I am apprehensive about being assigned a case manager. My instinct is to treat it like a punishment and recoil with a hiss. I’m so rational. But I can instead choose to find gratitude. This is an Opportunity. And since I am frantically thinking about this process instead of winding down for sleep, I will record my thoughts. Maybe parts of this will be useful to recycle for emails with new person.

Dear So And So (because)

Hello! I am excited for this chance to work with you. I do hope you are a person who likes puzzles because I’m kind of a challenge. As I’m sure you know, mental and physical health are intrinsically linked. All of the work of treating my physical health is held up by the work of treating my mental health. Before I get into either my physical or my mental health issues (don’t worry–I’ll get there) I feel it is important to introduce myself a little.

I like to set people up for success. I am quirky and it is hard to guess what things I am particular about and thus I volunteer more information than perhaps people might want to hear. I’m usually good at hearing boundaries like “I’ve heard enough on this topic, thanks” but unfortunately as a medical provider that is sticky. If you don’t let me finish on a topic (yes, it is annoying that I’m long-winded) you may not get all the necessary details. Sometimes they are at the end of a long schpeal.

I take a lot of patience to deal with. I am mercurial and moody and because you will almost entirely be dealing with me in a hospital setting I will frequently appear very angry. Unless we have just had a specific negative interaction the anger isn’t about you. I have a long and storied history with medical treatment. My family has had a lot of medical issues and I have spent many years of my life unhappily in hospitals. I am also in a lot of pain and very frustrated. I’m not angry because of you. I am angry when I’m in hospitals. I chose home birth partially for this reason. It was easier to change the setting than my attitude.

I know that this anger makes it hard for doctors to talk to me. I try to manage my feelings. I try to monitor my tone of voice and my words but they get away from me. I am suppressing a lot. I promise. This complicates health care a great deal.

As a case manager it is useful for you to know that I have a major chip on my shoulder about “people in authority” not caring about me. I fell through every crack in the system when I was a child. I had a horrifying life and no one helped and I’m bitter. I’m sorry that this will mean that I don’t give you as much patience as you deserve at first. It is very hard for me to build trust. If you are interested in the Readers Digest version of my list of traumas I can send you the one page sheet I give to new therapists. Approximately one sentence describing the major traumas that happened every year from two through twenty-five.  I don’t need to get into it here.

Working with systems is very hard for me. I have not traditionally been very successful in them. I have complex, unusual needs and it is very hard for me to get the awkward help I need. I look so very functional and mental illness is funny and invisible and so hard to treat.

I am particular about being both highly rigid and accommodating. What I mean by that (I’ll take punctuality as one example but there are many) is I can be very rigid about what I hear. “I’ll call you tomorrow” that doesn’t result in a phone call feels like a deliberate slight. A stab in the back. A betrayal. (I am… somewhat prone to the dramatic. Better to warn you.) However if you know that you are someone who is often running late you can say to me, “Hey! We have an appointment at x’o’clock. I frequently run up to an hour late. That is the reality of the kind of job I have. Bring a book and prepare to enjoy your lovely down time in the waiting room.” I will nod and say: “Cool.” And it will be totally ok. Even though usually I get kind of nutty when people are more than about twenty minutes late. If you set my expectations appropriately I am easily managed.

Really that is the key to successfully working with me. Set my expectations appropriately and I will think you are better than cheese on toast. Which sounds really good now that a doctor told me to cut gluten and dairy for a minimum of three months. Fuck. Fuck. Fuck. Fuck. (Obviously I will be editing before I send to a real professional. I’m crazy but I’m not that crazy.)

Physical health (in no particular order):

• digestion problems
• joint pain that has been sporadic, perhaps linked to PMDD/period?
• headaches
• nutrition support–this is *not* something where a generic group class would be even vaguely appropriate. I need someone to work with me on my food issues and they are weird.

Mostly (As my blood work and other work ups will tell you) I’m healthy. But I’m in pain. Pain that is sometimes severe enough to make it hard for me to engage in my normal life. Why?

Then of course we get into the layered mental health. Also in no particular order:

• I have PTSD
• I have GAD
• I have been diagnosed with depression at various points. It is not a label my current therapist feels is an over riding feature of my presentation so I’m including it partially for background notes.
• I have been diagnosed as bipolar, but this is again disputed. Some doctors claim my issues are all chemical. Some doctors look at the calendar and notice Hey! Every freak out is timed right next to a major trauma anniversary! 
• I deal with suicidal ideation. NOTE: I SAID IDEATION. I DID NOT SAY I AM CURRENTLY SUICIDAL AND FOR THE LOVE OF CHRISTMAS DO NOT FREAK OUT. Sorry for the shouting. Man this is a hard one to deal with. It is hard being me. People who say, “Suicide is a permanent solution to a temporary problem” can spend a decade or so in my life before they speak. My problems aren’t temporary. My problems are big and ongoing.
• That said! I am completely aware that I am living in the golden era of my life. I am more loved now than I have ever been or than I will be in the future. My kids will never like me this much again. Ha. Mental illness doesn’t care that my life is kind of awesome right now. It just tells me that I should be sad and scared and I should die because I am bad.
• I have a therapist. She is an incest specialist. She is totally happy to talk to you about my treatment if you are interested in her contact information. I hunt high and low for therapists. I need people who are used to dealing with some of my specific brand of broken.
• I am not particularly interested in trying psych medications at this time. I have tried in the past with great ill effects and little to no positive effect. I have a delicate balance in my life. I am not going to upset the cart to make Kaiser feel better about getting me on drugs. Thanks!
• I have a medical marijuana card. I recognize that Kaiser doesn’t do that sort of thing. Whatever. That’s fine. Could you please at least be polite about the fact that I started using pot when I was 27 and using it for medical reasons? I mean, if I had started self-medicating at 16 you should still be polite to me but I tried all of the meds you want to offer me first (and all of the other doctors at Kaiser should be polite too… and they aren’t..). I’m going to yank out a big fat-ass was of privilege mother-fucker. (Yes I will edit.)
• Even if there is “Some New Med” I’m kind of done. My body doesn’t like new hormones, thanks.

Leading me into: can I please, please, pretty please work with a nutritionist who cares about holistic health? Do such people work at Kaiser?

I understand that “gut health is the key to mental health” and I’m aware that seratonin is produced in the gut and it is common to get depressed when you have diarrhea (which I’ve had for most of my life) when your seratonin is flushed out of your body without being absorbed. Awesome, possum.

Ok. I’m starting to nod off.