I’ve completed six days in the Lutheran Hospital outpatient program, and I can’t tell yet if it’s making me better or worse.
There are two designations—IOP (Intensive Outpatient Program) 1 and 2. None of the literature explains the difference between the groups, but, basically IOP1 is for more functional, more acutely symptomatic folk. IOP2 is for more severely ill folk who maybe require other services (home care, rehab, medical, etc.).
The first two days I attended IOP1. The group was HUGE, 14-18 people with the usual one or two who dominated every conversation and folks talking over each other. I thought I would lose what little mind I had left.
I watched my intolerance and irritation skyrocket. My Libra penchant for fairness blew up into a neurotic need to silence the blabbermouths so that the silent suffers might get a second to squeak out a comment. But I also realized this was all my shit. If the facilitators felt no need to shut down the usurpers or redirect the tangential wanderers, then it wasn’t my place to step in. Instead I clutched my purse to my chest and took deep breaths.
After the second day (and no sleep that night), I knew I needed to talk to my designated handler. I told her through bitey, frantic, tear-and-snot laden spew that I couldn’t take another day of it. She listened with a beatific smile and commented in a gentle don’t-spook-the-Tasmanian Devil voice. Perhaps I should move to the other group. And feel free to find a quiet place to breathe whenever the desire to punch a talky-talker in the face arose.
My first day at “the other end of the hall” felt restful in comparison. There were only five of us in group, and I learned things about PTSD—one of my diagnoses, though something my therapist and I have never really explored. We usually have other immediate shinola to deal with, so we’ve only ever just touched on it. THIS was what I was hoping for—some new information, some new tools, a direction.
But, the next day the group expanded to 13, and the whole issue of blatherers and time-sucks reappeared on a crazier level. I tried to be compassionate, but that well seems to be dry at the moment. I know folks talk out of nervousness, insecurity, etc., so I tried to reason with myself. I still ended up out in the hall with my earbuds firmly in place, listening to Billy Joel sing “Innocent Man.”
I blame the insurance industry and our butt-head Governor, Terry Branstad. Most insurance coverage only allows three days a week in outpatient care, so Mondays, Wednesdays and Fridays end up with twice the group size as Tuesdays and Thursdays. It’s stressful to go from a small, intimate group where folks feel safe enough to open up, to a mob where everyone talks at the same time.
And because our Governor closed most of the mental health hospitals, took away funding for behavioral services, and basically told folks with mental illness to “get over it,” the programs that are left are bursting at the seams.
I watch the kind and knowledgable staff at Lutheran run around like headless chickens, trying to accommodate everyone’s needs, shore up folks enough to leave so that those who have been waiting a month for an opening in the program can take their place. The nurse practitioner who talked to me about medication laughed long and loud when I called it “a three-ring shit show.” This seems to be my new favorite phrase.
I came home every day more exhausted and people-avoidant than ever. I feel like an Introvert In Extremis, only able to function after hours of silent cat time, a couple episodes of Fringe and a frozen pizza from Costco (they have the best thin crust sausage pizzas…). Even then, “functional” may mean taking a four-hour nap or washing the dishes.
Yesterday I did my laundry at 3:00 in the morning, because I couldn’t stand the thought of going to the laundromat on the weekend when everyone else goes there. So, because I was already awake at 3:00, I did laundry for the first time in my apartment complex’s washer/dryer. Granted, one is not supposed to use the machines until 8:00 out of respect for the tenants who live next to the Common Room. But since I hate people right now, I didn’t care. And I tried to be quiet. No one came after me with a knife, and no one slashed my tires later, so I think I got away with it.
In between tippy-toeing, I sat at the nice dining table and worked on my journal. Along with my wheeled laundry hamper, I brought my traveling studio (everything should be on wheels) and a big mug of hot chai. I sat at my own little coffee shop with my earbuds in and the smell of clean wafting around me, and even through the itchy buzz of being up at 3:00 doing something illicit, I could feel my mind smooth out.
The same nurse practitioner who laughed so hard with me suggested a new strategy for next week. Bring my wheely cart and when group bugs me too much, take it to this out-of-the-way lounge I found and do art until I feel like coming back. I tried that on Friday, and I left the hospital less drained. I met my two meditation buddies for lunch and lasted about 30 minutes before I completely faded. My well is dry. That’s all there is to it.
I think the trick is to not panic. I feel myself considering the new drugs this kindly nurse practitioner suggests, even though I sat with my own NP before I started IOP and recounted my long list of Drugs Tried and why they didn’t work. She reminded me that there really is nothing new in psychotropics, just tweaks to the same old formulas. If they didn’t work then, they won’t now.
I’m grateful that the Lutheran staff is so willing to work with me. It’s ironic that the adaptability and flexibility I need from them is part of what makes me so irritable there. It’s a very loose, laissez-faire set-up for people who have different special needs. I must try to give my Libran craving for fairness, order and rules a rest. Maybe I can give her a Xanax.