it’s 2 am and I am still up

It’s 2 am and I am still up

Pain hit me bad around 2115 or so. My foot has been feeling like it is being crushed all day and still continues to feel this way despite my breakthrough med. But around 215, I started having severe suicidal ankle pain. This caused me so much fucking aggravation. Like the last nerve had been hit. I spoke the other day how I have all the ducks in a row and now they will call come together. I am sick of being and will be taking efforts soon to not be. It won’t be this week but sometime this month.

I am supposed to go to physical therapy in twelve hours. I am going to cancel the appointment mostly because my voice still isn’t there and I don’t want to be talking for 45 mins just for my throat to be sore the rest of the day. I will see if my voice is better next week and then have the eval then.

I sent a message to my psych to see when she wanted to talk, if she wanted to talk. I never got a response so I guess we aren’t talking. No big deal. I can try to talk to her on Tuesday. I sent her a thing she wanted me to write to try and get the therapist up to date on my suicidality. She hasn’t said anything about it so I guess it is ok. I wrote about the background and then how things are now. I also wrote about how I want her to be accountable to things we discuss and have them followed up the following week. I am tired of therapists not following through or continuing what was said the previous week. I have not printed this out. I don’t even want to see the therapist because I am afraid of what will happen. I told her some stuff about how I want to proceed in therapy from now on until the suicidality is somewhat under control. I am not sure how she will take this so I am nervous. I went through this with my long term therapist and things didn’t go well. She didn’t want to carry through on things and that frustrated me more than anything.

One of the things I talked about was the SSF (suicide status form). It is part of the Collaborating, Assessment, and Managing of Suicide (CAMS) framework. It is used to assess suicidality to get a better picture of what the episode it like for the patient. It is individualized for that patient and it really helps the clinician know where the problems or situations are that are leading to this person thinking about suicide. I have made copies of the forms from the 1st edition of the book but have not done so for the 2nd edition. The 2nd edition has the changes of a few things and on the current DSM (diagnostical system of mental disorders). The last message I had with the creator was a month or so ago and he was looking into an electronic form so that it could be easier sent to the medical record. The wonderful thing about the SSF is that it has all the documentation needed in just a few pages for the patient’s record. Right now that is just paper but eventually it will be electronic. I am not sure how that will go or if there will be a 3rd version of the book to reflect this or what. But it is in the works and last I heard would be ready sometime this year.

I don’t know if she would be interested in something she has not seen or heard of. The bottom line is that CBT and DBT (both of which she does) are also evidence based treatments for suicidality. I am not sure if this is true for chronic suicidality but I don’t think that has been studied.

1203 pm: I canceled my PT appointment. I didn’t sleep until after 0500 and with my voice being terrible, I really didn’t want to talk. Now I have the whole day to myself. It is nice out. I have one business I need to take care of before I go. I got to close my IRA account as I haven’t put any money in for years and because it is below the minimum amount, I have been charged every year, dwindling what was there. I figure I better close it before there is nothing and then be in the negative. The interest is not that great either. I just updated my book because I found it and it was only 1 to 2 cents given. I am just worried about how much taxes are going to be taken out because I am not of age to collect it. I went through this once before and it was a hassle. I think it was more because the bank didn’t want to do it than anything. Least that was my impression. Maybe I will go to the square and do it at the bank there as the one near me always gives me a fucking hassle with transactions.

I need to take a shower. I also need to change my bed sheets but that in itself is more tiring than taking a shower. My foot is a 7 right now. I know after the shower it will be up for a bit. Maybe in the afternoon I will go to do the bank business. I already had my coffee for the day so I won’t go to Starbucks. Though I might as someone misplaced or got rid of my reusable cup. I can’t find it anywhere. Maybe my nephew has it in his room. I will ask him when I see him.

Ducks in a row

Ducks in a row

I’ve been struggling all week. Pain and depression have been an all time mood sucker, increasing the suicidality to the point where the other night, I have things down pat. I am or should be “happy” about this but not really. The fact I can act at any time gives me some relief that when I want to escape, the choice is there. There really is nothing about what if anymore, well there is. I could be rescued or have a change of heart and get help before things take place. I won’t know until that moment. Worse case is I just get sick. I hope that doesn’t happen.

I had therapy this week. I still have no voice from my allergic reaction on the 16 Aug. I saw the folks in laryngology and the PA (physician assistant) said there is some constriction of the things surround the vocal cords, causing my voice to be the way it is. No cancer, polyps, or anything else causing this. I didn’t ask what was causing this as I just wanted to get the hell out of there. She was kind of freaking me out because when she started explaining things, she would shut her eyes and then go off tangent, making me all confused. My appointment was at 2 and even though I was in the room by like 215, I wasn’t seen till 245 and by the time I was done, it was 330. The camera was not pleasant. I had a microphone on my neck and it shifted. As she was trying to get it adjusted the damn fiber cable went further down my throat to the epiglottis, making me gag. I asked what can be done and she basically said time. I asked about speech therapy and she was not advocating for it so I practically had to beg to get referred to it. She said the therapy is booking out in a month’s time so theoretically, my voice could come back by then.

I was expecting this as the folks in the ED said the same thing (well more that I needed speech therapy, not so much it would get better on its own). My pcp pissed me off that day because he wanted me to stop my allergy meds. Even though I said I take it every day and have for years, they think it could be a reason. I really don’t see how all of a sudden this medication would make me hoarse. The laryngologist said the GERD could be causing this but I haven’t had too many episodes for this to happen and when it did happen before the allergic reaction, my voice didn’t change. She recommended some antacid that I am to take at night. It isn’t a kind that I can get at the drug store but online because it is supposedly made with seaweed. I don’t know. I don’t think that is the reason either, unless the ginger caused so much acid production it did affect my voice this bad.

I’ve been in contact with my psych. I spoke with her today. She asked what I was doing and I said I didn’t know as I just woke up and haven’t had coffee yet. She told me to get coffee. LOL She is too funny. Kind of strange that she only recently laughed at my humor and made jokes. Don’t get me wrong, I do love hearing her laugh. I just think it only took 26 years to hear it. LOL She didn’t tell me when she was going to be in an office soon. I haven’t asked because I know she will tell me when she has one. She does want me to write to the therapist about the stuff that is going on. Think I will do that today. I really struggled to talk to the therapist this week because of my voice. It was so shot after seeing her Wed. But then I was up more than 24 hours when I saw her. I was also up most of the day Wed. I just could not sleep despite taking melatonin and Ativan. I was so overtired. I felt like total shit yesterday and still feel crappy today, though much less so. I did a few errands today and my last stop had me weary. By the time I got home about 15 minutes later, my ankle flared up (it was already a 9 to begin with) and I just felt weak. I got some stuff to do in my room (there always is stuff to do in my room). My sister has once again become a tyrant. She said she was going to do stuff this week to clear my room and bring some stuff up. Has not done so but I am guessing tomorrow she will. I hoping she won’t. She is really sending my anxiety up the roof and I have been so hypervigilant that it is hard for me to relax. Yesterday I wanted to sleep but I kept thinking (even though she wasn’t home) that she was going to barge in my room at any second. If I can do two things that will make things easier for access to my alcove, I am going to try. Wish my nephew didn’t move all the stuff to block it even more. Now I got to move it all to the other side of the room where there isn’t much room to begin with. Just overwhelms me to the Nth degree.

a lot has happened this week

A lot has happened this week. Tues I had therapy. I thought all that day that it was Monday, even though I knew I didn’t have an appointment that day. Because I didn’t have much of a voice, I had written out what had transpired since the last time I saw her. After she finished reading it, she wondered why she didn’t get notified that I was in the emergency room. I thought that was weird and said so. She said some providers get notified. Ok. Don’t know why a psychotherapist would get notified about an allergic reaction, but what do I know.

I didn’t talk for most of the session as she would ask a question and then I would either shake my head or nod. That only worked for so long. By the end of session, my throat hurt and I don’t think I could speak. We had talked about my being suicidal and she kept on asking me if I was safe. I didn’t know where she was going with this. I have no idea if she was using the “no harm” contract or what. I could have gone in so many directions with this but 1) I had no voice and 2) I am so damn tired of teaching or maybe informing is a better word, a therapist about how to deal a chronic suicidal person. I am still thinking of bringing in the suicide safety plan by Stanley and Brown but I am just not ready to do so, only because in my intense moments, I doubt I will do the stuff that I had agreed to do. I was supposed to call my psych and I don’t remember if I did or not. I know I emailed her and that is all I remember.

Wednesday I had groceries delivered. I put most of them away and then decided to get my haircut as I had to go to the bank for my mother. My barber said he would be unavailable between 2-3 so I went to Starbucks and just wrote in my journal. I don’t think I had anything caffeinated because I had coffee while waiting for my groceries. I might have ordered a tea and that was it. I got my haircut and hour later and then went home. I was tired and my ankle was hurting but then when isn’t it hurting?

Thursday I had an appointment with the new psychopharm. I was really nervous about it. Before the appointment I was almost in tears as I didn’t want to see this guy. I just wanted my psych and the realization that she was gone was causing intense grief. I had emailed my psych so we had a convo a little before the doc got me. I felt a little reassure she was okay with this and that she knew that she would always be my psychiatrist, no matter what. I went to the guy’s office and could only speak a little above a whisper. Some days I feel like my voice is better and other days I can hardly talk. That day was one where I could hardly talk. The doc wanted my psych history and what had lead me to see mental health services. He didn’t have me elaborate on why I was hoarse, why I was disabled, why I was wearing an AFO, nor did he inquire about my past medical history. I gave short answers as I was in a bad mood for most of the day and wasn’t very talkative. I told him I had Bopolar 2 and he gave me a skeptical look as my record said I had bipolar 1 (I have never experienced true mania before in my life). The appointment was supposed to be an hour long. It lasted like twenty minutes, tops. My throat was sore so I knew I wouldn’t be talking to my psych that day.

I felt like the whole conversation could have been done via email or something. He said he was just for meds and all he wanted to do was increase my antipsychotic, even though I told him my psych didn’t want to for fear of side effects. I must have told him no at least three times that I didn’t want an increase. Then he said he will see me in a month and if I needed refills before then or wanted to get in touch with him to do so via the patient web thing. That was it. That was the appointment. I was in a worse mood when I left.

Thursday I had left early because I couldn’t stay still after I woke up. I got to the “new” bus stop and waited. The bus just blew right by me. There were no fricken signs indicating it was a bus stop and the previous bus stop had no signs either. I had to walk uphill to the only stop that I knew had signs, which was a good 300 feet beyond where I was uphill. My legs were killing me from the walking. When I came home from the disaster of an appointment, my ankle flared up. It had been a 7 most of the day (never good when I wake up with a 7) and it immediately went up to a 12 when I was resting. Things just got worse from there. I must have sent three or four emails to my psych over the course of the evening/night. I was extremely suicidal and the sketchy plan I had in my head became more detail and specific. I had picked out a day and dammit I was going to go through with it. I didn’t go to sleep till maybe 3 or 4 am. I wanted to write a blog but just posting the word “suicidal” on facebook triggered a report. Whether someone did or some fricken algorithm, I am not sure. It happened pretty quick so I am thinking it was their stupid algorithm that sent me the “being reported” bullshit. I had become even more despondent over this. I felt shutdown even though I was ready to fucking explode. I couldn’t get my thoughts together to even write in my journal, where I knew it was safe.

I slept till around 2 yesterday and thought all day that it was Saturday. I wasn’t feeling so suicidal but the thoughts of the night before still were shocking to me. I still had the plan in my head. All day yesterday I was overwhelmed with my thoughts and by 4 or 5 I was totally consumed by them. I took an Ativan to try and calm down as my anxiety was so high. I also sent my psych an email asking her to call me whenever she got the chance. I was free the rest of the evening so it didn’t matter what time she called. She called me around 2 hours after the email. I asked her you could become insane by the intensity of being suicidal and she laughed. She said that wasn’t the definition of insanity. I felt reassured. She said she is trying to reach out to the new psychopharm but he hasn’t responded to any of her messages. I am not surprised as he seemed like an asshole. She also wants me to let her know how the laryngology appointment goes. I said I would. She said I should write but I couldn’t last night. I felt like if I spoke my mind, the police would be at my door the next day. I just wrote in a notebook and my journal. She asked what I was doing this weekend and I said I didn’t have plans. I still needed to do stuff around my room. She said to keep in touch. I said I would.

I had gone to the pharmacy yesterday to pick up my meds. My right leg felt so weak. Actually, both legs felt weak. I knew it was because of Thursday’s activities. I wanted to do stuff around my room but I knew if I tried, I would hurt so I didn’t. I didn’t even want to shower though I needed one. I just couldn’t chance another flare. It would have sent me more over the edge than I already was. I just read. A friend texted me so we chatted for a bit until he had to go out with his family for dinner. I was glad we talked for a bit. I tried texting to another friend but she said her phone was dying and would talk later. Yea, 3 am later. JFC seriously? I don’t get why people don’t know their battery is dying when you are talking with someone. Why even bother answering when another time would have been fine. I don’t get it. But texting at 3 am, unless it is an emergency, is not ok. Yes, sometimes I am so it doesn’t matter but usually at that time, I am trying to wind down not have a conversation for an hour or two.

I haven’t done much today but I did finally shave and shower. I didn’t take a chunk of my face off while shaving either so that was good. I haven’t really eaten much but then I am not that hungry. I had bought some buffalo wings with my grocery order and forgot they were in the fridge. I found them while looking for my coffee. Our fridge is full so I basically just put my coffee where ever there was room. I realized today that one of the bottles of coffee I ordered didn’t come. It is too late now to call and say it didn’t. I am bummed about this, but not really. I need to get ice cream so I might get it tomorrow if my nephew isn’t working. I will get that particular coffee then.

frustrated on so many levels

Frustrated on so many levels

I saw the therapist today. I was really nervous about it because I didn’t have a voice. First part was of her reading all that transpired since I last saw her, which was last Monday. In there, I had mentioned I was suicidal and she asked if I was safe. I hate that fucking word when it comes with being suicidal. I never know if I am truly safe. If it was put in the how likely am I going to act or something, the answer might be a little different. Each time I get the urges, the situation is different so I have different levels of coping with it. It might be some grounding, music, distraction, going through social media and getting support there, or just maybe sitting with whatever I am feeling to get through the moment. I have recently just stared at a wall while letting the feelings hit me, one after the other and I try not to think in those moments, which is hard to do. Some times I can write but lately I seemed to have lost my words (mostly due to being reported on my feelings) that I cannot express myself, not even in my journal. The words are there, I just can’t seem to put them in cohesive sentences. This is the MOST frustrating thing because writing used to be my escape and because of vigilantes, my escape has been hindered.

I left aggravated and angry. I was looking for her to offer something to appease the suicidologist in me but nothing was forthcoming. I don’t know if she was looking for me to have some sort of plan (I have many, some good and some not so good) or what. Her biggest thing was for me to be “safe” whatever that meant. While I was home reflecting on this, I basically realized I have four choices: 1) go to ED of some sort; 2) call my psych, no matter what hour as I most likely will be in real danger at this point; 3) stew with the feelings as mentioned above; 4) act on my feelings/thoughts/urges. I have a straight forward plan so as long as I can walk (presuming physical pain isn’t the driver of the suicidal escape), the plan can be executed with no one much the wiser.

The ONE thing no one understands about suicidality is the need to escape from the pain (physical and mental or either/or in my case). It is also true that if I have an angry row with a family member that has me feeling unworthy, useless, lazy, etc., my thoughts of escape increase because I feelings of being trapped are heighted and I will think of suicide as my only choice in the matter. I honestly have no way of conveying this and having a “treatment” for it. Yes, I can bring up CAMS (my preferred way of dealing with my suicidal feelings) but my therapist doesn’t even know what the fuck it is, and from the sound of it, is not up to the latest suicide prevention stuff. Honestly, I don’t know who is as there is a LOT of information out there.

The therapist also wondering if being that the institution I was at was good for me as I have so much anger at it right now as it got rid of my psych. I think part of this is mostly likely the grief of her not being there and right now I am in the anger stage of that grief. The frustrating fucking thing right now is that because of my voice being fucked up, crying hurts so I am unable to process it with a good cry. Even as I am typing this and letting some tears out my throat is starting to hurt in a big way. I think once I have this cry, I can possibly moved on. My psych is still there for me; she hasn’t left. I just haven’t been able to see her as she doesn’t have a new home yet. I am still her patient because she has said so and I believe her. If anything, I think she fears me leaving her more than I fear her leaving me. If that makes sense.

I am utterly exhausted right now, mentally and physically. My throat is fatigues and hurts from the twenty minutes or so that I spent talking to the therapist. I honestly don’t want to talk to anyone, unless it is in written form, for the rest of the day. The only thing I have eaten today is a donut and a coffee cake. That seems to be the only thing I want today. I may have the last breakfast burrito (if there is one) that is in the freezer later but chances of that happening are low. I might have to make some more tomorrow after my groceries are delivered. It is nice to have some pre-made food that I like that I can zap in the microwave for a few minutes and have a meal.

I don’t have any plans for tonight. I might read Harry Potter or just be on social media. I would like a nap but that has yet to happen. I just seem to lay down and my pain decides to act up. My foot is already acting up with the ceiling fan going. Airwaves are annoying it. I really shouldn’t have listened to the meditation thing the therapist had me listen to. It started off by thinking of the feet and how they feel and such. Both feet were killing me so it was hard to “let go” of the feelings and shit. Then that was the only thing I could focus on. When they moved up to the abdomen I started feeling hypervigilant of someone barging through the door and had to stop it. At least we tried it. I knew it wasn’t going to work as I have done similar shit while inpatient and it is always a trigger for me.

I had written in the notes I wrote for the therapist to update her that I was thinking of getting ginger gummies and just sitting somewhere to eat them. By the time I came home, the plan was set. I figured out the location and all the how, what, when, where, and why. I have the four choices listed above on which one to choose when those urges arise. I will be left to my own devices and the choice really is mine to make. No one can stop me, no one needs to know, and no one will be there when the decision will be made. I am on a precipice. Question is, do I have a hand (figuratively) to hold me back…

I’ve decided that I won’t tell anyone about my suicidal thoughts. Might mention them here but just the thoughts. No one seems to want to hear them anyway.