Why This Nurse Cares.

In my time as a psychiatric nurse practitioner I’ve had people react to me in many different ways. I often say people either love me or hate me. There’s not much of an in between. But that’s wrong; I am learning the in between exists.

There’s a gray area where some people live where they just don’t understand me and are scared to hope that I might be real.

It’s taken me some time to recognize this particular response to me as it presents as hate some times. Often times. I’ve had clients scream at me, “BUT WHY ARE YOU BEING SO NICE?! I FUCKED UP!” I’ve had clients say, “BUT WHY DO YOU CARE?! YOU AREN’T MY RELATIVE SO WHY DO YOU FUCKING CARE?”

It surprised me the first couple times. Why would I not care? Why would I be in the profession I’m in if I didn’t give a shit?

I’ve reflected a lot about this particular reaction to me.

Clients that stick with me; who have been with me through divorces, marriages, bearing children, gender changes, sexual orientation changes, sobriety and relapses, and any other major life event you can think of…these clients know that I’ve got their back. They may hate me sometimes. When I’m not doing what they want me to do and I may push them in ways they don’t want to be pushed. But I’m there for them through it all.

I tell clients I don’t get mad at them, I just try and understand where they are struggling and why and work through it with them. And it’s really true. It takes too much energy and would require taking things very personally if I was to get upset with clients and sort of counterproductive to my role.

A client who recently questioned why I cared about them with skepticism said it must be because I have to care because it’s my job because I have to care about everyone who walks through the door. I immediately shook my head no. I do not keep every one who walks through my door. I do not take on everyone who calls. And certainly not everyone keeps me.

It has to be a good fit on both sides. We don’t necessarily have to like each other but we have to have respect for one another and we have to feel safe with one another. I’ve discharged people who threatened me or who were too acute for a private practice. And people have discharged themselves when they don’t get what they want or need from me.

But my peeps, my clients and my patients, yes I care about them. I don’t know any other way to be. I don’t know how to sit with some one and hear their story and try and partner with them to move forward and not feel something toward them. Empathy. Compassion. Because it is from those clients who I learn the most. The clients who take steps forward when the world pushes them back; they are the people who inspire me. They are the stars to see, to feel, to experience, and to be witness to that brings me joy like nothing else.

I saw a client recently and we got in really deep about something and they teared up, and we had this moment, and I’m like you just got therapized. But it’s not just them it’s me who learns from them. Me who learns that it took almost two years to get a tear from them to watch them progress toward feeling the hard mushy feelings.

I care about people because I couldn’t sit in the chair I sit in and not care.

I trained with an APRN who was amazing. She taught me tremendous amounts about everything but mostly she taught me how to see patients as people. She said she did half hour follow-ups instead of the standard fifteen minutes a psychiatrist does because, “Ya know. I like to talk to my people.” I agree with her. I like talking to my people. I like to know them, and although caring about each and every one makes me vulnerable it’s also what makes me good.

It makes people trust me because they know I am prescribing to them in a way that I would prescribe and treat my own family member.

To wonder why some one would care hurts me. Because it means that person has been wounded. Deeply.

Why the fuck do you care?

My answer is because I can. Because I do. Because I see you and you are worthy of being cared about. My question back would be why are you scared of being cared about?

Stop the stigma.

That Time My Wife Became Manic

I’ve talked about my wife before. A lot. So maybe acquaint yourself before you continue. Or not. Suffice it to say her parents disowned her and she was pretty messed up about it. For a long time. It took a really long time but I convinced her to seek therapy. Eventually her therapist convinced her to see a psychiatrist, and bingo bango she ended up on anti-depressants.

I’m a huge fan of psychiatric medication. I know many people are not, and that’s fine. But I’ve seen them save lives so I’m cool with them. I’ve also seen these medications have horrible side effects so, as I tell my clients on the regular, I have a healthy respect for them. When my wife started an antidepressant it made a huge difference in our lives. She was calmer, less angry, less depressed, and morphing before my eyes back into the woman I originally fell in love with.

It took a long time for her to get to that place though. For her entire life she was told to take her problems to God and that was all she would need. When faced with the ultimatum of the end of our relationship or a psychiatric consult though she finally went to some one other than God. Because no offense but He just wasn’t cutting it. She was crying all the time, irritable, and close to suicidal at times.

The antidepressant she took really changed her outlook on life. She became more ┬ápositive and hopeful and it was amazing. Enter ghosts from the past. She totally decompensated. I asked her to speak with her prescriber about what else they could do with medication because of the added stress of our current situation. Her prescriber added another antidepressant. Not an unreasonable thing to do, but in my wife’s case it totally backfired. She became this other weird person whom we now refer to as “manic-wife”. It was so gradual and I have such a high tolerance for crazy that it took us awhile to realize this was an adverse effect of medication.

When I say manic I mean- staying out until all hours of the night with people she met online, wanting to quit her job and drive across the country to California, but mostly wanting to leave me on a daily basis. Some days she seriously only stayed for the cats. This was not her. I felt like I was living with a stranger and she knew that her wires were not connecting correctly. It took me a couple months of hell before I connected the dots. This all started around the time she added the other anti-depressant. She immediately stopped it and agreed to not make any major life decisions for two months.

I cried a lot. Because even though I knew this wasn’t her, it still was her saying awful things to me. If there was ever a time I thought we wouldn’t make it, that was it. I came home from work every day expecting her to be gone. I went to work every day expecting to get a phone call from a hospital in Idaho or something telling me they had her there. And by the end of that horrible summer I just wanted to crawl into a hole and sleep for a long time.

Her psychiatrist was less than nice when we went for her follow up and I explained that our relationship literally almost ended because of her mania which was clearly induced by the addition of the second antidepressant. He spoke to us like we were wasting his time and he didn’t think it was true mania because she hadn’t gone more than 3 days without sleep. I wanted to strangle him and told her she was finding a new psychiatrist. She didn’t disagree that he was an ass but she despises change so that was another battle.

Her new psychiatrist is a gem and has never made me feel likes I am unworthy of his time or energy. (My wife loves him too). I’ve been to exactly two of her appointments ever. One post-manic episode with old psychiatrist and the intake with the new one. I try to stay out of it because it’s not my treatment, it’s hers. But when she got manic and her judgment was impaired I had to insert myself a bit.

My wife gave me permission before I wrote this. Because this is all very intimate knowledge to have about someone. But there are a lot of lessons to be learned here. My wife and I went through something totally awful separately yet so intertwined. Her experience of being manic was terrifying for her because she felt out of control of herself. My experience of her being manic was horrifying because I was literally living with a stranger, but I knew she was in there somewhere. Then when we finally realized what was happening and went to the healthcare professional responsible for her we were completely invalidated and talked down to. I don’t think he was homophobic but I do feel he was sexist. Then we saw a second doctor who was the total opposite. I am so thankful for that experience and to have him in my wife’s life. Because he’s extremely validating and though he could prescribe her something with adverse effects his reaction would never be one of skepticism or condemnation.

Through my navigation of mental health with my wife I learned what it feels like to sit on the other side. It’s not comfortable. As a woman and as a lesbian I was terrified. I was scared for my wife, my relationship, and that we weren’t being treated fairly because of our gender and our sexual orientation.

I feel like a blog post can’t do justice to the level of emotional turmoil we both experienced that Summer. We don’t talk about it much because it’s painful for us both to remember. It was also incredibly isolating. Who do you tell that your wife is manic? What friend or family member could possibly understand what the hell that even looks like? You tell some one your wife has cancer (God forbid) and I’d get casseroles and offers to take her for treatment or something. But you mention mental illness and I just couldn’t predict the responses I would get so I didn’t tell anyone. I also didn’t want any of my friends or family to judge her. But that was years ago and I’m sick of stigma. Stigma against mental health, stigma against homosexuals, stigma against women. Everything. I’m sick of it.

So that’s our story. One summer of absolute pure and utter Hell due to an adverse reaction to medication. Complicated by an asshole provider followed by a provider sent from Heaven. It took her awhile to fully reconstitute and it took our relationship awhile to fully recover. I was scarred by her unpredictability and her apathy. When she came out of the fog I remember her crying and apologizing. I know she didn’t have control of herself but at the same time I was so angry for everything she put me through. It was a bizarre and conflicting set of emotions to walk around with. It took a lot of time to heal but we did.

When we moved recently we had to pack up our house. There was a bike in the garage. It was really expensive and it was during “manic-wife” phase. She became obsessed with the fact that she didn’t have a bike. She also didn’t want a cheap bike from Wal-Mart she wanted the name brand 600$ bike from the name brand store with a warranty. It made no sense because she never even rode bikes. Like ever. And after she bought it she only rode it maybe twice. It became the symbol of manic-wife and over time it got shoved to the back of the garage covered in crap. But it was unearthed during our move. We both kind of stared at it, and she was like “I should sell it,” and then there was this awkward silence as we both remembered the pain of that Summer and then I looked at her and said, “Listen if this is all that’s left of manic-wife I’m glad. Because it could have been a lot worse.”

It’s true. It could have been a hell of a lot worse. We brought the bike with us, and then my Dad asked if he could use it at his house. We said sure and we haven’t seen it since. All traces of manic-wife are now gone. The thing about mental illness is that we both know at any time she may rear her ugly head. But for now we take one day at a time and we are thankful for every day we make it through with each other. I am some one who lives with no regrets. I don’t regret that time period and I firmly believe what doesn’t kill you makes you stronger.

People who meet my wife for the first time assume she’s this kind compassionate little person. Which she is. But I’m always thinking in my head you have no idea what this woman has been through. She’s a survivor of growing up in a cult, being disowned by her family, embracing her identity as a lesbian, embracing me as her wife, and a survivor of a horrendous psychiatric episode. She’s so much more than what you see on the surface and what would have broken so many people just moved her forward into the woman she is today. She’s not perfect. I mean if she leaves her shoes and dirty socks directly inside the doorway where I step on them one more time I’m going to lose my mind…but she embodies the beauty of freedom. Freedom to be her own self at a great cost.

Stop the stigma.

Love you babe.