#COVID-19 · Mental Health Stigma Suicide · Nursing

When I’m Called Out by Clients for Swearing, Caring, and Everything Else…With Love. A Day in The Life of a Mental Health Nurse.

An unexpected perk to having a therapist on staff full time with us is hearing from her what my patients think of me. I have referred more than a few of my clients to her though some of them I’ve seen for over three years for medication management and for one reason or another they needed a therapist at this time. Apparently the impressions are hilarious.

Occasionally my clients will directly throw my words back at me. Recently a young adult attending college in state needed to see me urgently. After we processed the current crisis and made decisions about medication I smiled and said, “Isn’t this great that your in state and we can do telehealth?” The client laughed and said, “Well I recall you saying if I went to school in Iowa, one of my top choices, that I’d be in ‘East bum fuck middle of fucking nowhere and there’s no way in hell I’m managing your meds out there'” I have a chagrinned smirk including blushing cheeks that emerge when properly embarrassed and I replied, “Yes well, that does sound like something I’d say…” We were both able to laugh. Now I know that client didn’t go to school in Iowa for a few reasons, including COVID, not just because I wouldn’t manage their meds in east bum fuck nowhere. But it is a humbling reminder to know that I do play into people’s major life decisions.

One of my clients did an imitation of me to the therapist at my practice…who texted me while laughing to tears because it was incredibly accurate and I am funny without meaning to be which usually makes it funnier. The impression was from our intake. Our intake was over three years ago. I was very direct. I warn people I’m direct. I don’t think any one really believes me until they experience it. And again, I was humbled. Because these moments in time are so important to clients. They stick in their brains these intermittent appointments with me. Words are so powerful. Body language. Facial expressions. This client nailed it all.

What I learn over and over is that my clients are paying attention. That I have an hour intake and thirty minute follow-ups maybe once every three or six months if they are stable and those minutes are precious. I try and respect them. I swear a lot. That’s not going to change. But apparently between the swears, the sarcasm, the checking in, I impart an energy and words that stick with people. It’s a privilege to be that person. We in mental health should never take it for granted.

I have a client I have been seeing for a few years, and the parents brought up at our last appointment, “Hey do you remember when you made us leave the room because you had to have a ‘Come to Jesus’ moment with them?” The Dad was cracking up. He said, “We didn’t know if we would see our kid again! But we knew then we were in the right place.” I did that embarrassed smirk as I thought back a couple years, and in fact I did remember telling the parents to leave. I didn’t raise my voice. I got down at the kid’s level though and told them to take their ear buds out when I ask them to take them out. To respect my fucking time because I’ve shown them nothing but respect even when they are acting like a little entitled punk. I may also have told them to undo their wedgie and let’s start again.

Sometimes I remember those moments and do a facepalm. I obviously do not speak to all people this way. It’s my job to read people. I’m good at it. I know who it’s going to be effective for and who it won’t be. And that kid never wore the ear buds again, and honestly has been very respectful to this day in our appointments.

Recently a parent asked me if I thought their educational plan for their child was “crazy”. I didn’t hesitate when I responded nodding, “Yes. I do.” I remember the parent looked at me and laughed a little and said, “Well you’re the first one who’s at least been honest with me.”

Honesty can be a bitter pill for people to swallow. It’s definitely not for everyone. Again, I give myself a disclaimer up front to any prospective clients. “I’m direct. I will call you out. I encourage you to call me out too if there’s anything that needs to be addressed.” But it can open doors to take your head out of the sand. My honest response to that parent opened up an entire conversation about their own self doubts and their strengths and weaknesses as a parent. It allowed a space for them to be vulnerable that wouldn’t have been there if I had just smiled and said “No of course not,”.

I’ve also learned that as long as I’m honest without being judgmental…which is a hard skill to master…it goes over a lot smoother. My clients that I take time to build rapport with and I really get to know and who get to know me, they know when I give them direct feedback it’s not from a place of judgement. It’s from a place of genuine curiosity and caring. I want to know if I’m on target with my assessment. I want to know if they know I’m on target or not. I want them to think and feel things that they haven’t let themselves think and feel. I want them ultimately to get better.

I was asked recently by someone how I felt about “…profiting off the pain and sorrow of others. I mean people have to be suffering in order for you to get work right?!” This was not a friend. And was said with some malice toward mental health professionals. I responded that I think about that a lot. And that should there come a day when my services are no longer needed I will feel such immense joy that it actually brings tears to my eyes to think of that day existing.

I remember resisting the impulse to defend all that I do; all that I give to my work. It doesn’t feel like a profit when a client is hospitalized for suicidal ideation. It doesn’t feel like profit when I end a day sitting on my floor wiping away tears because of all the emotional trauma I’ve held space for in the last eight hours…trying to pull myself together in the five minutes I have before my sons bounce through the door. It doesn’t feel like a success to educate my client about their diagnosis of schizoaffective disorder- how it’s lifelong and they will have more episodes of psychosis and we need to plan for when not if.

Those are all the moments that stick with me. So it’s nice to hear from clients who remember other moments. Who remember me swearing with love. Who remember the limits I set with fond affection and admiration. Some of my clients have done impressions in front of me and they are pretty good. I should be a meme.

Clients send me videos of their engagements. Wedding pictures. Newborn baby pics. Those hilarious therapist memes. Some one sent me a Christmas card thanking me for all my help and crediting me with helping them be healthy enough to become a Mom. I cried hardcore when I opened that one. I am allowed into these intimate moments in people’s lives because I know more than anyone the emotional labor they have put in to get to these crucial turning points in life.

The positive feedback is few and far between for healthcare providers, especially mental healthcare providers, but it’s there. Even the impressions. They crack me up. This year more than any I needed the positive feedback. I am beyond grateful for it.

To consumers of the mental health system- I thank you. For trusting me with your mental health. For seeing me for who I am even in moments of tough love. To families of consumers- I thank you. You have trusted me with your most precious cargo. I don’t accept that responsibility lightly. To the therapists who have to endure impressions of me- Enjoy. I’m pretty freaking funny especially when I’m not trying to be and yes. I swear that much.

#COVID-19 · Mental Health Stigma Suicide · Nursing

You Don’t Know Me At All. Me: to every hospital I’ve worked for.

I recently received a heavy metal coin in the mail from the hospital I work at per diem. It was accompanied by a trifold letter thanking me for my hard work during the pandemic and ended with a “we are all in this together” statement. It explained the coin too. Likening it to soldiers being honored with metal coins for acts of bravery.

I didn’t work much at the hospital this past year. I had enough to keep me busy with my practice. I also felt that the hospital left a lot to be desired in terms of infection control measures in the psychiatric hospital. I felt safer working remotely at my practice.

But there were many essential frontline workers working day and night caring for COVID patients. Caring for NICU patients during a pandemic. Caring for maternity patients who had to give birth alone wearing a mask after their partners tested positive.

I opened and read the generic letter, held the coin, and though of the scene in the Office when the CEO of the company, Robert California, looks at the regional manager Andy and says, “Sometimes I think you don’t know me at all,”

If you’ve seen The Office you know it’s satirical. It’s a commentary on how every one lower on the totem pole from management feels that management doesn’t actually know them at all.

I felt this viscerally holding that coin. I felt affirmed with every atom of my being with my decision to leave hospital and agency work full time and venture into the risky world of self employment via private practice. The few times I’ve worked at the hospital I thought I would have lost it if I was working there full time this past year. And the nurses and doctors and respiratory therapists working there full time for the past year deserve more than a worthless coin and generic thank-you letter.

I’m going to give the example of how I treat my employees. Because I’m a big bad boss now. My employees received everything necessary to do telehealth at home. Headphones. Lifted desks. Second monitors. Printers. Scanners. Anything they needed I got them. I screen all their calls and messages and deal with whatever I can on my own without bothering them. If they ask me to intervene and discharge some one I do it. No questions asked. Because I trust their judgement. For Christmas I gave my part time employee a bonus. I gave my full time employee the option of a cash bonus or tax exempt options like insurance premium, HSA contribution, student loan payment, etc.

I ask for their input on what charity to give to locally whenever I make a donation through the business.

I give them positive feedback whenever I get it from clinicians and patients. I pay them an extra hour a week if I know it was heavy on administrative time outside of client time. I say thank-you whenever I ask them to do something and they do it. I have never bought them pizza. I have bought them sushi and nice chocolate and wine and beer. I’ve given gift cards to restaurants and Amazon for nurses week.

One of my friends who is an APRN asked how much money I make from my employees. I told her I don’t make much because I didn’t take on employees to profit from them. I took them on because I wanted other prescribers to practice with me. And when I decided to take on employees I made a conscious decision to never treat them the way I had been treated by my employers and managers in hospital systems and private practice. I want my time that I spend doing their billing and scheduling and call backs to be covered. But aside from that I’d rather invest leftover money back into my business and subsequently back into my employees. Because I know what it feels like to work myself to the bone. Giving literal blood, sweat, and tears to a system that rewards you with pizza and a coin.

My fourth full time employee came on recently and took time to decide to increase to full time. The reason she gave for doing so was because she knew that the first two employees both started at less hours and both have continuously increased their hours in the past three years, one to full time and one to part time. She said that spoke to the business in terms of retention and in terms of them continuing to give more to the business. That moment felt good.

I despise how hospital systems cry poor. All the time. I didn’t get consistent raises my first eight years as a nurse. I felt powerless to fight for them. The systems were designed for us to fail to get increases. These are billion dollar organizations. Not million. Billion. Tell me they can’t give their employees something bigger. Why not cancel all current medical bills being held by their employees? Why not cover their health insurance premiums fully for at least a month? Why not provide free or discounted care for their employees? Why not pay 1000.00 toward every one’s student loans? Why not skip their CEO’s bonuses and give it back to their staff? Why not invest in their front lines essential heroic workers?

Freaking coin.

On the other end are burned out healthcare workers who think they don’t or can’t have better or more.

You can. You just have to work for it and you have to be willing to take risks.

Before the coin. Back before the pandemic back in 2017 when I opened my own practice. I put a 2$ fake paper bill from my hospital system on my wall. It’s still there. Taped over my desk. I treat employees of the system who recognize it and always ask why I have one of them taped on the wall. I encourage them to read the message on it. They lean in and then understanding dawns and they inhale sharply. Then they turn to me in disbelief. I nod. “Thanks for saving the life of a patient.” They always say it out loud. Like they are reading it wrong.

I nod again. “But I mean like you actually saved some one or it was just a close call?” they stammer trying to disbelieve it still.

“The patient was blue. I cleared her airway. I was told by multiple people there that day and after the patient would have died if I was not there.” Then they always nod their head and shrug their shoulders in resignation, “I believe it. 2 bucks. And a fake 2 bucks. That’s all we are worth around there.”

The two fake bucks that can only be used at the cafeteria of that particular system was not the first nor the last time I was let down by an employer in healthcare. But it was the first time I remember feeling resolute in my decision to get the hell out of there. I knew I needed to be somewhere that valued a patient life and my ability to save it. The coin six years later affirmed that decision.

To all my healthcare provider friends reading this. I see you. I know what you give every day. I know what it takes away from you. I’m sorry you are not valued more. But know that you are valued by me. I see you. You are not alone. You deserve more. If you are reading this and you have any say or control over how employees healthcare systems are treated: do better.

If you or someone you know is struggling with suicidal thoughts please call:



Masked Hot Yoga: 2021

You ever do hot yoga in a mask? I have. I have to be a honest it wasn’t as horrible as I thought it would be. Don’t get me wrong it was horrible. But on the inside I was still doing a happy dance that I could be doing hot yoga again. I finally was warm. 101 degrees warm with 58% humidity.

I also got into this pose recently that I have never been able to do. It’s called Bird of Paradise. You have to start either in Lizard or Warrior II and then you take a bind with one arm looping under the bent leg and one arm going behind your back. You hold your hands now looped under a bent leg. Take a big step forward with your straight back leg. Then keeping the bind you stand up and raise the leg that was bent and still bound.

Bird of Paradise

The thing about yoga is that no one knew the first time I did it in a class. Because I’m often in class with different people. This year I’ve been in Zoom class in my living room and I can barely see any one else in their little rectangle on my iPad.

So as I first bound my hands together I was surprised I could actually bind them because I never could before. Then when I clumsily stepped forward and attempted to stand I was so excited that I could do it I almost fell over and then I did sort of fall over but I had this stupid grin on my face because fuck yeah. Year three of yoga and I finally nailed Bird of Paradise.

I think there were a lot of contributions to this success. One- my perseverance. Every time we would go into extended side angle I attempted the bind. For three years. I could feel my hands getting closer and closer and then touching my fingertips was a small victory. Two- I lost fifty pounds in the last two and a half years. I don’t know how having a small stomach helped me bind my arms behind my back but I know it did. Three- Fuck COVID.

I wasn’t going to let the pandemic stop my yoga practice. It was the one thing I have engaged in during my thirty’s that I loved. I felt so connected to hot yoga. I felt empowered. I felt warm; literally. I felt challenged physically and mentally and finally an hour of intense physical work out that also let me zone out of all my stress. I don’t have my phone during yoga. I am completely disconnected.

In March 2020 when my studios closed I moped and pouted and found the Zoom classes. I kept practicing. With my cats. With my sons. Through a separation. Through possibly the most stressful year of my life. I kept practicing. While other people were expanding their waistlines (I say that with love because no shame in an expanding waist line I’m just not a stress eater. I’m a stress non-eater) I was reducing mine.

Then my studios were open. Then I was vaccinated. I attended cold yoga first with my sister-in-law. That was actually where I first got into Bird of Paradise. With multiple layers, feeling chilly, I smiled as I took the bind and had to stop myself laughing from joy as I stood and attempted to extend my leg.

Then I stepped back into a hot studio. There’s not really a way I can describe it other than a sort of coming home. The first class kicked my ass. So did the fourth one. I’ve clumsily still been getting into Bird of Paradise trying not to grin like an idiot as I’m doing it.

I’m proud that 2020 was not lost. I’m so relieved that I can see the actual growth in my practice over the last year.

I videotaped myself getting into it. I asked my son to hold my phone to “videotape” me and he asked me what a videotape is. I didn’t really know what to say. I said just hold the phone and record me. He did. I felt old. But I also felt cool. Because I got into a pose that I wasn’t sure I would ever grow and fold and bind into.

Post-COVID life will never be the same. People have died. People were born. People divorced. Married. Loved. Hated. And for me, I’ve been through a lot. My therapist validates that it’s been a little extra. But through it I’m grateful for my constant practice of yoga. The poses don’t change but every time I get into one or out of one I change. Yoga has helped me understand that change will happen. That sometimes it’s scary but ultimately through change we grow.


The Reason I Stopped Treating Teenage Mental Health. (It’s not because of the teens)

It’s good to know your strengths and weaknesses. I am brutally honest with myself so I am generally aware of my own. Strength- baking. Weakness- brownies. I can never get them right. I’ve tried. So I don’t try anymore. Ask my sons. They didn’t even know what a brownie was recently when my Mom brought them some. Banana bread, yeast breads, cakes, frostings, ganache, chocolate chip muffins, etc. I can nail anything else. Not brownies.

Strength- Fighting and working hard for underserved communities. Weakness- general annoyance sometimes developing into anger toward entitled non-underserved individuals.

My friends and many of the therapists I work and collaborate with know this about me. The white cis-het male APRN who works for me knows this about me. Because as I’m passing him all the cis-white-het males who call for intakes I am…maybe complaining about them. I do apologize for dissing “him” in a general vague sort of way. He laughs it off and keeps working for me. I dunno; I give good bonuses.

The last year has highlighted the strengths and weaknesses (great chasms) of our healthcare system. Strength- Our healthcare workers. We rock. Weakness- Our infrastructure, our costs, insurers, and the lack of support financially, emotionally, and every way you can possibly imagine for our healthcare workers, and the complete inadequacy of our mental health services and systems.

I receive upward of five calls a day for adolescent referrals. I’m closed to adolescent referrals.

Strength- Love the teens and they usually love me or hate me initially then grow to respect/fear/love me. Weakness- Fucking parents. I generally rub them the wrong way eventually. For my trans teens I tell their parents to stop being transphobic. God forbid. For my teens depressed because their parents scream at each other daily- I tell their parents to stop screaming at each other daily and to maybe recognize the impact they are having on their teen’s mental health. Strength- Honesty. Weakness- Honesty.

I had a parent tell me that if they started using their child’s preferred pronoun and gender “they win”. I’ve had parents tell me, “I know you think it’s all because of the stupid sexual abuse. You think I haven’t heard that! I’m not getting a divorce. They are going to have to learn to live together.” If you are thinking the worst case scenario you are correct. That is not the first nor the last parent treated who has forced their child to continue to endure close contact with a known perpetrator (yes investigations were done etc. etc. this was always reported to the appropriate authorities).

I recognized in 2020 that the parents were burning me out. Not the teens.

I saw too many teenagers over my career destroyed by their parents physically, emotionally, and in so many other ways. After I became a parent I became more horrified than I used to be at parental behavior.

I’m no angel as a parent. I yell sometimes. I talk loudly and firmly when we are in public if they are misbehaving. I have no shame in reprimanding them in front of other people because if they can act the fool publicly they can be corrected publicly. I also have spent more time with my kids in the last twelve months then I imagined I ever would. I have to be honest though I never got too sick of them. We keep busy and those little buggers know how to get to my heart with their hugs and snuggles and dimples. I unashamedly mushy gushy love my kids.

I would never knowingly harm my child though physically or emotionally or otherwise. I also would not invalidate them by not respecting their preferred gender/pronoun/name and I hope I would never invalidate them by not believing them or ignoring them if they disclose something to me. And if I knew some one was harming my child; well I would go for the throat.

Strength- Fierce love and loyalty for my family and few close friends Weakness- I would totally land in jail if some one messes with some one I love.

I found in 2020 so many things about myself. Strength I didn’t know I had. Weakness and empathy I didn’t know I could still access. I also recognized that treating teenagers, and in turn their parents, as a parent, was burning me out. Because I could not ever imagine treating my children the way I have seen so many children treated. Literally right in front of me. There are no filters in the psych world.

When people ask why there is such a shortage of pediatric providers it’s not because there is a dearth of actual providers who can treat children. There is a shortage of providers who have the stomach and heart to stick with it for years, through their own parenting journeys, because the transference and counter-transference is real and it’s not helpful or healthy.

One of my greatest strengths has always been recognizing my limitations. This was a hard one because I so enjoy working with teenagers. But I needed to distance myself from parents. Because they were breaking my faith in humanity.

Hearing accounts of sexual abuse and physical abuse from children and teens is heart wrenching. Hearing that they have told their parent and their parent confirms this, and that their parent doesn’t believe them makes me ill. I’ve had to tell grown adults that children generally don’t make up sexual assault and rape stories. The number of kids who have not been believed by their parents is staggering.

I’ve tried to figure it out. I’ve wondered if it’s generational. Most parents of teens are now born between the 70’s-80’s. I try and figure out what the hell happened to those people. Then I wonder if it’s a white suburbia thing. Most parents center themselves and is that a symptom of white entitlement? But I treat minorities also and this issue is not confined to white families. By September of last year I stopped trying to figure out why and stopped taking teenagers. The why doesn’t matter. The result of me being burned out mattered.

My days are less interesting with fewer teenagers in my schedule because they are fun. I can’t be as sarcastic with any other age range than the teens. I also love that little smirk they try and hide when they hear me call their parent out on bad behavior. It’s like they finally are being seen and heard and justice has come. It’s tough work getting to that moment with the parent and the kid. They both have to be comfortable enough with me that they won’t get mad when I call them out. They have to be open enough to change to really hear me. It’s a labor of love because the reimbursement will just never cover the emotional energy that goes into treating teens and their families.

But I’ve selectively only taken adult LGBTQ clients for intakes which makes me happy. Some day I’ll circle back to the teens but for now I need a break. I need to stop trying to figure out a generation of parents and focus on my own kids. Who I love. Who will never know how good they have it thank God. Because I would never want them to have it so bad.

If you are reading this as a parent I hope you do not identify with any invalidating behaviors I’ve mentioned. If you do I’d encourage you to explore that part of you. Is it shame that is coming up? Fear? Avoidance? Don’t turn away from that dark part of yourself. Be honest with yourself. Be honest with your teen.

If you are reading this as a teenager or former teenager and you identify with this; I’m deep from my gut sorry. But I promise you that your life can go on even with an experience of emotionally abusive or unavailable parents. Watch “Hanging Up” with Meg Ryan. It’s from the 90’s; obviously so out of date. But there’s this scene where she’s talking about her messed up alcoholic father and she says, “This! This is what I’ve got as my Father! This is it! This mess!” It’s a beautifully done scene and movie about acceptance of our parents faults and about not letting our parents faults define us or break us.

I feel like I’ve spent the better part of seven years helping teenagers see that they may have a mess as parents but they are still valuable and worthy and deserving of love. It is hard to let that go but I know it will only be for a while. In the mean time. Parents let’s get our shit together. Our kids deserve the best parents we can be. Play to your strengths. Acknowledge your weaknesses. And be nice to their therapists otherwise there won’t be any of us left.