Severina

Wow. You have awesome coping skills, and I can tell, a fighting personality who is determined to 'make it'. A flight nurse! the green berets of nursing. *bows in obeisance* Severina

So, can menopause make psych symptoms worse??? Great, I have that to look foward to. I'm 37 and starting to think about 'THE CHANGE'. Severina

Hang in there. Clinical instructors are notorious for making nursing students walk on egg shells, and be unnerved. They try to "weed out" those who can't take the pressure. The real world is much different. Have you thought about going into hospice? You sure do have the right philosophy and outlook. Your priorities are good. Severina

I have been a nurse for twenty years and have worked full time for both decades. I also live with DID/PTSD, dyslexia, and depression. It has not been easy by a long shot. (((can you say amen?? ))) Wow, 20 yrs! How long have you known about your DID? How have you coped with work/being a nurse as a multiple? Severina

Haa haa haa. GUMs. I love it. Severina

Yesterday, at work, I had a disturbing experience to be sure. I work afternoon shift at a hospice residence and the night before last one guy who was pre-active to active started going into some sort of terminal restlessness. But it was different than what I usually see. He was a little restless and twitching occasionally, but it really looked like he was dreaming. His eyes were darting around under his closed lids and his facial expressions were changing and making little noises. Exactly what it looks like when someone (even your dog) is in an active dream state. The next day at 3 I was back to find out that his restlessness had increased beyond all reason and no amount of sedation was touching it. We went in at shift change to clear the pain pump and I wittnessed the creepiest thing I have yet to wittness so far as a hospice nurse. Part of it was physical observation, but part of it was just a strong sense and a palpable sense of the spiritual. This guy was doing what he was doing the night before, but tenfold. He was so obviously seeing/experiencing somthing terrible, on a spiritual level. The strong thougt that I had, and which I believe, is that he was standing on the brink of hell of some sort. I don't judge my patients in terms of ultimate judgment, but it was so obvious with this patient. I am very sensitive to the supernatural around me and was overwhelmed by the oppression present in the room. It was so bad that, outside the room, where the med cart was, I had to move it down the hall, away from that room, because I couldn't concentrate. Luckily for all of us watching, he died about an hour later. But I am left wondering things like: Did he go to 'hell'? Or, was there some sort of spiritual battle that he was in for his soul? Who won? Did he do unspeakable things in his life that he was now having to face. Was he going through some sort of a 'life review' in which years of denial were stripped away and he was forced to review life in all its realities? Being a survivor of severe abuse myself where my perpetrators live lives of impunity in the here and now, will there eventually be a 'reckoning' for them, even if it comes at the brink of death? Will they be forced to recognize the lives that they tried to destroy, no longer hiding behind a cloak of denial? Brings up a lot of questions. One thing is sure, the whole building could feel the spiritual tension in the air, even people who were up front and had nothing to do with this situation. Also, though, the last few days we have had a huge die off. So I'm sure there is a lot of spirtual activity present in the atmosphere that people are able to pick up on.

That is sooooo stupid. They cannot discriminate based on MI blah blah blah. Who do they think they are kidding? All they have to do is come up with some other "legitamate" reason for letting you go and deny that it has anything to do with MI. Its as simple as that. I for one would cover my a**. Companies discriminate any way they want to in spite of the "law". You can't prove a thing. Severina

Dang! what state do you live in??!! Remind me to never move there. I live in Michigan and no one has ever inquired as to my mental health background. I think that is discriminatory. Do they inquire as to physical limitations as well? I think I would be writing to them and/or my state congress about that. Thats horrendous! :angryfire Severina

Wow. I am so touched. I don't know what else to say. I know that I disclose too much about myself to people, sometimes too soon and it has caused me lots of problems. My kid alters were forced to keep secrets for so long that when we don't tell people about us, we feel like we're hiding and sneaking. My therapist has been working with all of us on the concept of the difference between secrets and privacy. We can and should have boundaries. I have to continually tell myself/selves that we have the right to privacy and ownership of our own mind, but still I persist. However, on the other side of the coin, the healthy part of this is that I want people to know about me. I want DID to become known and as a result also the horrendous abuse that children undergo everyday cannot be denied. As long as no one knows a person who is DID, the world will continue to believe that it is rare or even non-existant. I want people to see that I am not a freak, and can live a functional, happy life. Also, by disclosing, you also meet important friends that you can support or who can support you, so that we don't have to live in isolation, feeling like freakshows. Already through this thread, I have found two. So, I will continue to work on the healthy balance between privacy and disclosure, but I will never be ashamed of who I am and will continue to educate people about trauma/dissociation, and living with any MI. I thank you for your great appreciation and encouragement. Severina

hey, i love your name. i am really into my celtic heritage and all things celtic, but thats ot. i wish i had some magic pill that would put everything together for you. unfortunately this is a process and psych meds are not perfect. all i can say is stay on your meds and get them tweaked or changed if they are not helping you to function well. also, usually meds alone don't get you very far. i can't say enough about a good psychotherapist. i have no idea about the meds in pregnancy thing. i have 3 children, but i had them before any of this stuff really took knocked me down (i was by no means healthy then, though). the best advice i can give you is that you are your own best advocate. read books, and work on things yourself. there are a lot of tools. i have a workbook that i never finished (go figure, thats a big habit for me) called the depression workbook, i think. in the hospital i did some stuff out of it and it was pretty helpful. just know that you can't push yourself too hard. get to know your body and mind and what triggers episodes for you and what gets you escalating. meds don't really work alone. it takes a lot of personal work on your part to function well with mi. i suppose its like that for any chronic illness. i love your idea of meetup. i may try to pursue that. the only thing is that it is hard for me to be part of any group, since i work the evening (3-11:30) shift. most groups meet on weeknights. severina

I didn't know they were drug testing for nursing school! geez. I wouldn't worry too much about it though. When I got my hospice job, I had to be drug tested. I didn't tell them what meds I was on, I don't think. I was taking wellbutrin, zoloft, klonapin, and zyprexa, and I never heard a thing.

I think I would get another doc if I were you. I ECT is sometimes helpful for people with intractable depression, but for bipolar people it can be dangerous. It also messes with your memory, so if you are already dissociative, it will just aggravate the condition. I would also revisit your diagnosis, specifically looking at dissosiative disorders. Many people with a dual diagnosis of PTSD/Bipolar are misdiagnosed. That was what I was diagnosed with for years. Try to find someone with experience/ knowledge in dissociative disorders, and get second and third opinions. And please, its vital that you read this book Stranger In The Mirror- The hidden epidemic of dissociative disorders, by Dr. Marlene Steinberg. http://www.strangerinthemirror.com/index.shtml It is highly readable and not dry and clinical. It was a huge eye opener for me. I checked it out from my local library. I believe everyone should read this book. Its not just about DID, but there are a whole range of disociative disorders. Its on a continuum. Please read it. Severina

Wow, thanks for all the replies. I guess there are a lot of nurses out there with these problems. It just seems that in nursing there is a lot of pressure to be "tough" and perfect. To ARPN: I admire you for pursuing this career, and funtionality and wholeness. In order to do though, you have to work hard at internal communication and cooperation. I lost a really good job in an onc/hem/BMT unit because I had recently found out about the DID and didn't know how to deal with the emerging alters. Many of them (young ones) were terrified of being in the environment and of "doing things to people". I also wasn't on the right meds, although I was in therapy. One day I was dissociated and was walking around like a zombie, being slow and my preceptor picked up on the difference with me. I tried to be vague about it, but she and other higher ups pushed me further for what was wrong. I ended up breaking down and divulging my abuse history and diagnosis to them. They gave me one week to have a psychiatrist write an official letter stating that I was safe to work there. This was impossible. I did get in to see a psychiatrist who put me on the right meds to manage my condition at the time, but it wasn't soon enough and I lost the job. After that, I hit bottom. My parts were rising up in anarchy and saying that they didn't want me to work. I thought that my career was over and all of the hard work that I had done to get my BSN and my BA were for nothing. I wound up in the psych hospital for a few days. After a while, I got a job in homecare, mostly doing private duty, and some visits. I had a lot of panic attacks and anxiety before going to a home much of the time, but I pushed through it. Slowly, through the next year, I did things one at a time. I showed myself that I could do things that I thought I couldn't. I also had a genuine disability, so I went to the Center for Independant Living where they helped me gain more confidence. Gave me job hunting and keeping skills, supported me and we tried to find options for me. There just wasn't much out there for RNs besides clinical hospital, or homecare work. I started reading books on death and dying and watching video series' etc. and felt more and more that I would be suited for that kind of work. So, in Nov. 2003, one year after my hospitalization, I took the step and applied for the job that I have now. They loved me and wanted me in right away. The HR person, said she had never seen so much enthusiasm from the nurse managers about an applicant. I was floored. So, I started and luckily was well supported in the learning of the job and got a gradual increase in patient load as I was ready. Pretty soon I was up to carrying a full load (10 pts) and handling it. I couldn't believe it. For a long time, no one knew anything about my mental illness. I wanted them to get to know me without seeing me through a filter, just seeing me as a person and my clinical skills. Of course, a couple months into it, I did encounter a highly triggery situation with a patient and had to go to someone. I took a risk and told my supervisor about my history, and she was very supportive. She has become one of my greatest advocates. Of course, during this time I was on meds for depression (wellbutrin & zoloft), anxiety (klonapin), and for switching/dissociation (zyprexa). As I became more confident of my skills and handling of the job, I realized that the zyprexa suppressing my alters was getting in the way of me making any progress in therapy and I made the decision to stop it and work on my relationship with my alter systems and to resolve the trauma. I told a couple of people at work about my PTSD/DID, which was stupid and I guess it got around the rumor mill, because now most people know. Mostly, I don't mind them knowing because as long as people like me hide in the shadows, our illness continues to be "rare" to the gen. public and the misconceptions and stereotypes get perpetuated. I want to be an example of somone with DID/MPD who can succeed and isn't a basket case. The bad thing is that there have been two really bad incidences where I have gotten triggered badly. The first involved getting yelled at and lied about by an aide, which sent me into a panic and made me switch into a little person. The DON of all people found me on the floor huddled behind the lockers. I thought that now it was all over. But, she was supportive. She encouraged me to take time to do what I needed to do to get myself together, but she also encouraged me to pick myself up and keep going. I took a while, but after a couple hours, I was better and went back and resumed my duties. I felt really supported until recently when I had another "freak out". I saw something that really triggered and terrified me on a patients TV. I left the room and totally fell apart. That time, I couldn't continue and had to go home, however, I never abandoned my patients and duties. I made sure that what was undone, got done and finished paperwork later. However, one nurse who is a drama queen and a trouble maker, went to the DON the next day and told a skewed story of what happened, making it sound much worse than it was, like I basically freaked out and walked off the job, which wasn't the case. The DON talked to me and said that if I have another episode where I cannot finish the shift, she would have to let me go. I told her what really happened, and she talked to my supervisor who corroborated my story, and she said that it made a difference. But all I heard was the threat of termination. I felt like I was under a microscope. The DON was watching everything about me, my clothes, makeup. She told my supervisor that she noticed the changes in amounts of makeup and colors etc. and wondered if that was my switching personalties. The thing is, that other than this, I have done a stellar performance in this job. I have never had a complaint from a patient or a family, in fact the opposite. Never been written up for any reason. No serious med errors. Good attendance etc. I talked to HR and told them I felt like I was discriminated against because of my disability. She talked to the DON who then talked to me and didn't know that I had been living in such fear. She said that after she heard the whole story, the matter was settled in her mind, and we both agreed that the safety and care was foremost and I promised her that whatever state I found myself in, I would make sure my patients needs were attended to. Lately, I've been going through some real rough stuff and a whole new load of trauma material is trying to surface and so I rally all of the energy I have to do the job and am pretty much a mess the rest of the time. I have missed some days because of it. So, thats basically my story surrounding my career issues. I want to encourage people not to hide in the shadows like they have some nasty secret, but to let people get to know them for who they are and see that we can be capable, sane, contributing members of society. Only then will the stigma of mental illness start to be lifted. Yes, there are risks and predjudices, but I think its worth it. We can overcome. Severina

I was just wondering if there are any other nurses who struggle with mental illness. It seems to be one disability that is met with little tolerance and support in the medical field. I do have major co-morbid mental illness, Major depression/PTSD/DID, and have had many problems in my career. I have been in therapy and on meds for a long time and have worked very hard to be functional, and I have suprised myself by what I have been able to achieve. Currently, I am a hospice nurse in a residential setting and it seems that I have found my niche. It doesn't aggravate my illness too much. I am very busy at times and most of my job revolves in much cognitive thinking and decision making about the best ways to respond to a patient's emerging or existing symptoms, and in assessing patients to see where they are in the dying process, plus lots of educating to patients and families. My extensive personal trauma background has made me able to have a different perspective on death and don't see it as the scary thing that is SO SAD, that a lot of people do. Plus, because of the things that I have been through, I am more able to be compassionate and understanding of patients and their fears. I especially do well with patients with existing mental illness or lots of anxiety. I notice that a lot of nurses have little tolerance for a patients anxiety and are not willing to take the extra time to walk them through things and provide the extra reassurance that they need. Yes, there are some nursing jobs that I don't think I would be able to do because of the fast on the spot life and death action necessary. ER and Trauma/Burn are pretty much out for me. But thats OK. A lot of nurses couldn't handle doing what I do either for their own reasons. We are all suited to certain things. Having mental illness doesn't automatically make you unsuited for the nursing profession. Even though I have heard many times, "what are you doing here?" "Shouldn't you be doing something else, less stressful?" I am here and am doing the thing I am suited for. Yes sometimes I have to take time off due to my illness, but its no different than somone who has flare ups of a chronic physical illness like lupus, chronic fatigue, or fibromyalgia. I would like to know how other nurses have coped with their own illness and their nursing careers. Severina

How do I upload my own avatar? I could only find where I could only choose between ones the site had. Severina

I don't think it works that way in nursing homes. Just at our hospice. Although, we have a few Docs who oversee things and write order etc. and we have one NP. Sometimes they do collaborate with the PCP if the family or pt wants them to. But generally, when someone comes to our residence, they are managed by our team. Its not a bad place to be by any means. People are pretty happy at Arbor Hospice and most have very good deaths. If they don't, its generally because we couldn't get on top of symptoms of some some sort. The med and procedure conflicts that I am speaking about flare up the most over our longer term patients. Plus, we nurses are powerful advocates for our patients, AND we tell the families about the things that the doc tends to D/C and encourage them to be advocates for themselves, to insist that their loved one gets the meds they need to manage their symptoms. We have our ways of getting what we need. BTW I know a lot of docs across the board are predjudiced against benzodiazapines. I myself have encountered it. I have an anxiety disorder and used to has this psychiatrist who wouldn't give me bezos of any kind. He tried to manage my anxiety with risperidol, which just made me feel like an anxious zombie. And then he tried to manage it with Clonidine of all things, which dropped my BP to 50/32. He was convinced that I would become an addict. My therapist had to have a one on one phone call to get me some ativan so that I could go to the dentist. Needless to say, I got rid of him, and now I have been managed pretty well with antidepressants and Klonapin. I take a little bit every day, and yes, I would have withdrawl if I just quit taking it, BUT that isn't the same thing as addiction. I am taking the appropriate amount of the med to manage legitamate symptoms, not for recreation. I know thats OT, but I just thought I would add that. Severina

What do you mean by PCP? When a patient comes into our facility, our medical director takes over their care. They come with a list of meds that they are on and between the Med dir. and HP, they decide which ones to keep and not or switch to same kind covered by HP. Severina

I don't know if anyone else has this problem, but I'm curious. There are certain things that come up as a source of dissagreement between the nurses and our medical director. 1. Our use of ativan standing order, or the use of ativan at all. 2. the use of foley catheters 3. Allowing patients to continue meds they have been on that have worked (usually benzos). Our medical director is one of those docs who have a lot of predjudice against the benzo family. It is true that they can cause confusion and delerium in elderly patients at times, but she tends to D/C our standing orders of this for anxiety wanting us to substitute haldol. The problem with this is that haldol is not an anti-anxiety med, but an antipsycotic. For people with true anxiety disorders, it doesn't work. Plus, ativan works marvelously when combined with roxanal for shortness of breath/resp. distress. Also, she has a problem with foleys because of the infection risk (point well taken), but she will tend to make us D/C a foley that we have put in for comfort. An example is someone who has skin breakdown or is at high risk for it, is bedbound and incontinent. She will sometimes D/C foleys on pre-active patients, and ones who have trouble getting in and out of bed due to pain or shortness of breath. The third thing is when patients come in with something like xanax, it will be the first thing to go, even if the patient has been on it for years. This leads to lots of angry patients and families. It also leads us to risking getting in trouble by going around her to get the med back, and advocating for our patients. So what if xanax has a more complicated clearing process (physiologically). This is the end of life and whatever makes the patient most comfortable should be used in our opinion. This happened this weekend where there was another, more reasonable doc on call who re-ordered xanax for a patient who had been on it for years and for whom it was the only thing she had tried which had the least S.E. and helped her rest the most. My CN also talked to the pts. DPOA who wanted us to bring it back, and everything was documented thouroughly. Now on Monday, my CN is afraid that she is going to get in trouble when the medical director comes in and finds out that the order is back in place. We shouldn't have to fear for our jobs when advocating for a patient's needs. Just a big rant, I guess, but curious to know if anyone else has the same problems. Severina :angryfire

[i work in a residential facility in Ann Arbor, MI and we hire LPN's to work here. They are allowed to do everything except IV push meds. Severina

The drug disposal thing is a weighty issue for us working in a residence/facility. This is with respect to narcs. Other meds are just logged on a sheet and sent back to pharmacy, if thats where they came from, or just disposed of, if they came from home. With narcs, the state law says that after someone dies we have to dispose of them that day. Our policy is to put them into a locked cabinet and then two nurses (the charge nurse and staff nurse) dispose of them on the midnight shift. The thing is, we have continual problems with miscommunication leading to pharmacy not getting us meds on time for when patients need them. This leads us to "borrowing", signing out meds as "wasted", from one patient for another; or, hoarding certain narcs from deceased patients that take a long time to get here, or which we are continually short. A lot of nurses have a problem with the drug disposal law because it leads to so much waste. It seems that pharmacy either sends us too little of something, or too much. It seems terrible to destroy 60 or so DRA gel packets when they have to be compounded by HP and take 2-3 days to get here. We know that we could get a new patient, or one of our patients could develop sudden intractable N/V which would be greatly helped by starting this med right away. As for standing orders, we have a whole lot of them. We have several standing orders for almost any symptom that presents itself. The ones that we institute most often are: Roxanal, compazine, ducolax suppositories, haldol, ativan (which leads to much controversy between the nurses and the medical director), atropine, scopalamine patches, Morphine inj., and procedures such as, wound care and foley catheters (also leading to controversy). Severina

Thanks for this. Great article.

Does anyone know a site where, or somewhere I can get info on the phenomena of third spacing at end of life? I looked at my nursing text and it only mentioned it once, but in connection with burns. I'm trying to understand how this happens and why, and the pathophysiology involved. Severina

We are with Hospice Pharmacia and they have 2 kits, a general comfort pack and a seizure kit. The comfort pack has the following: 6 ABHR suppositories (ativan, benadryl, haldol, reglan) 6 650mg Tylenol suppositories 15 ml Haldol liquid 2mg/ml 10 Levsin tabs 10 1mg Ativan tabs 15ml Roxanol 20mg/ml 6 10mg Compazine tabs 6 25mg Compazine suppositories Seizure Kit 5 2mg Ativan suppositories 3 Dilantin 200mg suppositories 3 Dilantin 400mg suppositories I've never really examined these kits closely since I work in the residence so this is a good exercise for me. Severina

I'm in Michigan, too. Ann Arbor. Are you nearby?

I'm glad she's feeling better. I was going to suggest either Tigan IM or we have great successs with either DRA (decadron/reglan/ativan) gel, or BDR (benadryl/decadron/reglan) gel, scheduled either q6 hrs or q 4 hrs. Also, isn't she a hospice patient? Why the concern at end of life with need of nutrition? The body naturally eshews food when it starts shutting down. Its one of the first things that happens. I find that sudden, difficult to manage symptoms, often herald the beginning of the active dying process. Just a little baffled here.