Talking Body, Part 2

I'm going to tantrum here just for a minute, or five, or maybe ten.

Pardon the occassional expletive, because I am feeling a tad pissed.

I am so not impressed Mr. Guy Sitting in the Parking Lot.

I managed to keep my cool in the parking lot, mostly, but I cried in anger and frustration on the way home. And now that I have had some time to get riled up, screw you and the high horse you rode in on.

Listen, I don't like that I have to calculate how much walking I can do in a given day.  I don't enjoy determining if my time is better used walking the shopping cart back to the place where you are supposed to deposit them or used to do the laundry or stand in the shower or some other home based activity.  I'm the kind of person who cleans up other people's trash and goes out of my way to be courteous.

You know what?  I decided to leave that cart there.  I figured it wasn't blocking any cars, it wasn't blocking a significant portion of the sidewalk and there are dozens of young men employed by the grocery store who have the unenviable job of gathing the carts up to return them to the store.

But you, Mr. Parking Lot, sitting in the car next to me mumbled loud enough for me to hear something about me not having the "courtesy" and "decency" to put the cart where it belonged.

Yep, I sure as hell look able bodied and whole.  But I am not.  I have been in daily pain for over a year and I am tired.

I don't manage my shit as well when I am tired, which is why I threw my car in park, got out and used my precious walking time to walk over to your car, where you were righteously sitting with your burning cigarrette.


"Sir," I started when you interrupted me.

"Oh you heard me, did you?" he said.

"Yes I did. I have Lyme Disease and I have severe joint pain.  I left that cart there because I can only be on my feet one hour a day."  My voice was not kind or soft.

You persisted in your quest to right the world of my wrong doing and grumbled something about "Oh, you've used up your hour have you?"

I said "Yes!"

As I turned to leave you said "Well, I will just move that cart for you."

So much kindness Mr. Judgey McJudgey Pants, I didn't hardly know what to do with myself.  So, I spit out "Thank you." Followed by "You might want to think before you judge a stranger!"

To which he replied something about me needing to stop judging strangers.  Right.  I raised my arms up in the international gesture for "What the hell is wrong with you?" and drove away.

To cry at home on my couch.  I have an unfortunate habit of crying when I am angry.

And because I don't like being limited and I don't like being sick and I don't like being unable to return to the stupid cart to the stupid place.

I really don't care about Mr. Parking Lot or his attitude, he is likely an angry man who dumps his anger out on everyone as he goes through life.  If I were to guess, I'd say his life probably sucks.  I could be wrong about that, but generally happy people don't act rude to strangers.

If I weren't so freaking tired, I'd have ignored him and gone along my merry way.  Like I said though, my shit management skills are really lacking when I get to a certain level of exhaustion.

My guess is if I had a cane or looked disabled, he would have been less likely to say anything.  But I look perfectly healthy.

But I am not perfectly healthy, I have Lyme Disease.  I have a disease that is hard to treat and can be very debilitating.  I consider myself lucky because I'm only dealing with joint pain and fatigue, rather than a myriad of problems in multiple body systems.  My husband might have the disease and so might my 9 year old daughter.  Treatment is hard and I can't imagine my little girl going through that. That really makes me want to cry.

So, I am not sitting on my couch crying because Mr. Judgey McJudgey Pants hurt my feelings but because a confrontation with a stranger in the parking lot puts a spot light on my internal struggle with my lack of capabilities. I had to talk myself into leaving that cart there.

My cats Blizzy and Ju-ju sitting on the
chair I use in the kitchen.

I'm not contributing much with household chores.  I can't garden much.  I have to sit in a chair in the kitchen when I do dishes or cook.  I mostly don't shower because it involves standing.  My husband pushed me in a wheel chair when we accompanied my daughter's class on a field trip. Then I feel guilty because I am not contributing.

For the first time in my life, I have physical limitations and it sucks. Coming to grips with my limitations is not an easy thing to do.  There are way too many instances of "I can't" when I have lived my life as an "I can" kind of girl.

So, Mr. Parking Lot, thank you for reals for providing me an opportunity to deal with my struggles.  I need to grieve these changes in my life, even if they are only temporary.   I haven't gotten it totally worked out, but I will.

And, maybe if this happens again, I will keep it together better and use it as chance to advocate for those with invisible illnesses.


You can read Talking Body, Part 1 here and Part 3 here

Talking Body, Part 1

I knew better.  I knew that it wasn't the place to build a foundation.  I endeavored to make something solid and wanted to base my sense of self on something that was going to be a steady.  Something that would be under my control.  

I knew physical beauty is fleeting and a gift given only to the young, even when I was young.  I recognized that my slender body, flat abs and glowing skin were because I won the genetic lottery, not because I was special or better than anyone else.  I resolved to grow old gracefully.  I determined I would embrace the hippie earth mother vibe fully.  No hair dye.  No Botox. No fad diets. Society's obsession with beauty, sexiness, make-overs and all the lot could go fuck itself.


I also fully embraced the idea that liking myself in a society that profited from my self-doubt was an act of rebellion against a toxic environment.  But, let's face it.  It wasn't hard for me to do that.  While I wasn't the ideal woman, you know, a leggy, busty blue-eyed blond bomb shell, I did get pretty lucky in the looks department.  

Yay me!

But knowing that even those of us who win the genetic lottery fade with time, I made efforts to ground myself in something other than my looks and body.

Fail.

Not an epic fail, but a fail none the less.

Still no hair dye and I am still embracing my wrinkles.  I still refuse to diet.

But damn it!  I am gaining weight.  And starting to wonder if maybe I should diet.  All while knowing that there is no way on God's green earth I am going to go on a diet.  I was actively starving to death during the first part of my pregnancy due to Hyperemsis Gravidarum, I am sure as hell not going to restrict food on purpose (more can be read about that here).

Exercise would be helpful but the Lyme disease is making that impossible.  Right now standing more than an hour per day creates so much pain I can't sleep, so that rules out exercise because, you know, I have to use that hour to do things like walk to the bathroom or make dinner for my family.

It has forced me to recognize that while I made a conscious effort to base my self-worth on something else, the idea that I had value because I looked good still managed to sneak in.  Lyme disease has really stripped my psyche down to it's bare bones.

So, as I am gaining weight I am struggling with my body image.  Which is dumb, because even though I am heavier than I was in my 20's and 30's, I look fine.

And as I am struggling with my body image, I am also struggling with feeling good about myself as a person. Which is also dumb because I am so much more than my body.  Or my looks.  Especially my looks.

Dumb. Dumb. Dumb. Dumb.

Now, I'm not dumb but the idea is dumb.  And it is an idea that gets pummeled at us from every freaking angle.  What I am struggling with is what millions of women have struggled with for years.  Little girls are absorbing these messages.  I recently overheard a 9 year old girl say "Yay! I am skinny." NINE YEARS OLD!  I didn't even think about my body when I was 9.  My daughter is currently 9 and I hope she doesn't think about her body except to be kind to it when it needs care.

For those of you who have struggled with body image for a long time, I am so very sorry.  It is not right and it is not fair and you are more than that.  I hesitate to even share about my recent struggles because I know it is so small in comparison to what other women have experienced.

Stupid, insidious, bull-shit messages about beauty and worth.


You can read Talking Body, Part 2 here and Part 3 here

Turning Lyme in to Lymeade

I had my finger in my ear, again.  There was a bump in my right ear that just wouldn't go away.  It had been there a few days.  My Grandma finally said to me "Why do you have your finger in your ear all the time?"

I said "There's a bump in there and I don't know what it is."

She peered into my ear and declared "It is a tick."  I promptly started crying hysterically and yelled "GET IT OUT GET IT OUT GET IT OUT!!!"  I was only 5 years old and emotional regulation wasn't so much the strong point.

I heard her sigh and say "I shouldn't have told you until I took it out."

Grandma found a hair pin and dug it out.  I'm a little fuzzy on the details on how exactly she did that.  I do recall watching the fat tick body sizzle in the frying pan, where she dropped it once it was out of my ear.  You can kill ticks three ways: pop them, burn them or drown them.  Popping them was super gross, so burning or flushing them down the toilet was the preferred method of execution.

And we carried on.  I played outside with my cousins, went to preschool, colored in my coloring books; all the normal 5 year old things.

Fast forward approximately 36 years.  I'm sitting in my doctor's office as she picks up the sheaf of papers that contained the lab results from my blood test.  I held up my hand to show crossed fingers.  She asked "Which way are you hoping for?"  I just shrugged, because really I didn't know.

My knees, wrists and lower back had been sore and aching.  I'd initially chalked up the sore knees and back to unsupportive shoes and being out of shape.  Then my wrists started to hurt. Initially the symptoms pointed towards osteoarthritis.  I'm only 41 years old, so that was tough to wrap my brain around.  What would life look like when I was 60?

X-rays confirmed that I did have some arthritis in my lower back, but nothing was found in me knees or wrists.  My pain was also not decreasing with standard arthritis treatments.  In fact, the pain was increasing to the point where I was taking 3,000 mg of Tylenol in order to sleep.  I'd had chronic fatigue since middle school, making my daily functioning a struggle.  The increased levels of fatigue were making me feel pretty desperate.

My doctor said, "I am interpreting these test results as positive for Lyme Disease."

Well, then.

My brother and I around 1986
I probably had Lyme Disease.

"What is your percent confidence that is is Lyme?" I queried, "85 or 90%?"

She nodded.  "Yeah, 90%."

Lyme is a tricky disease, it hides in the body and sometimes the immune system isn't able to detect it.  The blood tests look for antibodies known to be formed in response to the presence of the Lyme bacteria (Borrelia).  Having antibodies present means you have been exposed to the bacteria.  I had the symptoms (fatigue and joint point) and a lot of the antibodies.  I've probably had it since I was a little girl, at least 20 years but probably more.

Given some time to think about it, I am relieved.  Arthritis is a degenerative disease.  You can slow the progression but there is no cure.  With Lyme, there is a possibility of a cure.  Or at least beating the disease down to the point where I experience minimal symptoms.  

I am interested to see what life would be like without fatigue.  And I certainly could go without joint pain.  

My doctor is pretty kick ass.  And she says that I am "tough as brass," so we both expect treatment to go well.  It is a long haul, usually 6 months to 2 years, but I can do that.  Two years are going to pass no matter what, so I might as well be doing something to improve the quality of my life.  

I spent some time wondering "why me?" which is generally a path to misery, so I put the brakes on that thought process.  Really, a better question is "why not me?"  I spent every summer of my childhood in northern Minnesota.  Ticks were everywhere and I had one in my ear for days.  And that was only the first tick I remember having.  

I'm feeling a bit emotionally wobbly because this is not the first major diagnosis I've gotten in my life (you can read a bit about that here.  I promise I don't complain).  I am tad tired of constantly being handed new obstacles.  But I am a fighter and I've got plans to be doing things for another 4 or 5 decades.  

And have I mentioned that I am really, really, really grateful that I don't have arthritis? 

When life hands you Lyme, you make Lymeade.  

Here's to going forward with gratitude.  

Tattle Tail Tale

The little dog, Bella, came into my bedroom and looked at me meaningfully.  Bella is a Dachshund-terrier mix and is prone to giving me meaningful looks.  This happens frequently because it usually signals that she has to go to the bathroom.  She is a small dog with a small bladder and I spend an inordinate amount of time hanging out in the backyard waiting for her to

The look of concern:
"Why are you letting him eat my food?"

do her business.

Bella also has meaningful looks because as a terrier mix, she has ideas.  Half the time I have no idea what she is talking about.   Sometimes she is so frustrated by my idiocy that she whines and paws at me. Other than going to the bathroom, her bright ideas include charging out the door into the street, charging into the backyard to kill the chickens, charging into the room to chase the cats or charging into a litter box to have a little poop snack.  She's very confident.

I generally prefer my dogs to not have ideas.  I like sort of stupid dogs that mostly sleep or hang around looking for belly rubs.  My big dog, Kona, who is a St. Bernard is such a dog.  She has a rumbly tummy and a bit of fluff in her head like Winnie the Pooh.  (I wrote about Kona here). Her main ideas comprise of where to sleep next and looking for food.

Bella, resting after a hard charging day!

This time Bella was taking no chances.  After looking at me meaningfully, she started to walk out the room.  Then she stopped and looked over her shoulder to make sure I was following her.  She did this several times as she led me down the hall.  It was just like Lassie! Only this time I wasn't being led to little Timmy who was stuck in the well.  Nope.  This time she walked right to Kona and tattled on her.

Kona sleeping on my husband's back.

Kona, true to form, was munching on something.  Unfortunately, this something wasn't an approved dog item.  It wasn't even an unapproved human item.  As a tall dog, Kona is fond of snagging items off the kitchen counters.  She has consumed a lot of unapproved human items. We usually put stuff on top of the refrigerator but our friends and family often forget.  Kona has had way more than her fair share of pizza and breadsticks.  Kona was happily grubbing on a plastic bag!

In addition to eating as much human food as she can get her paws on, Kona will also eat anything that smells like food.  Within the first three days of adopting Kona she threw up bits of an entire leather work glove.  Evidently, this particular bag had something delicious on it.

Bella sat on her little butt until I had retrieved all the pieces of plastic bag and scolded Kona. Then she charged off into another part of the house to complete other very important terrier business.

Silver Linings

Our Tiny Dancer in person- 1 week old

Saturday, March 14, 2015 marked the eight years anniversary out of a very dark cloud. Eight years past a battle for my life. My pregnancy seemed normal enough at the beginning. A plus sign showed up in the “indicator window” of a home pregnancy test. We weren't trying for a baby and I hadn't really expected to see a plus sign. My husband Aaron, who was my boyfriend at the time, went into a daze and repeated several times “What do we do now?” He was so shocked that he tripped three times in about three minutes and cut his foot! We were pretty stunned, but our desire to have a child had been steadily increasing over the time we had been together, making the plus sign a happy sight.

In my case the nausea started at week five, around the middle of July 2006 but it seemed like normal morning sickness. We went on vacation around week seven. We cut our vacation short because I was so nauseated that I couldn't get out of bed. I attempted to go to work around week eight and didn’t make it through even one day. I was throwing up so much I couldn't drive myself home. I pulled over in a parking lot about two blocks from the office and had a friend come get me.

That was the last thing I did until October of that year. My life became nothing but nausea and vomiting. I couldn’t even hold down water. I lost over seven percent of my body weight in less than two months. I thought I might lose my baby. I thought I might die.

I think I am ready to write about it. I wrote about it while I was pregnant and then I stopped. After my daughter Aden was born, I didn't want to speak of it, write about it, think of it, or remember it. I wanted to have my baby in my arms, drink water, eat whatever I wanted and never, ever vomit again. My little girl turned eight this year. She is a beautiful, glorious girl. She is smart, sweet, athletic and the spitting image of her dad. We had a celebration with our friends and family. Aden was really excited because she had a pool party and her best friend was there. She didn't understand how much of a celebration this really was for me.

Not only was this a celebration of Aden's eight years of life, it was a celebration of living through the trauma that was my pregnancy. It was not just a celebration of creating life, it was a celebration of not dying and not losing my baby. It was a war against my body as it turned against me. Any joy and excitement was stripped, replaced with fear, nausea, vomiting, helplessness and grief. It was a daily battle to survive and grow a baby. This battle cost me 9 months of my life, $43,000 in debt, healthy teeth, the ability to eat entire categories of food, future children and a whole host of other things have been etched into myself.

It is eight years past Hyperemesis Gravidarum (HG). HG is a severe illness that strikes less than 1% of pregnant women. The Hyperemesis Education and Research Foundation describes HG as a severe form of nausea and vomiting in pregnancy. It is unrelenting, excessive pregnancy-related nausea and vomiting that prevents adequate intake of food and fluids. If this disease is severe or not sufficiently treated, it includes: loss of more than 5% of pre-pregnancy body weight, dehydration and production of ketones, malnutrition, metabolic imbalances and difficulty with daily activities. It usually resolves by the second trimester but often lasts the entire nine months. This disease received a much needed increase in awareness when Kate Middleton, Duchess of Cambridge was diagnosed. She suffered from HG during the first trimester of both her pregnancies. Thankfully her symptoms lessened during the second trimester of both pregnancies.

In the beginning, Aaron was the only light in the darkness created by HG. We had been together only a year when I got pregnant. He did the grocery shopping, cleaned the house, took care of the dog, paid the bills, took care of the details of my emergency medical leave from work, held my hair while I threw up, helped me take showers, and went to the store dozens of times a week to try to find something, anything I might hold down. He held me when I cried and cried and cried. When I joined an online support group for women with HG, I was shocked to find that many of these women were abandoned by their significant others; often emotionally and sometimes literally. I have very little memory of those first few months of my pregnancy other than unending nausea, vomiting and utter desperation. However, I did know that we would get through this dark cloud together.

Somewhere in the haze of the first trimester, when the disease was at its full power, we had an ultrasound. The doctor wanted to determine if I had a single fetus or multiples. Women carrying multiples have HG more frequently than women carrying single babies. This was not the case for me. I had one tiny baby dancing all over my womb. Aaron called it “Tiny Dancer” from then on. I hung on to the image of Tiny Dancer, because it reminded me I wasn't just sick, I was pregnant. I began to see a tiny sparkle of the silver lining.

Despite this, I felt unable to bond with my baby. My version of bonding was ensuring that I didn't die, didn't lose the baby and didn't hate the baby. It is difficult to say which of those tasks was most difficult. No baby equals no illness. Many women with HG feel resentment and anger towards the developing baby. Then they feel horrible guilt because what kind of woman hates her own child? My strategy for dealing with this was to hate my body and my malfunctioning reproductive system instead. If my daughter could have been gestated in another woman, that woman would have only a 1% chance of being sick because it is the mother's biology that causes the problem, not the fetus. It was my body that had the problem. It was my body that responded to pregnancy hormones as if they were poison. It was my body that was not suitable. This strategy allowed me to keep the feelings of anger and desperation separate from my daughter.


Medication for pregnant women is a problem. There was no medication that was known to help this disease that the doctor could say was safe for my baby. But by the end of the first trimester we were desperate. My doctor prescribed Phenergan, a medication used to treat allergies and motion sickness and stated that there probably wouldn't be any side effects that would harm the baby. However, there could be harm to the baby if I continued being dehydrated and malnourished. We decided the risk was worth it because I truly believed I might die if I continued with such severe symptoms.

Blessedly, the Phenergan eventually stopped the vomiting. The only side effect for me was incredible drowsiness. I slept so much that I lost a few months. The only thing I remember is Aaron waking me up to give me medication and spoon some food into my mouth. The nausea also lessened several weeks later but only if I took my medication exactly on time, ate only “safe” foods and didn't overexert myself. While I was not completely well, I was able to gain weight and regain some strength.

Sonogram from October

In October we had another sonogram to ensure the baby was developing normally. We received the happy news that not only did the baby look healthy, we were having a girl! The sonogram picture captured our baby girl's profile; she looked like her mama! And, I felt the baby move for the first time. There was a little bubble rolling back and forth across the inside of my abdomen. It was like a bubble of renewed hope and I caught sight of that sparkle again.

Glimpses of that sparkle is what kept me going. I carried wallet-sized pictures of the sonograms with me. I counted down pregnancy milestones such as having a “baby bump” or making it to 20 weeks. I celebrated small victories such as being able to sit outside or drink iced tea. I kept careful track of my baby's development and knew when she was getting eyelashes or developing hearing. Aaron and I became experts at manufacturing hope. I hoped that my symptoms would resolve by the end of the first trimester. When that didn't happen, I hoped that the medication would make me well again. When the medication failed to restore full functioning, I hoped what functioning I had was enough to get me through. I was simply determined to beat HG.

That was my life until my water broke around 6 am, March 14, 2007.

Had I not had HG, I might have contemplated alternative birthing options. HG removed all options, except delivering in a hospital. We thought I was strong enough to deliver without a Cesarean section, but that wasn't guaranteed. Many women with HG have C-sections due to weakness and malnourishment. I'd had 3 months to regain some strength after the worst of HG, but was by no means strong. I knew that HG would be directing my birthing experience.

Off we went, Aaron clad in his Homer Simpson pajamas. My contractions were slow to get going and after about 4 hours, we decided to administer Pitocin, a synthetic form of oxytocin used to induce labor. Then the contractions hit hard. I don't really remember much, except that all the information about handling pain I'd gotten from the child birth class was not enough to compensate for what my body had already endured. After an additional 6 hours of hard contractions, I had an epidural.

I started pushing at 11pm and I promptly vomited for the last time and cried. During the last part of my delivery, I said over and over “I am so done with this. I am so done with this. I am so done with this” as my mom, my mother-in-law and Aaron surrounded me. I was ready to have the final victory over HG and once they told me to push, I was going to push that baby out before the day was done. She was born 22 minutes later and the dark cloud we were living in disappeared.

Aden Elisabeth, born March 14, 2007 at 11:22 pm. 7 pounds, 7 ounces. 21 inches.

As I sit here writing this, I can hear the sound of my daughter laughing at silly cat videos on You Tube. Like her mama, Aden belly laughs until she can hardly breathe. When she is determined to solve a problem, she does not stop until it is done, just like her daddy. She loves hugs and hates washing her hair. She designs Lego projects in her imagination and makes them a reality. She loves science and nature.

It is hard to take a step back and see how this experience shaped me as a parent and shaped my relationship with my daughter. How much of my anxiety as a parent is because I almost wasn’t a parent? How much of my fierce protectiveness is due to the fierceness with which I fought for our lives? Are my hopes and dreams for her intensified because she is a battle hard won? I don’t have answers to these questions. What I do know is that this small girl, who was nearly the death of me, is now my life.

Watching her grow and develop into the amazing little person that she is today is a gift I didn't envision when I was fighting for our lives.

Best silver lining of my life.  

Decorating in Shades of Dirt

On two separate occasions I have gotten a brand new bathtub as part of remodeling a bathroom. In both instances, I swore that I would be diligent about scrubbing the bathtub on a regular basis to preserve its pristine whiteness.

The new tub as it was being installed

As I was scrubbing tub #2, which was installed almost 2 years ago, I had time to contemplate my cleaning abilities.  I can state unequivocally that I am incapable of keeping a bathtub in pristine condition.  I'd blame my family but honestly, I am the primary bathtub cleaner around here so this is primarily due to my slothfulness.

I  love home decorating but my house needs a special type of decorating!  Based on the color of the grime in my tub, I should probably get all my bathroom fixtures in a light grey/beige color.  Fancy-schmancy designers have taken to calling this color greige.  My family's dirt tends to be in the range of the lightest colors on these paint chips.  Not only would I be disguising our dirt, I'd also be trendy!

Popular greige options
from https://s-media-cache-ak0.pinimg.com/originals/53/f0/c6/53f0c69276f366c4b7274949743e0da3.jpg

As I continued scrubbing, I realized that making decorating choices based on the color of our dirt is an option that works well in other areas of my home.

Take the hallway for instance.  There is a St. Bernard sized patch on the wall right above the baseboard that is a warm beige versus the rest of the white walls, courtesy of my St. Bernard.  She is pained whenever we are separated by the door and makes it a habit to lie outside of whatever door I am behind.  This shade of beige would actually be quite lovely and I am thinking of having my husband repaint the hall right before we put in new flooring.

Yes, our flooring does need to be replaced.  When we moved into a house with pristine white carpeting and promptly got a St. Bernard.  Did I mention we did that in January, in the rainy Pacific Northwest?  Yeah, our carpet was toast.  We've just been waiting until it got so gross we couldn't stand it anymore.  Incidentally, that has given us enough time to save up to pay for the new flooring.  I am hoping that we will be able to do that this spring, because parts of the carpet are now approaching shades of dark greige.

I have also chosen the color of this new flooring based on our dirt.  This is more of a dark brown shade due to tracking dried pine needles and bits of mud.  I've already replaced the flooring in two bathrooms with this color scheme.  Let me just say that this does an excellent job of disguising debris.  Even the St. Bernard hair.  Her white hair is kind of translucent, so until there is so much on the floor that it starts to clump, it works excellently!

I was feeling pretty happy with my plan until I started on the bathroom ceiling.  I ran into a bit of a snag in my decorating plan to hide all traces of dirt.  The climate of the Pacific Northwest facilitates lush plant growth, including mold and mildew.  Which is why I was scrubbing the mold off of my ceiling.  In order to disguise that little problem, I'd have to paint my ceiling black.  I can't say that I would like a black ceiling.  And my husband had the nerve to point out that unchecked mold growth on ceiling might pose a health problem.

Ahh...guess I am just going to have to deal with the mess the old fashioned way.

Drowning

We got the call back in the counseling center from "up front" where social workers and other staff served homeless people walking in off the street.  They wanted an intern to deal with a "situation" that they couldn't handle.  I was the one intern without a scheduled client, so I treked to the front of the facility, a homeless shelter, medical clinic, counseling center & food service center that helped 300-500 homeless people a day.  It was a big facility and winding my way through passageways and corridors, I arrived up front about 5 minutes later.

A social worker showed me my task.  A disheveled man*, partially unclothed and damp was requesting a shower.  He was not taking no for an answer and kept entering the shower room partially clothed.  The staff was frantic because he was becoming agitated and disrupting the facility.

I was introduced to this gentleman who explained that he was an Army Ranger and he needed to "hit the showers" prior to being sent to his "next assignment."  This made it immediately clear that he was delusional.

So, I introduced myself as the Commander of the facility, or some such high ranking military official.  I can't remember exactly what but I do remember that I made sure to outrank him.  I have exactly zero military training but my step-dad is a former Marine, so I had enough to get by.  I told the pilot "Permission denied" to his request to take a shower.  I then told him to "stand down."  He went into the "parade rest" posture.  At this point, I had maxed out my military jargon and asked him his name, rank and family information.  We used this information to contact his wife.

His wife told us that he had been in the military but was discharged for mental health reasons. He had just been released from psychiatric hospitalization, which had done little to improve his psychotic episode.  She couldn't allow him back home because his illness was so severe.  She requested that we attempt to get him re-admitted to the hospital.

At the time, despite my training, I was a little surprised that his wife was not willing to do more.  Now I totally get it.  Having completed my training and worked in private practice for 11 years I get it.  I get it even more now that I have family members with severe mental illness.

We assume that when someone is psychotic or severely depressed or otherwise severely mentally ill that they enter a psychiatric hospital, receive treatment and discharged when their symptoms abate.  This is not the case.

Getting into a psychiatric facility is a crapshoot at best.  First, it is dependant on the availability of beds.  If everything is full, it doesn't matter how ill you are, you won't be admitted.  You may be shipped to another facility with space available hours from home.  Once you get there, if that facility doesn't think you meet the criteria for hospitalization, they will not admit you, leaving you stranded in a strange place with a severe mental illness. Furthermore, even if a bed is available, you have to meet stringent criteria.

The criteria are as follows: you have to be in imminent danger of harming yourself, harming others or gravely disabled.  If I have a client who tells me they plan to kill themselves immediately after their appointment, I am obligated to intervene.  My job is to get them to the hospital.  Once they are at the hospital if they then state that they are no longer suicidal they are released.  Same goes for homicidal individuals.  You'd think that being psychotic would make someone a shoe in for hospitalization, but it doesn't.  If a person with psychosis is eating and basically minding their own business they won't meet the criteria for hospitalization.

Once you are admitted, the length of your stay is often determined by insurance benefits, regardless of your symptoms.  If you have "good" insurance that will pay for you to stay as long as the hospital recommends, the hospital still has to discharge you once you no longer meet the criteria for treatment.  This may or may not involve actual improvement.  I've seen cases where the individual was discharged from a psychiatric hospitalization with negligible improvement.

All that is to say that it is very hard to get adequate treatment for the mentally ill.  This is why an actively delusional man was discharged from the hospital and sent to the homeless shelter.

This leaves family members with very little resources and few options to help their loved ones. Depending on the type and severity of the illness, family members may not be able to meaningfully intervene, such as the case with the former military man.

Having a mental illness can be like drowning.  The symptoms are overwhelming and debilitating.  People with untreated severe mental illnesses can't maintain activities of daily living, meaningful relationships or employment.  Likewise, the toll of caring for someone with a severe mental illness is akin to drowning.  Some symptoms, such as suicidality or hallucinations are terrifying, sometimes even to trained professionals.  Other symptoms such as tangential and confused speech that can accompany manic episodes or Schizophrenia are exhausting.  It is overwhelming and very common to feel completely helpless.  It is common to have no options available help your loved one.

It may seem cruel but as with drowning, you can't go down with the victim.  You do all you can to help get the victim to shore so long as you are not in danger of drowning as well.  If you are strong swimmer, you can attempt to tow them to shore.  If not, then you throw a life preserver or stretch your hand out from solid ground or find some other option that does not also endanger yourself.

The lines are less clear cut when we are attempting to save someone from "drowning" in a mental illness.  Sometimes they don't even know that they are in need of rescue.  At what point in attempting to provide care do you determine that you are "drowning" as well?  I think that answer is different for each person.  It depends on each person's resources, psychological functioning and daily stresses.  However, if you are not able to provide your own self-care or you are working harder than the individual with a mental illness chances are good that you are going under. Checking with a therapist or another trained professional can help you determine what when you are not swimming well.  Therapy can also help you learn how to set boundaries, learn new coping strategies and handle stressful situations better.

Because when you are drowning you cannot rescue another drowning person no matter how much you want to or how much you love them.


*As always, I do not disclose identifying information or any information that could reasonably lead to identification of any individual.  Any examples of specific individuals are fictional compilations.