Friendship & New Moms.

Right before I got pregnant four of my very close friends moved out of state. All to different states. They were all people I hung out with regularly and none of them have children at this point, and were not planning to when I got pregnant.

Then I had the worst pregnancy ever and puked every day literally for nine months. So not much socializing then. It was incredibly isolating actually. I had previously been spending at least weekly visits with my niece and sister and sister-in-law and hanging out with friends and then bam. Puking. Never could leave the house and just trying to survive my work days.

Then I had twins. Bam. Trust me no one lines up to offer to take care of twins. As infants and as toddlers we’ve heard crickets when looking around for any extra help. Which is fine in some ways because I don’t regret any time I spend with my sons. And when we’ve really been in a jam my family has definitely pulled through for us.

I worked very hard to grow them. I never want to feel any resentment toward them. And I don’t. I just feel sort of a loss.

The loss of a social life. And also the loss of regular visits and time with my niece and extended family. Because the boys are a lot. They are energetic, they are stubborn, and they have no fear. All very bad combinations. Three and a half year old twin boys. Yup it is as bad as it sounds.

Through the first year I rarely made it out, and therefore grew apart and lost more friends. It was like I lost my inner circle and my outer circle all in a few short  years.

Then I stopped feeling sorry for myself and made myself reach out to people I lost touch with. I reconnected with some girls I went to high school with, now mom’s of kids the boys age. We have get-togethers with a ton of kids and three or four moms every 3 months or so. It’s great!

My best friend who moved to Florida has actually been back a shocking number of times so far, and makes it a point to stop in and stay with us every time. So I think I’ve actually seen her more this year with her living in Florida than when she lived thirty minutes away.

I connected with other therapists as I forayed deeper into mental health. I now have a couple nurse practitioners I’m close with and their spouses and kids. I also am so lucky to have kept a friendship going over time with a therapist I trained with many years ago. We grew apart and saw each other maybe once or twice a year and then slowly reconnected; now she was the one I called when my dad died and I asked her to watch my kids with her partner. And they did. For roughly eight hours. God bless them.

My business partner used to be my boss, and she and I have always been close but grew closer in the last couple years in starting a business and then after the deaths of our Dad’s within three weeks of one another.

I do have supportive family around also (and far away supportive family as well).

But socially it’s been the hardest adjustment for me. I’ve never had a ton of friends but I’ve always had people I can hang out with and just relax and have fun with. It’s like with the boy’s birth I shed some really good friends, gained some great new ones, and reconnected with others. But it took time and there were months at the beginning when it was just me, the boys, and my wife. And the cats.

I feel much less lonely now than I did three years ago, and more connected. I have learned that I have to put myself out there. I can’t just expect good friends to drop on my doorstep. I also have to reset my expectations for friends with kids versus without kids.

My friends with kids don’t blink an eye at having a bunch of kids and adults get together. My friends without kids I always give the option of just seeing me alone without the boys or seeing us all together.

I try and be respectful of others expectations. But it’s hard. It’s hard to be a good friend a good mom and a good wife and all that other stuff. Having twins has been the most wild adventure of my life. But also the most isolating. The most challenging.

While deeply rewarding and marveling still sometimes that there’s TWO of them…I sometimes think how much I truly sacrificed for them. It’s a lot.

I wouldn’t trade them for a hundred friends. But there have been moments I’ve wished for at least a couple more.

My point to this long rambling is not to make anyone feel sorry for me, because please don’t. I’m loved by my friends and family and most importantly by my boys. My point is to bring awareness to the fact that new moms; especially of twins and multiples are still the same people they were before just with some extra babies floating around. In my case three year old monsters.

We still want to be called and texted and messaged. We still want invites. We still think of you and all our wonderful pre-kid times together often. We hope to connect with new friends and stay connected with old friends. Don’t leave us alone during these first few years of mommy-hood. We are being pulled in tons of emotional and physical directions.

What was striking to me was that more people reached out to me when my dad died then when my sons were born. More people offered to “help out” when my dad died then when my sons were born. I needed the support more three years ago. I don’t need help now. I need you to just show up and either take me out for a drink or tell me you’ll watch my boys for an hour so my wife and I can go have a drink together. Alone. Maybe we will just have sex in the car. Or a nap.

Either way an hour alone together would be magical. Either way just show up. Or call or text. I’m still here and so is every other new mom. Don’t forget them.

 

p.s. Thank-you to every one who has done this! You know who you are and I could not live my life without the support of everyone who shows up!

Also did a family photo shoot in our bathing suits. Yes. Next blog post.

 

Vagina, Penis, and Poop Problems in Psychiatry

Let’s set this straight. I work in mental health. Psychiatry. I am a psychiatric mental health nurse practitioner. Technically.

Yet when I go to my “open recent” tab in Word I find “Bowel Regimens” as a commonly and recently opened file. I prescribe many medications that cause constipation. So we talk a lot about poop in my office.

Diarrhea is often also a symptoms of anxiety so yeah, poop comes with the territory of mental health.

Nothing surprised me more though than the first time someone told me about their vagina problems. Or their penis problems. I have made the following statements in my office:

“You can use plain yogurt as lubricant because it doesn’t affect your ph so it shouldn’t cause a yeast infection, just make sure it’s plain. No sugar added.”

“Is the rash on the shaft of the penis or are you talking upper thighs?”

“‘Down there’ doesn’t cut it my friend, and remember I’m married to a woman, so you’re gonna have to be wicked specific.” 

“An odor can be caused by many things. Don’t douche that’s so bad for your ph. Stop using all the wipes and scented crap. Let your body regulate itself. I promise your vagina will thank you for it.” 

“That sounds like Herpes. Get that shit tested.” 

“Pull your damn pants up, NO I don’t want to see your rash! Go see your gyno!!”

“So are you able to ejaculate or no?” 

“You understand this means that your testicles will be removed permanently from your body?” 

“You can still orgasm, you just need a partner who’s committed to getting you there. You are familiar with your clitoris yes?…NO!? okay. Here’s a drawing for you. Start externally. Move internally. Use a vibrator at the same time as internal stimulation. From the expression on your face you’ve never used a vibrator. Okay you ever heard of one?” 

“Very rarely this medication can cause a sustained erection. Take sudafed. It works.” 

“Have you ever heard of the jade egg? Well you can pop it in before you start making dinner, by the time you’re done with dinner you will definitely be ready to have sex.”

“Yes there are some that are made with a stringy thing attached so you can pull it out.”

“Your how old? Ugh…okay….let me take a breath here….okay yes we can talk about sex but just know that I think you’re not old enough and the only reason I’m entertaining this conversation is because if you’re going to have intercourse anyway I’d rather you do it safely, but good lord please God wait!”

“To clarify condoms protect against STDs and birth control only protects against getting pregnant and only if you take your pill every day.” 

“And you’re sure there’s no possible way you are pregnant?…..I think you’re pregnant.” (I have said this on multiple occasions and have yet to be wrong. Four times I told the patient before they knew and they later called me to confirm and ask how the hell I knew.)

“Well your partner is stating that douching before anal sex is important to them. How do you feel about that?”

“I’m not the person to tell if you should or shouldn’t have an abortion. I’m just here to support you. I see you. I am here for you no matter what you decide. Let’s keep talking.” 

“You’ve decided to keep it. Okay. Let’s talk about how you’ll finish high school and the stigma of being a young mom. There are people who will want you to fail. But I know you won’t. I know you have what it takes to do this. You’re going to be a great Mom.” 

“The abortion was when? Okay, so let’s talk about how you’ve been feeling since.” *

There are a couple reasons I end up talking about vaginas and penises. Medications I prescribe have sexual side effects. Depression causes a decrease in sex drive. Bipolar mania can cause an increase in sex drive. So people’s sex lives can directly correlate with their mood.

But also, what I’ve discovered, is people want a safe space to talk about sex and sexual organs.

MD’s in their white coats draping patients in awkward paper create a sterile environment. One in which patients don’t feel like people. They feel like specimens. Whereas in my office we may never have touched physically but I know intimate secrets about them and their mental health.

I also treat them like humans. Not specimens.

I also ask. Not about their actual parts. But about their sex lives. Do they have one? Are they satisfied with it? Do they use protection? What kind? I ask these questions and then they know it’s okay to talk about that stuff here.

No I was not expecting the questions about vaginal odors and rashes that accompanied the safe space sex talk. But after it started happening and my initial shock and horror subsided I realized that it was actually complementary. I made them feel comfortable. When I asked why they didn’t ask their medical doctor these questions they often shift in their chair and look down, “Well, I dunno, it always feels like she’s in a rush,” or “I dunno I mean I’m naked and they are in and out, and it’s embarrassing talking about this.”

They are less embarrassed asking me whose never seen their vagina, then asking the doctor who is up their elbows in their vagina.

I also treat a lot of transgender and non-binary individuals who are pursuing surgical intervention for their gender journey. If I’m writing the letter of mental health clearance I have to bluntly say what exactly will happen and what the consequences are so I can write they have a true understanding and can consent to the surgery.

It’s not that I’m uncomfortable talking about sex and sexual parts. It’s that it shocked me at first because I went to school to treat the brain. I felt like I was at the wrong end.

Disclaimer: I have never diagnosed or treated with medicine or assessed visually any of the issues that are brought to me by my clients when it comes to anything below the brain. I listen and provide feedback and refer them to a specialist. I am obviously very careful about not practicing outside of my scope.

I think it’s wonderful that clients feel safe with me. I think it’s disheartening that so many don’t feel safe enough to say these things without my support to their primary OB/GYN or urologist or primary. Modern medicine has become so forced, quick, and detached that patients are missing a connection with their providers. They are missing the opportunity to feel safe and supported by all their healthcare providers. Not just in mental health.

It used to bother me. The vagina and penis questions. But now I take it as an opportunity to try and understand what’s missing from their relationship with their medical provider. Why don’t they feel safe saying this to the people who can actually assess, diagnose, and treat it?

I’ve learned a lot about sexual health and sexual dysfunction. I’m proud to say I could likely help any one with difficulty orgasming. I also know more than I ever imagined one could possibly know about anal and vaginal intercourse. I can say the words: penis, vagina, anus, ejacualation, masturbation etc. without blinking an eye or making faces and changing my body language. I mean that’s a score one for me. Try it. Try saying any of the phrases I quoted above to anyone and try keeping a poker face.

My point to all of this: If you are a healthcare provider: people WANT to talk about sex. They need to. They need guidance and help and they have questions. Be open to it. Welcome it. Create a safe space.

If you are not a healthcare provider: ask the questions. You deserve the answers. There is nothing wrong with you for asking.

To all the Mental Health Practitioners: God bless. Find a quality picture of the anatomy of a vagina and a penis. Trust me. You’ll use it.

****To any one who thinks any woman makes the choice to have an abortion lightly: they don’t. We don’t. I have held clients as they wept over the loss. I have treated teenage moms in the thick of it. Society doesn’t like teenage mom’s yet we also judge those who have abortions or who become pregnant. The young women I’ve treated who have faced abortion versus becoming a teenage mom have continuously impressed me with their grace, their strength, and their pain no matter what path they choose.

Let’s Talk “Mental Health Reforms” (eye-roll)

I’ve worked in mental health formally since March 2013. I’ve worked as a nurse, and in an emergency department for seven years prior to that.

It disturbs and angers me when I read or hear ignorant people make ignorant statements such as:

“We must reform our mental health laws to better identify mentally disturbed individuals who may commit acts of violence,” Trump said in an address to the nation from the White House on Monday. “Mental illness and hatred pulls the trigger, not the gun.”

Back in 2015 I did a research project and presentation to incoming resident psychiatrists regarding mass murders. I specifically reviewed data and research related to school shootings and looked deeply into fourteen perpetrators. They were all high school shootings except for one college perpetrator- Virginia Tech.

I also looked at more recent cases (not schools) that didn’t have data in studies yet- Aurora, Giffords in Tucson, and naval base shooting: all three had mental health professionals report the perpetrators PRIOR to the shootings. All three times nothing happened. Specifically in Tucson the person refused treatment and state laws protected his choice to refuse treatment.

I also explored the Tarasoff case. That is the case in 1969 that the duty to warn law came out of. A psychologist reported the patient as a threat. Nothing was done. A month later the patient killed the person they threatened the month before. Out of that the Duty to Warn law came: a mental health professional can break privacy laws in order to warn a named target. To be clear- the psychologist did provide a warning. Nothing was done about it.

Here’s why.

Those pesky state laws and HIPPAA interfere with legal and mental health intervention when something is threatened but not actually carried out. A person who is threatened can get a restraining order or protective order. But as we see in every single dramatic movie about domestic violence; what the hell does a piece of paper do when a person shows up and breaks the protective order with a bullet?

Let’s start at the beginning. I have a patient in my office. They are homicidal. They don’t have an intended target. They just have images of killing people when they are sitting in class or walking down the street. They watch ISIS videos of beheadings. They find these thrilling. All of this is disturbing to me. If they are under 18 I will tell their parents my concerns and encourage a higher level of care. If they are over 18 I may talk to their therapist as I am likely just doing medication management. We may chew over what we can do.

It’s usually a whole lot of nothing. Without a specific intended target we as mental health professionals can do nothing. I can threaten to discharge them if they don’t complete an IOP or go inpatient. But usually they leave and don’t come back.

If there is an intended target I can hospitalize them. Rather I can send them to the emergency department. There they will be evaluated. If there are no inpatient beds the emergency room doctor or APRN will likely try and lead them into stating they are not actually going to kill any one, get them to agree to go to an intensive outpatient program (IOP) and then discharge them.

If on the off chance they are admitted…well I’ve worked there too. Insurance companies will be breathing down our necks to discharge them. We will likely not be able to medicate them because they will refuse and we won’t have enough evidence to win an involuntary medication hearing. Even if we do win a hearing, medicate them, and discharge them they can stop taking the medication as soon as they are back home. We set them up with an IOP or back to their primary therapist and prescriber. And then we start back at square one.

I’ve had patients who are homicidal. They generally stop coming to see me as I relentlessly try and medicate them and push them into higher levels of care when the homicidal ideation does not stabilize.

“Mental health reforms” would have to include: private and public insurance companies being told to back off, pay out the nose for treatment for every single person who has an inkling of homicidal ideation, and never question the length or intensity of treatment.

It would have to include training every single mental health professional in the country to better assess and predict violent behavior. Good luck with that. It’s not something that can be predicted.

It would have to include sweeping federal legislation and the states to give up their individual laws and be okay with ceding power to the federal government (which right now is made of dipshits who I wouldn’t trust to baby-sit my children let alone create standardized mental health laws)…this legislation would have to include the ability to involuntarily mandate individuals to higher levels of care who have homicidal ideation and not all together as I don’t think group treatment of a room full of homicidal individuals would be a smart thing.

It would have to expand duty to warn to include any one who has contact with children/schools/public spaces: student teachers who make generalized statements about killing a room full of children. Currently we can’t report that. Daycare workers. Students. For all ages there should be some sort of mandate regarding medication compliance if some one is actively homicidal. For under 18: there should be regulations for parents about following the recommendations of a mental health professional if their child is homicidal. Etc. Etc. Etc.

The list could literally go on and on. All of it will impede patient rights. All of it would put mental health professionals in a position of power that is not deserved. We should not be making these decisions for other people. It strips people of their ability to choose.

Guess what would be easier. Banning freaking guns. But it’s cool. Just keep throwing this back on mental health as our funding is cut and we have less people going into the field because it pays crap and it’s dangerous in many different ways, and oh yeah, there has yet to be ANY reform to our mental health system.

In all the cases I examined they all had one thing in common. EASY and OPEN access to guns NONE of them were registered to the perpetrator. They were all registered to family members. The Jonesboro murders: by the way they are alive and well, and one tried to register for a conceal and carry license under an assumed name…but I digress. The boy who’s guns they used…the parents had locked them up so they changed their plans the day of and just drove a mile to his grandparents because the grandparents had plenty of guns laying around. And those boys used them to kill children.

THREE shootings mental health professionals made the call to report a concern. NOTHING happened. They still had access to guns. Guess which shootings were not reported by mental health professionals? The one’s perpetrated by children. Because it’s very hard to access a child’s homicidal ideation. Trust me on this one. It’s then even harder to convince the parent that little Johnny the apple of their eyes is actually homicidal. Trust me on that one also. Been there.

Mental health is broken for sure. But “reform” of the system will not stop mass murder. Banning guns will. And “reform” of mental health will require an administration who understands the mental health system. The barriers to treatment. The barriers to mandating treatment, and the lack of training we receive in predicting violence. Because yeah that’s not a thing.

I only pull this out occasionally…I attended an ivy league school and worked with some of the top psychiatrists in our country. They write the research papers. Not one time was I taught how to predict violence. In fact I was told that is not our role at all and it’s virtually impossible to do anyway. This was from the best of the best.

I’ll leave you with this:

  • Stated by the US Supreme Court (1980’s) and the American Psychiatric Association in the 1980’s and then after El Paso 2019:

    • “Neither petitioner nor the APA suggests that psychiatrists are always wrong with respect to future dangerousness, only most of the time.”

    • “Routinely blaming mass shootings on mental illness is unfounded and stigmatizing. Research has shown that only a very small percentage of violent acts are committed by people who are diagnosed with, or in treatment for, mental illness. The rates of mental illness are roughly the same around the world, yet other countries are not experiencing these traumatic events as often as we face them. One critical factor is access to, and the lethality of, the weapons that are being used in these crimes. Adding racism, intolerance and bigotry to the mix is a recipe for disaster. 

    • “If we want to address the gun violence that is tearing our country apart, we must keep our focus on finding evidence-based solutions. This includes restricting access to guns for people who are at risk for violence and working with psychologists and other experts to find solutions to the intolerance that is infecting our nation and the public dialogue.”

“In 2017 the NRA spent over 5.1 million dollars in lobbying.”

Guess how much the combined families of all the parents of all the children killed by guns contributed. Not 5.1 million. But yeah it’s totally a mental health problem.

Next time someone makes the statement “We need mental health reform not control,” please ask then to expand on exactly what mental health reform means to them. How will it be accomplished? What would the goals be? Where will funding come from?

Because make no mistake it needs to be reformed. But no amount of laws and reform and funding will help humans predict which humans will commit murder.

  • Campbell, Messing, Kub, Agnew, Sheridan, Workplace violence prevalence and risk factors in the Safe at Work Study, JOEM, 2011
  • Chaloner, R., Hall, W., Friedman, S., Guns, Schools, and Mental Illness: Potential Concerns for Physicians and Mental Health Professionals. Mayo Clinic Proceedings, 2013
  • Czaja, Moss, Mealer, Symptoms of PTSD among pediatric acute care nurses, Journal of Pediatric Nursing, 2012
  • Gates, Gillespie, Succop, Violence against nurses and its impact on stress and productivity, Nursing Economics, 2011
  • Hawkins, McIntosh, Silver, Holman, Early Responses to school violence: A qualitative analysis of students’ and parents’ immediate reactions to the shootings at Columbine High School, Journal of Emotional Abuse, 2004
  • Shulz, Muschert, Dingwall, Cohen, The Sandy Hook Elementary school shooting as tipping point, Disaster Health, 2013.
  • Daniels, Bradley, Hays, The impact of school violence on school personnel: Implications for psychologists, Professional Psychology, 2007
  • Book- Deadly Lessons-Mark H. Moore, Carol V. Petrie, Anthony A. Braga, and Brenda L. McLaughlin, 2003, IOM

Finding Our Other Sister.

From a young age I knew there were other siblings. I don’t know how I knew. I don’t remember being sat down and told I had three half siblings somewhere out there. I just remember knowing. I remember always wondering about them. I remember wondering why my Dad had no contact with them. I remember wondering if they wondered about me.

My dad was the simplest and most complicated man I knew.

He and I were always playing a game of chess. Trying to outsmart the other and me specifically trying to get him to reveal something; anything about his past.

He had a past in Vietnam that I would piece together over my entire life; with so many pieces still missing at the time of his death. He had a past family that I would also piece together over time with bits and pieces from various family members and friends.

They were always something I came back to, these elusive siblings.

I’ve treated quite a few clients now who have siblings or half siblings they’ve never met. They always express feeling a certain way about that and I get it. Because when some one asks me if I have just one sister, my sister I grew up with, I always hesitate. Well yes but no. I don’t like to lie, and that felt like lying.

It’s a chronic sort of wonder and curiosity that plagued me.

When I was twenty eight or twenty nine I was with my sister one night. I had done a lot of wondering over the years and turns out so had she. We drank too much then of course where did we go but to facebook. We found them. We friended one of them. One of our sisters.

She friended us back.

At some point I realized the how and the why my Dad was cut off from them didn’t matter. I realized that it didn’t mean my sister and I couldn’t connect with them or at least try to. We had no agenda. We did not want to reconnect them with our Dad. We wanted to meet them. To know them. To see our siblings.

We met with one of our sisters at a restaurant. We were all nervous, we all brought our spouses, and I remember saying to my sister “What’s she going to think that we are both lesbians?” I mean it’s one thing reuniting with two sisters you’ve never met, but two lesbian sisters?! My sister is much calmer than I am and she didn’t ever think it would be an issue. And it wasn’t.

I got out of my car and I approached a woman in front of a restaurant. My wife trailing behind me, and her husband behind her. We came face to face and it was bizarre. Because she was this mix of my sister and I. There was a third one of us. She said, “Do people call you Mere? Because people call me Ger!” It rhymed and she smiled and I smiled and we had this one stupid thing in common immediately and would come to find out so much more.

We laughed and we hugged. Then we all spent the next six hours in a restaurant asking about the last thirty years of each others lives. It was incredibly comfortable.

We had a lot of weird stuff in common that felt like stuff only siblings could really know about each other even though we never met before. The whole experience was surreal and felt like we were in a movie where long lost relatives are united.

We took a picture, the three of us and my niece and we all looked at it later and thought holy crap we look like sisters. It wasn’t until I saw that picture again and again that it really sunk in for me. The half siblings I always wondered about were real and I met one. And I could call her my sister now, not just some distant half sibling. She was my sister now too.

When I got pregnant with twin boys later on, and I worried about Declan’s big head she sent me photos of her sons as infants. Big heads. I was so relieved. They also looked incredibly like my sons. My mom’s side of the family only has one boy. So it has been great to have other boys to compare my sons’ likeness’ to. It seems silly, these little things, but they are important to me.

We have met up a few times since our initial meeting. We text and call and message when we can. What’s great is that there is not this pressure to develop any sort of relationship that is fake or forced. It’s like we know that the other one is there. Really there. Not just a far off dream. That she is a phone call away and vice versa is comforting. It laid something to rest for me.

I don’t know many things about my Dad’s life before he was my Dad. But I left nothing unsaid between he and I. I have no regrets about our relationship. And now I have no regrets about my siblings either.