understanding (n.)

I am having to learn how to be a DMHP all over again.  And it is exhausting.  (read: the person who acts as an arm of the superior court to make decisions as to involuntarily detaining patients to psychiatric beds.)

A week before my wedding in 2012,  literally the week before my wedding, I was at a DMHP week long training in the city.  And then I went back to the community in which I was working, and the coursework did not transfer over to any practical skills.  O, how I just dreaded, dreaded, dreaded crisis work in the previous community.

For propriety's sake (and o, my word, is it difficult to be in a place where I observe any propriety), I'll refrain from going into why they skills did not transfer over.  That county just did things that county's way.

So now, while I am building up my child and family caseload at the New Clinic, I am being trained again in DMHP work, because I will be expected to take crisis shifts 3 to 4 nights a month.  There is always a sliver of worry that pierces my spine when the crisis calls come - hard and sharp and automatic.

I am slowly learning that the New Clinic's way of doing crisis is so different from the Old Clinic (and we're talking the job before my last one, folks.  Two jobs ago) that it shouldn't even have the same name.  I'm learning.  Learning how to trust my clinical skills.  Learning to trust that help will actually be there.  Learning that I *can* make sound clinical decisions that serve my patients' best interests.

Slowly learning that crisis calls don't have to be spears of fear.

I'm grateful for that.  It's a slow gratefulness, but gratefulness none the less.

The head crisis worker at the New Clinic has been training me carefully.  He is a quiet, gentle, seasoned veteran, and he continually asks me quietly, "What do you make of this?"  "What do you think about (something)?" "What could this be from?"  And then when I hesitate or apologize for thoughts he quietly says, "I like your line of thinking" or "Go on with that thought a little further."

And this is where we get all Mufasa lifting Simba to the sun.

My MIL was a clinical psychologist in the area for years.  Head of mental health, retired now for a bit.  Next state over, but the same geographical region as where we all live now.  The Head Crisis Worker at the New Agency actually worked under my MIL for a long time.  (That's how it goes in small towns.)  Today Head Crisis Worker and I responded to a particularly sticky crisis call at the ICU.

As he was writing his final documentation (and we had been there for hours, my stomach grumbling and my head swimming from information), he started chuckling, looked up at me over his glasses and said,  "I find it ironic that as I'm writing this, I'm very much remembering things I learned from (my MIL)."

It's all in the family, I guess.

Look, folks.  All I really want to do is get back to providing child and family therapy.  But if this is what has to happen as part of this package deal, as long as it looks like this and has this type of support, and as long as I'm surrounded by clinicians who are in this for the patient's best interest, I think I can stick this out.  Being an Every Person with Other Duties As Assigned is part of working rural community outpatient health.  I wasn't prepared for that at first.  I think I'm getting closer to that point.

July 12, 2014 ~ Captain's exploration log.

This new clinic is a foreign, bewildering place of hot tea, water features and piped in music.  The inhabitants claim to be rural community outpatient mental health, but I continue to look for signs of proof to this claim.  Upon arrival, the presiding therapists came out of their offices and while I presumed their first, most pressing question for me would be "When are you going to take your first crisis shift?," they most confusedly instead asked me my name.  Additional observation needed; we don't appear to be speaking the same language.


Maybe it's because this clinic is actually in the town with the PAC12 University.  Maybe it's because of some vision somebody had ages ago to buck all stereotypes of rural community outpatient mental health.  Maybe I don't know why it is, but this workplace is different.

~ We have a prescriber who's there several days a week.  A prescriber!
~ We have several licensed social workers, licensed mental health counselors and clinical psychologists.
They like each other. (??)
~ The executive director attends all clinical meetings.  Quietly.  Just so he can "really know what you guys are dealing with on a daily basis."
~ Despite the fact that I am already qualified to be a DMHP in this state (read: I can involuntarily detain people to psych beds), nobody has asked me when I'm going to start taking crisis shifts.  They like doing it.  There's no rush to push it off on someone else.
~ There are *several* case managers.
~ I am actually being *trained* to do crisis on call, and with that, am receiving a ton of training on SPMI (never had that before, folks.)
~ I called my first clients and when I asked where I needed to document that, I received a concerned, but caring, look, and my co-worker stated, "Oh, you don't.  It's fine.  People trust you here."
~ We gave a "great" relationship with local law enforcement.  (? What ?)
~ The Friday Therapists (the few of us who work Fridays) asked me to lunch the first week.
~ HR actually sat down with me the first day to explain benefits, gave me a key and asked me several times if I had any questions.

Look.  I'm not saying it's perfect.  I'm not saying things aren't going to bother the crap out of me at points or that I'm going to love everything.  I'm not delusional.

What I am saying is that this clinic feels more like the clinic I left in my native Portland.  I'm saying that I'm having cross disciplinary meetings.  I'm saying that we're speaking about heteronormative and gender normative language.  I'm saying that somebody said "prodromal" this week and I literally have not used that word in two years, despite working in mental health.

I *am* saying that people are happy at this clinic.  People have worked at this clinic for 20+ years and nearly every one of the old timers has said, "Fresh eyes!  Ask questions!  Let's better this process!"  I am saying that, after two years of rural driving, the clinic is 7 minutes from my house.  I am saying that I worked 40 hours (as opposed to 55 or 60) this week.

I *am* wondering if this is going to be the switch Shoes and I needed to be able to stay in this area for a few more years.    I am cautious, but I am hopeful.

And by that, I mean, oh, this poor me.

(I may not even pretend to try to suck it up in this one, guys.  I'm not looking for your pity, per se, but a well placed social worker "amen," "hallelujah," or "preach it, sister"will not be rebuffed.)

This blog has seen the evolution of my life for the past nine years - from the days I worked in juvenile justice and was married to a Different Guy,  to the decomposition of that marriage, to deciding to go to grad school, to meeting and marrying Shoes, etc, etc, etc.

Etcetera.  Etcetera.  Etcetera.

I have not used this blog to document my first two years after graduate school, however.  Two years?  How did that happen?  Living and working in the rural, RURAL, Inland NW has been an experience unlike any other.  I have not yet found my niche.  I have job hopped twice now.  That's not me.  I thrive on consistency and routine in my own life.  This just isn't me.

You might remember that I left community outpatient mental health, for reasons I won't speak about, to join a new agency, providing in home family therapy in an effort to prevent placement of children into the foster care system.   That was very, very good work that I loved whole heartedly.  It turns out I didn't, love, however, being on call 24/7 (literally going months being tied to my work cell phone), working almost every weekend, working 60 hour weeks, and putting thousands and thousands of miles on my car driving to the most remote locations you can imagine.  Places without electricity.  Places without running water.  Places where I fed goats and stacked firewood.

(That last one actually wasn't that bad.  I like farm chores.)

And it didn't work.  It didn't work with my family.  It caused stress within my family.  It caused mini meltdowns.  I have missed out on holiday functions and birthday dinners and quiet moments with my spouse.  Most days I have managed to take care of basic hygiene functions, but nothing really beyond shower, deodorant and combing my hair.

(Uh, ok, whatever.  I didn't always comb my hair.  But it was washed.  Most days.)

It just reached this critical stage, you know?  One of my best friends from graduate school finally told me I was being unethical.  I wasn't taking care of myself, I was distant from my family, and oh, this next one was ouchy, but it was entirely true:  he stated that because I was so burnt out, I wasn't giving my clients the best care I could because there was nothing else to give.

Put your own oxygen mask on first, folks.

So I did.  Ok, that's a lie.  It wasn't only on my own accord that I reached up for the magical oxygen mask and it's not like those things are just hanging down magically everywhere....  A therapist friend of mine who works at a local clinic contacted me and said they had an opening and were willing to consider hiring an unlicensed therapist (I am 2/3 of the way done.)  I applied.  And interviewed.  And 45 minutes after the interview, they called and offered me the job.

So I'm transitioning again.

My last day with the last agency was yesterday; I start the new job on 7/7 as a children's mental health counselor at the new clinic.   That is closed on the weekends and major holidays.  That comes with a pay raise.  That comes with agency sponsored CEUs (no more paying for my own!).    I'm not on call all the time.  I have looked for my dumb pink work cell phone about 50,000 times today, panicked when it's not right there because HOW WILL I HEAR IT???  Only, that part is done.

 Today I SHOWERED, and COMBED my hair, and glory be, I even put product in it and styled it.  What.  I'm *bringing* the personal hygiene now.  I took my car in to necessary repairs.  Scheduled Rosie's grooming appointment.  Normally I would be catching up on housework, but, as it happened, one of my last families struggled with organizational challenges and when that happens, my own house gleams.

I'm re-entering the land of the living.  And I have goals.  We planted a vegetable garden.  I would like to see it live.  Shoes and I are planning some big changes in our family.  I want to write the short story I've been meaning to.  One of my parents is having major, major health challenges.  All of these things will need attending to.

So I haven't really been blogging the past two years.  It is what it is.  Now I get to pick it up again and continue.  My hope is to reconnect with my old blogging network (that community has changed significantly, though, so unsure what that will look like) and make new blogging connections.

And be a normal human being (whatever that means.)  I am also looking forward to that.

Shoes and I are trying to find footing again after the past two weeks.  The situation continues to grow in complexity, and as much as out hearts are just broken, we always come back to the same point:  we did not lose each other.  

As you know from my last post, our (Shoes and I) sweet friend, V., died two weeks ago.

I don't really know how to write this post.  It might turn out disjointed and nonsensical.  That might be fitting.

Five and a half  years ago, after Shoes and I had decided that we were serious and moving forward in our relationship, I started to meet his friends.  This was 100%, thoroughly and utterly nerve wracking.  Shoes grew up with the same group of friends, attended undergrad with many of them (lived with them as roommates), and after undergrad, when they split for graduate school and different parts of the world, they stayed as close as they had ever been.  Years upon years upon years of shared history and experience.  They are still an extremely tightly knit group, full of love, encouragement and forgiveness for each other (when you're friends for that long, rifts are bound to happen.)

V. was the wife of Shoes' long time friend S.  The first time we met them, we had gone up to the Northern part of this state to have a long weekend with them and two other couples.   In essence, the entire group was welcoming, loving, enthusiastic and opening.

So very open to having me infiltrate their strong friendships.

V. was there that weekend.  And she, with the other women, was vivacious, loving, curious, affirming.  She was a large part of what made being friends with all of these guys so very easy.

V. is hard to explain.  She was, in a sense, the best part of who you are. Honest and blunt, but without force or aggression.  She was vivacious and loved to laugh and adored making sure you were comfortable.  She was compassionate and tender hearted and tough.  So very strong.  V. came from a very large Laotian family; watching her relationships with her family was a sight to behold.  Loving and loud and boisterous.  Her family were her friends and no matter who you were, V. made you feel like you genuinely, authentically were her best friend.  All of she and S.'s summer barbeques, graduation parties, etc, were packed to the walls with the friends they had accumulated over the years.

This is where it gets a little sad.  That's my grief.  You don't have to keep reading from here.  I would understand.

Everybody - and I mean that quite literally - everybody loved V.   On the day that V. passed away, she had been experiencing strange physical symptoms in the morning.  The events surrounding how she got the hospital are long and complicated, but she did.  She was taken by ambulance to the hospital S. works at, and a medical team who was very familiar with S. worked all day to revive her as she kept crashing.  (That's not exactly quite how it went, but to protect the family's privacy a little, that's how this version goes.)

They were unable to keep her stable, and at one point, after 20 minutes of chest compressions, the medical team had to let her go.   As the medical team filed out, the nurses dissolved into tears and the lead physician crept around the corner, and believing he was unseen, crouched down on the floor, put his head in his hands and started sobbing.

When S. told the children's preschool teacher, she also dissolved into uncontrollable tears.  V. had made friends with her, with the other parents, with the children ... V. was your friend.  Period.  If you knew her, you were loved by  her.

Shoes and I have been rocked to our core with grief.  I realize that sounds melodramatic, but I cannot remember the last time I was this affected by anything.   I have spent hours in tears that sneak up out of nowhere.  Shoes and I have been sad, and irritable, and slightly grouchy with each other.  We have spent hours texting our close friends, emailing them, talking on the phone with them.  The loss of V. creates a giant hole in each of us individually, and in the group as a whole.

Shoes and I just returned from her out of town, Laotian Buddhist memorial service.  Please know my heart - in no way do I want at all to disrespect another person's culture - but the ceremony did not offer the sense of closure we were hoping for.  I think this is because it's just not how we, in our Western thinking, have been accustomed to grieving and the ceremony of saying Goodbye.  We all know that V. would have most definitely wanted a fully Laotian service, though, and for that we were very, very grateful.  Some elements were shocking to us and while I won't mention most of them here, I do want to touch on that final goodbye.

This may be uneasy to read and may be triggering for people who are experiencing grief or have complicated loss / grief in their pasts.  Please feel free to stop reading.

At the conclusion of the memorial service, my husband and his close friends were asked to follow S. with wreaths and lead a processional from the room the service was held in, around the side of the funeral home, to the room with the crematorium.  Shoes and his friends were followed by the monks, who were followed by the nuns, who were followed by V.'s casket (on wheels.)  The rest of the ceremony guests followed this processional as Laotian matriarchs threw coins wrapped in tin foil at us for luck.

Once we arrived at the incinerator at the crematorium, those at the front loaded V. in her casket into the incinerator.  The door was shut and latched.  The incinerator was immediately turned on.

Most people left for the Laotian Buddhist temple at that point.  We lingered to be with our friend as he visited with other funeral guests.  As Shoes and I were getting ready to leave, we looked back at the crematorium roof as smoke started clouding out of the chimney.  Shoes looked at me with tears in his eyes and said, "What did we just do?"

Of course, that's not that.  After that, our close friends went to dinner and stayed up late drinking wine and telling V. stories, grieving in the ways we know how.

Woke up the following day, and still felt sad.

Sad that my friend is gone.  Sad that her two very young children don't have a mother.  Sad that her husband now has his own grief that only he can get through, in his own way.  Sad that when we gather together as a group, her loss will continue to be a large hole in our fabric.  Sad that an entire mess of people miss the woman who  let them know that they were loved.  Accepted.

It doesn't make sense that a 35 year old woman with two very small children four and under woke up one morning, didn't feel well, and by the end of the day, had passed away.  It doesn't make sense that a four year old child now asks their father every day "when mommy is coming home."  It is heartbreaking to watch an even younger child cling to their father and scream when given to somebody else to hold because the entire situation is too confusing, too scary and to devastating on an entirely emotional level.  And while none of it makes sense, I've stopped looking for meaning and just come face to face with this terrible grief and sadness.

The only way through it is through it.

I get that.  But I would totally be lying if I didn't also say that I am looking for the days when it doesn't feel so heavy, so enveloping, so all encompassing.

It's such a terrible cliche, but V. was the best of all of us.
And that's a very hard thing to let go of.

There is no order to this post - random thoughts only.  Apologies for the lack of linear writing.

Of Grief:

Shoes and I are deeply, deeply grieving the very unexpected loss of one of our closest friends.  I have much to say about that, but I cannot organize my thoughts in any coherent fashion.  It felt wrong to continue this post without recognizing that this - the loss - our dear friend - is much more important than the rest of this post.  I don't know what I would give to have her back with us.  With her husband.  With her toddler / preschool sons.

Probably everything.

Of Resistance:

Sometimes I do not have the same experiences with clients that other therapists do.  Sometimes I am given families and literally told, "if they don't get this with you, we're terminating their children."  Sometimes I am told, "you are their last chance."  I hate that.  I'm not a miracle worker.  I can't motivate people to do something they're not ready to do.

And.

Sometimes what looks like resistance is not resistance.   Sometimes what looks like, "F* you" is really "I'm scared and I don't know what to do and I know I don't really have any chances left." Sometimes resistance is really people saying, "What if I reach for you to help and you're not there?"

I am closing with a client soon.  Today this person dissolved into tears and stated, "I don't know what's going to happen when you leave.  We've learned how to be a family again."

Resistant.

Of Promotions:

I received one.  To Lead Therapist.

Don't really know what that means, but am realizing I'm two years post Masters and they said this would happen at about this time.  Don't really know how much low level supervision I'll get to do, as workers keep handing me their most resistant clients.

Sometimes I don't get this life - what happens - the directions we take - why some clients make it and some don't - how we measure success - why some people are taken from us so early - they whys of anything.

Tonight, I think I'm just tired.
That is what it is, I guess.

Oh yoga.

I started yoga in 2007 after I separated from the former spouse.  It was wildly nourishing and challenging and for 90 minutes I could concentrate on something other than some of the worst of human emotions.  I was, and I say this lovingly, and to roughly borrow a phrase from Elizabeth Gilbert, a cliche of an almost divorced 30 year old taking divorced lady classes at the Y.

But whatever.  It was healing in the most healing of ways.

A year later, I managed to sneak restorative yoga into a credit earning part of my graduate school schedule.  And THAT was wildly nourishing in all new ways ... a return to the same, stable quiet sense of self ... the friend that had accompanied my move to an unfamiliar city.

And now, I've returned again, in an effort to have a space in which I am challenged, and clear headed, and letting go.  This has been really humbling, guys.  Turns out when you don't practice regularly, you lose flexibility and balance.  (Or at least, I did.) This has been a process.  Even concentrating on breath work and meditation has been a process - one wandering thought and suddenly I find I'm off rhythm with the Agni-Prasana and completely off kilter.  (Sometimes just being in the moment is the hardest part.)  (Agni Prasana is also called Breath of Fire and involves breathing in and out rhythmically, with the emphasis put on breathing out.  It forces me to concentrate on my abdomen - the drawing in and filling the lungs and the pushing out to exhale.  Other than the pace and emphasis, it's similar in form to the breathing exercises we use in TF-CBT and CPT.)

Last Saturday, in some strange turn of events, I was the only person at my usual morning class.   Slightly awkward, but the instructor kindly took the time to go over my form in a couple of poses that are more challenging for me.

Like this one:

(Image is hyperlinked - thank you, KatieYoga, for this beautiful example.)

I  might mention here that my yoga instructor is 7 months pregnant and did this pose as if it was the easiest thing ever. In the universe.  I, however, have not yet been able to do a headstand.  And, turns out, I am still not be able to do a headstand, but at least now I know a safer, more supported way to enter a headstand.  But here's the humbling part:  as I was trying to come into this pose, I experienced a moment of fear that caused all of my upper back to tense and today, I am still experiencing some pain in my levator scapulae (I'm fairly certain, anyway, that that is the affected muscle.)

My mind took over.  Again.   This is fascinating to me.
The increasing awareness that my thoughts are loud, bossy and somewhat anxious and fearful, and that they interfere with my body, is incredible.

Maybe one day headstand will be more accessible and slightly less intimidating.  Maybe one day my mind will just let my body be.

That's the hope, anyway.