It's been a hot while since I've posted, but I've been busy with lots of hospital stays, lots of days studying, lots of days struggling and lots of days of doing relatively well.
Here are some achievements that I am proud of:
ā¢ I am currently 58 days self-harm free.
ā¢ I made it through an entire group program (8 weeks) at the clinic.
ā¢ I finished my Masters' degree with a great GPA.
ā¢ I am taking steps towards publishing my thesis looking at BPD from an insiders' perspective.
ā¢ I made realistic goals for next year and I am future focused as much as I can be whilst still suffering from intense suicidal ideation.
ā¢ I paired up with my new Assistance Dog and we passed all our training making us an official team.
ā¢ I APPLIED FOR NEW JOBS. I doubt very much I will get them but I put myself out there and attempted something very scary.
ā¢ I connected with people.
ā¢ I finished the theory for my Cert IV in Mental Health Peer Support Work.
ā¢ I explored my creativity.
I know they are somewhat boring. I know that in the grand scheme of things that I'm still struggling and my team are very worried about me. But I'm making steps towards returning to nursing, whatever that looks like for me now, and I hope I can continue to educate others on the reality of Borderline Personality Disorders and comorbid mental health conditions.
*Today* I got told that I needed toĀ āradically acceptā my trauma. As most people with BPD know this is a DBT (Dialectical Behavioural Therapy) term that is used to describe a skill used to recognise reality, to prevent pain from turning into suffering, stop responding with destructive behaviour or poor emotion regulation skills.Ā
I am one of DBTās biggest fans, and believe in using this skill. It works well. I use it daily when things are out of my control. Someone comments on my scars? I canāt change that it occurred. Radically accept and move on. I donāt need to waste my time and energy ruminating about it. Someone side-swipes my car? Again, I canāt change it, I canāt undo that it happened. Radically accept it and move on. There are many things that I am able to or am willing to, or try to, accept.
I donāt think Iām at a point where I can accept my trauma <yet>. Iām still processing it. I am still exploring the ugly reality that I am just starting to face now that we have prised the edges out from the corners and laid it all out to see. I donāt accept that it happened. I donāt want to. I still want to defy it and deny it, to fight it vicariously and viciously. Itās made me feel violated and I need to sit with that and explore that and challenge it before I can radically accept the entirety of what happened to me.
Borderline personality disorder is hard. Itās supposed to be the most difficult mental illness to live with (Google itā¦) though Iām not sure who gets to decide the list to be completelyĀ honest (and fair?).Ā I had BPD long before I was a nurse but only recently has it actually impacted on my work. Not as a risk to my patients rather that some maladaptive behaviours were noticed and I was subject to conditions on my registration because I posed a risk to myself. Itās been a hard year and itās only set to get harder as I fight to maintain my employment and get back to doing what I love doing.Ā
I thought that when I became a nurse (walked across that stage to be specific) that I would be instantly cured of my mental health diagnosesā¦ that because I was anĀ āeducated health practitionerā that I wouldnāt be subject to the same torture as everyone else with BPD has and will experience. Needless to say it doesnāt work like that and while I was initially quite annoyed that this wasnāt the case I began to recognise the value of my history and perseverance in helping others. I began to share my story (with care and remaining mindful of my audience) with my patients and their families and found that this had a favourable impact with 99.9% of patients thanking me for allowing them to be both hopeful and realistic with their expectations about their lives, BPD and dreams.Ā
So why werenāt my superiors so happy to see the effect that this had on my patients (I use this word repeatedly instead of consumer as patient is more widely recognised as the language in which health practitioners are familiar with, though we should actively be moving towards the titleĀ āconsumerā - more about that in another post!)? Was it because I was exposing myself? Leaving the health service more vulnerable? No-one ever told me what I had doneĀ āwrongā - just that I was.Ā
Nurses are in the best position to have a significant impact on the lives of consumers with BPD. Similarly those with lived experience, when they are well enough (and only they themselves can judge that, believe meā¦) have a huge role in the part of recovery of othersā. So lets let the two intersect and have nurses with Borderline Personality Disorder be actively supported and encouraged to share their stories and to contribute to the medical profession. To not immediately place restrictions on registration or to encourage nurses (or any medical practitioner) to terminate andĀ āgive upā on their dreams and hope because BPD is a lifelong sentence. Letās celebrate the value of lived experience and what it can offer consumers of all health services.Ā
Iāve got lived experience, so now Iām laughed at.
I have sprouted the benefits of lived experience in previous posts and I still believe in itās benefits in the clinical care of mental health consumers and medical patients. This fact is irrefutable and there are hundreds of articles that I could choose from to support this. Personally, I have seen it make a difference in my own practice, and have been assisted by it in my own dark times.
But what happens when that lived experience is too much for your colleagues? Too inexcusable, too confrontational, too difficult to understand. I came across this amazing articleĀ during my current research for a publication and it hit me as so real and so similar to my own experiences that I found it necessary to write about it.
The nature of mental illness (even when in a good place) is the vulnerability it places people in. Add to this the stigma associated with mental health conditions and the misunderstandings especially regarding clinicians who have been brave enough to share their own stories, and the represents a significantly vulnerable population group that are particularly susceptible to workplace bullying and harassment.
I work(ed) in a high risk, high stress environment.Ā
As I got used to the processes, the patients, the procedures, I started to relax. I began sharing bits about myself, my journey, what lead me into nursing. Normal things that are regularly discussed but my story happened to include a 6 month hospitalisation for my mental health.
The workplace bullying started. At first it was joking that made me feel uncomfortable but I tried to take it good-naturedly. Then I had comments made about my medication use and accusations made that I was stealing medications, that I was advocating for patients rightsā to the point where they suggested I was giving our patientsĀ āpermissionā to self harm. I thought this was as bad as it was going to get.
We treated a particularly significant self-harm incident. Iām talking trauma response, pushing fluids, major haemorhhage and the potential for this patient to die in front of us. Luckily he survived and soon came back to us albeit directly to the mental health portion of our facility.Ā
Because of the nature of our work, incidents are always photographed. They normally get loaded directly on the database that the nurses donāt use and we never see them. Instead, they got emailed directly to me, with the comment that I would use it asĀ āinspiration.ā 14 days later I was directed to remove his 207 sutures. By this time I had formed a good therapeutic relationship with him and had no trouble with this but you can see the potential difficulties that some nurses may face with this task. I left work. Iām still not back at work because of what they did. I donāt think Iāll ever go back to that role, despite absolutely adoring the work and the patients. Itās a shame, because such amazing clinicians turned out to be the nastiest, vindictive people.
Letās eliminate bullying. In every sense. But especially so in people that have been brave enough to show their scars, either literally or metaophorically. There is so, so much research on the validity and benefit of lived experience in the lives of those undertaking their own recovery journey. So donāt discount my experiences, donāt discount my story. Recognise my unique contribution to the team and allow me to assist you and myself to involve my lived experience in the work you are already doing. I want to help, so please treat me with the respect I deserve.Ā
This is absolutely notĀ āunarchived.ā This is real, current, raw and killing me.
I did something Iām not proud of. It had been a long time coming, planned yet impulsive. Iām not here to trigger anyone or to incite a competition so I wonāt go into specifics except to say that I hid it for days. I had almost forgotten about it until the complications got so massive that I unintentionally revealed it to someone I really trusted. Who had -has- an obligation to share it and to get meĀ āhelp.ā I didnāt resist. I was in pain. Excruciating pain.
Surgery was required.Ā
They didnāt give me any analgesia.
I know Iāve posted a lot about analgesia but itās a REAL thing that it is withheld from patients with a perceived mental health diagnosis and especially so in the case where they have intentionally caused themselves harm. But in many cases this self-injury was never meant to cause the person pain, but for a variety of other reasons. If you would offer someone with a laceration pain relief, then OFFER THE SAME THING to a person with the same *self-inflicted* injury.
I am furious.Ā
Not just for me, Iāll be fine. But I am so angry for all the people who are going through this that might think itās normal or okay. It definitely shouldnāt be. Clinicians have a duty of care to listen to patients and to respect their choices and wishes. READ: they do not have an obligation to offer pain relief. But they are obligated to treat each patient with the same dignity that they deserve.Ā
PLEASE current med school students, current nursing students, NURSE AND DOCTORS - recognise when your patients are in distress. Advocate for them. Please. I have been in excruciating pain for days now and have been too scared to ask for help because in my head IĀ ādeserveā it. I donāt deserve it. No-one deserves that.
Learning about self-harm as a student in 2015. This is the ONLY slide that attempted to explain self harm. This was the absolutely sole piece of information that informed 300+ nursing students about the subject at all. And we wonder why clinicians are misinformed and donāt afford consumers with the decency and respect they deserve.
(this was written in 2017, but I decided to hit the post button because itās still relevant and I want people to know itās still happening and itās not okay).
Anaesthetic and analgesia.
Apart from being pretty complicated words to say really fast they are also a primary part of emergency medicine. Whether the form or administration differs, the fact remains that doctors and nurses should remain current on what is best practice. The majority of the time, that means offering and/or ordering pain relief for people presenting with traumatic injuries, even if they appear minor. Simple pain relief should be used as a first option (think paracetamol, ibuprofen and/or aspirin dependent on contraindications) before other options like opioids are considered. Traumatic injuries, especially when being manipulated or treated in particularly painful ways, should be handled with care and efforts made as to the anaesthetic of the local area where possible.
Today, I was offered neither and I was too scared to ask.
I presented to ED, and was asked to wait, which I understood. While my wound was actively bleeding, there wasnāt any major haemorrhage and I knew I could tolerate a small period without treatment. Then I asked for some Panadol, which was met with scoffs. Eventually, once I had bled through my bandages on onto my (new) shirt, I was called through.Ā
It was a fight to get sutures at all. Iām not overly concerned about scars (maybe I should be?) but I seek wound closure for infection control purposes, especially given my profession. But then he picked up his forceps and needle holder and drove that needle and thread into my arm and tugged until the edges came together.Ā āYou forgot the local!ā said the young (grad?) nurse with him.Ā
āI didnāt forget.ā
fuck you.
I am human. I deserve adequate analgesia and anaesthetic even when I self-harm. Donāt deny me my basic medical rights just because you donāt agree with my form of emotion regulation.Ā
Trauma, from... trauma? Causing your own trauma/you did this to yourself (trigger warning)
I felt compelled to write this as I came across a photograph of myself this time last year. Nasogastric tube in situ, oxygen, heavily bandaged arms, jugular venous catheterisation, cardiac monitoring leads, various pumps and bags of fluids, a urinary catheter sneaking out the bottom of my bed (glamorous, I never claimed to be). Iām pretty sure I was also in soft restraints, though my hands are buried under multiple blankets. Hospitals are always cold.
Immediate flashbacks.Ā
I donāt remember the events leading up to it so much. Somehow theyāve faded away. I donāt know what that says about me, or the attempt, or any of it really.
I remember the in and out feeling. Initially gagging on the oropharyngeal airway, then the nasopharyngeal tube scraping along the insides of my nose. Hearing the squeezing of the bag valve mask. Being dragged out of the bathroom. Suddenly Iām in the ambulance. How did I get here? Yelling. Sirens. More yelling. Quiet. Quiet. Quiet.
you did this to yourself.
Iām in ED. How did I get here? Theyāre yelling about something, again. Someone says something about starting a clock. Of calling TEMSU. Thatās not good. Thereās a noise, and then thereās unbearable pain. In my leg. I didnāt do anything to my leg? I try to scream. Then, āWE HAVE A PAIN RESPONSE.ā Then the most intense pressure I have ever felt through my entire leg. I didnāt know it at the time, but that was an intraosseous push. Then the ketamine hits. Iām spiralling, under, spiralling, under and under. Then nothing. I donāt remember the feeling of nothing.
you did this to yourself.
I do remember the feeling of waking up. Of feeling that tube down my throat, trying to pull it out and realising my arms were tied to the bed. Feeling like I was drowning. The nurse telling me to relax, that they were bringing me out of sedation. Drowning.
you did this to yourself.
It had been five days since that first ambulance trip and when I was brought out of sedation. Five days, a helicopter trip and emergency surgery. I was desperate to get to the toilet, but they told me I would need to wait for a physio review before I would be able to walk. I tried anyway. I failed. I waited for physio. I learnt how to force my fucking legs to walk when they didnāt want to. I used up energy brushing my teeth. My GP visited me, when my family didnāt. Eventually, I was able to stand up long enough that they discharged me back home, which was a 90 minute bus drive away.
you did this to yourself.
I got hospital-acquired pneumonia after that admission and was re-admitted two days later for a week, at the start of the COVID pandemic. Because of my āflu-likeā symptoms, I was in isolation for the week while we waited for results. Again, once I had finished my IV antibiotics, they discharge me home.
you did this to yourself.
I broke down crying at an ambulance siren the other day. I was shaking and gasping for air, sitting on the ground outside the Emergency Department. Being a nurse, and being afraid of ambulances, is not great. The hospital environment itself is traumatic. It puts me back there every single day. But I have to remember my purpose. Iām here to help. Here to help others and to help myself. So I persist.
i did this to myself.
There is evidence that oneās own self-harm and suicide attempts can cause trauma responses after the harm has occurred and beenĀ āresolved.ā ThisĀ article discusses it at length. Medical trauma is a relatively recent term that encompasses the long-lasting effects of treatment, procedures etc. ThisĀ explains it much better than I can. There is a need for PTSD as a result of (in addition to a cause for in some instances) suicide attempts and/or non-suicidal self-harm to be recognised as a legitimate disorder and for health practitioners to be aware of the implications of this for treating patients both in a pre-hospital and hospital environment.
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