Uncategorized

Single Mom vs. Christmas Tree: year 3.

Everything I thought I knew about parenting when there were two adults in the house went out the door with my ex back in 2020. Because single parenting is a new ballgame.

We got our Christmas tree this weekend. And it was a debacle because I wanted pre-cut and went to a place, it was cut your own, before I knew what was happening a guy was shoving a saw in my hand and the boys were running up a hill. It’s not a little hill. It’s a half mile completely up hill. Since doing this on my own I have always gotten a pre-cut tree so I’m trekking up the hill already nervous that this is going to go poorly.

We make it up the hill. We find the tree. I’m on the ground in kind of a nice outfit because I was expecting a pre-cut tree, and with my hair down. I have a lot of hair. Curly. Trees. Sap. It was a thing. So I’m sawing the tree. My son keeps trying to grab the saw to “help” and I’m like please stop because I’m going to cut off your finger by accident.

When I hear a male voice from above, “You need a hand?”

I emerge from the ground/tree. There is a very nice man and five children of various ages and a small wife all smiling down at me and my kids. He and his teenage son get the tree down within about ten seconds like freaking champs. And the family is circled around us and I’m thinking they are going to start singing a song from a the Sound of Music or something. They look picturesque and sort of whole in a way that a single mom covered in sap, crazy hair, may have been swearing at the tree, and her two twin boys…well don’t. If my sons and I would break into song it would be a song from Jungle Cruise. Because, man, we are just trying to survive.

We get the tree. Thanks to the very kind Von Trapp-esque family. The tree farm people seem to emerge out of the trees as we are dragging the tree out and take it from the boys and I and throw it on a tractor that brings it down the hill. They strap it to our car. I mean overall it was great service and all inclusive.

The hardest part was when we got home. Because then it’s just me. I set up the stand, and the boys helped me hose it off, and I drag it inside, and am wrestling with it to get it in the stand and upright. This of course is after I got if off the car.

So there I am, wrestling a tree. It was a lot fatter than it looked in the field. And I still had on my nice clothes. And I am in the damn thing. And I’m trying to drop it on center of the stand, then lean down and screw the screw things and then it kind slouches over when I think I’ve got it.

It happened then. One of my sons was standing on the other side of the fat tree. I thought he was watching his brother play a Switch game but he was apparently monitoring me quite intently. I made a noise- somewhere between a sigh/sob/groan of frustration.

It’s in those moments that- well you ever get those flashes of the most intense thoughts and emotions that sort of leak in? Like when I first got divorced I was angry, grieving, resentful all the time low level. I’m not anymore. But in those moments it comes through- a flash of all that hurt and pain and anger at having to do these moments alone. It’s quite visceral and unless you’ve experienced it rather difficult to describe.

But it’s important to name it. To write it. Because if there is one single parent out there who reads this and feels that and this normalizes it for you, then it’s for the best. We, as a society, do not talk about divorce and the repercussions of it and single parenting two and three years in because we are all just supposed to adapt and smile and post on social media pretending every moment is liquid gold.

But it’s not. Because when my son heard that sound I made he came around and looked at me concerned, “Are you okay Mama?” “Yeah baby, I am okay, some things are just really hard to do with one person, and this is one of them.” He looked more concerned even though I was trying to take deep breaths and smile and act okay. “Mommy should be here.” He said quietly. And I knew in that moment he was remembering the Von Trapps at the Christmas tree farm, and yearning for that for himself. And for me.

I had to be at my sisters within about twenty minutes, and they went with my ex that night.

I got the tree up. It’s still standing and mostly straight. But this is divorced single Mama life. Moments of utter punch in the gut raw parenthood while I’m standing there alone putting up the tree. Then I just carry that. Alone.

My kids see me. They see cracks in my invincible Mama armor because I am human and how can I not have moments where I let my feelings slip through?

Other then hugging my kids and telling them I love them there are not “happy endings” to these moments. I had to finish the tree and then move on with our day. But that was a hard one and I was not okay after that. I don’t want my ex here. The divorce was very necessary for many reasons. And I am better as an individual and as a parent without her. I am allowed to feel alone though and lonely. And I would have appreciated another person over five feet in the room helping me with the tree.

And my son saw this whole family and then saw me break a little bit.

And this is why parenting changed when I started doing it alone. This is why it became harder and I feel even more blind navigating it.

Since becoming a single parent I’ve done some research and what I found were alarming statistics including 63% of suicides are individuals from single parent households. The stress, the shame, and the loneliness of single parenting is real and of course it impacts the children in the homes. Study after study showed an increase in anxiety, depression, and substance abuse as well as poverty and welfare among single Moms. There are of course many postulations on these statistics but seeing as how I live it I want to throw my own in there.

We have to start talking about these moments. We have to bring them into the light and out of this horrible shaming mindset. Being a single parent and having vulnerability and having sad moments with our kids is okay, normal, and should be expected. Because it’s hard and there are no normalizing factors within our communities for single parents.

It was less than ten seconds. That interaction with my son while I was holding a sappy Christmas tree. I’ve had other moments like this. They are intimate and visceral and raw and they make me feel like the worst human and also the strongest and most resilient and most alone.

I have resources though. I have great friends & family who see me and support me and I engage in my own therapy and I have built and continue to build financial security for myself and my sons. I also am a strong person and I’m too damn stubborn to give up on anything but especially not on my sons and myself. But there are many parents out there who don’t have the resources and maybe are not as strong. This is for you. You are not alone. These painful moments happen to us all and you are allowed to feel that pain in the moment and you’re allowed to let your kids see you feel it too. Give yourself some grace and accept help from people who offer it. You are not alone.

988- Lifeline/Suicide hotline

http://www.thetrevorproject.org

Trans lifeline- 877-565-8860

Nursing

“Tilt When You Should Withdraw”

You know you’re a millennial when…the movies of the late 90’s and early 2000’s still define who I am as a person. And they are grossly underrated by all these twats coming after us. You know I’ve met multiple people (mostly my clients in their early to mid-20’s) who have never see Lethal Weapon or Bad Boys? To be fair Lethal Weapon was 80’s but Bad Boys?! None of them! Do you know how many times I’ve referenced a line and they stare at me blankly or worse like I’m old?!

Despicable. But the worst is if they have not seen A Knight’s Tale. Not only is Heath Ledger probably one of the best actors to live (and die far too young) but it’s hilarious, sad, poignant, and action packed.

It’s also historically relevant because it’s loosely based on Chaucer’s A Knights Tale. There are many parts of this movie that speak to me, essentially the whole movie. Because it’s an underdog story of a young man being told he can’t. But then he does. I have always felt that. As a girl I was told I was too smart, too loud, too opinionated, as a woman I’ve been told the same.

All William wants to do is joust. And he’s rather good at it. He builds a team ultimately who believe in him and who stand in front of him in the stocks to block the rotten food being thrown at him. That’s when Prince Edward unveils himself and steps up to William who is dirty and weak and bent in the stocks.

Prince Edward (who is also kind of hot) leans over and says “What a pair we make huh? Both trying to hide who we are, both unable to do so. Your men love you. If I knew nothing else about you, that would be enough. But you also tilt when you should withdraw…and that is knightly, too.”

Tilting exposing a knight’s face and leaves them vulnerable to injury but it also gives them the most advantage in striking their opponent.

That scene gets me every time. I’m usually crying by the time he pulls William out of the stocks and he shakily kneels in front of the prince.

It’s quite a thing to be seen. To truly be seen. If you think about it there are very few people we come across in life who see our true selves for all that we are. Who have the patience, the insight, and the ability to see who you are.

That scene gave me hope as a teenager that I could be something more. That I could “change my stars” and along the way I would meet people who truly do see me.

I had to grow into a person I was proud to have people truly see. It was hard in nursing as a confident, smart, and direct woman. The feedback was mostly negative. And the message was to do my job and not question management even when nurses were being assaulted and abused. God forbid I ask for mental health services after a major assault or updated TdAp vaccines for the entire staff after two pertussis exposures to me personally and twenty other staff members.

It took distance and time and therapy for me to realize that what I sought was not wrong. I’m allowed to take up space and ask for reasonable accommodations, help, and support from my employer especially when working in high acuity and dangerous areas.

People seemed to listen when I spoke. I was told by a manager after I became an APRN that I was an “unofficial leader” because they knew everyone would listen to me but that I was not actually in charge. That surprised me. I didn’t realize people paid attention to me honestly.

That conversation opened the door for me to open my own practice. I was not wrong to be smart and confident and direct. I was not wrong to expect a safe work environment. And I could get that. But I’d have to do it on my own.

Five years later I am safe and I’m surrounded by people who truly see me and appreciate me personally and professionally.

It’s been validating to be in business for myself and treat employees the way I wanted to be treated and to see their appreciation and the loyalty that it builds. I’m not perfect. I’m still too direct. And I am impatient sometimes. And maybe too patient other times. I also tilt when I should withdraw- I fight the fight for clients, employees, I fight insurers, and my favorite line is “I’ve got nothing but time,” whenever I’m told that something is not possible…I make it possible. And my friends, family, and co-workers see this.

They see me and finally that what were perceived as negative traits are actually positive and have helped me grow a business and expand mental health services for the Queer community.

I’d like to think if I was in the stocks I’d have some people who would stand up to block the rotting vegetables from hitting me.

That’s a good feeling actually. Knowing I have people who see me and who think I’m worth protecting. They also would probably make very sarcastic remarks and jokes to work off their anxiety in the moment but they’d be there. (You know who you are;)

Because that is what’s important right? To have people who would block the rotten vegetables from you.

And every Gen Z-er reading this…this is why you are missing out. You don’t even know one of the life goals you are supposed to have. Lord have mercy.

#COVID-19 · Nursing

The Grim Reaper & A Nurse

Contrary to my normal procrastination I bought tickets to a haunted attraction way back in the beginning of September. I was determined to get there. Last year I bought tickets and it got rained out. A few years before COVID we went on a night to something you couldn’t pre-buy tickets to, and the night we went it was closed. Then COVID.

Needless to say I was frantically stalking the weather all week, and very excited the night came with no rain in sight and no global illness causing mass lockdowns…we were good to go!

When we got there we had to wait for our turn to go through as they send people through in small groups. We were a group of four, my three friends and I, and while we are all in our mid-late 30’s, and tough as nails psych nurses and a therapist, of course none of us wanted to go first or last. Finally the therapist went first and the three nurses followed. I doth my hat to our therapist friend of course.

We screamed and held onto each others vests and coats in a train of four excited and terrified friends.

We came upon our first ghouls who spoke to us and instructed one of us to reach a hand into a bucket of water and pull out two syringes. One of us may have freaked out about touching syringes to the point that the grim reaper asked “Are you nurses?” in a growl, and we nodded “Yes, three nurses and a therapist,” and the grim reaper in his grim reaper voice bowed his head a bit and said, “Thank you for your service,” and the scary baby-doll with face paint reminiscent of Frankenstein agreed in her creepy baby doll voice, “Yes, thank you.”

And there we were. In a haunted house with a grim reaper and a creepy baby-doll tipping their heads to us in thanks.

They still made my friend grab the syringes.

And on went the show.

It was followed by another grim reaper who did not speak motioning me to push a button on a wall. Well I was pushing the damn button and nothing was happening. He made a down motion with his scythe(?) and I pushed down and it fell off the wall. He’s growling at me and I can almost hear him sighing at my stupidity and my three friends are a mixture of laughter and screaming each time he waves the scythe at me telling me to just push the button. And they are yelling at me “Just push the button” and I’m like duh I would if I could, but it’s dark and there’s grim reaper growling at me, I grab it and stick it back on the wall.

If you’ve not had a grim reaper shake his head at you in complete frustration and disbelief at how stupid you can be….it’s an experience.

As I stick it on the wall the thing lights up. Finally. I pushed the button somewhere. He lets us past and follows us, the whole time pointing his scythe at me. He did not need words. Even through a full coverage mask his message was clear. You are too stupid to live and I will end you.

My friends thought it was hysterical and then of course later we did get lost and the same grim reaper popped out and had to growl and herd us back on track.

It didn’t hit me until we got out though and we were back in the car. That moment with the first grim reaper and the ghoulish baby doll. It was surreal and kind and even though it broke the scary haunted house thrill for a moment to be brought so forcefully back to reality, it felt more authentic and more real than any of the hundreds of pizza parties the hospital I worked for thought were ‘good enough’ of a thanks.

What healthcare providers- not just nurses- psychotherapists, doctors, techs, etc. have been through from 2020 to present, is inexplicable to people outside of healthcare. It’s been constant chaos and tragedy and feeling invalidated and not good enough and underlying it a deep and true terror. Terror that we would catch an illness and spread it to our loved ones. Terror that our patients would die. Terror that going to work would lead to our deaths. And on top of that dealing with the irritability and anger that has permeated seemingly every human interaction. People are angry and they are taking it out on healthcare providers and practices.

So for a random grim reaper and haunted baby doll to acknowledge us in the throes of a terror inspiring activity- it felt so wrong and yet so right.

To the ghouls at Evidence of Evil- we had a great time, and you made three nurses and a therapist feel seen and appreciated. Thank-you.

Mental Health Stigma Suicide · Nursing

My Thoughts on Treating Murderers signed: a nurse.

Working in private practice people sometimes make the assumption I only treat the “worried well”. Every prospective employee I interview I tell them- while there are serious perks to private practice including total control of your schedule and fully remote work…we still treat sick people. You may get an easy straightforward anxiety…but you likely will have some serious cases that will push you.

For me, I’ve treated…a lot. I’ve treated sexual abuse victims, incest victims, victims of DV, and many other incredibly intense cases over the years.

What has been surprising for me, and what no one ever discussed when I attended school and training- were treating patients who committed murder. Working both inpatient and outpatient I’ve treated roughly 40-50 patients who have committed murder in some capacity.

There are many different kinds- negligent homicide is something like a drunk driver who hits a car and some one in the other car dies- basically an unintentional homicide but caused by the person’s negligence. There are homicides that are intentional, or perhaps just witnessed but the witness is held responsible for not stopping it or for contributing to it, and the saddest are probably the murders committed by people in a psychotic state such as with postpartum psychosis- those are probably the most publicized in the media.

We learn a lot about transference and counter-transference in school- and we do talk about how it would feel to treat a perpetrator of a sex crime but for some reason we never touched on treating some one who commits a murder.

But it’s an important conversation to have.

Working in mental health has caused me to take stock of my values, ethics, and core belief systems…and made me re-evaluate all of those things repeatedly at a very visceral level.

I remember working in the pediatric emergency department. There was a certain coldness projected toward the parents that overtook all of our demeanors when we realized the child we were treating was the victim of abuse- whether sexual or physical. At some point the truth always comes out. And I did treat some children who died of their injuries. And if you could have bottled the rage in the room from the healthcare providers…well that would be some potent nuclear energy.

So I had that background going into mental healthcare.

Then I sat across from my first patient who committed a homicide. I did not have that rage encompass me though. I still do not. I think they expect it. But as the mental health provider treating the perpetrator of a crime, well they are still my patient, and I treat all my patient’s the same. With respect and I try to come from a place of empathy and understanding.

In reflecting on murderers I’ve thought of my Dad. Was he a murderer? Not by my our standards I suppose. But he did kill people when he fought in Vietnam. He was a gunner on a helicopter- one of the big ones where the sides are open…hopefully you’ve seen enough war movies you know what I mean. I asked him one day when I was old enough to realize what a “gunner” meant “Dad does that mean you killed people” and in typical Dad fashion he said, “Well I killed more cows than people hon,” and that was that. My Dad was excellent at non-answers. Especially about Vietnam.

So I suppose the first “murderer” I sat across from at a table was my Dad.

So you can see why I have a stronger response to pedophiles than to murderers? Murder I’ve had to assimilate and rationalize because I grew up the daughter of a combat veteran. There ain’t no assimilating or rationalizing pedophilia though. That’s never okay. Not even in war.

I am speaking somewhat facetiously because the double standard is absurd. Murder is never okay. Pedophilia is never okay. But we live in a society that is more okay with murder than any other type of crime. As evidenced by the lack of gun legislation in America after the first mass school shooting. We receive the message from the highest level of politicians and courts that murder is justified as long as it’s with a gun that you should be free to carry.

We also live in a society with combat veterans who have committed legal murders. And we praise them, respect them, salute them. I am not saying we shouldn’t do all of that. I am grateful for all the people who have served and continue to serve our country because I see the sacrifices they’ve made in my work every day in the veterans I treat who carry such shame, guilt, and trauma.

I used to be very black and white in my thinking. Back when I was 22 and thought I could be part of the solution in saving the world. I’m 37 now. I’ve seen children die at the hands of their parents- intentionally and unintentionally. I’ve treated men and women who have been raped and who have killed.

I also grew up with a Dad who was a Vietnam veteran and deeply committed to the love of his country.

Through all of this I’ve come to realize there cannot be a black and white version of myself or of mental health treatment. I’ve treated rapists who I did trauma work with who were deeply wounded humans perpetrating in the cycle of their own traumas. I’ve treated incredibly brave and resilient victims and supported them through court proceedings to bring their perpetrator to justice. I’ve treated murderers who carried the deep wound of taking a life. And I’ve treated murderers whose murders were legal in the face of battle but who have to make the decision to live every day because the incredible wounds they feel internally drive them so close to suicide.

There is no black and white and there is no right or wrong. What I’ve discovered in myself is that I have to present myself with empathy, understanding, and I have to listen to my gut and bodies responses. If my body is telling me that there is no remorse here, and potentially sociopathy, our consultation appointment is just that. A consult. And I will not be following up with them.

But those are rare. More common is the person who is just a person. Trying to survive. Who was thrust or who put themselves into unthinkable circumstances and who are spending the rest of their lives trying to not be defined by that one moment. There is grief for the person they once were, compassion for who they are in this moment- vulnerable and seeking a non-judgmental space- and hope for the person they can become.

Fifteen years in and I still love being a nurse. I love this field, I love that it pushes me to see beyond society’s expectations and norms. I love that it makes me examine my own weaknesses and prejudices and challenges me to do better and be better. In these cases it’s pushed me to examine my beliefs about “murderers” and what I found is they are just people with a story. Stories that deserve to be told and to be heard.

p.s. #banguns #fucktheNRA

p.p.s. For all those asshats saying you should have the choice to not treat people who are LGBTQ…you are assholes. If you continue in that vein for your “religious freedom” shouldn’t you also not treat adulterers, murderers, pedophiles…etc? How come you can decide to not treat one population of people but not all the rest? How come you are more comfortable treating a heterosexual murderer than a law abiding non-rapist and non-murdering lesbian? Y’all need to have a Come to Jesus moment. Cuz you make no sense. Just own it and say you are homophobic and transphobic.

Uncategorized

Salty About Stimulants…signed: a prescriber

My practice has strict prescribing practices around stimulants and benzodiazepines. People seem to get the most irritated by these practices with stimulants though. Over the years multiple therapists have voiced their displeasure at us for not prescribing a stimulant to some one suffering with ADHD because: they smoke cannabis, their urine screen popped positive for a substance, they don’t have anxiety it’s all driven by ADHD, etc.

Mental health prescribing is by far one of the most Monday morning quarterbacked fields of practice. Every one knows better including but not limited to Google, WebMD, ‘My Aunt/Mom/Sister/boyfriend’s sister who is a nurse’, ‘my therapist who is not licensed to prescribe medications and has no training in prescribing’, their primary care doctor, their neurologist, and any one else who wants to hop on board the “we know better than people with actual psychiatry training” train. Not that I’m bitter. Imagine me saying all of this in a very singsong smiley voice.

I did not have such strict policies when I started practicing. I’d be more open to prescribing stimulants to some one who used cannabis or would not grab a urine toxicology screen on everyone. But then shit hit the fan.

To assume you know better than some one who has been working in this field and trained in this field when you are not working or trained in this field is…annoying at the very least and dangerous at the most.

In the past 12 months alone the practice has had four urine toxicology screens pop positive for substances that were not disclosed to the prescriber in the appointment. Two of the positives revealed a significant substance use disorder that could have otherwise been missed and that the primary psychotherapist knew nothing about.

Addiction does not discriminate- and these positive urine screens were gateways to a dialogue for potentially life saving treatment for people. God forbid the other 98 people have to pee in a cup because it’s so judgmental and punitive….I’ll send 1,000 people for a urine screen because even if just one pops positive that’s one person who has been potentially struggling with addiction in the dark, alone, and is at risk of overdose and death. I can’t as a prescriber in good conscious just say, “Well I see that hurts your feelings when I ask you to pee in a cup and test it for substances before I prescribe a controlled substance you, so you’re good.” It’s not punitive. It’s just that people have lied about substance abuse and addiction. And I’m not saying that in a derogatory way- part of addiction is living with it in isolation which contributes to shame and guilt- people don’t disclose because they are ashamed. It’s part of the cycle of addiction.

Every time I prescribe a stimulant I receive a letter from the insurer- especially Anthem and Aetna- they send letters that they noticed I prescribed a stimulant to one of their members- and they name the member- then they have about two pages of why prescribing a controlled substance is dangerous and they hope I’m prescribing it responsibly and I should really consider getting the patient off the stimulant as quickly as possible. Not making this up.

Then I get an email from the state of CT who tells me they noticed I prescribed another controlled substance- and it’s in a report of all the controlled substances I’ve prescribed in the last month. It’s one of those “We see you and we are watching” e-mails. I attest to my liability company that I prescribe controlled substances. I have to sign off on federal guidelines to have a DEA. AKA it’s a big freaking deal every time I write a prescription for a controlled substance.

In case you missed it, people are dying at record numbers from drug overdoses. Guess what? Most overdoses are not just one substance- they are often multiple substances- including stimulants because people snort them after drinking alcohol to perk themselves back up, or after heroin or opiate use. Then they may want another buzz or high so they drink more or take more opiates or heroin…you can see where I’m going right? You need more and more upper to overcome the downer, and more and more downer to overcome the upper. Then you die.

So no. I do not prescribe stimulants to patients concurrently using cannabis. Cannabis=downer stimulant=upper. Also- long term cannabis use (daily for over a year) causes cognitive clouding and blunting in the form of short term memory impairment, slowed cognition and slowed reaction times, in ability to focus and difficulty concentrating….guess what all those are also symptoms of? You’re right! ADHD.

So how do I know some one truly has ADHD when they’ve been smoking weed daily for five years and did not have ADHD prior to weed use? I don’t. The answer is I don’t. And I won’t until they get off the weed for at least three months.

Next let’s talk about the world in the last few years. It’s gone to hell. The effects of chronic stress are well documented in children who grow up in abusive households, in adolescents who live in homophobic households, and in war veterans who are exposed to chronic combat stress. Guess what the symptoms are? Cognitive clouding, poor focus, poor concentration, short term memory impairment, poor organizational skills, and anxiety that can present as impulsivity….sound familiar? Yes. All symptoms of ADHD. Executive dysfunction is a symptom of chronic stress. You can’t have existed in the world since March 2020 without being under some form of chronic stress which results in executive dysfunction. So no, you did not suddenly develop ADHD at age 40. It started two years ago because that’s when the world went to hell.

People generally do not like to hear that though. They want a pill and a quick fix and a treatable diagnosis.

In the past two years I’ve had countless patients tell me they have ADHD. I disagree with the diagnosis sometimes. I decline to prescribe stimulants other times even if I agree with the diagnosis due to substance use. And then there are a couple people in the past year who came to me for “anxiety”. And within about two minutes of our intake I was thinking ‘how the hell do they exist in the world with this severe of an ADHD?’

Careful history taking, chronic struggles academically, chronic struggles socially, chronic struggles occupationally, has had people in their life tell them they have ADHD, and not nicely. They also talk non-linearly. It’s hard to describe but there’s definitely a feel to them. They often wander off from the answer they are trying to give to a question then ask “What was the question?” somewhat embarrassed. There is more to it than that, but suffice to say it’s quite overt after you’ve seen it a few times. Which I have. Because this is what I do every day all day for ten years.

These are my favorite people though. They legitimately have ADHD. They have been misdiagnosed or not diagnosed at all because they are usually female- and females are super under diagnosed for a variety of reasons- including but not limited to: it’s inattentive type, not hyperactive, and they are able to compensate in other ways that allow them to still be mild to moderately successful.

These people when I mention ADHD and do some psychoeducation around it, and say maybe the anxiety is driven by an ADHD and they have a learning disorder…they break down and cry. Because they usually have always suspected it, and they check all the boxes, and there is effective treatment. These people, when they come back after the urine screen and trial of a stimulant cry again because they are grieving that they have lived so long without a proper diagnosis and in relief at being able to function just generally better.

Do I prescribe stimulants? YES. Do I do so carefully in order to protect the patient and myself from liability? YES. Do I see how incredibly life changing these medications can be? Absolutely.

I do actually know how to assess and diagnose ADHD. I also know how to safely prescribe psycho-stimulants. And I’m not going to waver because it may cause some one to feel upset that I prescribe this way. Safely. It’s unfortunate that offends some people. But it is what it is.

So to any one out there diagnosing yourself off TikTok. Please stop.

Couple things- you can’t have sudden onset ADHD, chronic stress causes the same symptoms of ADHD, PTSD can present as ADHD, chronic anxiety also can present as ADHD. I’m not saying don’t get a second opinion if you disagree with the person you do an intake with. Get as many opinions as possible for you to feel confident in the diagnosis and treatment. But also don’t assume you know more than a provider with education and clinical training and experience.

And for any one truly suffering with ADHD if you suspect you have it, seek treatment! There is treatment. And it can work. Just don’t get salty if you’re asked to do a toxicology screen in order to receive a prescription for a controlled substance. These medications are serious and heavily regulated. Have some respect for that. I sure as hell do.

#COVID-19

Catharsis Defined via Six.

It’s hard to define catharsis. I remember learning about the term in a high school English class. I remember it was defined as “a release of emotion”. But it’s hard to truly understand it until you experience it. Part of what theater and the arts provides for me specifically are moments of catharsis in a space and through a medium that is outside of my daily norm.

Have you ever been moved to tears by a movie? That is catharsis. The movie caused a release of emotion.

And while movies can certainly provide a nice cathartic moment there is nothing, for me, quite like the theater.

I am lucky to live a short car ride from the train station which has an express train to Grand Central. About a month ago my friend and I bought second row tickets to Six. We hopped on the train this morning, made it through GCS, during which I heard a few New Yorker’s put a woman in her place for yelling at a child who tripped resulting in her having to stop short resulting in her yelling at said small child whose dad was clearly a tourist who just looked scared. My friend says people on the East coast are kind but not nice. I feel that in NYC more than anywhere else.

These three clear New Yorkers stepped in for the tourist Dad and son and yelled at the woman for yelling at a child for making a mistake. Then tsk tsk’d at her, and clucked over the child. While not smiling at all and seemingly sounding generally loud and scary but when they are on the side of good….it’s a sight to behold.

That all unfolded outside the bathrooms. Inside of which a random woman had started directing traffic into the open stalls because she was waiting for her sister “Who is taking forever”….from a further away stall “Well I’m sooooo sorry Dotty, you can wait out in the hall ya know?!” “Who needs the hall I’m directing people. Just do your business so we can leave!”

We then fast walked/ran to the theater, and came upon a Polish parade on 5th avenue which detoured us a couple blocks south back to 45th street from 47th. Side note- the Polish parade was still going 2 hours later on our way back…and we talked to some NYPD officers who also could not believe it was a 5 hour parade and it was running late because “it’s Polish” and “only a Polish parade would run for 5 hours on 5th avenue” per the police officer…

So we finally make it to the restaurant right next to the theater. We eat super fast. Then with nine minutes to show time we think we can go stroll in. Well we walked. And walked. To find the end of the line. When we started questioning if the line could really be that long a man heard us talking and was like, “Hey over here, you guys are with me right?” He was super nice. The people behind him hated us. But we totally cut the line. His wife showed up with diet cokes for them. And then we are being waved through security by a security guard and he’s saying “Single file, single file, ladies looking very pretty today” and tips his hat at us.

Then we see this epic show. I mean totally epic. Six. The six wives of Henry the VIII reclaiming their stories and changing history to “her”story. So it’s heavy right? Because two of his wives are beheaded. I mean. There’s that. They also were all teenagers. Awful. Multiple miscarriages etc. But they did an amazing job of blending humor into the story and engaging the audience, and there we were. Watching Jane Seymour (the 3rd wife of Henry VIII) sing a beautiful song and she hits these high notes that I can’t even describe. And the song is about being unshakeable and brave and courageous in the face of so many fears. “You can build me up, you can tear me down, You can try but I’m unbreakable, You can do your best, but I’ll stand the test You’ll find that I’m unshakeable. When the fire’s burned when the wind has blown, When the water’s dried you’ll still find stone.”

And it was then, that I felt my eyes well up. And I thought why am I about to cry? Couple reasons. I have post-COVID grief. I’m sad and pissed that we missed two years of the arts and trips and fun times with friends out in places with people and hearing a New Yorker berate some one, and being told we are pretty in a super sweet and innocent way. Running through streets, stumbling on parades, we missed that. We missed so much. I grieve all that I do not even know that I missed.

And in that moment I also was thinking of all the shit I’ve been through. Personally and professionally and, it’s kind of like in therapy where you’re walls crack, and you hear a song that just hits you right. And I felt so much, incredibly deeply in that moment, about what we’ve lost, what we still have, and everything I’ve been through and still am going through; and that my friends…is catharsis.

I loved the show. But I also loved the experience of going to NYC for the day without fear of death. Let me rephrase- now the only fear of death is from mass shootings, bombings, car accidents, subway stabbings, you know the normal NYC fears. Not death from a virus.

Now we just have the normal fears back.

Overall the entire day was perfect and I wouldn’t change a thing. Well maybe I wouldn’t have thrown away the cup my friend had bought me at the theater. It had red wine in it, and I didn’t want it to spill on my bag. It’s a nice bag. Really nice. And we were in the street. It was crazy. It was red wine! So I threw it out. She will never get over it. I’d change that moment yes. The rest is all good.

#COVID-19 · mom of boys

Parent’s Night Post-Covid

I went to my kids parents night at their school. It was really cute and also weird… post-COVID. For one, I was inside my sons school. We were allowed inside at the very end of last school year, with masks. Tonight was a normal parents night though. No masks. Teachers. Desks. No social distancing. There is still a no food rule, which is fine, but it was just totally normal. In a super NOT normal way.

For two years normal became not socializing. Masks. Fear. Then we are all just supposed to bounce back. It was bizarre.

I sat in my sons desks. I had to go back and forth between two classrooms and two teachers doing the first grade presentations at the same time…which was fun. I recognized other parents, and said hi to them, and we talked about our kids. Without masks. Inside a building. In our kids classrooms.

When I was walking out, I had to park far away, and as I was walking to my car I passed, well almost everyone, but specifically two parents talking who I know- but it’s that kind of know when we are friends but new friends so it’s still kinda awkward or at least I’m still kind of awkward I also didn’t make friends for two years…pandemic…so I’m more awkward than normal…so there I am.

Walking toward my car and I actually think to myself- because they are talking- do I say hi? Do I wave? Do I pretend I don’t see them? Ugh! I can’t pretend I don’t see them. I have to walk within a foot of them. I say “hi guys,” as I approach, and keep walking. They say hi, how are you, and I answer and keep walking and they resume conversation, totally chill, and I’m like why was that so weird? Why did that make me so anxious? I literally just sat with both of them at a kids birthday party last weekend.

Oh yea. I haven’t had to “people” in over two years. That’s why. I’m out of practice. I was never good at “people-ing” pre-pandemic and then take away two years of forced socialization and not just allow but encourage isolation…yeah. I need some practice.

How bizarre though that there is this point in my life where I have to remember how to socialize. I have to retrain my brain to engage with people instead of hide from them. I also sat next to a dad who is as socially awkward as I am. We ran a field day station together in the Spring. I love socially awkward people. We can sit in comfortable silence. We acknowledge one another, hello, how are you, good, great, silence.

So aside from my mind blowing socialization situations I also learned the teachers know my sons. One son is sitting in the back row, furthest from the teacher, and he is there because he is incredibly obedient and I know he can be trusted to be far away from the teacher. My other son…is front row center. I was always a kid that could be back row. Very quiet. Very obedient. My other son- the front row center- not obedient. Pleasant. Polite-ish. But not back row obedient material.

Front row son has a broken arm. It’s been a long horrible week honestly. So today was his first day back to school. And the teacher told me she heard the girl next to him (who I know b/c we went to her bday party last school year) told him today after they got their lunchboxes for snack, “Whatever you need I’m here for you,” and then opened his lunchbox and juice box straw for him. Melt my damn heart.

I’ve also been told by his teacher he has been doing great and extremely well behaved. I laughed and said, “Keep him in the front. No matter how well behaved he acts for no matter how long.” She smiled and said, “Yeah, I kinda got that vibe.”

So I am learning how to socialize again, and it doesn’t feel bad. Just weird. And terrifying. But not bad.

Of course there was the one parent who asked about lockdown drills and I had to remember mass school shootings are a thing; even though I had already scoped out the room and noted two exits and my immediate thought had been if there is ever a shooter they have a way out…totally cool having that thought as a parent of a 6 yr old.

#IlovetheUSA #gunssuck #fucktheNRA

Uncategorized

Medication Management…when it’s not about the meds. From a Psych APRN.

When I worked at the hospital I used to take APRN students frequently. It was an easy place to have a student because you don’t do long term work with patients and patients in the hospital setting are used to students being present.

I stopped taking them when I moved to private practice full time but for the first time this year I felt comfortable taking one on. It’s a commitment. September-May one-two days a week for FULL days. Often shadowing, especially with some one in their first specialty year they do not have the skills to work independently.

It’s a lot of explaining, it’s a lot of asking clients if it’s okay for her to join our sessions and in between sessions it’s a lot of answering questions. It’s a lot of work.

But it’s important because everyone has to learn. And I’m kind of good at what I do. So I don’t mind people learning from me. Especially some one who is Queer.

It’s a weird thing though to have some one watch all you do. It’s a mirror really. I don’t change how I act or how I interact with clients. I’m generally bad at censoring myself.

So I’ve learned a couple things in the two days so far that she’s been shadowing me. I see a wide array of clients. In just the two days- she looked at me today and said, “You see every type, but why do you see that one? She’s not…” I interrupted her, “She’s Queer. I’ll see anyone who’s Queer.” She looked at me kind of surprised. I knew what she was going to say. The client is not my “normal” client for a variety of reasons. But I’ve treated her for two years because she’s Queer.

In just two days- roughly twenty-five client visits she’s watched me see clients who are destitute, wealthy, multiple ethnicities, Queer, healthcare providers, first responders of all types, post-partum clients, all ages, clients I’ve treated for eight years and clients I’ve treated for eight weeks. Most of them were long term though. Also coincidentally, most of them were follow-ups after a come to Jesus moment at our last visit. So there were at least four who came in saying “I thought about what you said, you’re right, thanks for giving me the kick in the ass I needed.”

I counseled some one struggling with hunger due to skipping meals in order to pay bills. I counseled some one dealing with infidelity, addiction, I said good-bye to a long term client moving out of state and she cried (after we disconnected I 100% needed a tissue) because I had seen the client through many life transitions, and so much more. That’s just two days.

It struck a chord at the end of today when she looked over at me somewhat comatosed as I asked her if she had any questions.

She said she didn’t have questions. She just was realizing it’s not about meds.

In school they drive home psychopharmacology; but it’s not about the meds. I smiled sadly. No it’s not about the meds.

It’s about forming a connection, an alliance, trust, it’s about remembering their kids names, knowing without looking at the chart when we started treatment together, how many IVF cycles they did, and that the anniversary of their Mom’s death is coming up next month.

It’s about remembering the first psychotic break post partum and how long their depressive episode lasted in the aftermath and comparing that for them to how long this depressive episode will last in the aftermath of the hypomania. It’s about eye contact. It’s about a little bit of self disclosure- like many of my long term-er’s know know I have twin boys, and they ask how they are doing. It’s about making a person feel seen, heard, and validated.

We talk about meds in our visits but there is so much more. I made very few changes to medication regimens in the last two days. It was more supportive therapy, validation, and reassurance. Many people cried. Just cried. And they apologized to my student and we both provided reassurance that just because she’s there doesn’t mean they cannot cry.

I think she was surprised at the amount of pain we hold space for. At the amount of secrets we hold for people. And at the level of connection we maintain.

I reflected that I could do 15 minute follow-ups and barely talk to people and conclude that every symptom requires a med change. But that’s not how I roll. I see people for 30 minute follow-ups, longer if needed or requested. And I talk to them. I get to know them. And in the age of telehealth I meet their partners, spouses, parents, co-workers and any one else who wonders in the background of the frame.

Not everything needs a medication change. A lot of what humans need is simply connection and validation and the feeling that one person out in the world gives a shit about them. I’m happy and humbled to be that person for my clients. I think to an APRN student who is just starting to understand our role though…it’s daunting. And if I think about it. Like really step back and think about it…it’s a lot.

It is not a coincidence that there is a mental health provider shortage. People are falling apart and we as mental health providers shoulder more and more of their burden. It becomes heavy and isolating and daunting to potential new clinicians.

Again, I’m not going to censor myself and I’m not going to make the job seem like something it’s not. It’s hard. It’s emotional. And long term outpatient work is not for everyone. But it also made me grateful for my work. I tell people all the time I still love my work. I am lucky because I am one of few people who does what I love. But lord, it’s hard and sometimes it takes a mirror of an APRN student to remind me how heavy it truly is.

lesbian mom

Moira Rose’s Wisdom…Take Naked Pics.

Schitt’s Creek is one of my favorite shows (DAVID!) A part that has always stayed with me is an episode where Moira Rose (the mom) tries to find naked pictures of herself online that she thought were posted. She can’t find them. It’s a whole thing. But at one point she says to Stevie who is young enough to be her daughter,

“Then allow me to offer you some advice: Take a thousand, naked pictures of yourself now. You may currently think, “Oh, I’m too spooky.” Or, “Nobody wants to see these tiny boobies.” But, believe me, one day you will look at those photos with much kinder eyes and say, “Dear God, I was a beautiful thing!”

I loved that line.

My weight has waxed and waned throughout my life. I was never secure. I got height and boobs far sooner than all the other girls in my grade. And by the time they all passed me in height, well to this day they still think I’m taller and they stand at least 2-3 inches taller.

I’ve been called fat. I’ve been called “slim”. I’ve been called beautiful. I’ve been called ugly.

Needless to say I’ve always been a bit insecure about how I present to the world based on the feedback.

Then of course carrying babies and having them cut out of me didn’t help.

But I actually followed Moira’s advice. And let me tell you…it’s a challenge. Because the whole iCloud situation and having kids. So note to self- before you embark on nude photos- make a separate iCloud account for your kids. And/Or turn off your iCloud sharing with photos. And then never. I mean never. Loan out your phone. Keep them in a separate album. Hide the album. Password protect that shit. I knew I would need to do all of the above, and let me tell you it’s worked.

Not only are my pics secure from anyone. But I absolutely do look back at them and think, “Damn, look at me. I’m beautiful”. And then, the more I do it, the longer it happens, it’s now been 4 years! I appreciate the pictures. I appreciate myself. I love myself more. If you’ve watched Schitt’s Creek you are probably thinking huh. Pretty damn weird that Moira gave actual life changing advice. But she did.

Now to clarify, I’m not taking nudes daily. It’s a couple times a year when I remember this is something that helps me. I hate it. In the moment I absolutely despise all the curves, all the stretch marks, all the scars. But then a year later…it’s all “Damn, I was freaking beautiful”.

Then slowly, over time, you realize if you were beautiful then, when you “hated” yourself, you’re probably beautiful now. You can probably let go of the self hate and replace it with some self love.

So do it up people. Take all the naked pics you can tolerate…but seriously…password protect that shit.

homophobia · Mental Health Stigma Suicide

Queer-phobia in Mental Health Care

My practice website is pretty gay. Rainbows and Queer stuff all over the place. My job posting that I have up for therapists links to my website- it also explicitly says “LGBTQ experience preferred but not required,” and goes on to explain that the majority of our patients fall under the Queer umbrella. We certainly have hetero-cis patients- many of them. But around 60% or more of our clients are Queer (And I’m Queer. The owner).

Therefore it continuously surprises me in job interviews that the people applying have no experience with LGBTQ affirming care and also do not seem that interested in expanding their skills to include being an LGBTQ affirming and competent provider.

I’ve heard some crazy stuff in job interviews. Around four months ago a therapist who supervises the therapists in my practice commented on how slow we are to on board people- one every 4-6 months. I sort of rolled my eyes and said we don’t have a large qualified pool of applicants. She remained skeptical. She also intimated that maybe I scare people. I have been told I am intimidating. I thought maybe she wasn’t wrong. But I really do try to smile and be kind in job interviews.

So I had her start to join me.

After 6? interviews she said, “Okay. You were right.” People will literally say transphobic or homophobic statements in the interview with a Queer practice owner.

The entire experience of hiring has opened my eyes to the rampant homophobic and transphobic attitudes that are ever-present among mental health clinicians.

I always preface my Queer competence question with- “it’s okay if you have no experience with the LGBTQ community. It’s important that you are open to learning about it though.” Because I can hire some one with no experience and teach them to be Queer competent if they are teachable. Teachable/coachable are incredibly important qualities in employees. One therapist I hired had no experience with BDSM and minimal experience with trans clients.

Now she knows the lingo and declines to take new patients who are not Queer and/or in the BDSM community. Because she asked the questions and was open to feedback and learning and took CEU courses and did supervision with me around Queer stuff.

I’ve heard bad stories from my LGBTQ clients about therapists saying homophobic and transphobic stuff. I’ve definitely heard stories of kink-shaming and BDSM-shaming. In fact I asked a therapy group who I referred to and they referred to me frequently about seeing clients in the BDSM community and they got all squirrelly and were clearly not okay even mentioning BDSM.

I could say to therapists who are interviewing that we will accommodate their experience and desires and not give them any Queer clients. I thought about it. But then I thought. Fuck that.

I’m not going to own a practice that I founded because of the 2016 election and because of Pulse and because Queer people don’t have safe spaces…and not have every clinician working there be 100% comfortable with treating Queer clients.

I will say the hiring process teaches me as an employer. It teaches me that I do not want to rush the hiring process and hire the wrong person. It teaches me that homophobia and transphobia are rampant even among therapists who claim to be “LGBT friendly”. What does that even mean these days? What I’ve found is it means I’m okay if your a lesbian and we do not ever need to mention internalized homophobia or your sex life. It means that being trans is fine as long as we do not need to address micro aggressions that you face even within this office space.

It teaches me that I’m even more dedicated in my mission to create a safe space for minority employees and clients. It teaches me that being selective is okay. That I should wait for the right fit. That I should trust my gut because even people in the “helping profession” can have their discriminatory views that they are bringing to the table.

I am still going to ask about Queer experience. I am still going to require if not experience an openness to learn and to accept. I always thought I would have to protect my practice from hate among hateful people. But I picture those people more as potential clients or client’s family members or random people who come across our website. I did not think, in my naïveté and sheltered bubble of acceptance, that I would need to protect it from those within my own profession.

But I do. And I will.

If anything it’s also made me even more grateful for the employees I have. Because every single one of them is LGBTQ affirming. Not just friendly. But affirming. Accepting. Loving. There is no bone of hate or discrimination in the practice as it is now. I will continue to strive and work to keep it that way.