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Wednesday, 3 August 2011

My Living Will

I have done  LOT of research on ways to finally follow through on a solution to everything.  No more being a backseat driver in my own life, no more pain, no more fucked up flashbacks, no more...well you get the point.

The best bit, the law was reviewed since so now under the Mental Health Act, you have to be deemed "competent", or at least, "not lacking capacity", in order to refuse medical treatment.  The law here in Northern Ireland still dictates that if you have a living will, or advanced directive as they are otherwise known, it has to be abided by regardless because the Mental Health Act doesn't apply here, but the laws on advanced healthcare directives do.
I have officially found  back door that means that a doctor cannot lay a finger on me should an alter bring me to hospital after a suicide attempt.  It means that I can choose whatever method I like and still be able to resent to the hospital for treatment to include pain relief and sedation should it be needed, and while there, unconscious or conscious, I cant be treated for whatever I have ingested to get me there.

On Friday night I attempted throwing myself into the River Foyle.  Went there, couldnt do it from this side of the river as it was too well lit, spied a dimly lit part where I was less likely to be seen (and 'rescued'), so made my way over.  When I got there, I was met head on by three guys in jackets, I can only assume was Foyle Search and Rescue.  For those of you who dont know who they are, it is their primary aim to thwart suicide attempts in and around the river.  Needless to say, I quickly changed my route, and came back later.  I was so scared of the same thing happening again, or bumping into them and it somehow being written all over my face what I was there for, the I decided to have a stab at it from the better lit area, and traffic flow was a lot lighter, I figured the risk of someone noticing me in dark clothes wanting to jump in, would be lower.  I made my way round the other side again, only to see the same guys standing at the other side.  I didnt want to double back on myself as I felt them seeing me twice already, surely they would know what I was up to, so I walked the opposite way home (so as to avoid having to walk past them) and had a meltdown.

That is when I started really thinking outside the box of how I could go about this.  I dont want to fuck someone up in the head by them finding the body.  I dont want to do it here, as then the staff here would have to deal with the body.  A lot of young people live here, and when word got out that someone topped themselves....they are an impressionable bunch I think; I dont want to be responsible for someone thinking it was a good idea because someone geographically close to them did.  I want a method that will be quick, but as painless as possible.  I want to go peacefully, or as peacefully as possible.  It would be easier to be able to take an overdose and die, but I cant do it here and dont have the money for a hotel peak season in a tourist trap.  So, with a living will, it covers everything.  I can have my cake and eat it, and not have to worry about shitting on the people here.  Healthcare professionals deal with death everyday.  It wont faze them to see me die.  The support workers here deal with trying to help people get their lives together and are a really good bunch of people.  It isn't fair to expect them to clean up that mess.  I dont have the heart to do that on them.
Flat will be cleaned, belongings packed, notes will not be left this time around.  I will do the deed, wait a certain amount of time, and when I feel consciousness fading, I will ring an ambulance with a copy of the living will and a letter saying what I am expecting from going to hospital (i.e. painkillers and sedation if needed, but ultimately, somewhere to die).

There is just a small hitch in the plan.  For it to stick here, I need to give a copy to anyone involved in my care.  I am afraid by giving a copy to my GP it will mean I will be sectioned on the spot, but I am sure I can avoid it should it come tam planning appropriately for upcoming events in my future, therefore I am the embodiment of sanity.  I doubt that will work actually.  Will say I am simply making out a detailed living will should the need arise and I have no future plans to inflict any harm on myself.  If I stick to my guns and (fingers fucking crossed) not lose time to an internal meddler, all should go according to plan.  I have been working on this for nearly a week now, just have to print off a couple of copies, then I am good to go.
It's hardly as if they can review the law here in the space of time it would take to give the document to those who are required to have it and me offing this circus.

Here is a copy:

Living Will

I, (my name) (Date of birth 0*-0*-198*) of (my address) being of sound mind, voluntarily make known my wishes that my life should not be prolonged as long as possible in all circumstances.

If at any time I develop a critical condition that will result in my death in a relatively short period of time (days or weeks), decline into a persistent comatose state from which there is no reasonable expectation of regaining consciousness without medical treatment, decline into a persistent vegetative state from which there is no reasonable expectation of regaining cognitive function without medical treatment, please note the following:
In these circumstances I wish life saving treatments be used or withheld or withdrawn as specified below. I wish to be permitted to die with dignity and I am grateful to those that respect my free and informed choices.
I do not wish to receive artificial nutrition or artificial hydration. I do not wish treatment with antibiotics. I do not wish a ventilator or other artificial respiration support to be used to sustain my breathing, however difficult breathing becomes. I do not wish serum or urinary alkinisation through any method. I do not wish to receive GI tract decontamination. I also do not wish to receive heamodialysis or charcoal heamoperfusion. I do not wish to be catheterised. I do not want blood or blood products. I do not want invasive diagnostic tests. I wish treatment for the easing of pain to be administered as necessary, even if this might hasten my death.
If an ambulance is called by myself in a situation that may lead to death, it is not because I want life-saving treatments, it is so staff at the housing association will not be forced to deal with my body, younger residents will witness my death in no way, and I can receive appropriate pain relief/sedation should the need arise.
I request that my living will be honoured by my medical team, as a final expression of my legal right to refuse medical and surgical treatments even if my life is at risk by so doing.
If any doctor treating me will not agree with my wishes, I ask that my care be transferred to another doctor, or healthcare provider, who will respect them. This transfer should be done as quickly as possible and with the utmost respect to all concerned.

Organ Donation
I wish to donate all my organs and tissue for transplant.
I agree to my organs being used for medical or scientific research.

Final Declarations
I understand that I may change my mind at any time and revoke or update my Living Will.
Should I do this I understand all previous editions of my Living Will will become invalid and
should be destroyed.
I understand that a signed copy of this form will have the same status as the original.
It is my wish that no legal action is taken against anyone because they have acted in good faith in
accordance with what I have requested in this Advance Healthcare Directive.
I understand it is in my best interest to lodge a copy of this signed Living Will with my doctor and/or medical team.
I am of sound mind and am 18 years of age or older.

Signature                                                   Date

______________________________    _________________

You see, you have to be very specific in these things I found.  Every single piece of legislation and every case study I came across demonstrated that to say no to treatment, you need to be specific in what you are saying no to.

I have a way out, and fuck it, even if I m admitted to that infested dump of a hospital again, when I am discharged, there will still be a copy of this on my file, I will still have met all the stipulations, and I will make sure I have a copy pinned to me when I call the blues and twos.  I still have an end in sight.  And no fucker can take that from me, butterfly net and white coat or not.

Friday, 29 July 2011

I feel like a broken record. I'm not coping. I have spent the day arguing with various alters, then checked out around half 2, only to come back now (11pm). Today and yesterday has been really tough. Yesterday was very switchy. When I wasn't out, I was still there watching what was going on with whoever was out. When I was out, at least one person would be there with me, as real as anyone else, walking around, commenting on what I was doing, incessant questions, advice giving that I feel unable to take, then there would be a switch when I wouldnt listen and someone else would take over and do what they had been suggesting in the first place.
To begin with, it was unnerving, mainly for the fact that I had a chat with one of the support workers here, and someone else was there the whole time, distracting me from what I was trying to say, demanding that I answer him. I tried talking to him mentally to ask for some time/space, but then panicked that he would take over and the support worker wouldn't know what to do. I don't even know if that was yesterday or the day before actually, everything is meshing together.
I was up at Foyle Advocates to get some help with housing stuff, and the whole time there I was switching. I arrived, nearly got squashed by the lift door, panicked, and Marie was there, she jumped in and left me 'out' and I stood there screaming at her to stop fucking about as she had a smoke and a chat with two of the workers there. It wasn't until we got up to the office did I get back in, as she sat opposite me, laughing at how much I got my knickers in a twist. After that, I tried to get some stuff sorted, then waited for a while with another worker from there on the sofa as it was lunch hour and the person needing contacting at the Housing Executive was on lunch. I was a mess, trying not to cry, completely thrown by why Marie had done that (almost to intentionally throw me off guard), and he was talking away to me. I think he could tell I was struggling. I cant remember a lot of the conversation, just a lot of trying not to be a mess. Then Marie was joined by Lucy. I panicked. What if Lucy did what Marie done and came out there and then?
She didn't, and I got home OK.
I asked the staff here to maybe try their hand with housing as well as I didn't see much headway being made with Foyle Advocates.
I came upstairs, shouted at Marie, not knowing if it was me who was in the body or out of it, got into a state and lost time. When I came round, it was this morning. Only Siobhan was with me for a while, and was just trying to comfort me. The whole time yesterday, and of what time I had today, everyone has been chattering constantly, the body has been torn so many different directions emotionally. Panic attacks, followed by being fine, then feeling's like everyone's feelings are leaking into the one boiling pot. Physically dealing with anxiety, then sudden cheerfulness, then sudden pining? I think, stomach is upset, and head is killing me.
No wonder it was thought I was emotionally unstable. “I'm” not though, I pretty much spend most of my days being overwhelmed or depressed, it is trying to deal with emotions from everyone else is the problem.

This is all fuelling the fire of hopelessness. I think I can see why things are so out of control at the moment. Hospital meant reality was suspended for a while, I could choose to avoid stresses such as housing, daily living, etc. I should have been more open about a lot of things while I was in there, but I wasn't. I just wanted out, and done everything in my power to make them let me out. Which included not using the service properly, just trying to muddle along saying what they wanted to hear, and doing things like getting out of bed in the morning, showering, eating the odd thing, etc. I had a distraction, a project even. Project Discharge. It gave me a focus other than the constant suicidal thoughts and for the first time in a long time, we all banded together in getting discharged. There were a few hiccups here and there, but, it seemed to work. Out now, and as worse as ever.

But being dropped straight back into the practical situation I was in before and realising that nothing has changed, has meant that things have went back to suare one. There is a massive reaction to my thought processes over the past while and it has all culminated on, what seems to be, me being supervised when I am out and unhelpful interruptions into areas of functioning (term used very loosely).
I know I should ask for help, that is what everone (even on this side) is telling me, but I don't know how. The thing is, I am afraid if I don't, someone else will step and do it for me. Do they not realise we will all end up back in hospital if this happens though? I can feel a shift and I don't like it.

The 27th was a bit of a trigger for everyone. I am hoping this is just all part of the aftermath. Things should settle a bit, shouldnt they? Things will go back to good old fashioned loud head and losing time, with only the odd one here and there coming out to grace me with their presence. I have started remembering some stuff from when I am inside. Usually, I just remember soft, warm, darkness, but a nice darkness, not a scary type. Some of the others have started to come to me more when I am inside now though, but my brain isn't cooperating and will only allow me to remember snippets.

What's happening with me? I can self analyse all I want, but I really don't have a clue what is going on.

Wednesday, 27 July 2011

I need help

I had an appointment for the first time ever with a CPN on Tuesday morning.  Having lost time all Monday, and only coming round Tuesday morning, I was in a strange house, on a couch I didst recognise, and pissed as a fart.
I looked through some post in the kitchen to get an address so I knew where to call the taxi to.  I didn't recognise the names on any of the letters.  The taxi came, and I went, still rat-arsed drunk, to the primary care liaison service, dressed like a tramp, smelling like an alcoholic and stumbling over my feet.
When the CPN called me in, she couldn't have been nicer.  I was too busy being on the defensive about everything.  I had come round fuck knows where, and was now sitting in front of this woman drunk and still dressed like a teenager.  I felt so small, and ashamed of the situation I was in.  What must her impression of me been?
Of course, I didn't tell her where I had come from or why I was sitting there bestraggled and half cut.  When she asked me how I had been, how I was sleeping, etc, I gave her all very perfunctory "I'm fine" type answers.  I told her I didn't want to be there, I didn't need the help, and I would manage perfectly fine alone.  Why was I such an eejit?  I am really struggling with everything at the moment and could really use some support, yet when I am sitting there in front of said support, I do nothing but push it away.
I rang her back today.  I apologised for the state I was in when I saw her last and arranged another appointment.  She told me following out last meeting, she had spoken to the consultant and they had agreed on 3 meetings with me, seeing as I didn't want to engage, and then, I presume, discharging me from the service.  I just kind of "uh-huhed" and changed the subject.
How do I bring up with her that I have changed my mind, that I feel I need the service, and the only reason I was so dismissive of everything was a mixture of being pissed, embarrassed and feeling very vulnerable the last time I spoke to her?  Do I even have a right to ask?  Should I expect her to say "OK, that's fine", or "too late, you had your chance"?

Today as well I got the news that the place where I am living is no longer offering their services to people aged 16-25, it is now going to 16-21.  This means that now I need to move.  It isn't an immediate thing, they wont leave me on the streets or anything, but I do need to try to find suitable accommodation other than here.
The Housing Executive have been horrible to deal with here.  To begin with, they said I was intentionally homeless, a decision which they were forced to review and overturn, and now they are saying, OK, you are unintentionally homeless but you are not in priority need.  Despite the fact I meet more than half the list of criteria, of which you only have to meet one thing.  I sent an email on Monday, of which I have heard nothing back, and left a few phone messages for the woman dealing with me, none of which have been returned.  I made an appointment with Foyle Advocates, who were really helpful while I was in hospital and who have promised that they will help me come to some sort of resolution on the matter.
DLA is yet to be sorted out because they haven't got all the information they need yet, so a decision has yet to be made.  Meanwhile, I am skint, I cant move forward on some things like housing, because I haven't been awarded the DLA yet, and everyone seems to measure your needs based on the outcome of your eligibility for certain benefits, which is both ridiculous, and counter productive.

Nothing has changed since I tried to take my life.  I was completely overwhelmed by everything.  I had lost my home, my partner, had my previous life torn from me, went to a hellhole for a few weeks, ran from refuge to refuge and settled back in Northern Ireland with nothing but a suitcase and not a single person to put down even as a next of kin.  I know no-one in the area, have no support system, and flashbacks, nightmares and dissociative symptoms are at the worst they have been in a long time.  I have had to fight tooth and nail for something as basic as housing, despite meeting criteria, and have come across constant obstacles in anything I have tried to pursue.  I am physically and emotionally exhausted.  Being in hospital served as a suspension of reality, it allowed me to lose focus of the real issues for a while in favour of focusing on getting discharged, but now I am out, I am back to square one, and back in the emotional mess I was before, but now with the cherry on top of having to move from a place I had just started to think of as somewhere where I could at least maybe tap into the support.
Then there is all the emotional crap on top of that.  Trying to deal with losing time and coming round to all my money being gone (before I went grocery shopping or paid bills), not sleeping well, my head being rammed up my own arse not knowing which way I am coming or going and generally being an incapable mess.  Maybe I just feel like I am coming up against walls with everything because of how much I am struggling, and not able to deal with the basic stuff, and actually, everything is OK?  No, it is far from OK, but I do think my inability to function is certainly playing a role in all of this.

I feel like I cant even leave the flat because I don't want to be around people.

I am back where I was maybe a week before I went into hospital.  This is suffocating.

Saturday, 23 July 2011

Miss Marple strikes again

There is an appointment on Tuesday with a CPN.  Do I tell her how much I have been struggling with everything, do I open myself up and be completely honest, lay myself open and bare to either help, or making myself too vulnerable to another blow from the mental health system?

Today was a hard one. I came round at about 2pm/3pm dressed like a 2 bit tramp.  Skirt so colourful it would give a blind man vertigo, short enough to display ridiculous matching knickers.  Top you could see a bra (denim and pink, balconette affair) through and a dodgy teeny bopper jacket.  In short, Marie was out.  And she had been shopping, leaving me with very little in my account and a belly full of ice cream (thankfully one of the easier purged foods).  The flat was a bomb site, and I just sat looking at it with a stonking headache and started to cry.  I hate when this happens.  When you take the effort to have a place spotless, plan a day out, try to do "positive" crap for yourself, and all that gets stolen from you.  My head was really loud, so I was getting no peace in sitting down, so I got up and went to go to the kitchen to make a hot drink and chuck back some meds.  I opened the door to find jam all over the floor, a teddy lying there with a spoon of jam up to its mouth and the name "lucy" drawn on the floor with jam.  At that point, I just about lost it.  I went straight to the fridge, took a bottle of wine, grabbed a glass and came out of the kitchen, closing the door behind me.
I haven't went back in since.
Now I am sitting here, really agitated and wanting to self harm, and having tried every distraction techniue out there, then some, I am here, writing, trying to make sense of what is going on up there and to see if I can hold back from seriously injuring myself.
I feel completely out of control, of every aspect of my life.  Not that there are many aspects to it.  It's just 'the part I have' and 'the part I dont'.  I wish I could even remember some of what happens, so I am able to piece together some of what happens in my absence, without having to play Miss Marple every time I come to.

Wine...more wine.

Friday, 22 July 2011

Post properly now I am back the land of the alive

Transient suicidal thoughts. Or at least catching myself on every now and again as if to say, what are you doing, you know life is pointless, why the fuck are you smiling? I have nothing to live for, and so any attempt I make at trying to 'live', is met with scorn, with a reminder that I don't deserve any of this, I am not entitled to even try.
Does that make the thoughts transient? If they are always there, just time and again I get distracted and allow myself to relax a bit? They havent gone at all. At least this time, I know what I am doing, and I am not about to fuck it up. I am going to hang from the loft here. This Monday. I want the weekend to allow everyone to have have a chance to do one last thing to make themselves happy. Then all done.
This way as well, it is over in minutes, no chance of rescue, no chance of coming back from it. Can pack stuff, or even donate all to a charity shop or something, although given our record with suicide attempts, maybe just pack it. Or have a decent plan B. Drowning isnt really an option unless we can find somewhere that isnt policed so much by Foyle search and rescue. Again, too much chace of rescue. It needs to be something violent and quick. Don't care about pain. Pain is cathartic. A final punishment. Need to leave a note though saying Daddy should get my body, whatever state it will be in, and not mummy. I don't even know if he will want to bury me.
I didnt see the doctor today. I'm afraid what my plans are will be written all over me. Although, the nurses there are pretty astute, well, kind of, and they haven't picked up on it at all.
Before I go, I am going to tell someone everything. I am going to tell them about my life, about what I have seen and done. The truth about every part of me.
Only then will I be ready to let go, and ashamed enough that someone knows everything that I will have no choice but to delete myself. Someone else will know how dirty I am. What they did and how they hurt me. How I was to weak to let go. How I was too weak to stand up to anything.

Discharge. Finally here. I'm home, have unpacked my toiletries and books, but yet to start on clothes. Too daunting a task, even on post-discharge high!
My medications have been a bit muddled with as PRN's don't follow you out of hospital, but have a stash of chlorpromazine in the kitchen that should see me through until I call the GP, not go see her. I really don't want to see anyone who can put me in hospital, ever again.
I'm glad to be out. I didn't use the support there the way I should have, and that is my fault. I turned what should have been a therapeutic, helpful treatment, into a stay in a building that was frustratingly shit to be in and hating every second of being stuck in there with some of the oddest people I have met in my life. The patients were OK though.
No, the place was understaffed and overestimated in their capabilities. I am sure they are very capable of helping, but this was seriously restricted by time. Due to under-staffing, the time allocated to each patient was minimal, unless in ICU or on 1:1 obs. No time to get to know someone, to do any kind of therapy work see what people were dealing with psychologically.
I was in ICU to begin with, and on 1:1 obs, but at those times, my place of residence was under the covers, ignoring anyone who came near me. I just wanted let home. I suppose I was a bit of a mess at the time, even if I couldn't see it myself.
Now I am out, I don't know where my head is at. The other day I was planning suicide for Monday. Then today, I promised a friend I would go see her in Newcastle on the 5th. I still want to die, actively, not just as a safety net, and have all in order for that, so why did I make plans for 2wks away?
Maybe it is true, maybe I am emotionally unstable. The way I experience it though is everyone inside having different emotions and experiencing them all simultaneously. Or my “personality” is disordered. Singular.
Doubt it.
When the plans were being made with Rachel, I was kind of there. “Kind of” being I was there, but not in my body, I saw the sink at the other side of the dorm in the hospital, I heard what was being said, I was “kind of” there. But I was absent at the same time. My body wasn't attached to anything, least of all me. The voice sounded disembodied, even though it was animated. It wasn't me. Or was it?
My “multiplicity” may in fact be a neurological thing. Memory problems caused by blackouts, or something. Voices just being a very active thought process that takes on different intonation and gender. Maybe all this is part of being “emotionally unstable”. The disconnection to things happening around me are maybe some sort of concussed type 'blips' that make me think there is someone else driving my body who isn't me, but in fact, is. But suggesting such physical anomalies would surely give weight to the fact I am factitious?
The first person to suggest that I had dissociative identity disorder was the same doctor that has been struck off for being unfit to practice. That was when I was 15. Since then, diagnosis accumulated have included depression, unipolar, anxiety disorder, post traumatic stress disorder, bulimia, borderline personality disorder, emotionally unstable personality disorder, complex trauma and factitious disorder. The last one was rubber-stamped willy nilly by an A&E doctor after an insulin overdose a few years back. I said I was diabetic, thinking that then this would mean I would not be taken to be suicidal, just clumsy and would be let loose again in no time providing they got my blood sugars stabilised. Obviously, diabetes is a very serious disease and would be on my medical records, and it wasn't. The doctor didn't come back to question why I had lied, hadnt spoken to me about my mental state and assumed that I had got myself into a state by taking insulin so I would get sick for the hell of it. Hence that diagnosis.
I have no idea which of these diagnoses stayed and which remain, whether a new one automatically means the old ones are deleted or if new ones mean the old ones are just disregarded.
All my diagnosis' are all covered by my first ever diagnosis: dissociative identity disorder. Yet that one seems to have fallen by the way side too, or at least it wasn't mentioned at today's discharge meeting, despite the best part of my stay in hospital being a switchy mess and talking 'openly' about my experiences of dissociation.
I used to not care about what the latest label smacked on me was. That was when I was not being forced to engage with services though. It becomes important now, when that is the preconceived idea that whatever professional will have on you, based on your shiny new label. Not everyone is going to delve into your psychiatric history to get a fuller picture, but more importantly, not everyone is going to ask you what you think, which to me is the most important thing. After all, it is you who is wanting help for what you think is wrong, and ultimately, you who will fix that with the guidance of whomsoever you get lumped with courtesy of the NHS.
What am I ranting for, what is it I want?
I want help, but I want help for the problems I am actually dealing with. Not mood instability as I experience pretty consistent and coherent moods, with the exception of when I switch, come around and people tell me that whoever was out was whatever mood then, or when I am overwhelmed with more than one emotional situation due to sharing a fucking body with more than one person. That explains the “emotional instability”. But losing time, hallucinations, a head so loud it could rival Glastonbury at times and not knowing how to cope other than self harming, those are things not explained by emotional instability, but explained by dissociation.
I looked up the criteria. I fit 3 out of the 9 category at a stretch. You have to fit at least 5 for a diagnosis. Hmm...
If I had the right diagnosis, treatment would be focused on the above. But because I am “emotionally unstable”, it will be focused instead on mood regulation. No good to me. I am a pro at switching off or dampening down feelings, and can choose a lot of the time to employ this 'skill' when becoming overwhelmed. Or I get too wound up, get past the tuning out stage and inevitably lose the plot, blank out, switch.
But perhaps the DID diagnosis is still there and this is just an 'alongside' diagnosis and I am being unstable over something silly?

P.S. Should maybe email the link to my blog to psychiatrist? See where I get then...
...on second thoughts, perhaps not.