I was discharged from a psychiatric assessment unit yesterday. I sent this e-mail 3 days ago to Brilliant Diabetic Nurse. Its a full on explanation of events. Anything in bold has been either been slightly altered to protect identities, or added now to explain the medically bits some more.
Hi Brilliant Diabetic Nurse,
This comes courtesy of my phone so sorry if there's a few typo's (damn predictive dictionary) So happy Monday morning to you, hope you're okay? Protip: get a coffee in your hand, this might be a long read . . .
So; two weeks ago on Sunday, I presented to the Emergency Eye Centre because I'd had intensifying pain in my Left (aka good) eye all night, and even though in the mirror they looked the same; it felt like the eyeball was bulging out of my face. So immediately I was shitting it (forewarning: language in this message may be bad no offense intended) because if the Left one goes I'm stuffed so I wanted to get it checked out asap. They had a look, measured the pressures, and said it was fine, and as I had appointment coming up with Consultant Opthamologist not to worry. Said it could be my sinuses (??)
My response to my genuine fear of impending blindness (I know it sounds blazè but that's how I'm dealing with it right now) was to disconnect my pump -- readers, I am here referring to my insulin pump. See minimed.com for more details but basically it is supposed to run continuously 24/7 and so purposefully disconnecting it will result in physical unwellness-- on Monday lunchtime and drink a lot of lucozade and eat some ice cream. Not entirely sure what the intention was - I reconnected the pump Tuesday (1st Dec) morn at 5am but I turned up for work looking like shit, feeling like shit, reeking of ketones and stumbling I was promptly plonked into a chair and wheeled down to A&E in the hospital where I work. It was a DK(diabetic keto-), don't think I was grossly acidotic. (as in, it wasn't full blown DKA)BG(blood glucose dear readers) was 54. (normal is less than 7 before meals and less than 10 after meals. in mmols/L for anyone reading over the pond)
Please note thus next bit is all totally as I interpreted it, in my perception. I'm not trying having a go at My Consultant Diabetologist (a well respected man in his field), but this was just how I felt.
He randomly happened to be in resus, spotted me, and implied to the staff there that it was all self induced and I'd be right as rain after s bit of fluid. He wrote very clear instructions in my notes about bringing the IV insulin down at tea time and sending me home that night. When I arrived on the medical assessment unit he was already there in conversation with the medical consultant on-take, no doubt enlightening him as to what a time wasting, insulin manipulating, wierdo I am.
So I got all on the offensive said I was taking my own discharge, but this doctor said he had no preconceptions about me; his priority was sorting out my DKA and getting me home that evening. So I calmed myself and agreed to stay.
Then my now ex- Evil Witch Lesser Boss happened to wander on by (she's the matron on there now, permanently) and found me crying and was actually quite sympathetic to me when I got all worked up about all the nurses and doctors thinking I am a lost cause and time waster. The total irony of the situation didn't escape me: I was getting upset because Consultant Diabetiologist was implying I had induced my own DKA and insisting I hadn't; and she was like "Crazy Nurse you know how it is, shit sticks" saying she knew I had come a long way since then, and that I had to prove him wrong; but all the while I was in fact to blame for the whole thing.
Her words resonated though and so in my infinite wisdom I decided the way to "prove him wrong" would be to display some insulin resistance, making it look like it was a genuine episode. So I took the 50ml syringe out of the syringe driver, emptied it's contents down the sink, and filled it with tap water. Obviously then for the next few hours my blood glucose level was static or slowly crept up; so they doubled the rate of infusion. The syringe was changed when it ran out and I left it alone but tea time as my blood glucose level was still in double figures at 11, the nurses wouldn't stop it. Then I was moved to a ward where the ward registrar read through my medical notes and saw consultant diabetologists detailed instructions and suggested we take it down first thing and I went back onto my own pump. So I was discharged on Weds at 10:15 and made it to my late shift.
When I thought about it all a few days later I was horrified by what I had done and was grateful to the big man in the sky, or fate, or destiny, that I hadn't contracted some bacteremia or something. And then I made an appointment to see you. The rest of the week was spent skimming DKA and staying out of A&E and thinking about how I need to get my act together and stop being such an insulin halfwit. But on the bright side, I defo lost a few pounds.
But the last week things went from shit to shitterific Saw my orthopaedic surgeon Monday 7th - in his own words, he could "faff around with another 4 or 5 ops and still not have it straight" so pinkie is defo being chopped off, it'll be early Feb. At the time I was like 'I'm actually okay with this, I just want rid, as soon as.'
Also on Monday I rang the labs at my hospital posing as my GP and discovered the HbA1c they had taken on me on medical admissions unit was 10.9. For more info on HbA1c see here:
In a nutshell the ideal is below 7%. even though I couldn't be surprised , I was really, really pissed off at myself.
Then I saw Consultant Opthamologist on Weds 9th - unshockingly enough , any documentation from my visit to the emergency eye place had yet to locate themselves in my medical notes - the eyes section; so I filled her in, and she had a look and said I needed more laser to the Left eye but that it was holding up ok and the feelings of pressure might be a sinus problem (again ?) She was more fussed about the Right eye - sent me for some fancy pics, and has referred me to a surgeon. The way she explained it to me; and I'm guessing you know a lot more about diabetic eyes than I do; was that the fluid in my macular oedema has sort of jellified which means it might pull away and bring the retina with it; and thinks an op to detach the jelly from the retina would be worthwhile and might also improve some of my R eye vision. Might have got a bit muddled there but what she said at the time made sense.
But I left feeling totally despondent; because this is totally all my fault. The thought of having an operation on my eyes freaks me out completely. Sometimes it's done under GA General Anaesthetic i.e. they put you to sleep sometimes local anaesthetic, so I'm already racing away with myself and thinking 'oh local is better as no GA means less risk etc etc' but then I'm also thinking 'OMG a needle into my eye? I'm going to want to be asleep for that'. But end of, I wouldn't be needing this op if I hadn't been pissing around with the insulin in the first place. And to top it all off, I'm not even thin.
And I felt like, losing the finger although not entirely my fault I hadn't helped the wound healing by being so poorly controlled and perhaps if I had a HbA1c of 6 it would of mended just fine.
So I disconnected the pump, started beating myself up about the eye, and the finger, and I started thinking like, FFS I'm falling apart and I'm not even 30 and it's all my fault; and was thinking about why I hadn't got my act together after everything I've been through and I reached the stage where I was like 'know what? There's no way that this life is all there is to existence and since I've messed it up why not try the next stage?' and I was just like, in all honesty; what is the point of me?
So then I ate all the prescription drugs I had amassed over the previous 18 months through hand surgery or being mentally interesting; namely co-dydromol, tramadol, codeine phos, promazine, and diazepam. And then I sent some "thank you for being such a good frend" texts and one of my friends panicked and I wasn't answering the phone so she came round and rammed on the door and then let herself in with one of my spare keys (I have 5 scattered around with various people to avoid emergency locksmith fees) and found me and I was drowsy and she rang 999.
The ambulance got to mine at 3am ish Thurs morning. I vaguely remember being in the ambulance, I remember being pat slided onto an A&E trolley at the hospital near my house which is not where I work, it all goes a bit hazy and I remember someone saying "her last set of gases are even shitter" I remember up until about maybe 4:30 am and then my next memory is waking up. Time all a bit iffy here but I managed to work out on my own that I had a urinary catheter in and that I was attached to a cardiac monitor (no art line tho)
And I asked a nurse the time and she said '11' and it was daylight out the window and then she said again "Friday morning, 11 o clock' and I was like 'what??' I'm still none the wiser as to the interim 30 or so hours.
My sliding scale (IV insulin) came down 3pm Fri. I am going to rant now because since then my diabetes control has been outrageous for someone who was an in-pt: they had my pump and wouldn't let me have it. So when they tested me pre- tea rime it was 21, as obviously I'd no insulin in me for 3 hours. Then they said I couldn't have the pump back as I'd misused it and this junior doctor was treating me like I had no neurons whatsoever; and proceeded in his infinite wisdom to prescribe 12u lantus (an insulin) for bed time and 6u novorapid(another insulin) for meals. Honest to god, there was no conversation involved, this man literally dosed me with numbers he had plucked from his head.
I did try to be patient and explain that I didn't think 12u of Lantus would be sufficient for a person of my bodyweight and that pre-pump I used to have 20u of lantus each bedtime; but he was having none of it. On Sat morn I was 4.9 pre-breakfast and expressed my concerns to the nurse that having 6u of insulin and 2 pieces of toast would send me into a hypo; to which her response was 'well if you do you're in the right place' so sure enough about half eleven I had a massive hypo episode of hypoglycemia (shakes sweats the lot) and once over that she was insisting I had my 6u insulin for lunch as that was what was px even though I was eating salad. So I kicked off then, and this junior doctor came back and I managed to get him to change the novorapid to 4u at meal times. I tried to get a variable prescription I.e 4-6 units or whatever depending on BG and carbohydrate intake but he wouldn't have that either.
So after tea, massively frustrated I took a walk and found my way to the top of a flight of stairs that led to a locked door; and climbed over the barriers and was stood there on the ledge for about 50mins trying to have the balls to jump. But then some nurse spotted me, and then security were there and I didn't want a drama so I climbed back over and was frogmarched back to the ward, where I completely lost it and bawled for about 3 hours until I got a nosebleed, and then decided to hack up my arm with a needle.
Then pre-bed Saturday, as I'd only had the 12u lantus the night before not to mention all the adrenaline of the stair incident; I was 17.3 but there was no prescription for top up novorapid so then unbeknown to the ward staff; I managed to slyly give myself a 3u correction shot.
So (bear with me, I'm nearly at the end now I promise) on Sunday morning I was seen by a Female doctor who said she was a consultant and said she specialised in diabetes; and that she was here to get me started back on the pump. And I'm like 'thank god' and she knew her stuff; she said lots of medical blarb about pump therapy and dosing and I'm like yep all well and good. She declares me medically fit (despite the fact I'm not actually back on my own insulin) so I'm seen by the on-call registrar for psychiatry who says he wants to admit me to psychiatric 12-72hr assessment unit and I say ok.
Lunch arrives, and the nurse announces they can't give me novorapid from a pre-filled pen
for my pump; as it's against their policy (asif! What policy?) so I end up having an injection of 4u at lunch and bless aforementioned friend; she goes round my house and brings back my own insulin out of my fridge.
So we're now at about 4pm sun and I'm getting ready to reconnect my pump when the nurse says I can't as it's not prescribed. So I asked her to check the notes and see what the doctor had written in the morning; but aforementioned consultant had neglected to document having ever seen me. I frantically asked them to bleep the doctor, or call the nurse who had been looking after me on the early shift who could confirm; but they refused to do either; treating me as though I had conjured this doctor up out of my magic crazy person wand. So I had my 4u at tea time as an injection and then came over to psychiatric 12-72hr assessment unit .
Never thought I'd see the day when I was happy to see a psych ward but honest to god I was so relieved to be off that medical ward. I appreciate it's all a bit raw at the moment and I'm not in the most rationale of minds, but what would your opinion be of me going through PALS? I just thought the almost 'fear' of the staff regarding this insulin pump they had never seen before was ridiculous.
So I got over here about 8pm last night. Their Dr has said would it be alright with me if I have another insulin injection sun night before bed and he will come and prescribe the pump this morning. They've 'risk assessed' me and concluded they are happy to let me control the pump. So last night with a BG of 18, I gave myself 12u lantus under supervision and again on the sly had another 2u novorapid and now I'm at 5.3
So things are better, from a diabetes control point of view I guess. I've not been admitted properly yet, I'll meet 'my' nurse this morn and we can do all the paperwork and male a plan.
So, err, yeah, if you've not dozed unto your coffee that's where I'm up to. I'm so sorry, I had no idea when I started writing this, like, 2 hours ago that it would be this long. It's been quite cathartic for me. So obviously I won't be in to see you at 1pm as per my appointment. I'd hugely appreciate your advice re: getting back on the pump and basal adjustments and stuff.
I'm on my mobile number, Psychiatric Zone of Hospital reception is phone number and I think psychiatric 12-72hr assessment unit is phone number.
What happened after that was that the next morning (Monday) the psychiatric doctor who covered the assessment unit wouldn't prescribe any insulin because he was unfamiliar with the dosing; and so brilliant diabetic nurse spoke to them on the phone; and I finally got my pump back at 3pm. I met with the nurse and the doctor for about an hour on Monday. He altered my antidepressants from 60mg of fluoxitine once a day in the morning to 40mg, with 15mg of mirtazapine once a day at night time.
So I had my first ever mirtazapine tablet monday night. Well. I was woken at 10am the next morning to have my 40mg fluoxitine and I had a brew and went back to sleep. I was woken at 1pm and I had some lunch and went back to sleep. I woke up at 4pm and stayed awake until 8:30pm; during which time I expressed my huge concern over the amount of sleeping I was doing; but the nurses didn't seem to fussed, they said give it time; and then went back to sleep and was woken at 10pm to have another 15mg. This time I asked for the patient information leaflet which identified the main side effects as drowsiness, hunger and weight gain. So I slipped it inside my cheek and promptly spat it into a tissue once back in my room.
Despite the fact I had not taken it and bearing in mind the fact that I had slept all day on Tuesday; I went to sleep at about 1am on wednesday morning and didn't wake up until 8:30am. On wednesday I was told I was going to be discharged under the care of the crisis team. One of the nurses from the crisis team came up to talk to me. They are calling round today (since technically we are now into the small hours of Thursday morning) at 4pm. The doctor told me to take 20mg fluoxitine the next 2 mornings, as in today and friday; and then stop altogether.
I got home about 7pm on Weds eve. I had fallen asleep again between 2 and half four in the afternoon, but seemingly no worry because the ward was still waiting on the bloody pharmacy to get my TTO's up.
I have since consulted doctor google about mirtazapine and welcome any advice or experiences s any readers may have regarding using this drug. Insofar as I can fathom; the reason it works as an anti-depressent is because it knocks you out to the point where you're too bloody doped up to actually successfully carry out any task, including suicide. I am planning to tell the crisis team that there is not a chance in hell I am going to take it again, like, ever; might as well be honest with them, and see what they reccommend.
This morning I need to abuse an emergency appointment at my GP practice to get a sick note for work. And yes, finally, we come onto work . . . .
The situation is that I went to work last Wednesday, came home, moped for a bit, and then OD'd. I was due in on Friday morning but obviously didn't turn up as I was wired up and knew nothing about nothing. So when I came around, I had voicemails from them every half hour from 8am onwards until one about 11am which said 'we've found out you're in hospital; just call when you can'. So the panic set in then. Did they know why?
I called and apologised profusely for not my no show. The sister in charge was one of the band 6's who I get on really well with. It transpires that they had called my mum as my emergency contact; but the number they had for her was an old one. I remember deliberately not giving them her new one when she moved house 12 months ago so she couldn't be panicked by anything like this.
So then they had contacted ambulance control who had confirmed there had been an ambulance out to my house on the Thursday morning, and then they had called the hospital and confirmed I was an in-patient.
She just assumed it was a DKA. I didn't actively tell any lies: they asked what my blood sugar was on admission: I said I didn't know
But on Saturday night after the whole episode on the stairs; and after ignoring all other texts and calls I had had off various friends and work collegues since thursday; I finally told one of the sisters on the ward, via an extreamly long text conversation since she was asking DKA related questions. Total panic set in then, as I waited for a text back to tell me that she would have to get in touch with the NMC or something along that line. But she was actually very reassuring. She offered to speak to nice lesser boss for me, which I pathetically accepted. The psydonym speaks for itself. She has never been anything other than very understanding with my mentalness, so I shouldn't be so worried. But I feel like I have let her down hugely, and that she will be dissapointed in me.
So on Monday I had a text from her to say nice lesser boss was on holiday all week and that she had spoken to one of the band 7 charge nurses as he was holding the bleep all week and effectively was nice lesser boss in her absence. Then I had a call from him. He was really calm and spoke very gently on the phone. It was a bit wierd because I'm mates with him outside of work, we've been to gigs together and stuff; so I was like "what exactly do you know?" and he was like "she told me you tried to top yourself" so I told him I had been transferred to the psych assessment unit. He said he had informed ultimate boss because he thought it was the right thing to do.
I was panicking, because that was basically another 3 people (himself, ultimate boss, and nice lesser boss on her return from holiday) who were aware of what had happened. I had so far limited it to my friend who had called 999, the sister from work I had told, and my actual sister. He said he would sign me off for a week, and asked me to send in a sick note.
The nurses on the psych assessment unit, and the doctor were like "take you're time getting back to work" but I don't really know what that means. A week? two? A month? Its difficult to know what to do. Do I ask for a certain length of time; or let them decide? What if I go to the GP and they're like 'I'm not writing you a sick note - look at you, there's nothing wrong with you.' then I'm totally buggered. Not to mention the fact that this is the worst time of year to be off. Everyone will think I am on the skive. Sick at Christmas? Yeah, right
Thats how it stands at the moment. I feel like I haven't had much time to think about what has happened, and I need time to sort out in my head what has gone on. I can't just carry on as normal, not yet. I don't feel ready to go to work. At first I was mad at myself for failing, now I've accepted that but I don't know how to act, how to feel, what to say, how to be. Writing this is starting to make me feel worse. Maybe I'm not ready to think about it. Maybe its still too raw in my mind.