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A+E and the Crisis Team and a new Doctor

Posted Oct 04 2009 11:12pm
After I wrote my last post, I got into bed and cried. And cried and cried and cried. Pathetic I know but I was literally at my wits end. I tried to sleep as well but shockingly enough that wasn't happening.

I was on a day off but I was meant to be on a study day. I watched the minutes go by, knowing I wouldn't get there on time. I thought about getting a taxi. And then I cried some more and decided I wasn't in a good enough state to go.

So bang on 8AM I called Dr F's secretary and OMG, like, oh wow - she actually answered. Success! But the news was bad. It transpires that DrF is no longer my doctor; because they've had 'a change around' and so DrF is only seeing inpatients. She informed my my doctor was now Dr? [so called because I can't rememnber the name. I think it was a woman.] So I asked if I could get an appointment with her; but seemingly she has a different secretary. So DrF's secretary went off and came back and told me one had been made for November and to expect a letter in the post. I asked if the thing about having to have a new doctor was final, like I definately couldn't stay under DrF; but seemingly that is indeed the case.

And then I cried some more. And bang on 8:30AM I called the GP's because by this point I was read to spill my innards to a stranger if it meant they would calm me down (I was kind of hoping for a bit of promazine to be honest) but the receptionist had no appointments until next Thursday. I was managing not to cry down the phone but I think my warbaly voice was giving the game away a little. I had been blatently crying to DrF's secretary. The shame. At least I'm never going to have to speak to her again. So I said to her 'what if its a mental health emergency?' hoping she might panic thinking she had a mentalist at the other end of the line and magically find me an appointment; but she told me to go to cas(ualty).

I spent a good few hours pondering that. I didn't want to waste anybody's time. I wasn't sure I was really ill enough? On the surface, I was fine. I had gone back to work, I had kept myself out of hospital. No-one would know what was going on inside my head. Which was mainly thoughts about potassium. I was thinking about how much I would have to take to induce an arrythmia. And playing a movie in my mind of being struck off the register for stealing potassium supplements from work, and I really don't want that to happen. I realised it boiled down to whether or not I could trust myself not to steal any drugs from work. And as much as I didn't want to openly accept it; at the moment I'm not sure I can. At which point I decided I would go to cas.

So I must of turned up about 3ish. I had showered and washed my hair and moisturised before I went, because I'd been rather neglectful in the personal hygiene department of late, and I didn't want to give them reason to make me stay (they don't look favourably on self neglect. Look clean at all time). I was really really twitchy once I had booked in. I must of changed seats in the waiting room over ten times. I couldn't keep still. I was trying really hard to sit still and keep my mind busy.

I got called in and started pouring everything out to the poor triage nurse, who was like 'I'll go and get the psych liason nurses'. This was new. My hospital (as in, where I work and where I see DrF) has a cas psych liason team; but when I had been once before to this hospital (as in the one round the corner from my new house) they had just had psych house officer on call.

Anyway, I was put in the crazy persons room and met two nurses from liason, a man and a woman. I instantly liked her, she had doc marten boots which were black with daisy's on. He was a nice enough bloke as well. They were just like 'kathryn, slow down' because apparently I had accelerated speech. I must of talked for a good hour and a half. She said a more junior HO might mistake me for being manic but I wasn't, I was just super stressed.
Apparently if you're manic nothing can calm/slow you down; whereas as I spilled everything out and got all my stresses off my chest, I did begin to relax to the point where I was able to sit down and sip a cup of tea.
If being manic is having that 'mega jittery can't keep still can't concentrate on anything for more than a couple of seconds' feeling for an extended period of time I'm grateful it's not something I've ever experienced. No haloperidol in my ass thankyou very much!

They felt the best option was to refer me to the crisis team, so calls were made and I was given their card. They debated about giving me some promazine, but said they'd leave it for now, and that the crisis team can always prescribe it out in the community.
I completely lost it when it came to talking about having to call nice lesser boss to say I would be off sick tomorrow. I just don't want to let her down - I've been so well for so long, everything has been going really well, I've got onto this masters and stuff and I don't want to shatter the illusion. So the liason nurse said she would call for me. I was like 'thats so pathetic, I can't let you do that ' and she was like 'look at the state of you, I'll do it'.

I left feeling quite a bit better; but Thursday night was hellish: stupid mind having stupid intrusive thoughts, and playing movies over and over. I dialled the number of the crisis team card a couple of times but hung up before anyone answered. I called two of my amazing friends. One was on nights so I called her at work. The other, I woke up, at 3 in the morning, and she was equally supportive. It certainly helped my 'I have no friends because I am worthless and why would anyone want to be my friend?' mentality.

I must of nodded off about 5ish but didn't get up til after 9 on friday morning. I had a voicemail from the liason nurse saying she had spoken nice lesser boss. Liason nurse said she had given nice lesser boss the bare minimum - that I was having a visit from their team this afternoon, I wouldn't be on my late shift, and that I would call later. And so I spent the next 3 hrs stressing about having to call later and what I was going to say and what she was going to think and that it was YET ANOTHER episode of sickness.

The crisis team came to see me on Friday afternoon. It seems like a similar set up to the crisis team at my hospital, who I was under for a couple of weeks last year

[for more info see these posts:
http://blogofcrazynurse.blogspot.com/2008/09/being-discharged-and-crisis-team.html
]http://blogofcrazynurse.blogspot.com/2008/09/being-discharged-and-crisis-team-round.html]

They come out and see you in your house and try to prevent hospital admissions. They can see people for up to 6 weeks, and they're all mental health nurses. A man and a women came round. They stayed for a couple of hours; I gave them a basic mental health history and then ranted about why I couldn't stop obsessing about taking rndom tablets and seeing what happened. They said that if I was going to have to have a new doctor at my hospital, why not move my care to the hospital round the corner. Technically I should be there anyway: its nearer to my house, and my GP practice is covered by their services. Makes sense to me, and I like the idea of having my mental health care away from work. So they said they would sort that out. They talked about referring me to their psychology team because it had been over 2 years since I had CBT. I said that was fine. I was much calmer than I had been in A+E. I sort of worried that they probably thought I wasn't ill enough to be under their care.

They arranged to come back on Sunday (as in today) but I was supposed to be working the early on Sunday. I explained to them about having to call nice lesser boss back and how I was stressing about it. They advised I went to see my GP next week and got a sick note for a week or two, and then I didn't have to worry about work. They said they would call me when they got back to the office, by which time I would have spoken to nice lesser boss, and then we could arrange an visit time.

So I called her, and she was so lovely. I know you don't have to say anything, but I told her that I was having some issues, and that it wasn't safe for me to be in work at the moment, but I hadn't wanted to admit that, and that DKA was a more valid reason to be off, hence implying it wasn't exactly an accident. She told me to look after myself over the weekend, and to contact the appropriate people if I needed to. She said she would put me down as sick for Monday and that I should call her on Monday afternoon.

The friend who I had woken up at 3AM invited me to hers for the weekend as her boyf was away so she had the place to myself. On Friday she had 4 of us over and we got a Chinease delivery and she tried different make up on for her impending wedding, which is in 2 weeks. I'm a bridesmaid!
On Saturday she slept in til after midday while I speed red through her book collection. On saturday night we got some Definately Very Dodgy's and watched District 9 and Dorian Grey and I got State Of Play which I never got round to watching at the cinema.
I was really grateful to her: the fact that soemone else was around all the time meant I didn't ruminate over things too much. I managed to sleep as well. Bonus.

She dropped me back off here this morning, and one of the nurses from the crisis team who had been here on Friday came round. I inwardly smiled thinking that now they had established I wasn't going to hurt them, they could come alone. But he refused tea or coffee. Reminded me of my student nurse placements in the community - there were places you knew not to accept a brew, and places deemed safe enough to accept. Clearly he hadn't made his mind up about me yet!

I talked quite openly to him. I feel like I'm just sitting tight, waiting for my thoughts to go away. Then I worry they never will, and that takes me down the whole 'what's the point?' road which only leads to feeling even worse. I'm also obsessing quite a bit about death. Death in general that is, not my own particularly. We talked about distraction mechanisms and using rubber bands instead of cutting, and previous coping strategies.

He said they would contact their psychology team tomorrow, and call me with an appointment. My job is to go to the GP during their open clinic hour (since I know their are no appointments til Thursday) and get a sick note for next week at least. But I also need to go to the GP for another reason: I had put a lighter to my leg on Monday and Tuesday after work and then picked at the scabs, and now one of them is blatently infected. I've got a nice cellulitis on the skin around the scab all red and hot; but more worryingly covering a wider area than the scab and cellulitis, like underneath the scab as it were, I've got a large lump. My friend thought it might be an absess. I don't know much about them, but am already panicking that it might involve IV antibiotics. I seriously hope not.

And thats where I'm up to.

CN
xXx
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