Therapy and other stuff

I have a feeling this post is going to turn out more stream-of-consciousness than anything else. And I'm fine with that. This shit's for me anyway.

I had therapy this morning and it was a great session. I talked a lot about work (which surprised M as it's a subject I usually steer clear of), my mood swings as of late, sexual dysfunction and whatnot.

There's a few things I'm trying to figure out right now. First and foremost, my recent mood swings. I had some days where I've been downright depressed, where I've had irrational anger and irritability, or, on rare instances, where I've had fleeting moments of hypomania. The hypomania lasts around 30-60 minutes and is punctuated by racing thoughts, rapid speech, and inappropriate speech. In between this I'm usually okay. Typically down and withdrawn, but okay.

I'm trying to figure out why I've had this spike in emotional lability. At first I was thinking hormones (I never know when my "menstrual cycle" would be as I have no uterus). But it's been roughly 2 weeks of this now, more markedly the last week. So I'm not so sure this is it.

My other theory is work. Namely, the added stress of being back at work. I've been back for 3 weeks now and it's exhausting. The stress and drain I feel with it might be causing the cycling (which stress can do for us bipolars). And this stress is something that, sadly, I can do nothing about. I can do relaxation exercises, take hot baths, drink tea, whatever, but that doesn't remove the problem.

Now, about work . . . people have noticed a change in me. Several have remarked about how "quiet" I've become. Or how "tired" I always look. And I am quiet. I am tired. At work I've become more withdrawn. I tend to do okay with patients, just not with coworkers. If a conversation lasts longer than a couple of minutes I start to shut down. I can't handle it - I simply get overwhelmed and can't cope. And I hate that feeling. And people notice. And comment. And wonder if I'm really okay.

Work drains me. By 2 or 3 I'm pretty much done. I'm in shut down mode. My processing slows, I become more withdrawn, I can't concentrate or focus or cope with problems. People notice this too. And ask if I'm okay. I don't want people to ask if I'm okay. I don't want people to notice.

I've been doing some reading in bipolar magazines and on forums and the fatigue with work and with stress of work causing symptoms is pretty common. So at least I know I'm not alone. I guess. Go me.

I wish I knew why work tires me so much. I wish I knew why I find it so overwhelming and difficult to cope with. I want to know the what, why, and how of it. Why does stress trigger mood episodes? Exactly what the hell is going on inside my brain?

I'll probably never know the answers to those questions.

And while I'm writing, let's talk about the whole "I don't know who I am" bullshit. I know who I am. On some fundamental level, I know who I am. I still have the same sense of humor, the same loves and other "same" shit. But I have changed. I'm different and I am having to find and reinvent myself.

I don't like the process.

I find that overall I'm more down. Overall I'm more irritable and easily annoyed. I'm hoping this goes away because I don't like myself for it. It takes everything I've got not to beat myself up over it, too (something I'm brilliant at doing). Hopefully with time it will subside. But in the meantime it's quite bothersome.

My sex life is also bothersome. Or lack there of, I should say. No desire, no arousal, no orgasm. I got nothing. I might as well be watching cacti grow. I know it's a direct result of the geodon but I can't go off it now - I'm too terrified of what would happen.

But I want to actually enjoy sex. I'd like to actually have a sex life. Typically, sexual dysfunction is a deal breaker. But, I'm going to give it time in hopes of my body "growing out of" this whole sexual dysfunction phase. I don't think time is going to make one difference but hey - what else can I do? I plan on talking with Dr. C in April about it (that'll give me about 3.5 months on the medication) and see what he thinks. Originally the antipsychotic was going to be a temporary thing - maybe it still can be.

I guess that's all. For now at least. I have a headache and it's hard to concentrate on a computer screen when your eyes want to jump out of your skull.

Why am I so tired?

Seriously? My friend stopped by to hang out and chat for a little while and it was exhausting. I love hanging out with her. I love talking with her. She's my best friend. But after about 45 minutes I was ready for her to go. Not because I didn't want her company - but because I was getting exhausted. I felt overwhelmed just talking with her.

What. The actual. Fuck.

This is stupid. It's so damn stupid. Talking to a friend should not be exhausting.

But it was.

I really hate me right now.

So About Work . . .

Yesterday was my first day back at work. I was in the nursery (meaning going to deliveries - every delivery) and we were steady - we did 6 deliveries. Overall, I would say that it was a good day.

Now, having said that, I did noticed some definite deficits.

First and foremost - cognition. I was processing things more slowly. Luckily, in a life or death situation (I did a resuscitation on the baby in my first delivery), I was good. Snap, on-the-fly decisions came without hesitation - my critical thinking wasn't affected.

When it came to prioritizing things - charting, making charts, phone calls, lab draws, circumcision checks . . . I was not so good. I was slow to process and I had a hard time focusing and concentrating. You might want to say "but Cami, it was your first day back after 5 weeks off." And I would say yep, you're right - but I shouldn't have issues with this kind of stuff. I'm the most organized, efficient person at work.

Or at least I was.

Next - exhaustion. By 1pm I was done with people. Done. The fact that I had to interact at all was too much for me. I became withdrawn and flat, saying little. I felt mentally and emotionally drained. I felt tired. I found it difficult to be present.

And lastly - myself. Yes, I was a problem. Which is quite stupid, if you ask me. I was a problem because I had high expectations of myself - and I didn't meet these expectations. The day was both harder and easier than I thought it would be. I had a preconceived notion that I was going to fail miserably - and I didn't. So easier. But I didn't meet my high expectations, so harder.

See, my problem is the deficits. With each mood episode you get worse. Where as 2.5 years ago I was 100%, now I'm functioning at maybe 87%. And it will continue to get worse. I notice these deficits. I've been noticing them get worse over the last year (most notably over the last 4 months). And for me that's devastating. To not be able to function at my best, especially at work, is just not okay.

And I'm starting to beat myself up over it which could cause a downward spiral. I'm doing my best to curb the negative thoughts and for now I'm succeeding. It's just that they keep coming. Negative thoughts, what-ifs, and doubt is all trying to creep in. I don't want to function at 87% - I want to be 100%. I should be 100%.

"Shoulds" are bad. "Shoulds" make you feel bad. Part of my problem.

The other issue is whether or not I go part time. I honestly think that for right now, part time would be best for me. A little less work, a little less stress, a little more recovery time. I think it's what I need.

But I have a strong work ethic. And I feel like I'll be letting people down.

I also feel I have an obligation to my family. If I go part time we'll have a major shift in how we're living - namely, foreclosing on our house, filing bankruptcy, and moving into a rental house. That's a lot to process and that whole situation is based on what I chose to do.

How fucking terrifying is that??

I feel all this pressure to perform, to perform well, and make everything be okay. Most of it is probably put on by myself and my expectations, but I can't change that that's how I feel.

And I'm not catastrophizing - I should get that out there. I'm actually trying to minimize everything. I'm trying not to catastrophize. I'm trying to be practical.

Well, there you have it. There are deficits. I'm at 87% instead of 100%. I'm terrified of what going part time means, even though I think it would be better for me. Boom. Done.