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Sunday, January 1, 2023

Diagnosis and Emotions

When I went to the doctor I was desperate for help. 

Then I got diagnosed with ADHD and I felt... 

Relieved that it wasn't that I was just stupid or lazy or whatever else. There's actually a reason that I forget my keys and lose everything I touch. 

Sad that I actually am broken. They say I'm not. But I don't think I'll ever not feel that way. 

Hopeful that with an actual diagnosis I could figure out ways to function. 

Hopeless that no matter how hard I try, I'll probably never be able to fully function like everyone else. It'll never be easy or natural to just clean up after myself, or remember things. I'll always have to have systems and reminders, and it will always feel like hard work to do the simplest things. 

Grief for the 40 years of my life that I'd been struggling and not really even knowing it. How much different could my life be if I had learned tips and systems at a young age? I'll never know. 







The Worst Five Years: Year 5


Year 5: CoVID. 

But not only did I have to deal with CoVID just like the rest of the world. But CoVID as a nurse who had decided to try out the ER and ICU starting a month before the pandemic reached the US. A nurse who picked up an extra shift a week to help out a hospital that was in dire need. A nurse who was suddenly back to homeschooling two kids, but this time teens and pre-teens. Quite a jump from when I had stopped homeschooling my 1st grader and preschooler to go to nursing school. Dealing with CoVID while working in a hospital when I was already coming into it with severe anxiety just about killed me. I can remember standing in the ER and just feeling terrified of everything. Terrified of getting sick. Terrified of bringing sickness home to my family. Work was scary. Public was scary. Home was scary. We couldn't buy basic items for daily living. I felt like we were transported back in time to times of war and rationing. I became somewhat obsessed with trying to save money and grow our own food. Except my executive functioning was completely tapped out by all the stress and anxiety. 




The Worst Five Years: Year 4

Year 4: Travel Nursing

From the beginning of my nursing journey I had wanted to work in Labor & Delivery. I fell in love with prenatal education when working for Early Head Start and wanted to do more with it. I mistakenly thought nursing was the best way. Now I know that's not quite right for me, but I don't regret becoming a nurse even one bit. I love the work I do. Anyway... around here L&D is very hard to get into. Once people start working there they don't leave until they retire. After my first year they had one opening but they hired a new grad, which killed me a little inside. But she had been a CNA on the unit and it was a good hire for them. They posted a second position but somehow it turned out that when they hired the new grad she was in a "new grad" position, but that didn't actually count as an L&D position, so they had to either hire her to the opening, or she would have to move to another department, which made no sense at all. I don't begrudge anyone for keeping her. Maybe a year after that they had another position come open. There was a nurse working with me on MedSurg who had years of L&D experience but she said she wasn't interested in the job because it was full time nights, so I thought I was a shoe-in. Except at the last minute she decided to apply and they hired her instead. Again, can't really blame them for hiring someone with more than a decade of experience over someone with no true L&D nursing experience. But I was so frustrated, and by then I was kind of over MedSurg. I enjoyed my time while I was there, and I will always be glad for the experience I gained in the 2 years there. But MedSurg was not my goal or my passion and I felt frustrated after being passed over for a position three separate times. I needed a change. And we needed money. We weren't desperately poor or anything, but money was tight. I said something to my husband, only half joking, that I if we didn't have family and obligations here I would go do travel nursing because it pays twice as much as being a staff nurse just about anywhere. We started toying with the idea and before I knew it I was heading to Alaska to live with my cousin, also a nurse, and work in a hospital there for 3-4 months. The stressful part is hard to describe. Obviously traveling the entire way across the country with my kids but without my husband, to work in a new hospital with people I didn't know was stressful. But the biggest stressor that affected the entire experience was that when I got there the state was back-logged on processing nursing licenses, and I had to wait an extra few weeks before I could start work, which basically negated the "extra" money I got the first few weeks of work. Thankfully we (the kids and I) were living with my cousin, and she leant me enough money to live on and pay bills those first few weeks. But the worst part of all was FaceTiming with my husband as he cried and begged me to fix what I just couldn't fix right then. He wanted me to go work at McDonalds or somewhere until the license thing got straightened out. But by the time I applied, had an interview, got hired, and went through orientation etc., I would be working in the hospital. It would have been a complete waste of time and I'd still have nothing to show for it. It was excruciating spending the day doing nothing and waiting for a phone call from my husband, knowing how stressed he was and that I had nothing new to tell him. I finally started working mid-July. In August my husband flew out and spent a couple weeks with us and then took the girls home to start school. I finished my contract through mid-October and flew home just in time for my daughter's birthday. We did make enough to make it worth it financially. But I was unsettled the entire time. I'm not sure I ever fully got over it. When I came back to Maine there were limited options for travel contracts so I ended up in one about 2 hours away from home. You'd think being closer to home would be easier, and it was definitely nice to see my family more often. But I was just living out of a suitcase. Always in limbo, feeling like I wasn't actually living anywhere. Having to figure out the schedule of transporting kids and grocery shopping when I was never around. In some ways it was harder than just being away for 3-4 months. When that contract was up I hoped to get back into my home hospital. The only opening they had was in the ICU/ER. These weren't anything I was particularly into or excited about, but I was ready to just be home full time. So in January 2020 I took the job. It was a bit of a learning curve of course, but it was alright. I got to know some more of the staff from different departments in the hospital. And I was just settling into that role when... 




Up next

Year 5: CoVID. Need I say more? 

The Worst Five Years: Year 3

 Year 3: EPIC. But not the good kind of epic.

When I first started at the hospital they had an archaic computer system that reminded me of MS-DOS. When they announced that we were upgrading to a new system called EPIC I was thrilled. The original person who was going to go to the trainings had moved out of state, so I mentioned that I'd be willing to do it, because I love computers. They had someone else in mind but I think a family member ended up having some health issues and she decided not to do it, and I was up next. We had originally been told that the training was about 2 straight weeks and then 4 more weeks of intermittent training. In reality it was six weeks of living in a hotel and training Monday-Friday, two hours from home. We were being trained to be the trainers for the rest of the hospital, and another hospital in the health system. None of this was made clear to us in the beginning. So after the six weeks of being away from home we implemented classes and training and traveled to New Hampshire for a couple months before attending their "Go-Live" when the system went live. We had trainers there in every department 24/7 for the first two weeks. Then we came back to our own hospital and started the process all over again. I was basically a full time instructor for months, and then we had our own "Go-Live" with 24/7 support. That was August through June? of my second year of nursing. 



 

Up next 

Year 4: Travel Nursing


The Worst Five Years: Year 2

 Year 2: New Grad Nurse

We call it the 5th semester of nursing school. As I mentioned already, nursing school is hard. And when it's over you think we'd be relieved. And we were... kind of. During our last semester they had some of the last year's graduates come and talk about their first year of nursing. One of them said "When you finish school you feel like you've studied and learned so much, and then when you start working and realize you know nothing." And I thought that sounded depressing, but it was very true. And then comes the nurse licensing examination, the NCLEX. It's a computer run exam with anywhere from 75 to 130 questions. The test adapts to the answers you get right and wrong to see how much you really know. If the test stops at number 75 then you either did very well or very bad. And you have no idea till the next day. Mine stopped at 75 questions. I was terrified. I remember thinking "I didn't even know some of those words!" But somehow I passed. The next morning the state website showed my nursing license as active. Phew. 

I had already started working at the hospital. There are just certain things you can't do as a "new grad" until you pass the NCLEX. I made it through the week of general orientation to the hospital, and then started my preceptorship. I was matched with a nurse who was very good at her job, but was not a good teacher. Most people on the unit were "afraid" of her. Not in the actual fear sense, but they all hated giving her report because she'd question everything you said you did all day and make you feel like an idiot. She had been a nurse for over 30 years and her way was the only way. She talked down to me every day and told me I did everything wrong, even if it was exactly the way I was taught in school. She even went to the manager and told her she didn't think I was cut out for being a nurse and they called me in for a surprise meeting where they both talked about how they weren't sure I was nurse material. I left every day feeling less confident than the day before. She was one of the only nurses left who worked 8 hour shifts, so about two months in I switched to a couple other nurses who worked 12 hour shifts to get used to a full day. Thankfully these girls were wonderful, compassionate, and I was able to learn and grow so much under them. The minimum orientation for a new grad is 12 weeks on the MedSurg unit, but I kept working with them until about 19 weeks. Then I finally felt ready to work on my own. Thankfully we have great teams throughout the hospital and you're never truly on your own as there is always someone to ask for help. Even after orientation you're considered a "new nurse" for the first year. And I definitely felt the change somewhere around the one year mark. I was about a year in the first time I had that "nurse's intuition." I kept calling the doctor in to assess a patient that I had a bad feeling about, and he kept blowing me off. By the next day when I came back he had been moved to ICU and then transferred to another hospital. That's when I realized what nurse's intuition felt like. 



 

Up next 

Year 3: EPIC


The Worst Five Years: Year 1


The most stressful five years of my life ended with an ADHD diagnosis. 

I quit my career in Early Childhood in 2011 to stay home with my children and open an in-home daycare with the plan to go to nursing school once the kids were in school. In 2014 I started taking part time classes at the local community college. And in the fall of 2015 I started the nursing program. One of the instructors sat us down within the first month and basically told us that we were all in for one of the hardest parts of our lives. She said that we would make friends, and lose friends. We would work hard with each other. Some of us wouldn't make it to the end. Some of us who made it wouldn't have the same spouse or partner that we started with. Because the program is hard, and it's even harder for those who have never done it to "get it." She wasn't wrong. Thankfully I made it through the nursing program with my family and friends intact, and even came out with a little more self esteem at first. But I'm getting ahead of myself. The first year of nursing school wasn't so bad, other than being extra tight on the budget because I was now working as a dishwasher at a local restaurant on nights and weekends since I was in school 4-5 days a week. 

That was just the intro to how stressed I was going to be. So here we go:

Year 1: Selling our house during the second year of nursing school. 

We had been outgrowing our house for a while and I thought we'd buy something bigger after I graduated and had a good nursing job. A nursing job would pay twice as much as my former career, and probably four times what I'd been making as a part time dishwasher. My husband started getting itchy to get out of our small space, and we figured if we listed the house it would probably take close to a year to sell, so we'd have plenty of time to get ready before moving. We posted the house for sale in June. Forty-five days. Our house was on the market for forty-five days before we had an offer and the house was under contract. In that time After a few tours we found a place that we eventually bought, but in the mean time we were in a bidding war and weren't sure we'd have a place to move into when we closed on our sale. School started in September. We closed on both houses on a Friday in October. My husband is usually gone for the month of October. He came home for a long weekend to sign the papers and move trucks and trailers of furniture and boxes. Then he left Sunday night to go back to work. Tuesday I sent the kids to their first day in a new school (which they were terrified of, but thankfully had a great day.) The following weekend was my daughter's birthday. We always had birthday parties on Sundays because it was the only day we could guarantee that my husband wouldn't be working. This was the first time that she'd remember her birthday being on a Sunday and I had promised she could have her party on her actual birthday that year. Though we had moved in barely a week before and were still living out of boxes, we hosted 8 extra children that weekend for a birthday party sleepover.

Winter break during that last year of nursing school was when I had my first break down. I was a mess the whole month. I went to the doctor begging for something that would help me. It turned out I hadn't been sleeping and didn't really even realize it. I hadn't slept well in months. And anyone who knows me well knows that sleep is like the foundation of my hierarchy of needs. Food, warmth, shelter... those are all on the first floor, but sleep is the true foundation. After winter break I failed the first test of the final semester. Bad. I spent the rest of the semester working just to get my grade above passing. I had hoped to do well on the second test to make up for the first one. I didn't fail it, but it wasn't enough to bring my grade up very far. That same afternoon I completely bombed an interview with one of my first choice hospitals. The rest of the semester was more of the same; moving my grade up inch by inch but never quite enough to guarantee that I'd pass. And getting turned down at every hospital I applied for. Talk about stress. I put the last 2-3 years of my life into this program and I may not even pass. And if I do pass, I still have no job lined up to pay for all the schooling. I finally got a job offer when someone backed out of a position they had accepted. That's great and all, but I still didn't know if I was going to actually graduate in order to qualify for the job. I wasn't sure I was going to pass until the very last day, after I took the final. One of the instructors had pity on me and showed me my final grade as soon as the computer tallied my grade on the final. I passed by like 1.3 points if I remember right. After the final we all went out to breakfast and ordered hard drinks.  

Up next

Year 2: New Grad


ADHD and Me

 My ADHD diagnosis two years ago really didn't come as any surprise to anyone. I was just glad it wasn't something else. However, I wasn't prepared for the emotional and mental toll processing the diagnosis would take. In fact, I'm still processing sometimes. Which is why I'm writing this blog. I don't care if no one ever reads this. But something about typing my thoughts out helps to put them in order in a way I can't do if they're just floating around in my head. And I can type so much faster than I can write that it's way better for me to type it out.

Thirty years ago when I was in elementary school ADHD was for hyper little boys (and the rare hyper little girls) who bounced around the classrooms, couldn't sit still, and interrupted without raising their hands. Quiet little girls like me who got good grades certainly didn't fit the criteria. But looking back I feel like there should have been a neon sign above my head flashing ADHDer! 

I was a smart kid. I was reading at age three, and reading well by age 4. Young enough that I don't remember learning to read. It's as if I've just always known how. The first book I remember reading was The Secret Garden. Not an abbreviated kids' version. The whole thing. One of my mom's favorite stories to tell about how I could read at such a young age went like this: She tried to tell my kindergarten teacher that I knew how to read, but I was shy. I didn't want to be singled out as different, so when I realized other kids my age couldn't read I stopped letting people know I could do it. Of course the teachers just thought my mom was bragging about her extra smart kid, just like all parents do. Like the parents who swear their kid said a word at 2 months old. They said a sound that was like a word "da-da" but they didn't mean anything by it. They don't yet know that "da-da" is associated with that person in their house. Anyway... A few weeks into school my mom was going through my backpack and found a paper on which everything I had done was marked wrong. She thought that was especially odd since the directions were at the bottom of the page and I had done everything it said. So she brought the paper in to the teacher and asked why she had marked it wrong when my answers were correct. Turns out the teacher had ignored the instructions on the paper and asked the kids to do something else with it. I don't know exactly what the instructions were, but something like, the directions said color everything that starts with P, but the teacher said to circle everything that starts with a T. The teacher made up her own instructions to go along with whatever lesson she had been teaching, and never considered that one of her kindergarteners would read the instructions and do that assignment instead. Like I said; I was a smart kid. I could read well. But paying attention... not exactly my strong suit. 

The signs were all there and continued as I got older but no one knew what symptoms to look for back then. I was a doodler. I couldn't keep my room or my car clean to save my life. I lost things on a regular basis. I was constantly forgetting important things. I locked my keys in my car, or left my headlights on and killed the battery more times than I can count. As time went on I worked out some systems to help me get through the day. When cars starting having noisy alerts that let you know when your lights were on or your keys were still in the ignition it was a game changer for me. And then cars with automatic daytime running lights? Genius! If I have something important at work that I don't want to forget to bring home I put my keys with it. I never leave the building without checking for my keys (because I know there's a fair chance they won't be where I thought I left them). Even if the items are foods that belong in the fridge or freezer, my keys go right into the fridge or freezer with them. I don't forget to bring things home that way. I still had my quirks of course. And I thought that's exactly what they were, just quirks. 

I remember having a conversation with my husband, and then my cousin about a comedian who joked about "thinking about nothing." He said "Ladies, when you ask a man what he's thinking about and he says 'nothing', he's thinking about nothing! He ain't lying." And I said "Well that's just ridiculous. You can't think about nothing!" but my husband said it was indeed possible. And I said "I can't even imagine it! I can't think of less than 4 things at a time! And there's always a song playing in the background." It might be a song I recently heard on the radio, on a commercial, or a song that popped in my mind after something somebody said had the same words as a song I know, or just a song that came from nowhere. My cousin said that sounded exhausting to her. Yup, it's exhausting to me too.

Then in 2015 I began what would turn out to be the hardest five year span of my life, which changed everything. I'll get deeper into that later but for now I'll say that sometime in 2019 I had a couple episodes of what I now know to be called extreme hyper-focus. At the time I feared it was something like bi-polar showing up in adulthood. The first episode consisted of me spending three days in a row fixated on one topic. I researched the topic from top to bottom and created a business plan and a layout for my proposed future business that wouldn't be even remotely possible for more than a few years. I can't quite remember what the second one was. But it was enough for me to be concerned and make a doctor's appointment. I'd also been having more trouble than ever with executive functioning and my husband was ready to go crazy. 

My initial appointment was with my PCP but she quickly referred me to the Psych NP in the office. On my first appointment with the Psych NP she said "Let me guess... you're the kind of person who can drink a cup of coffee in the afternoon and have no trouble sleeping that night." I replied "I can drink coffee at 8pm and go straight to bed with no problems." Then she said "I don't like to diagnose on the first visit, but fill out these papers and at our next visit we'll talk about ADHD." After my official diagnosis she asked if I wanted to try medication or something else and I said that I had tried so many things to organize myself even without a diagnosis that I thought the only thing left to try was meds. So she started me out on a low dose of Vyvanse. The second day on the medication my mind was empty. I could focus on whatever I wanted. There were no racing thoughts. There wasn't even any music. Honestly it felt creepy to me. I get that same feeling in a room that is exceptionally clean and tidy when it's dark. It's a little eerie. Unfortunately the effects only lasted a little while on the low dose, and I had to increase the dose to a more therapeutic level, which is very common the first few months on this medication. But by the time we got to a therapeutic dose it was causing my heart to race too fast and I ended up stopping it. One of the docs had put me back on Wellbutrin a while back and so we increased the dose for that which seems to be helping quite a bit for now. It's not perfect. Probably won't ever be. But I at least feel a little more like a functional human most days. I'm starting to climb out of the cave I've been in for a long time now. I just hope it's not too late to save my relationships.