Today something happened to me that never happened before.

I got reprimanded at work.

I apologize for the quality of this post ahead…I’m too tired and my brain is too fried to write well. Here’s what happened.

The last few weeks went surprisingly smoothly, the anger was under control, I was performing ok, and things seemed to be moving along reasonably considering being off all meds. My mental well-being surprised even me.

I think if not for two things, I would have been ok.

One was menstruation, which always fucks me up, and the other was another marathon of on-call nights and sleep deprivation.

It started last Wednesday around 1 AM, I started to lose patience, a hand laceration came in to the ER. I didn’t feel comfortable closing it, so I wanted the plastic surgeon or ortho on call to do it. They refused…and I started to blow. I was exhausted and overwhelmed. I did not want to cause permanent nerve damage to anyone’s hand. After being so proud at how I’d held together so well, I lost it again, had a hissy fit of misery about how I hate my job. Mature, I know. I wish I could take it back. But I just snapped.

(I also ended up suturing the hand. I’m sure that after my vocal refusal and claimed lack of know-how, the patient was thrilled to receive me as his doctor.)

I was so tired, and on top of everything, the attending was jerking me around, making me see every patient (while she is paid ten times what I am paid to be there, and it is part of her job to see patients, she isn’t there as a preceptor or consultant, she’s the main doctor on call) – actually running over me about every decision I made, then going and re-seeing every patient I saw. I couldn’t figure out why she was riding me so hard. I wondered if I had recently made a mistake she had to cop to or something.

For example – a 22 year old healthy guy comes back from a long, exhausting trip with mild diarrhea as chief complaint, and, as it turns out, upper respiratory symptoms. (Why he was in the emergency room in the middle of the night, god only knows…) So I write a quick discharge: Diarrhea – Presumed Infectious/URTI. She goes in there, makes this huge deal about how it is URTI with diarrhea, tears up my whole discharge letter because I wrote it as a “diarrhea” letter, including suggesting giardia check & stool culture if it continues (he had camped and drank from streams). I got a huge lecture on how the diarrhea is part of his respiratory infection, how I went way too far…yet on a similar patient, I got also yelled at earlier for not writing a referral to a GI to rule out IBD if symptoms continue. She was just being nasty, and I didn’t know why. On one hand I got knocked for being too thorough, on the other for not being thorough enough.

This weekend I started to sink into the same old depression. I did some meditating and other things, which helped (didn’t run, though) but it hit hard this morning with a busy ER. She kept doing the same shit. Asked me to present at the level of a med student, checked everything I did. Also, though there were three of us, she sent me all the patients, including orthopedics and urology ones, who are supposed to be covered during the day by ortho and uro. She made me see them just for the sake of making me do it. Then she would return their file to the ortho/uro stacks, meaning that they would be seen by ortho and uro, that my work would be useless.

I admit, I was doing a shitty job. I didn’t miss anything big, but my brain is so slow, I just can’t think quickly like you have to in the ER, didn’t delve into anything that wouldn’t have a direct effect on treatment plan. Presented sloppily – while in my head I had a clear picture, I was scattershot about presenting. I felt so overwhelmed.

I almost got to tears, even while dealing with patients I was trying hard not to tear up; I was already teary from the damn depression. I slipped out at noon or so and called the shrink, told him I wasn’t doing very well, asked what to do. He told me to take some benzo, and I said I didn’t need anything that would slow me down even more. I asked if I should start the bupropion again or what, and he sort of got impatient.

“You’re a big girl, you’re a doctor, you do what you want, you don’t need me to start it again. I can’t deal with this on the phone.” I really am not sure where the hostility came from, except I’m getting it on so many fronts that I know that I must be provoking it.

I just wish he could have been nicer. He’s sick of me too.

I also thought: Now I’m the kind of patient that they don’t even try to limit the benzos for anymore. Take as many as you want, just shut the fuck up.

Then I went in and one of the nice nurses who is my age saw I was falling apart and gave me a hug, said it’s a hard place to work, that that attending can be a bitch to work with, everyone knows (I actually get along with her usually, and I like her). Usual girlfriendy type stuff. I was immensely grateful.

Well, the doc saw this and dragged me off into a corner (in front of other people), and started in about how she’s torturing me for a reason, that I’m lazy and just because I’m smart that doesn’t mean I can be lazy and have such a bad attitude and do a shitty job and the whole reason she’s treating me like that is that I brought it all on myself. How everyone has days they don’t feel like working and they don’t get like me.

This went on for about five minutes. In front of multiple docs. Pointing out many of my failings, personal and professional, number one among them being my laziness.

Ironically, she also said, “I just don’t get it – sometimes you have these periods when you’re so ON, do everything beautifully, you’re unstoppable. And then sometimes you just don’t care and everything you do is shit.” My heart stopped, for one heartbeat I thought she was going to accuse me, then and there, in front of everyone, of being manic-depressive. But she didn’t. She just went on shitting on me.

And get this: I didn’t even care, really. I think that’s a pretty good sign of how depressed I am. Usually something like that would send me into a shame spiral. Now, I’m too far gone to get upset. It’s not like I need any more people telling me how wonderful I used to be, how shitty I am now. I’m living it.

As it went, I just mouthed off back, agreed in that sarcastic way I always did as a kid when I got in trouble, the one that makes them just want to pound you more.

I think I thought that it was better to let them think it was laziness and bad attitude than crazy.

* * *

On the way home, I stopped and bought a sweater for my partner. For some reason, this almost made me cry too. I just wanted to do something nice for someone. Show a little love, which is another thing that has been gone from me for a long time. I wanted to give him so much more, and somehow this crappy sweater just seemed so inadequate, a mute trying to recite poetry. A symbol of the broken shards of what I wanted to be able to give. I want him to be happy. I want him to be warm. I want him to be loved. But I can’t give him any of those things. I can’t give anything to anyone anymore.

Maybe I just cried because I sort of wondered if it was going to be the last thing I ever gave him, and was sorry it was so crappy.

* * *

I then drove to my family doctor, who has office hours this evening. I knew that without an appointment I’d wait, and that was all right. Where was I going, anyway? The shrink was obviously not going to be of any help. I can’t really bring this down on any of my friends. They are under as much stress as I am. I don’t talk to my partner about these things, they aren’t the kinds of things that need to be in a relationship. I didn’t have anywhere else to go.

I brought my dark Soviet novel that I haven’t been able to concentrate on, sat down in the waiting room and tried to read with tears in my eyes. Some elderly woman sat down next to me and started chatting. She was tremendously nice, not annoying at all, but I really didn’t want to make small talk. Maybe she saw me and was trying to help, I don’t know. It was kind of nice finally being somewhere where they didn’t know I am a doctor…to have waiting-room chit-chat with someone on the outside. Someone who, thankfully, didn’t bitch about how bad her doctor is, and who wasn’t a sucking pit of need.

One of the staff members I guess had a birthday and they had a little thing with cake and candles and then passed it around the waiting room. I couldn’t even lift my eyes, though it was a nice gesture and feel in the room. The glowing candles and the singing, a little surreal.

The doc saw me sitting there and called me in fast. I don’t know if that was professional courtesy or what. Of course, having come from work, I was dressed semi-decently and still had on makeup, combed hair. I didn’t look depressed. I don’t think I ever do.

I just told him the depression was back, go ahead, pick a drug, doesn’t really matter what. He tossed me a prescription for citalopram. I also took one for bupropion. I can choose later which to take. He asked what I had taken before. I rattled off a more or less complete list. He asked why I took lithium. I told him, “Because I get like that, sometimes, too.”

He asked what about the shrink, and I told him that I think he’s just frustrated, sort of given up. “You know how it is,” I said. “The patients who don’t get better, no matter what you do. After a while, you just don’t want to see them anymore.”

He said I should try valproate, but that wasn’t his job to deal with. I told him that mostly what was bothering me is that I’d had a year of bad function and was scared I’d never be normal again. He asked in a general way about “dark thoughts,” the kind of thing I could answer, “No more than usual,” without feeling like a liar. He didn’t ask directly about suicide.

* * *

I guess I’ll start taking one or the other. Maybe the bupropion, because it worked so fast. Probably should cancel the shrink later in the week – I can’t see how it could do anything but make me feel worse.

I’m scared. I’ve had plenty of internal disasters, but I’ve always been able to hold it together externally. I know that in this last year, I’ve ruined my reputation everywhere I’ve worked, that no one wants to work with me because of my attitude, which isn’t really attitude but rather me doing my best through a granite tsunami of depression and mood problems. Mood disorders. I am mood disordered. I am disordered.

* * *

From the outside, I can’t escape a feeling that these little things are all harbingers of doom. I can’t help thinking about all those statistics and sayings, the ones about x% of people visit their regular doctor in the four months or week before suicide; about the typical case study, the perfectionist who fucks up, some seemingly inconsequential narcissistic insult that somehow is the invisible riptide that pulls him under. If I were watching this like a movie, like a novel, I couldn’t avoid the heavy-handed cues, the foreshadowing: Things do not bode well for our heroine.

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14 Comments

  1. Being raked over the coals like that is total CRAP. Why do people have to be so awful? I am not depressed (at the moment) and I am not you, but that person’s words make my stomach hurt. sheesh
    (((hugs)))) I am proud of you even going to work when depressed. That person is a DR. and yet has no empathy. grrrrrrrrrr. I am sorry;~((

  2. Thanks, that was quick. And again, I’m not sure it’s a lack of empathy…from the outside, it does look like just laziness and bad attitude.

    My mother said, “Well, maybe someone is just worried for you.” Nice thought – but I’d have to be showing some pain or something for that. And I never do.

  3. Hi Sara,
    (((HUGS))). It sounds like you are having a really difficult time. I wish people would “get” that mental illness is a physical illness. Please try hard to remember you are not alone. Keep posting and we can support you when you need some care.

    Also, I think pdocs understand there are difficult cases of depression, and/or bipolar disorder. If your pdoc is good at what he does, he knows that it can take a while to stabilize a mood disorder…hell I’m no doctor and I know that.

    I feel for you. It would be so much easier to “be” if there were no stigma around these illnesses. I am trying really hard to TELL people I have this illness when they ask what I do, or expect me to do things I find difficult. I explain what happens to me and how I am trying as hard as I can to become well, but nothing has helped…yet. I figure the more people I explain it to the higher chance we have of getting rid of all the stigma.

    …at a party the other night I told a woman (who has two children with severe bipolar disorder ), why I wasn’t working. She said, “but you were on such a great career path. It seemed nothing could stop you from success. How did YOU get this mood disorder” See, even the people who should know (that BP, or Depression are not our fault or choice) have wrong ideas about who gets these illnesses.

    Please take care of yourself.
    Hugs,
    …aqua

  4. Hi there,
    I know you’re feeling bad right now. And maybe it’s a fading in and fading out of the various levels of feeling bad– or maybe it’s just a straight out solid feeling bad…
    Either way, this will get better with time. I promise.

    If it’s at all possible, slowly redirect your energy into accepting the bad feelings as contrast to when you feel good. It’s a cycle, not a linear continuum. This, too, will pass, and it’ll pass before you know it.

    One foot in front of the other. One breath after the next. One hour at a time. One day at a time.
    *hugs from a stranger*

  5. Your attending is an ass. Don’t know if that helps, but she is. The nurse was right. There may have been something she needed to say to you, but it should have been in private and at the bare minimum included some offer of assistance and some kind of follow-up.

    I hurt for you, kiddo. It’s a dark, painful place to be.

  6. Hi Sara,
    I think Citrolopram sucks. I have been on it for a year. Did max up to 40mg but am on 10mg now. Depression went but I settled for increased anxiety instead. I wish I hadnt but I cant find a way to tell my doc I want another anti-depressant instead. The anxiety sucks. I keep it relatively hidden but you know what, it sucks. Not as bad as depression though.

  7. *Hugs*. The shrink was quite out of line to say that. Since when is a patient who is a doctor supposed to initiative their own treatment? And objectively treat themselves? What a ridiculous thing to say.
    *Hugs again*

  8. Aqua – the shrink knows it takes time, I think they say the average to finding good meds is something like 10 years from diagnosis. I’m the one who can’t wait and loses patience.

    And Ash – Alice Walker in some essay wrote about the dark moods, and something that there is some Indian philosophy about how that is also part of the universe’s cycle. I do try to remember that.

    Jay, thanks. Always nice to hear from someone who knows the hell that is medical training.

  9. Oh, Sara, your attending is a super bitch, i guess that goes without saying. She obviously has things going on in her life and decided to take it out on you, which is soooo horrible and mean and extremely hurtful to you, i can’t beging to express how sorry i am that you were hurt in this way. It is certianly the last thing you needed. My heart hurts for you…please know you are in my thoughts and i hope for a much better time, very soon. i, too, know that dark, awful place. A n d your psychiatrist acted like an ass!!! Peace, my friend, and love.

  10. I am totally impressed that you can talk about everything so openly. I always feel exposed when I write down my thoughts and feelings. It sounds very much like the attending really was looking for a reason to make an example of you for some reason, which is not a pleasant position to be in, but sometimes can happen in a high stress environment such as you are in.

    The reason I stumbled upon your blog was because I was having a quick look around to see if people had reported feeling like Lithium Carbonate had ‘taken something away from them’. I know a couple of people who have to take it and they need to, to avoid the depression that results from not taking it, but one of them feels that it robs them of part of their mind. I didn’t know that it affected memory as well though (I read that in another part of your blog).

    Although you say these things are things you can’t talk about with your partner, I would have thought they would be things you can talk to him about. All he has to do is listen (I mean really listen) and love you, and you do the same for him. Having said that, I managed to fail to make my relationship last so I can hardly say I have the perfect answers.

    Anyway, good luck. I hope things go better in the future, it sounds like your attending is being very personal which is a bit unprofessional, particularly having a go at you in front of other staff, I would almost consider it abuse or harrassment. I hope you don’t have to suffer that again.

  11. Thanks. The only reason I can talk so openly is that I keep it so anonymous.

  12. Do you know the saying, ” a fool is a doctor who has himself as a patient?” Read it to your psych. doc. He/she knows better. There’s self-care, yes, but you were seeking a physician’s care. Good on you for distinguishing the two.

    The attending has a behavior/communication problem separate from anything you said or did. Don’t own what’s not yours.

    Does this hospital by any chance use nurse clinicians or nurse practitioners in mental health? If so, they may be a resource for you. Are there any peer groups which would be of support to you? (You might call the EAP to investigate)

    Personally, the way we drag new nurses and physicians through the muck and mud along with grueling schedules isn’t conducive to much in the way of wellness and health.

    Some of what you are experiencing is happening to your peers without your illness and challenges. It’s rough seas, and everyone is tossing and pitching (and hurling).

    In that, you are not alone, and so perhaps, you can find support by sharing at least some of your experiences with your colleagues.

  13. Yes, we got a big talk at the beginning of employment about how we could always turn to the psych dept (that’s the closest there is to an EAP), but I have absolutely no faith in confidentiality there. For doctors, licensing is a huge issue – EVERYTHING is required to be reported. A huge hospital is still a small world.

    There are no “mid-level providers” of any sort around here…in the inpatient psych wards I’ve seen, the nursing staff has been mostly horrific – mostly untrained, impatient, the marginally-licensed, the worst of the nursing world.

    Some of my friends are now rotating through departments where I suffered a lot, and in some ways it is comforting to see that they are just as miserable; ie it isn’t just my crazy, it really does suck.

    Thanks for your thoughtful comments, looking forward to surf your blog.

  14. Hi. I am reading your posts about your depression. I realize you mention being diagnosed as bi-polar. Have you considered having a stimulant prescibed in conjuction with an anti-depressant by your psychiatrist, or whatever doctor you ultimately decide to continue with. I read that with some who have treatment resistent depression, a prescribed stimulant and anti-depressant seem to work wonders. I hear from patients I deal with that Pristiq is a good anti-depressant and some prefer Cymbalta. A few are also on Ambilify, but I do know a doctor who says he is leery of Ambilify for the side affects. Please discuss with your doctor adding a stimulant in conjunction with the anti-depressant med of choice. Also, although not for depression, Nuvigil and Provigil seem to work teriffic on a lot of people for energy, focus, depression, motivation, concentration etc. Maybe you should try Nuvigil 250 mg One tablet daily or Provigil 200 mg up to 2 times daily. They work within 30 miniutes. You may see a huge difference. Please note that I am not a doctor and am suggesting your sking your doctor about prescribing one of the above with your anti0depressant asap. Please advise. Thanks. Grace


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