrate me.  I am hanging tight to the idea that this should only last about 5 years as it's sped up somewhat by having my fallopian tubes removed with my hysterectomy.  That reduces ovarian blood supply and usually makes everything stop more quickly.  We'll see.

A secret about therapy

I can't sleep tonight.  It's been hard for days; tonight is worse than the others.  It's all anxiety.  I've had a few mild panic attacks to accompany this and I'm exhausted yet sleepless.

I've not posted in a long time.  That has to do with the sleep issues, a medication increase that had me really groggy for a while, a migraine that combined with the med change left me kind of like I imagine being stoned is, out of town family visiting and I just haven't known what to say.

But the anxiety right now is so bad and a lot comes from an unusual source.  For the sake of being truthful what I'll talk about is not the only cause of anxiety.  Moving is getting harder.  There are financial issues pending about whether I will have the garage apartment that I've been picturing or if I'm going to rent.  I hate renting and with asthma renting can be difficult (if I'm allergic to something in the rental I may not be able to do anything for a year until a lease is up).  Living in a scattered home and realizing that I packed a series of books but forgot #3 and now it's in the random pile, or wanting something that is packed, sealed and stacked in another room frustrates me.

But the biggest thing is that I am mad at Dr. Mind.  I'm actually really mad at Dr. Mind.  Usually I talk about him like he is only a source of happiness and support.  But that's not always true.  In recent years there has been less confrontation, minus the months of PTSD treatment that were very confrontational.  In the first months I saw him we had several disagreements that got pretty heated.  I'd never had a therapist show anger or raise their voice even slightly or even disagree with me if I said I could take care of myself regarding hurting myself.  But in time  it became ok for him to confront or disagree with me.  However, right now he is doing it so much that I feel like he's being extremely picky.  Monday was the last straw when he said something that to me means "You're not trying".  I seriously doubt this was his intent but it was how it came across, especially since it was 5 minutes after another thing I did wrong.  I did something I don't think I've ever done in there; I shut down.  I talked and listened but I was not paying attention and I didn't want to respond to him.  I wanted to cry but I didn't want him to see me cry when it was because I was so mad.   When I started writing I realized that he's interpreting something wrong, I think.  Or what I think is true is really just what he's saying although I don't think so.  Regardless I'm unsure how to handle it.  I know things I need to say but I don't know how to say them without sounding accusatory or defensive.  The end result is that I wind up feeling completely lost.He tried to tell me he was being direct because I need to hear what he is saying.  But I don't agree and I think I feel judged.  I'm used to hearing that I'm being brave, that I'm doing what I can, that I'm being strong.  Now it feels like all I do is wrong.  I'm positive he doesn't mean that but it's what it is coming across as. 

I don't know.  I know I used to picture therapy as being all supportive and happy.  I didn't picture difficult conflicts  between the patient and therapist.  I had that supportive/happy therapist and it didn't go well.  I had a pacifist therapist when I was angry and needed to have someone fight back.  I got a lot of fight out but it was by refusing to talk and the therapist reciprocated so we stared at each other for 14 minutes.  I know hearing things I don't like can help me.  I just don't know what happens when I'm pretty certain those observations that I don't like are truly inaccurate.

Hmm, maybe sleepy.  It's 5:15 AM so that would be nice.

Night.  Morning?

Matthew Warren

I've written a lot about suicide lately.  I've been dealing with it heavily for nearly 2 months per Dr. Mind 's notes and it is something that both weigh on my mind and terrifies me.  I didn't write about this and I should have.  Michal reminded me of it and I guess I can focus on someone else for a change.

For those who don't know, Matthew is the son of pastor and author Rick Warren.  Last weekend he killed himself.  His father has spoken of it, essentially saying that Matthew had mental illness and everything was done to help him but it didn't work.  That last thing is really important:  it didn't work is much, much different than casting blame.  It's not about blame and it's not about guilt.  It's about illness that is so hard to live with that sometimes  desperation feels like the only solution.  Suicide is not about not having faith.  I thought for a long time that it was the unforgivable sin because you can't ask forgiveness.  I don't believe that now.  I believe God recognizes desperation and God forgives.  God know what mental illness is and it is not something that He has chosen to take away like some many physical diseases.  We live in a world where most kids won't have chicken pox, something that was nearly universal for us (except me, I wasn't immune when tested and I only had half the shots because of psych reactions that occurred simultaneously to the shot.  It's probably not the shot but we aren't taking chances.  So when I get chicken pox at 38 you can know it was my decision), but mental illness is controlled for some and not for others.  Not knowing why things work for what people makes treatment extremely difficult.

 Mental illness has a lot more treatment options now than it did 20 years ago but a quick look at my undermedicated because of lack of meds life shows why there are still so many who find they cannot find the hope to make it another day.  Finding hope daily is an actual job with mental illness.  When the reality is that counseling is very helpful for many but commonly needs to be augmented with meds, yet there is no way to know what med will work for what person and what combination is needed.  Sometimes people can't take the wait to find what works.  Sometimes the meds are just too much to deal with.  People forget sometimes that being on psych meds often includes:  significant weight gain, thirst, tooth decay from dry mouth, diabetes, fatigue, restlessness,nausea, GERD, insomnia, interaction with other meds, anxiety, severe constipation, diarrhea, sedation, sensitivity to light, sensitivity to the sun, heat sensitivity, and hundreds of others.  Psych meds aren't easy.  What is even harder is that they don't know why meds work.  I was on a med called Latuda in 2011.  I was on it soon after it came out.  It lasted maybe 2 weeks.  It made me worse and I couldn't describe how.  A few months later I was taking that NAMI class I took and someone in there and later in my support group was having amazing results from this new drug.  I asked and it was Latuda.  A month later another support group member started Latuda and had immediate improvement.  Soon after someone commented on here or emailed me about how much Latuda was helping them. I am convinced it is the drug that helps everyone but me.

I guess what I'm saying is that some will judge this man.  He presumably was a Christian and "shouldn't" kill himself.  Some Christians think mental illness is all about not having enough faith and not asking God for help the right way.  Some in fact completely discourage treatment, something we know was not true of the family of this man.  Unfortunately it's hard to not absorb this belief when you already are depressed and feel that you should be doing SOMETHING different or you wouldn't feel this way.

He should not be judged.  Neither should his family or anyone involved with him.  I know that Dr. Mind once had a patient kill himself/herself within a few days of seeing Dr. Mind.  I know that he feels tremendous guilt and that he feels he should be exceedingly cautious, which is how I know I'll wind up in the hospital if he is concerned.

Suicide is an awful, desperate choice.  Feeling you wanat to die more than you want to keep trying to live is nearly impossible to describe.  When you are a Christian there is even more to contend with in that you (I, I assume others) feel like there is no hope and yet faith is about believing there is hope.  To me it's about  feeling there is no hope for life here but that if I can move into the life I know awaits me after death that maybe  I'll find that hope I struggle desperately to hold to because I know it is what God promises.

It's so hard.  That's all I can say to describe it. Talking about it is good, but it is also not socially acceptable.  It is not easy.  Even with people I'm comfortable discussing it with it is hard because you don't want to be hospitalized where you can't do what you've decided.  Seeing and wanting help is hard. On the other hand help can happen.  Dr. Mind asked me recently how close I'd been.  The answer is scary.  My last hospitalization, the one for suicide, the first few days they didn't get it.  They thought it was all about my lithium levels and they were trying to get those increasing and send me home.  When I realized Tuesday night that they intended to send me home Friday I realized I was there because I wanted one more chance.  I wrote what later was described as a suicide note and go the help I needed.  It was so tempting to go home, blame the hospital for not getting it, and following through with the plans.

Right now I keep  pointing out to people that I may be talking about this as something that seems to be part of any loss now.  I keep telling them that I can't do this for another 30-40-50 years.  This is existence, not life.  I think they get it and Dr. Brain promised to throw every med that comes out at me until something makes that time sound less awful.  But hopeless is insidious and when your brain creates it it's hard to live with.  In my case my brain seems to look forward and malfunction; it has for years.  It's always the future that makes me want to die.  If I had even a hint of what would happen 10 years into a career that I fought for I wouldn't have done it.  And I would have missed so much, but that can be impossible to see.

All this is to say, I hope that this is something that helps Christians grow in their knowledge and understanding of mental illness.  I hope that people learn and that this gives a positive to the Warrens' loss.  I hope that they do not judge and that they remember how much they respect Rick Warren and that they extend that respect to his son, someone who sought treatment and still couldn't face a life of pain that is not easily imagined by someone who is not in that position.

Grace please,  just let people react with grace.  God will.

Confession

I think I'm also going through a jealous period.  For years I worked with patients.  Most of the time they had therapy, improved and went back to their lives. After I moved to home health I discovered that the transition wasn't as seamless as it could appear if you didn't think about it at the early rehab level.  I knew that I was referring most homegoing nursing home patients for further therapy.  I just didn't know that therapy was about reshaping their lives in the context of what happened to them.  I thought home health was about making things normal for them, even though I learned that mostly they didn't go back to totally normal.  Most suffered losses but then were able to re-arrange life enough to go on.  It could be very hard and I gave a lot of support.  Sometimes support was half of my job.  Sometimes I had to get support to give support; there was once a patient who believed with 100% determination that if stroke recovery was not 100% that was my fault.  I had actually done a pretty impressive job with her (for those in the know I reduced a significant shoulder subluxation from I think 2 fingers to less than 1/2) and that had reduced her severe pain and then we had regained most function in that arm. We were working on precision and she was not going to get all of that back at that time.  But it took a social worker to convince her that she couldn't expect me to fix things 100%. 

Another person had lost her husband and then had major health problems develop.  I was called in partly to show her that I had developed asthma and allergies during the past 6 months and that I struggled to cope as well, while helping her learn ways to deal with her health.  It worked for her.

Sometimes I couldn't make it better.  Both in nursing homes and home health I had some  very hard conversations about this and about recommendations nobody wanted to hear.  I didn't want to make them either.  But it was my job and not one I could delegate.  There were nights I cried because someone had worked so hard and improved so much and it just wasn't enough for what they wanted.  That was the hardest thing I did I think, watching people progress so far and then not quite manage to make it.  On the other hand watching people do things that they really shouldn't have been able to do or people who I didn't think would recover return home to their prior lives was the highlight of my life. I loved having people come back and show off what they could do now.

Last week I wrote about my need to watch movies that are sad to help me cry and let go of some of my excess emotion during this moving thing.  Later I realized that mostly one movie was what I wanted to watch, over and over.  I know there are a few others in my pile that share what this movie had but this one is very close to home somehow.  What makes me cry is watching someone lose everything to illness or accident and then recover and experience life, good and bad.  It's the thing I worked for so long to help others achieve  and now I find it so painful to watch. 

I'm on the side now that receives the little talks about what I can do and what I need help with.  I'm on the side where I have to hear that eating one egg and a handful of crackers each day is not acceptable, that I need help with my meds, that my life is going to show signs of this illness probably every day for the rest of my life.  I made it home but am accepting that home doesn't work and so I'm moving to half the size of my home.  I suspect the smaller home will make me happier.  But I'm jealous of those who went home and found that even the difficult things were easier when they were back in their routines.  Their lives go on to have good and bad because that is normal, and the good and bad isn't significantly affected by whatever made them need rehab.  Instead for me the impact of everything else makes what I'm dealing with continually worse.

It's sort of like a nightmare where I have to have those awful talks with people over and over and every time I say they'll do well they turn out to do awful, which is my own fault.  What is happening to me isn't anyone's fault, I just believed the positives I heard more than they were meant to be believed.  It's a common error. But for now it's painful for me to see what used to make my world happy:  someone recover.

It's so backwards.  i don't wish anyone to have to face this kind of loss.  Losing independence means losing yourself as well.But what I did for so many years has made this one specific thing the thing that makes me cry.  It's a weird way to heal yet I suspect that's the process.

I hope nobody is offended by this.

Surprise Again

The medication did not make me fall asleep again.  I'm not sleeping all that well.  But I am more rested, although I've been really tired and kind of groggy from the increase.  I am hoping to be allowed to bump up a little more because I think this is going to work at some point, at least somewhat.  Somewhat seems good at this point.

Dr. Mind and I had a review of the suicide discussion plus the Dr. Brain additions.  I think I have managed to get a lot more safety in my life.  I'm still struggling with needing it and knowing that there are limits on the safety that is in place, but as I was told immediately after returning home from the hospital the suicidal time nothing can keep me safe if I don't choose for it to do so.  Valid and humbling point.

For whatever reason this is bringing out more understanding of my situation than anything else has.  A long time ago Dr. Brain would tell me from time to time that I was the highest functioning patient with the level of severity of illness that she'd ever had.  Since she sees a LOT of bipolar patients that was a big deal.

What I hadn't figured out completely was that has a flip side.  I knew my bipolar is severe.  But there are clues from the last year or two that tell me how much so and I'd chosen to ignore them or pass them off as irrelevant.  I knew I was approved through an SSDI process for people so severely ill that the computer says there isn't any chance that approval won't occur.  I knew that mental illness rarely triggers this system.  I knew that student loans are rarely discharged for disability unless the disability is very serious.  My was.  Again that's nearly unheard of for mental illness.  Then there is the way my life has been for nearly 2 years now and how much I struggled for it to be different before that.  There is the 15 months of suicide precautions just because I am considered high risk due to knowing how to do it and everyone seems to agree that I would not mess around with an attempt.  Now that's just a chronic thing that will be tightly watched.  I found out Monday that I really have been at high risk again for the last 6 weeks or so and have bordered on hospitalization.  I was also reminded that I can wind up there sometimes with this because careful is safer.  I knew I was out of meds; I didn't realize how bad Dr. Brain feels about this until she promised me to keep trying everything that comes out until something helps.

I knew other things.  I knew that I'm being encouraged to find things to do after I move but also that I've been told no matter how much better I get working is probably not a good idea.  I thought it was just because my personality doesn't do well in that kind situation but it's not only that.  It's because even if meds stabilize that will always be fragile and we do not ever want to go through more years of having no meds that I can take and that work.  It's because I need to choose whether I want time that I can enjoy with my niece and my ????? (later this week!) or do I want to risk being too stressed to handle them.  My niece is going to be SO excited about my new home.  She already thinks grandma and I are a weird unit where I'm sometimes at grandma's and sometimes disappear.  Now things will be as she has always thought they should be.  And I'm thrilled about that.  I can't wait for her to spend the night at my house and to be able to spend even more time with her/eventually them.  But I have to be not exhausted to expect that and working, possibly even volunteering, is more than I can handle. 

I'm realizing this more too as I face this house sale.  No way am I going to do it without my mom both making sure things are done right and that I have support through the painful parts.  But this is also about having someone else to cook when I can't, to help make decisions, to help with paying bills if I struggle (which happens frequently, not the money part but the mistakes part).

I somehow based so much of my perception of all this on the rather goofy fact that I go to the mood disorders unit of the hospital and most bipolar patients don't.  So if I'm so sick I would be assigned differently.  Until I realized that I have a doctor who is an attending, who has promised me "I'll never let you go elsewhere" and that for her to be able to promise that is very different than the vast majority of people who come in to the ER and who have community doctors who aren't even consulted, much less participate throughout the hospitalization in their meds.  I've had nurses say things a few times that imply I have more control about things like what day I am admitted and that I don't have to go to the ER when most people do.  I know last time I was discharged I was supposed to be sent to intensive outpatient and the social worker and ignored my repeated requests for a meeting and hadn't set it up.  The student social worker told me that she couldn't do it for me.  I was very upset and told the OT that I was no in a position to do this for myself, that I'd been trying since the 2nd day I was there to talk to the social worker and she'd ignored me.  (The social worker does not like me.  It dates back to my first hospitalization).  The people who were working scurried around and set it up immediately because "we don't want Dr. Brain to be upset".  And that's true, Dr. Brain is not fun when angered.  But it shouldn't have been about that, it should have been about everyone had agreed from admission on that I needed to go to this program and the social worker is the one who sets it up.

When you realize that your logic is both faulty and hanging on a thread a lot of reality pours in.  I'm not suicidal because I'm suicidal, I'm not being dramatic, it is part of my illness(es) (I think PTSD bears a big load in this although after PTSD therapy last year it is so much better).  I know so much about bipolar.  I know so little about MY bipolar.  I have always chosen not to know a ton about PTSD.  It is very weird the illness I tried to know everything about is the one that I have never learned much about my own case.  Possibly this is because I am an atypical case and nobody has sat down and told me "this you have, this you don't but you have this instead", etc.

I have no idea how to end this.  It's just a bunch of random thoughts right now.  I just know that I'm not really who I thought I was, which is strange.

Surprise

Yesterday I learned that there are several anti-psychotics that are likely to be out relatively soon.  Relatively means "a long time if you're waiting for them" but after 2 years of waiting another 2 years isn't THAT long.  I guess.  Dr. Brain is trying to find out about one that sounds like it may be coming before too much longer.  The only other new med is an antidepressant that I can't have because it has caused rage issues, not ideal in the bipolar and suicidal group.

Because I need sleep and there is just not much harm in trying things that aren't likely to do much for my mood we bumped up my Neurontin dose again and will head for a therapeutic level if I can tolerate it.  In the past I did not but the circumstances might have played a role there. 

So about 11:45 last night I was writing an email and suddenly was having trouble typing.  I realized my head was kind of spinning too.  Then I realized this is what medicated sleep feels like.  I closed my eyes and slept BEFORE midnight.  It was a decent night of sleep although I woke up frequently.  Still, I'd forgotten what it felt like to have a sleeping medication work.  It used to be routine; I'd take meds, 2 hours later I'd feel very drowsy and I'd sleep all night.  It's been so long since that happened.  I'm hoping to repeat although I'm not sure it is since I took my meds 3 hours ago and am still awake.  Regardless, perhaps this will help me sleep without waiting until nearly time to wake up to get there.

I also found a place today where someone had apparently written something not complimentary about my blog but had deleted the content and left the title.  I wish I knew what it said at the same time I'm glad I don't.

truth can be rough

I saw Dr. Brain today.  We talked a lot about how hard it is that everything keeps changing in ways that I didn't ask for, that this is now 2 years old and that I'm likely to go through losing Dr. Mind in a year.  We also discussed what I'm only beginning to understand the implications of, my brain's determination that I can only take so much and that I will not choose to keep pushing to live for however long that's supposed

 be.  I know not now but that unless we fix this that someday I'll reach a point that I will choose to give up. 

Talking about that is hard enough.  Adding the important yet she already knows it fact that I do not feel that something impulsive and recoverable is something I'd do.  I know enough about medications that if I reach that point I'm very likely to succeed.
 

I have known that this was a concern for a while.  When I was in the hospital suicidal and afterward it wasn't ever specifically said but it was implied that my risk was higher.  Dr. Mind and I talked about that last year some and I know that he agrees as well.

So chances are that I am not just on precautions, I just am not entirely safe with access to certain things.  Hearing that was hard.  She said there are new meds that will emerge in the next year or two and I'll try every one that I can until something helps.  She said that something will.  I realized while we talked that in reality when I was first diagnosed and saw the Guru of bipolar disorder he seemed to think I'd run out of med options very quickly.  But so many meds were made available that I got about 8 years out of it.  It's just hard to think of time I spent fighting so hard as bonus time, and it's hard to care that this was predictable and discussed at various times.

I needed to have the conversation we had today.  I need people to know so they can help me stay safe.  I also need them to know that I need to be considered a risk all the time if something is hard.

I'm going to try to get to a therapeutic level of neurontin.  It's a weak mood stabilizer but it has been helping with sleep somewhat in the last few months at low doses.  In the past I didn't handle it well at the dose I started tonight but at  that time I had so much going on that I'm not sure it got a fair start.  Dealing with it if it is bad isn't hard.  So we're trying and if it works I may actually catch up on some sleep in the next few days.

I can't believe how tired these trips to see her make me.  It's worth it but 4 hours of driving plus nearly 2 hours at the office (1.5 with her) today is tiring.  I need to go eat and I'm so tired I can't imagine wanting anything.

Prescription: Tears

Dr. Mind was off for a week.  I think I needed the break, even though it really wasn't one since I saw him on Saturday and then 9 days later instead of 7.  But we haven't had many breaks in the last year.  With my at-risk status if he's gone I see someone else to be sure I'm safe or we manipulate things like we did this time.

Regardless I have been feeling a bit better.  Sunshine has helped a great deal I think.  I even got a psyhotropic induced sunburn over the weekend.  But something else has helped:  crying.  Crying is usually really difficult for me.  I cry in Dr. Mind's office and usually that's it.  Lately that's meant sobbing for an hour with him, crying in my car for a while longer, and then waiting a week.  While he was off I watched a movie that made me cry.  I felt compelled to watch it again the next night and the next.  Several nights of watching and sobbing made me feel better.  So for now I'm actually trying to cry every day by watching the few movies that have that effect.

It's not really the standard treatment for depression but it is working.  Now it just has to keep working.

I should add that I'm packing my home up now and that makes tears a little easier to come by.  It's amazing how quickly things seem missing when there is still so much to pack.  But I am making progress and handling it well enough.   That's not to say that I don't cry when I think of it, but at least packing makes me feel in control a little.  I'm also working on finding cabinets flooring, paints, bathroom choices, etc. and since my new home is only 500 square feet that's kind of a challenge.  I need things to be as open as possible and the color selections matter.  That's particularly true since my bedroom is going to be an attempt to help me sleep and will be pretty dark in color to keep things as dark as possible.  The rest of it needs to be contrasting to that darkness.

Anyway, that's what is up here.  Sanctioned crying and packing, one box at a time.

The Future

Jean Grey always gives me things to think about.  She's been through loss with disability and she is able to give me answers that are based on experience.

This time she wrote:

If you are like me, you are not going to be happy until you have a plan- even if it is just a dream at this point. I don't know what you want to do in the future. Maybe it is to be a peer counselor, a nanny for a special needs child, or a part-time OT. You have learned skills that are still with you- and that can benefit someone.

She's right.  A plan would help immensely.  The truth is that part of my grieving is that right now I can't have a plan.  I got through a while by weaning myself away from the idea of returning to being an OT.  Then I thought that I might be able to do various things just to make a little extra money and have something to do.

But at this point, while nobody is discouraging me, I'm also not being encouraged to think that way.  I don't precisely know what I have to achieve to be allowed to consider working but I know it includes at least a year of stability as defined my my particular illness (ie, cycling but not drastic, not suicidal, sleeping regularly, etc).  Considering that it's been 15 months that I've not been allowed to have control of my medications or sharps and while an end was approaching I have now nearly certainly bought another period of safety time, I think that this is a very long way from happening.

There are a few other issues with working or even volunteering.  One is that even the last 2 years I worked I was taking advantage of flex time a LOT to manage.  Most jobs aren't going to offer that.  I really doubt I could handle a work schedule that wasn't flexible without serious difficulty  because of my sleep and exhaustion issues.  The more meds I take trying to stabilize and/or sleep the harder it is to operate on a schedule.  Another issue is that the kind of job I could possibly get is not going to pay enough for the limited number of hours I'd be allowed to work to make much sense.  My work history also doesn't lend itself to getting a job in an economy where jobs are rare.  Years of not working, multiple job changes, fired twice, etc. aren't good.  The last thing is that I can't work until we know that I psychologically can manage not feeling excessively responsible.  I can't exist as a job while ignoring my health needs, and all it takes for me to start out of control is a simple request to pick up a couple hours.  I've had that problem since my very first job.

The final thing is that I can't easily find myself thinking "I could do that" when I don't live where I will be living in a few months.  I don' t know my new area all that well.  I worked there for a while but with little community involvement.  I know my way around and what stores exist, mostly.  So in 6 months this may all feel different.

Who knows.  This is all so much more involved than I thought it would be.