"Triaging you mental health? That sounds really useful; I'd love to know more about this process if you're willing to share!"

tri·age

I are fucked up. If you want to know why, now there is a book!  I'm pretty excited about that. The whole being able to post a link thing. Anyway.

Ok, not all of my fucked up is in the book. I have other stuff too. Lots of stuff. Sometimes I feel like I am drowning.

I'm not very good at talking to doctors. I have had a very high number of extremely negative experience with doctors. When you're starting off by being institutionalized and strapped to a table it's hard to not go downhill.  I went to a gynecologist once, asking her about extreme pain in my vagina and lack of libido. She told me to just think of something else because it didn't matter how it felt to me I was only doing it for the man anyway, right? I have had doctors refuse to treat my stomach until I get on psych medication. I have a lot of stories. I don't like doctors.

 Sometimes whether I like it or not I need help with my body. I try to get by without seeing doctors but there are things that I need them in order to accomplish. I want my arms to stop hurting. I understand that this is self-imposed damage; the problem is I really don't understand how to undo it or how to stop doing more. I require help. I need to sleep; without sleep my crazy is totally unmanageable. I've been having pain in my abdomen since Calli was born. the problem is that as more of a phantom pain. It will be hard to figure out what's going on there. It will take somebody trusting that I understand why this feels weird for my body; finding a doctor who will respect what I have to say about my body has been a pretty impossible task so far in life. I have been getting terrible headaches for a long while. I knew my vision had degraded. My eyes are working too hard. I have a lot of ambient stress in my life. I've had some really nasty bacterial infections that only got treatment because friends came to my house and dragged me to the ER. I don't seek medical care unless I feel like have no choice. Usually because I think there is a chance of something killing me or a bone is broken. 

When I decide to take the step of involving a doctor it's a big one. I need people to pressure me to go. I spend my life with the default expectation that I should be in pain. That is just life. I have been depressed for most of my life. It just makes everything hurt more. Keeping going when it hurts that bad feeds my masochism. Of course it is supposed to be this hard for me I'm a fucking loser.

Somehow I always keep walking. I get slower. I drop balls. I bring my focus of life in closer and exclude more and more people. But I always get up every day and am productive. 

So if I want to make a change in my body that is not about immediate death or injury or bleeding… it's kind of complicated The very action of scheduling an appointment and then knowing it is coming up aises my stress level throughout every level of my life. Everything is harder when I have the horrifying impending visit with yet another person who may dismiss me and refuse to help me because I am a fucking loser who doesn't deserve help. I dont really need more confirmation of how unworthy I am.

My abdominal pain is going to be hard to track down. It could be. I don't know. I thought about scripts of how to introduce the problem and I couldn't figure out how to word it for a stranger I don't trust. I can explain it to someone I trust. I can't say it to someone who is going to be nasty to me. I jus can't.

Walking in and saying, "I'm a writer. I hurt my arms." is one of those things wher they just believe you and then start treating you as a writer who is someone of status. quot;Oh what do you write? Do you write professionally?" 

A murky conversation revealed that getting paid for writing does make you a writer. I'm just starting in the transition after being a teacher and now I am a stay at home mom so things aren't instant. I told him I was just a blogger. He corrected me and said I published a book–which people bought thus I am a professional writer.

I like the doctor. 

When I say I need to triage I mean I need to rehearse and rehearse and rehearse scripts in my head for how I will present data to a doctor in order to get what I want. If I can't come up with a good script I just can't visit that issue on a given day. I just can't. I have to perfect the script or I can't talk about it. So I try on a whole bunch of different ways of presenting information.

This time I focused on what would bring me the most instant benefit and the easiest available scripts for building trust. My abdomen is hard for me to talk about. I'm very serious about wanting to not damage my arms. I will gosh darn be proactive about that. I have friends who are in really bad places. I'm scared. Obviously there is information I need to learn in order to not seriously hurt myself. Ok. I can take that seriously.

And I feel like I have taken too much over the counter sleep aid in my lifetime. I need to stop. So I rehearsed how I wanted this problem approached.

I am not a long term insomniac. Since having children I have become an early waker. I'm aware that is a common depression symptom. I deal with atypical depression. Medicating it in the standard ways do not work. I have PTSD. It causes a lot of problems for me but they tend to happen around anniversaries and milestones and holidays. In the scheme of my life they are kind of brief. 

My problem is when I get one night of sleep disruption it starts a cycle. If I let it go I can end up being seriously sleep deprived and it can go on and on for weeks. I've been using the over the counter stuff to stop it at about a week. I want to change my approach.

I asked for something that would be safe to take every three or so days if needed. In general I hope I won't be taking it that often. I will be taking it as soon as I get home from therapy on Tuesdays because that night of lost sleep is a particularly rough one. I slept about six hours last night with .5 mg of Lorazepam. Usually Tuesdays are nights when I get two or three hours of sleep. That's a big step in the right direction. I can't take the over the counter stuff in the same way because I am too groggy the day after. I get home too late at night and I would spend all of Wednesday a zombie; I have to take over the counter stuff by 8pm or it is just a bad plan. I don't get that with the Lorazepam. I have used it in the past for anxiety. I am far less groggy than with over the counter meds.

So the triage process was realizing that I really need to treat my stomach issues, but that will require trust. So I need to go build a relationship. Which means I need to be honest about some of my other sub optimal body issues and kind of pick from the list. My arms aren't something that I experience shame talking about. It's a common, straight forward issue. I knew I could start there and have that be probably taken well.

I was scared about sleep. I probably wouldn't have brought it up only I know I have to stop taking so many over the counter sleep aids. I'm going to die in a car accident driving the next day. Seriously. They just aren't great for my body.

I have to have sleep or I can't manage the stress of my life. Right now my life isn't very stressful. I have a pretty easy life all things considered. But I still can't function without sleep. Sometimes I can't get myself to sleep. I understand my cycles. I've been living in them a long time. I've done hundreds, maybe thousands of hours of reading about my set of issues. I understand how my atypical depression/anxiety/ptsd bounce around. I can describe the process. I can point at dates on the calendar when I will have bad spells. Inevitable as the sun rising.

Figuring out how to explain it was hard. I worked on that script really hard. I am so ridiculously grateful it went well. 

I expected him to send me home with 5-10 pills and instructions to email him and ask for a refill. Instead he gave me 30 pills with three refills. I feel kind of overwhelmed because he asked me point blank questions and I told him that I overdosed on sleeping pills as a teenager so pills are kind of weird for me. I can't swallow larger ones very well–I have a really overactive gag reflex. I don't take pain meds like ibuprofen because I can't deal with swallowing the pills. I barely manage sleeping pills. Those suckers are blessedly tiny. And half a Lorazepam I can't even feel. It's great. 

I will be able to make an appointment to talk about my abdomen. And I'll find other things. But I'm going to wait until after the glasses arrive because I want to see how much difference in general pain the headaches are. I feel like right now I don't have a concise and clear enough case. I will. I'm working on it. I will go to PT and talk about posture and all kinds of aches and pains and ask for advice. I'm going to bloody well take advantage of having this access. I'll be user. Then I will ask for help with my abdomen.

That is what I can handle dealing with right now. If I try to do this faster than I am ready for then I will experience a general uptick in anger and frustration and I will take it out on my kids. That's not acceptable. It is not acceptable to raise my stress level beyond what I can handle while being nice to my kids. That's the line. 

The triage process is slowly increasing how much I think about a given problem until I figure out how to solve it while carefully watching how I behave with the kids. If I start slipping I know I need to distract myself and stop trying to solve the problem for a while.

I need to settle in to this level of progress. Find out what it feels like. See what it does for me. Then think about more change.

Baby steps.