Mandatory End of Year Reflection, 2022 (A Peterson Family Update)

So, yes, I have fallen off of the face of the earth lately and hadn't posted any blogs for all of December to this point.  I haven't figured out a writing schedule with my new position as of yet, particularly with the extra frills of the holiday season.  

It's been another eventful year.

The new view on my way to work

On Loss

Grandma Peterson died last year, the first of Andy's four grandparents to pass.  Given the vaccination status of some family members, I was not able to attend the funeral without risk to myself (as an immunocompromised person) nor my patients, tangentially.  This was its own source of grief, to emphasize that one of the loudest lessons I've learned through the course of the ongoing pandemic is that many people would not do the bare minimum to keep others safe, even others that would actively drill holes in their own lifeboat in the name of selfish freedom.  I have seen firsthand what the long-term effects of COVID can look like in the hospital setting and have no need to roll the dice there, subsequently meaning that I have less guilt in removing myself physically from certain situations and interactions.  It's a complicated grief, all the same.

Additionally, Andy and I have two other grandparents with waning health--there is an anticipatory grief in these circumstances, a quiet preparation for eventualities.  For my last remaining grandparent, my mother and I have had frank, clinical conversations on what pattern we see happening, acknowledging that knowing is both comforting and not.  These thoughts linger in the back of my mind, quietly simmering as I see other patients enact the same process in the hospital setting or in the occasional family mass text update.  

Certainly, though, the most significant upheaval in our home this year was when Andy was let go at Rivian.  There are still moments when it catches us, where we go "why Andy, of all people?" who proselytized Rivian with enthusiasm and joy.  But it happened.  And the logistics had to be addressed, allowing space for the emotional components to process.  There was a lot to think about, including (but not limited to) household needs, identity, and the health insurance we had been getting through the company.  

That last one in particular, I have been running orange for a while, just a gentle shove away from red-overwhelm on my internal status bar, watching the internal rpms of my brain and body rev to some dangerous sounds.  It is not healthy to run the system at that degree of stress for a long period of time, but I could not be settled until we were settled with specifics on insurance.  Now with a plan set in place, the system is still in the yellow until I see the household figures after the first month, but yellow is at least edging back toward a healthier green.  The survival voices have been loud the last few months, and the great injustice of how expensive I am to keep alive because of a disease that is not my fault, well, it's galling to say the least.  There is more grief here than I know what to do with, especially knowing how proactive I am toward my health.  There is no moral failing in having a human body that needs care.  There is a terrible moral failing in taking advantage of that to profit oneself.  

In short, we started the year as DINKs with a clear plan on a relatively viable (for this country) healthcare plan and our financial and personal goals laid out.  We end it still sorting some pieces out, having lost a degree of security in that upheaval.  My experience with the unknown means that we have had strong safety nets that have held us above immediate danger, but there is a degree of bitterness in needing to use them.  

Nothing is wrong with Andy's leg!
He's a good sport for letting me practice.

On New Adventures

So, we actually paid off the Rivian this year.  That's some crazy shit, yo.  We are Millennial Unicorns.  Our remaining debt is my nursing school student loans and our mortgage.  Depending how the student loan forgiveness elements shake out, we could potentially pay off my student loans by the end of the year.  Comparing to where we started our marriage to where we are now, it's extraordinary to see the progress we've made.  

We've had some great adventures this year, including a family vacation to Pigeon Forge, a few trips to the Twin Cities to hang out Josh and Morgan to seem them in different productions, an adventure to the Wisconsin Dells around my birthday (involving an escape room, axe throwing, and Wizard Quest), and a couples trip down to St. Louis to hit all of the Upper Limits gyms that direction.

Ah, yes, we started rock climbing this year.  Hard to believe we've only been doing that since May.  Andy--who never does things halfway--has been especially taken with it.  After a cooling period post-Rivian, Andy now works at Upper Limits.  I've been envious of the opportunity he has to climb, certainly, but delight in his excitement and my own milestones.  He's finding his footing.  

The increased exercise has done Andy a lot of good; I have also found a nutritionist and have made some good strides there.  It's been very gratifying to see some physical results of our mutual progress.

And because we cannot do household upheavals one-at-a-time, I switched from inpatient to ambulatory nursing working at the Wound Healing Center.  I'll have some further specifics on the new job in some upcoming blogs, but the short version for the moment is that I am delighting in expressing nursing in some of the ways I specifically went to nursing school for.  I still have one foot in the inpatient world and the relationships I've made there, and simultaneously I'm finding a groove in my new place.  Now that I've been a nurse for over a year, I'm simply amazed at how much I've grown and learned in that time, what tricks and processes I've learned in that time, how I've solidified setting boundaries, and so many unquantifiable workflows I've refined in growing my professional practice.  There is a rightness here.  

Mike started a new adventure, too, working toward radiology at Heartland, seeing his preparation pay off in completing his first set of required classes.  It's been fun talking biology with him, to share those spaces and even a couple of my textbooks.  

On Continuing Adventures

Luna is still and adorable little derp.  That's a beautiful constant at the moment.

We had to delay our Iceland trip originally planned for the beginning of December.  We probably could have made it work, but in retrospect it would not have laid nicely with my orientation to my new position--when we were juggling many things, it was a ball we could put down for now.  We'll be looking at doing that at some point in the next year.  

I had a wild hair the other day and bought hockey tickets for a Blues v Blackhawks game in January--looking forward to that mini-break already.  I have some additional ideas for upcoming hijinks but also finding the odd joy in being able to do weekend things, too.

As I've been continuing to think about the ridiculous amount of money that we spend to keep me alive in this country, I also cannot help but continue to think about leaving it for another one, finding what steps it might take to do that.  There's a lot to think about here.  

And Where it Leads Us

There was a lot of growth this year in unexpected places.  And all of it was certainly in that feeling of "becoming."  This year, I look forward to "becoming more."  Specifically, I would want for our household to work on becoming more of whom we are meant to be.  The three of us are in different transition states--I'm excited to think about what that can look like in another few months.  When I have my feet fully underneath me at the Wound Clinic, how will I move in that space?  How will Andy inspire his team and improve in his climbing?  How will Mike express his new learning spaces and enjoy the clinical time in the program?  

What new elements of self will we all discover in the process?  

So I approach the new year with optimism and curiosity, ready to probe some of those spaces.  ...And to find a new pattern for writing again.

Transition State

How's the new job going?  Great question!  Glad I pretended you asked.

Originally, I was supposed to start my new position at the wound clinic Thanksgiving week.  It happened that there were a few courses I needed to complete first before I would be allowed to work with patients--the way that timing worked in this case, I suggested that I take off the rest of the days during Thanksgiving week and then start with the classes the subsequent week.

So on the one hand, yay, surprise vacation!  On the other, well, the existential dread starts to creep in.  I get confused with time off and a little bit paralyzed with how to fill it.  When Andy was let go from Rivian, I was insistent, probably to the point of annoyance, that he take time to simple be and process the change and the grief.  I am shit at taking my own advice in these places.  

I've worked on the inpatient side of things, been a medical floor nurse for a year and some change now.  I have learned a ridiculous amount of things in this time, delighted in teaching the nursing students that came through in particular, and shared in many, many stories with peers.  There is a particular kind of grief in leaving that behind.  I have been avoiding processing it, for multiple reasons.  I am curious to see how I might process it given a bit more temporal space.  

And at the same time, I've got that roiling excitement and anxiety about starting the new position.  Hammering out the little details of when the first day is and logins and lockers and starting those new relationships on the best impression possible.  I think I've prepared just about everything I can:  we're simply in the waiting phases.  

Waiting is not a passive thing.  Waiting is active.  Most every piece of preparation that can be done has been done.  It's time to let things happen and absorb all of that I can.  I am going to continue to be unsettled for a while now, and that is okay.  Expected, even.  And in the same breath, I know that my body does not sort out "excitement" and "danger" correctly sometimes.  There's a lot happening in our lives right now.  And it's okay to let that be.  I am feeling anxiety, but I am not my anxiety.  In the same breath, I'm certain that we'll work out all the kinks as we go.  Through all of those acknowledgements, it occurs to me that it is time to take that advice, to greet those parts of myself and name them.  

It's another period of transition and transformation.

...and before I can even gather those thoughts together, the week is done.  I've had my first full day shadowing and am just beginning to see the flow of the floor.  I'm trying to absorb EVERYTHING.  And it's exciting, and my brain hurts.  I'm also trying to get to know my new peers and to not be the "well, at my old job, we did it X way" person while also acknowledging that that is my basis for comparison.  This expression of nursing is different, has a different pace and utilizes different skills.  I have so much to learn.  

I feel uncertain in my steps but confident in my direction.  And that's not nothing.

All the THINGS

I've been working on processing a particular kind of grief lately.  

I froze to death and drowned quite a
few times with this one

When I read choose-you-own-adventure books growing up, I wanted to know all the possible outcomes, which lead to some very complex book-holding techniques as I had different fingers in past major decisions so that I could go back to them when I hit another dead-end.  Significant early decisions were granted a slip of paper for the next read-through.  Certain page numbers became recognizable as I flipped through again, fingers contorted in strands of plots and pages. 

I love learning.  When I meet people, it's something that sits in the back of my mind, wondering what kinds of new things they can teach me, what niche subject they are quietly passionate about until someone asks the right question.  And by listening, I learned a lot of random things over time.  Sometimes only enough to ask halfway intelligent questions; other times building off of past conversations.  

This made the idea of choosing a career very daunting.  In choosing a college, I knew I found the right place when they didn't bat an eye when I said I wanted to double major in biology and creative writing.  It was important to at least keep learning a vast breadth of things while sorting out the larger questions.  I remember hearing "Jack of all trades; master of none," and feeling the gentle censure, that I should knuckle down into a specialty of knowledge or skill.  But then I heard the rest of the phrase that is commonly left off:  "but better than being a master of one."  

All of this to say I'm processing a degree of grief at the moment in changing positions that I've been struggling to find a way to articulate.  This is my last full week on my floor.  Naturally, I think of my favorite workmates first when leaving a job--I will miss seeing and supporting a number of people on and adjacent to MOSU.  And I'm also frustrated that I'm leaving after I've been finding such a good groove lately.  I enjoy working with students.  I have almost all of my assessments done before ten-thirty each shift, usually two or three done before eight-fifteen.  I am learning how to pay attention to clues on when someone is ramping up on both pain and anxiety and preempting those spaces, setting better boundaries.  

It seems a terrible time to leave, when I feel like I'm coming into my own.  I have had a couple people tell me that I would be a good charge nurse, and I think at its right time I would enjoy it, finding ways I can support my peers.  

And in the same breath, I am immensely excited to start working with wounds, to learn all the nuances and tricks in this expression of nursing.  

I grieve that I cannot do everything.  There is simply not enough time to do everything.  And that is a particular kind of grief.  There are so many things I could do, and even things I could be good at:  I have to choose.  And I'm happy with my choice, but also am sad to leave things behind.  They exist in the same space.  My plan is to keep a foot in the inpatient world by picking up occasional shifts on my old floor, a beautiful intermediate and merging of worlds, and yet I know this won't be the same as it was before.  

There isn't enough time in life to do everything.  I have to choose how I want to spend it best I can.  I have pulled the metaphorical strips of paper out of the choose-your-own-adventure book on some past decisions, choosing to hold the book in such a way that gives my full attention to the pages I'm currently reading.  There is a grief, but there is also a particular kind of wonder in accepting the present whole-heartedly.  I want to find the best way to honor my transitions grief, while also acknowledging this side frustration of limited time on earth and the impermanence of existence.  

There is not enough time in life to do everything.  And that's okay.  

Dichotomous Thinking

I am not a fan of absolute statements.  There are a few absolutes out there, but there are a lot of things that have exceptions.  I like to leave space for those.  This frustrates Andy to no end when he's trying to get an answer out of me.  He'll ask me if we can do X or Y tonight and I'll reply with something akin to "most likely," not because I'm trying to be coy but because I cannot predict the future to know if some emergency will pop up or if either of us will run out of energy by that point or whatever else.  Sometimes, these are exercises in abstract thinking, I confess, trying to find the obscure reason why something is/isn't or will/won't, as my dedication to the idea continues and just the way my imagination works.  More often, though, it's about that space, leaving room for deviations and exceptions.

Consequently, when I hear someone use "this person ALWAYS/NEVER does X" or "people are either Y or Z" without acknowledging even backhandedly that there are other choices and shades of grey out there, I tend to feel a degree of doubt creep in around that speaker and their assertions.  Sometimes it's a sliver of doubt; sometimes it's a hefty helping of doubt, depending on the context.  

The world is richer in greys than it is in black and white.  Subtle value adds depth, adds meaning, when viewing the full picture.  

But we like our false dichotomies.  "If you're not with us, you're against us;" "my side or their side;" "democrat or republican;" "dog person or cat person."  These are easy.  They are comfortable.  We like patterns as humans, things that help us quickly put situations and people in boxes.  These don't serve us in all situations.  In fact, they are counterproductive in many.  We lose that value, that depth, and often someone's humanity in those spaces.  

There is a difference between a declarative statement and an absolute, and there are places where they can be confused.  An observation of the moment or circumstance can have a declaration.  If it then becomes something permanent, that it is the only way or generalized to all circumstances, that's where we negate other possibilities and create a false perception.  

I want to be precise in my language, which sometimes means I fail at being concise--I'm working on this.  Sometimes, I feel a rewording or adding in the full scene is helpful but respect that the recipient may hold a different opinion.  Ultimately, leaving space also furthers honesty, attempting to be more transparent by acknowledging the edges.  It is meant to further clarity, assert sincerity, rather than muddy the waters, though I know that's not always the impact.  

I tell my patients that I know better than to speak many absolutes in my field, when they are trying to pin my down on answers about timing or why their doctor is doing X or what will happen after Z.  I tell Andy a percentage when I don't feel I can give an authentic, firm yes or no.  And I tell myself that keeping a space for new ideas means that I can continue to grow and find those different perspectives.  

Peterson Family Update, Oscar Charlie Tango 2343

Things have been hella busy lately, but not necessarily in a bad way.  They are, however, hella busy in a way that I'm only able to take things in pieces at the moment, which means it's a brilliant time to deploy the bulleted list once again!

• Nutritionist meal plan is still going well. My anxiety around meal planning has decreased immensely and my body is adjusting to different macros and their appropriate portion sizes.  Now that the hypervigilance is continuing to recede, I think I actually feel...pretty good.  A few of my data points are moving in a good direction, too.  I also have not eaten out much since I started this, which is good in its own way.  
• Andy and I are still enjoying rock climbing and the last couple of times I have had some really good climbing days, where I felt I had more gas in the tank than I had previously and subsequently was able to complete a couple of routes that I have been projecting.  We have all learned so much since we started in May, and it's neat to see that progress in something tangible, tackling routes that seemed completely impossible just a few months before.  
• With the last Peterson Family Update, I announced that Andy's position had been eliminated from Rivian.  He has been spending a lot of his severance package time traveling, tackling house projects, the aforementioned rock climbing, and otherwise reacquainting with parts of himself.  
  

• Luna is still a delightful fluffbutt.  She hasn't mastered my attempt at covering her eyes as a trick called "Eclipse," but leans on her side and paws up a bit so that you can move them up to her eyes, so that's a start.  
• Work has been tough lately.  Our current patient population has a lot of confused bodies for one reason or another, which means there are places where logic and reasoning don't apply.  I am solidifying some successful boundaries with a few of these instances.  Sometimes calling security is a way to stop things from escalating rather than waiting for them to escalate past a point--arguing with a patient can be more far agitating than calmly following through with putting them physically back in bed, following through on the choices that have been outlined.  I have wasted forty-five minutes attempting to convince people that cannot understand reasoning--there's no need to continue an unproductive conversation to this degree.  I pick my battles differently; I give choices where I can but not at the expense of anyone's safety.  
• Mike has been continuing in his coursework at Heartland.  We've talked about bones and the like a few times, and I'm trying not to get too pedantic in certain spaces.  
• Absolutely loving the fall weather lately--took an excellent trip to Starved Rock with some friends to catch up, see the foliage, and have a lovely walk.  
  

• The new sofa and chairs we had bought before hearing about Andy's job change arrived and we have rearranged our downstairs accordingly--it's neat to have a new perspective and see our space in a different light.  
• Andy is still sorting through what his next steps might be, but in the meanwhile our health insurance is still covered until the end of the calendar year.  Health insurance plans might sound great until we factor in a Tier 6 medication, in which case I focus only on the max out-of-pocket to compare one plan against another.  I have been managing a lot of spreadsheet action regarding health insurance and starting to look at other employers for different plans.  It's a shitty reason to have to leave my current job, but this is about survival and we'll do what we have to do.  It's a raw but real truth.  I will continue to feel unsettled until we both have coverage lined up for January.  
  

We cannot seem to do big life choices one at a time in our household.  I met some delightful folks at Big Brother Carle through the Ostomy Care Associate class I took who happened to mention that their wound clinic was looking for people.  

I got into nursing specifically to be a wound/ostomy nurse—my heart is in ostomy, with the ingrained compassion from my own experience; my brain, however, is intrigued by wound and the different problem-solving that entails.  I submitted for a transfer that will officially start mid-November.  My plan is still to pick up some weekends on MOSU, but otherwise I'll be commuting for a Monday through Friday, 0800-1700.  This way, I can simultaneously further my ultimate professional goals, keep the relationships I have, while also making some additional money to supplement a higher need insurance plan for my situation.  

I'm still very much feeling the season of change ramifications.  And I'm also optimistic toward the new adventures ahead.

Sound and Space

So, the cold fronts moving through as the change of seasons has been a bit of a different kind of wallop on me this year.  Normally I get a bit of a cold when the weather starts turning, just a week or so of sinus drainage and lamenting all of the moments that I had been able to breathe easily through my nose and then it's done.  This year, though, I completely lost my voice.  Just...gone.  I cannot recall a time when I had lost it to this degree.  

And, of course, it all started happening while I was at work.  Or rather, I discovered it after I had arrived at work.  Saturday, I had a sore throat from the drainage, with some pain in swallowing but otherwise no other major issues.  Sunday, though, I got to work and the first time I had spoken that morning, I ended up cracking like Peter Brady.  I hadn't had a reason to say much before leaving the house so that was a moment of "Ah.  Shit."  Over the course of that shift, it proceeded to get worse.  People I spoke with from different departments asking the cursory "how are you?" got a bemused "I sound like Peter Brady!" back from me, as all I could really do was laugh at myself and open up another Ricola from my pocket.  

By the end of that Sunday shift, though, it was no longer a question--two words out of my mouth made it apparent to anyone I was talking to.  Had a couple of patients tell me that I sounded a little hoarse as a bit of an understatement.  But giving report to the oncoming nurses, that was a particular kind of squeaky special.  And then I would laugh at myself which also sounded ridiculous and laugh a little harder.  When I left, I had told the charge nurse I would see how the night went and call off if I needed to, since I was scheduled to work that Monday as well.  

At around ten that night, I began to see reason and called work.  The call went something like this:

Me:  Hey, this is Larissa.

Charge Nurse:  Oh, I can tell.

I started laughing and she joined.  

Charge Nurse:  I'm sorry, it's not funny.

Me:  It is a little funny.  

I explained that I felt it was prudent to call in and recover; she agreed that was probably a wise decision.  *end scene*

So, I slept in the recliner that night, since that felt better than flat with the sinus drainage again.  Andy made me a hot toddy, and I was going to be on vocal rest for the next day.  I think I spoke less than two hundred words that day.  Lots of Throat Coat Tea, honey, water, and a bit of rye whiskey, but little speaking.  To my dog, we have gestures that we do along with commands and she was able to do quite a bit with just the gestures, once she realized that I still had a treat available.  Getting her attention involved whistling and kissing sounds.  

Talking with the other adults in my household, though, that was a bit trickier.  I had to think about my communication differently and how much space I take up regarding sound.  I couldn't have a quippy reply or theorize what might happen next along with the show we were watching together--communication had to be prioritized and triaged to short ideas or not shared at all.  And trying to get an idea across involved some basic signs that I knew, mouthing, and voicing only a few key words for context.  Andy would repeat whatever he was understanding from me, which helped us confirm immediately in the moment and try again as needed.  

I enjoy ruminating on words in a normal day, but this was a different kind of overthinking.  And then I noticed that I was also walking more quietly, paying attention to the sound of my body in my own home a little differently.  I felt quiet in space as well as voice.  It was a unique moment of awareness of how I take up space in a different manner.  

When I'm in a public space and someone is taking a call on speakerphone, I'm annoyed, particularly when there are glares that seem to imply that you shouldn't be listening to their conversation--sound takes up space differently and they decided to have a private conversation, loudly, in line at the mall.  There is a breach of consent here, that a shared space has been taken over by non-typical intrusion.  While hiking at Starved Rock this summer, there were multiple groups that were blasting their own music while walking the trails.  Some held a tighter radius, where we could hear it coming but the sound left with the group; others interrupted the natural sounds for minutes on end, loud enough that even the group had to yell to talk to each other.  Public space intruded.  It wasn't against any rules, but it felt rude, a breach of courtesy.  Coughing, though, as another example also breaches a shared sound space but it seen as more acceptable, understanding that it is usually out of control of the body in question.  But there is still a point where excessive coughing requires different rules--I've slept in the recliner a few nights, now, half for my own comfort and half to ensure I do not disturb Andy more than necessary.  

There are invisible rules for how we take up space, and these boundaries do vary.  It was interesting to think about it for a while, even in my own microcosm of shared space with my housemates.  We have unspoken rules about when music or a podcast can be played.  Tor example, someone cooking the kitchen has priority.  And if someone was in the space first that can also grant priority, but there are consent check-ins, the easy "is it okay if I play X?"  It's also okay for us to request someone to use headphones or turn down the volume.  I won't say that we're perfect at it, but there are some good practices.  

And then there's Luna who borks anytime her great nemesis, the UPS truck, goes by.  Human social norms are clearly not her thing.  

Whelp, in the meanwhile I'm continuing to let this round of seasonal blah make it's way through, coupled with another Covid booster last week, I'm ready for some good days again on the other side.  I'll continue to take up space differently for a little while longer, including extra mugs, Ricola wrappers, and a more coughing.  I'm allowed to take up space; and it's interesting to consider it in a new light.  

About Food

I have a weird relationship with food.  Funnily enough, having an autoimmune disease that affects my digestive system.  Honestly, I would go as far to say that I have disorganized thinking around food.  There are a number of triggers and patterns that have made food a touchy subject for me.  

• I've lost thirty pounds in a month before because it was too painful to eat and I had no appetite--Crohn's flares are a beast
• Trying to force yourself to eat when the back of your mind screams that there will be Terrible Consequences! while simultaneously another part of your mind is screaming that if you don't eat there will be Terrible Consequences!...well, this results in Terrible Consequences! AND anxiety 
• Already experiencing a reduction in much joy of eating, eating something I don't feel I'm in the mood for is not something I can muscle through can be a special kind of nausea
• Back in 2016, I went keto and found that I felt better by sticking to that diet; I also felt very left out of the community aspects around eating
• The past few years, I've been doing a "lazy keto," where I attempt to stay mostly on diet but end up feeling terribly guilty at least twice a week
• Living with two vegetarians made it harder to find recipes that worked for all of us, which increased the emotional energy it took to plan out meals and groceries for the week and also meant that I reverted more to pre-packaged options and less cooking for our household overall

I know that it is unfortunately always a matter of time until my next Crohn's flare--that's what chronic illness do.  I acknowledge this truth at the same time I am relentlessly pouring my efforts into ensuring that this happens in the far-future rather than the near, always working toward a better state of health.  

All this negativity toward food, there is plenty of room for improvement, here.  So I spoke to my GP about a nutritionist.  And I met with said nutritionist.  Now I'm working through unlearning and relearning in some of the same spaces.  

Probably my favorite lunch so far

So far, I think it's going well.  Feeling full on keto compared to feeling full on my individualized meal plan is different--my body was conditioned to feel even the same portion sizes differently, in terms of registering the physical feeling of "full."  I've also had the chance to rediscover foods that I haven't had without significant guilt in a long time.  Homemade apple butter in Greek yogurt?  Hells yeah.  Even the general burden of what should I eat/cook this week is cinched down into seven days that I pick from, already designed and with dinners accessible to my housemates so that we can cook and eat together.  

I'm at the end of week two, now, still fine-tuning the rules and nuances.  At this point, my bodily hypervigilance is going to start to back down a notch or two, which will allow a more gentle introspection into how I am physically feeling on the plan, now that the crisis marker systems checks won't be flashing in background.  The anxiety parts of my brain that try to help protect me by planning through catastrophizing remind me that this could still go terribly wrong, but I have also learned to acknowledge them and work through those spaces only as much as they are productive.  Most interestingly, though, will be the emotional introspection about food in this time.  Eating is always an emotional experience, and I have a lot of negative associations to shake off.  There is space for reclamation, and, better still, there is opportunity for it.  

After a month, we can take a better sampling of change and adjust accordingly.  I get quarterly bloodwork for my Crohn's disease management as it stands, so a request for a couple of add-ons for my own curiosity and to check for progress in other metrics is also easily feasible (A1C to check if I have adjusted in sugar management from keto to a diet that has reintroduced carbs, for example).  I have many, many places that I watch concerning my health, where I can watch trending data, as well as keeping a general impressions subjective log.  

Ya'll--I am high maintenance in some interesting ways.  And I have fought for a long time to get to this degree of "healthy."  There are places where I have accepted a new normal; there are places where the current "normal" has been challenged and improved; and the line is incredibly difficult to discern. Having the emotional and physical energy to poke at it, though, requires a base degree of stability that I have not always had.  My limitations can change daily; the ranges that they can be found in, however, have been steadily increasing, advancing how good a good day can be and minimizing how poor a bad day can be.  It takes a lot of its own energy to manage this.  I'm grateful to simply have enough spoons to be able to investigate or even make an appointment in increments at a time.  I also have the blessing of a diagnosis that I can point to--not everyone managing their own care has this easily, languishing in the "unknowing" space.  There have been times when I had thought things wouldn't get better on a particular front and been right--this was a path, then, of radical self-acceptance and then leaning into how to make accommodations for that need.  There have been things that have improved over a period of years.  That's what it is to live with a disability, slowly sifting out what can be improved and accepting what can't, while simultaneously ignoring a lot of bullshit advice, even when it comes from a well-meaning source.  

So today, it's food.  A fundamental concept that I am deconstructing and re-interpreting into my life as it is now instead of my life as it has been.  And when life parameters change, so will the requirements.  And we will adjust again, with a necessary amount of grumbling.  

Melvin & Me, Part 38: a...Fan?

So, I had a delightful first the other day.  

I was forming a new acquaintance at work.  While we were talking in a relatively calm moment, Melvin made a triumphant BLURB-BLURBLEBLURBLURB under my shirt.  I threw my hand over my side to muffle the sound, as I usually do.  "Ah, sorry, that's just my ostomy," I explained.  

"That's SO COOL!" they nearly shouted.  

And I blinked for a moment.  

They apologized immediately, hoping that they had not embarrassed me or overstepped.  I reassured them with equal urgency, that I was fine, just not the reaction I was used to, even telling her it was not the usual response.  

Normally, when I choose to reveal my ostomy to someone without an ostomy, there are three main reactions:

• Sympathy
• Gentle embarrassment and curiosity
• Total confusion, which after the explanation is then shifted to one of the other two

But this, this was new.  This was...enthusiasm.  There is a lot of brilliant ingenuity in the modern stoma creation process.  There is also a great degree of adaptation and reframing to live with one.  I even had to pause for a moment and think, yeah, I guess I AM pretty cool.  

I'm used to apologies and explaining that, no, really, this terrible burden is something that is very livable and truly gives me my best life.  I did not have to qualify the experience, that "well, yes, it is a burden BUT..." phrase I've said in different words many, many times.  

And then of course there were more questions, and the enthusiasm remained.  I left that moment with beautifully, bemused joy.  It felt pretty good.  I know I am resilient, that I have a degree of natural charisma, but I don't often allow myself to acknowledge that, afraid of sounding full of myself.  And yet, I am a marvel.  It's nice to remember on occasion.  My ostomy is a part of that experience, a part of me.  I am currently living better than I had thought was possible, in some of those darker moments when I had circled the drain.  Time is strange; so is our passage through it.

Another thought crossed my mind later:  it is problematic to reduce someone with a disability to "wow, what an inspiration!"  A person living with a disability is living their life; they don't exist to serve as a example to others on how theirs "could be worse."  However, there is a balance between recognizing the strength of the individual without turning them into a caricature.  In this particular example, I felt seen as a person rather than a person with a disability, which made all the difference.  I felt seen.  And it was nice to have someone else see the benefit without having to introduce caveat after caveat.  

Melvin helps me live my best life.  That can be inspiring; it can also be heavy; it is something that has profoundly shaped my experience.  And it's kinda neat.

Season of Change

I am not wholly certain if this is something that my confirmation bias has reaffirmed again and again or if it is something truly happening.  It's like getting a new car and then suddenly seeing the same car everywhere.  

To everything turn, turn, turn/ There is a season; turn, turn, turn

We are in a season of change.  I know that change is constant, yet there are still periods of time where it seems more turbulent than others.  Where instead of small pockets of change there are major changes, tectonic shifts that shake the ground under our feet in transition to a different elevation.  Both ground and water have to adjust.  

And there are spaces when it seems a community feels the shifting, that multiple bodies are kicked off their own feet for the violence of the shift.  Not all the changes are bad, but they do require a degree of reframing and creating new patterns.  

A time to build up, a time to break down/ A time to dance, a time to mourn/ A time to cast away stones/ A time to gather stones together

New houses, new jobs, losing and gaining family members, new conditions and states of being.  Flux and uncertainty.  Even for those I've spoken with that were not involved in some of the changes directly, they seem to at least be affected by those that are.  

It could still be a "seems like" kind of thing; I feel better to acknowledge the feeling.  To take a moment and pause and acknowledge change as it is and how I am currently experiencing it, there is an odd segment of calm in the midst of the turbulence.  

A time to gain, a time to lose/ A time to rend, a time to sow/ A time for love, a time for hate/ A time for peace, I swear it's not too late

Sometimes we get our sea-legs again, remember how to walk with respect to the waves as the boat floats on.  Other times, we have to find something steady to hold on to for a while longer.  And sometimes, the storm stops as abruptly as it began, leaving folks wary and damp but also steady again.  

We weather the season.  We acknowledge the weight.  We move to the next season.  

Turn.  Turn.  Turn.

Processing in the Pool, Health Insurance Grieving

I went lap swimming the other day to clear my thoughts.  I find I leave the pool a more whole person than when I entered it.  

I had not had the chance to swim for a couple weeks--the hardest part of working out is getting to the gym.  Packing my swim bag, getting in the car, finding a locker, wrestling with my swim cap, and the uncertainty of knowing whether there would be an open lane when I arrived, it felt like too much work when my mind was already overloaded.  

But that first dive in, the shock of the cold water everywhere at once, my mind can only be present where I am, if only for a moment.  And then I could count the lengths, deciding what I wanted to do for my next set.  

Other thoughts meander in and out as I circle back once again and again as I swim the seventy-one lengths to meet my mile.  Occasionally, the count slips and I spend a whole length or two attempting to remember which one I was on, passing the time very effectively as I let my body complete the muscle memory circuit, one hand reaching and then the other, legs independent of all else in continuous motion, breathing timed within the stroke for optimum efficiency.  

When an idea pops up that needs more attention, though, it stays as long as it needs to.  

I have run through many hypothetical situations, how I would have wanted to respond better in a past situation or creating a scenario and playing it out in my mind as a potential future event.  I have also used the space to organize the scattered ideas and emotions of a particular event to make sense of them, to find the words I needed to articulate something murky or clouded by other factors.  

I always leave the pool a more whole person than when I entered it.  

There are a number of concerns that required sifting in this latest swim.  

• A patient and I had had a misunderstanding between us, and I needed to sort out how to let that go, owning my role in the situation without owning her reaction and the guilt that implies.  
• I recently had my first experience calling a family member to tell them their loved one had passed.  I knew that this ten-minute conversation was a pivoting point in their life and felt the gravity of that.
• We are in a season of change:  so many people I know are in a state of flux right now, where there is significant shifting and upheaval and uncertainty.  
• As part of that season, Andy and I are sorting out our plan forward from here, attempting to allow some space for connections to happen organically.  We are also getting a better grounding on what our basic needs are, drawing a fence around where we want to restructure, simplify, and focus.  
• And most importantly, I am investigating different health insurance options.  

Regrettably, I have a lot of experience sorting through my major medication plays out in these arenas.  I would be so happy to be wrong somewhere; being right has been both validating and soul-crushing at the same time.  Yet, I still have to ask questions.  I am grateful that I've mostly been met with persons taking my questions seriously, that I have not been given a "well, just read the plan," with an implied "and stop overreacting."  So far, I am met with sympathy but not solutions--it's too early yet.  

Somewhere around lap twenty, my brain went:  "The US healthcare system is normalized extortion."  I nearly stopped mid-stroke.  If a medication costs ten dollars, I'll pay it; if it costs a thousand dollars, I will find a way to pay it.  Nowhere else in the world do these medications cost the amount we pay here, where we as a collective pay far more for healthcare for poorer outcomes than the rest of the industrialized world (source, source, source, source, all just from a quick search).  On an individual level, we know that we have to plan, that we will find what the maximum out-of-pocket is by March or April.  There are many plans that have a max out-of-pocket amount higher than what can legally be deposited tax-free into an HSA ($7,300 for a family plan), meaning that we cannot even break even.  

Oh, and the bones in our mouths are on a different scale altogether, because mouth-bones are a luxury, I guess.  

So, my heart was engaged in two directions that stretch it, between exercise and grieving.  It is an injustice.  And it is real.  And it is exhausting.  The problem does not go away-- a chronic illness existing within a systemic problem is not a great combination.  Which means that I have talked about this before and will do so again.  The wound cannot close; and this is a wound particularly real to me at the moment.

I take some comfort that I'm doing the right things--I'm investigating in different arenas, to identify our best options and understand them in their entirety before moving forward.  At the same time, I mourn its necessity.  I feel myself reverting back to survival tactics that have gotten me through other crises in my life, which doesn't feel great and mentally puts me in those spaces again.  

There is tension in these processing spaces, knowing the value of creating a space where that is possible but also acknowledging the anxiety of uncomfortable truths and the burden of setting up the ingredients for such a space.  A swinging pendulum of processing and distraction and back again, allowing it to swing freely without forcing it to one slide.  

Flowing with the stroke.  Arms and breaths timed together.  Only able to be present and immersed in the moment.  Everything can wait until the other side of the locker room, if only for now.  

YIPE

I remember watching this dog and Foghorn Leghorn duke it out.  At least once an episode, Foghorn Leghorn would do something to antagonize him and then run away until he was just out of range of the leash, only to hear the dog go from low barking to a high "YIPE!" as all of his momentum is suddenly stopped and he lands flat on his back.  

I've been thinking a lot about that "YIPE!" moment.  Andy and I had been making a great deal of progress on our financial and personal goals, motoring along at a good momentum, and then suddenly I feel a strong, implacable yank across my midsection.  I fell hard on the ground, knocking the residual air from my lungs and stunning my senses.  I'm still on the ground, running a number of system-checks (no bones broken, any bleeding? etc.).  To make matters worse, the tether is around my waist, meaning that I am also checking my ostomy with some urgency, a special system-check that is my own disability and burden.  

And in many ways, this is my tether.  

My health is such a complicating factor in our lives.  When it's going well, I'm allowed to get momentum again, to run freely within its radius until I forget it's there.  And then suddenly the rope snags on a tree branch or I hit the full extent of its length and I'm violently pulled backwards.  I've learned to take a slower pace in some areas, to ensure that when I am yanked back, at least it won't be a devastating thing.  I've learned to place pillows on the ground in certain areas to ease the fall.  

I am never allowed to run at my full potential because the burden and restrictions of my healthcare costs inhibit me from running freely.  Having a chronic illness is not a moral failure.  The way we punish people with chronic illness in this country certainly is.  When we say we are against or "not ready for" Medicare for all, we say that we're okay with certain people dying.  When we support a for-profit system, we say that money is more important than people.  This is not the way it has to be; this is not the way it is in many other places.  More and more those other places are looking very appealing for this fact alone.  

Because accessibility to healthcare is literally about survival to me.  It is life-and-death.  I, somehow, need to get my hands on the medication I take every eight weeks that costs $15K here, without going into irreconcilable debt.  It is an ongoing maintenance medication that keeps me healthy and able to function.  Offerings of covering 80% once a deductible is hit, well, that still means I pay $3K every two months until the max out-of-pocket of somewhere between ten and twenty thousand is reached.  At these crossroads, I am running as fast as I can just to stay in place.  There is no more thriving.  On most other metrics we're doing fine; but this one, this one is a devastating blow.  Technically, I have "access" to it; in practicality, the inflated costs of everything are patently absurd.  

These are the worries that keep me on the ground a little longer, wondering when I'm ready to try running again.  Wondering if padding the entire area is possible and/or cost effective.  Wondering what a safe pace to move forward is.  Wondering if there is a nicer tree with less snags or a more generous line.  Always wondering what we could be if the tether wasn't there.  

I spoke with a friend whose tether was their student debt.  Another whose tether was an ailing family member.  Many of these things come down to money; many of these things are felt in grief.  Sometimes a dream to run freely can only be a dream; other times, well, we need to question what kinds of alternatives had yet to be considered.

Peterson Family Update? Peterson Family Update.

I blinked and July was gone?  Seriously, what happened?  

A lot.  A lot happened, actually.  Let's talk about that.

• I am at my one-year mark of being a nurse.  A full year.  Holy crow.  I have learned SO much and experienced so many things, and yet I'm very much aware of how much I have to learn.  I feel like I am part of the team, that I have a sense of belonging and purpose to go with my title.  I also know what a "good" day and a "bad" day feel like, meaning I have a stronger basis for comparison to start forming my own opinions and ideas on improvement in my flow and the unit's flow in general.  One pattern I've established in the last month is to get at least two patient assessments charted before starting morning med pass, meaning that I'm holding less information in my brain when all of the momentum of the morning really takes off--knowing that at least I have accomplished that one thing makes me feel better about those moments where my time is dictated for me.  It's been a small but important change, helping me find a better rhythm getting into the day.  
• Luna already knows "do a barrel roll" for roll over, "revolution" for spinning in a circle, and "spot" meaning come to a certain area and lay down, in addition to more common commands like sit, come, and shake.  We're working on a new one now:  "eclipse."  This involves Luna covering her eyes with her paws.  As with many things, she can be pretty smart when there is food involved, yet she is still in the beginning stages of trying to suss out what behavior she needs to do specifically to get the food.  
• I am part of class through work that has some additional ostomy information, that upon passing I would have the Ostomy Care Associate certification.  Some of their tips are "well, duh!" to me from my lived experience, but there have been a lot of important things that I've picked up, now to make it absolutely worth my time.  I tend to be happiest when I'm learning something new.
• I got to go to Family Camp for a chunk of it this year, for the first time in a while on Lake Geneva.  I hit some of the favorite highlights:  Pop and I went sailing on the catamaran, I played pinochle, we went on a lakeside walk to get ice cream, and otherwise I was able to catch up with folks a wee bit.  It's neat to re-meet family as a different person, sharing the ways that I have grown and meeting them as they are now, too, rather than my memory of them.  I was interested to see what Family Camp would mean to me now as an adult compared to staying in my swimsuit all day while playing games and swimming and sailing with my cousins growing up.  
• One cousin pointed out that I haven't been to camp much since I got married; I countered that this was a coincidence of timing but not inaccurate, because I had significant health issues that started ten days after Andy and I were married.  Ten years since that summer, circling the drain and back again, with all of the healing and adjusting that entailed.  Strange to think about, how my life permanently changed in many ways that year.  
• Mike has been preparing to start a new education journey at Heartland, starting some courses toward radiology.  I've taken some of the same courses at Heartland as prerequisites for nursing school, probably still have my notes somewhere.  Looking forward to talking shop with him and his new adventures!
• Mike also has a kick-ass new tattoo.  
• I bought a new phone case.  Andy says it looks like it came from Claire's.  There is a lot of floating glitter and pretty colors, along with plastic rhinestones.  It makes me happy.
• Our household has been very much enjoying rock climbing at Upper Limits.  We've been going there a couple of months, now, and it has been so encouraging to see actual, tangible progress. Mike enjoys more of the bouldering aspect while Andy and I have focused more on top rope.  Things we stared at and went "yeah, that's impossible," we're starting to try.  There have been many bumps and colorful bruises along with this, including a notable smash that broke the screen of my FitBit because, of course, I managed to hit it just so.  It's physical and puzzle-solving and requires effective communication with your partner.  
• We like rock climbing enough to take a mini-vacation to St. Louis, where the sister-gyms of our Upper Limits are.  Honestly, though, Andy and I don't recall the last time we took a vacation that wasn't completely packed with plans or focused on a particular event.  It's just a couple of nights, but it's been nice to just take some time for ourselves.  Three rock climbing gyms in two days, though, means my arms and back have some rather loud opinions.

But now, the Big Update:   

As I was preparing to leave Family Camp, I saw that I had missed a call from Andy.  I called him back and let him know that I was going to be heading out shortly, but he had news for me.  Rivian had announced that they would be cutting their staff by 6%:  Andy had just been told that he would be part of that, that his position had been eliminated.  

I may have sped a little more on my way home than I would have normally.  I also may have been trying to hold back my own tears, because that does make for difficult driving.  There is grief.  There is panic.  There is a degree of anger.  There is more grief.  We still have positive feelings toward the company as a whole, but, oof, it's hard not be hurt by that.  

All of our insurance has been through Andy's job.  And some of you may recall from a previous post that I am rather expensive to keep alive, that there are many, many absurd problems in our current healthcare system that would readily see me out to dry.  So, yes, part of my processing in this already difficult process was some sympathetic nervous system activation from good ol' PTSD.  I do not feel safe; I am on constant alert; it is exhausting.  

The only reason I'm a degree of okay right now is that we have some continuing coverage as part of the severance plan.  We have a few months to figure things out.  I'm insistent that Andy take at least a month to reevaluate what he wants from here.  Then we can start running the numbers and see what we actually need, dig into the research to find a solution.  There will be many, many spreadsheets involved.  Both grief and knowledge that we'll find our next right steps exist in the same space.  

Pressure Balance in the Reservoir

I think of my emotional mind like a reservoir.  The image in my mind is clear and polished, seeing both the surface of the created lake and then scaling out to a cross-section vertical image, to gauge the depth and health of the area below the surface. 

There are streams that feed into the reservoir.  There are a couple of gates that allow water to leave and natural spillovers at certain areas.  Too much water in the reservoir is too much pressure, where I feel overwhelmed and experience a great deal of executive dysfunction, tears, and collapse.  The dam and gate system require certain attention:  quality construction and foundation take time. 

There are many ways that I can care for the health of the reservoir.  There is always water in the system, as there is always something to react to, to dwell on again.  Rain feeds water into the system directly—these are stresses that cannot be avoided, that exist from living or cultural influences.  New streams or existing streams can add too much to the system—these are stresses that I do have some control of, that I can investigate and either divert elsewhere or at least reduce the degree of flow.  When the reservoir is full because of rain or stream intake, there are gates that I can use to help reduce the overall pressure in the system—these can be coping mechanisms like routine therapy, resting, exercising, having a good cry, spending time with friends, or a number of other things.  Not all gates are equal, but all gates reduce the pressure to some extent. 

It is imperative to continue to explore the reservoir.  Sometimes, I find gates that are rusty, that could be better help to the system particularly when there is excess rain.  Sometimes, I need to streamline which gates I am using and close others or allow one to close for maintenance if something is blocking that path currently.  Other times I have to venture upstream to understand why a particular source has increased its flow, see if it can be diverted, lessened, or at least understand the need for temporary increase to better make adjustments—in the literal sense, this looks like asking for help, establishing whether I can safely give the concern to another body, find other solutions to reduce the pain of the flow, or rebalance with coping strategies.  I also have to consider the walls of the reservoir:  more than once, I have uncovered a weakened space that was a source of tainted groundwater.  In other words, a past trauma that was hitherto unrecognized with regards to its degree of injury and compounded hurt is now a part of the reservoir system, bleeding stagnated and purulent water into the system.  This can take time and patience to flush out--gumming up some of the gates in the process--as well as some painful excavating.  The system will ultimately be more healthy and possibly even widen the reservoir’s capacity, but it does effect the ecosystem for some time, still leeching elements into the lake until it is diluted enough to become part of it.  Maybe it permanently changes the chemistry; maybe it doesn’t. 

I had felt recently (link to antidepressant blog post) that there had been a difficult combination in my reservoir:  too much rain, heavy stream intake, and some failing gates.  As a result, the water was overflowing and also static.  I felt the pressure and only the pressure, water slopping over some spillways occasionally, but not enough to see the system functioning well again.  The surrounding trees and wildlife were also suffering.  It was all too much.  The worst case scenario would be complete destruction of the gates and damming system, causing a catastrophic flood into the surrounding areas:  a complete mental breakdown.  I will not say that I was at a point where I saw leaks, but I feared cracks enough to continue to care for the system. 

I think Zoloft is helping.  It’s not helping in the way I expected, though.  I had thought that an antidepressant would increase the size of the reservoir, that my capacity for holding things might be increased.  What it seems to be doing instead is working a new pump.  The water is moving in the system now, moving toward the gates and otherwise not allowed to stagnate.  It did not stop the rain; it did not stop the streams; I still felt these things.  But I also did not stay in them indefinitely.  The water is moving, and so the pressure does not build up to impossible levels.  The stress on the system (which is literally representing stress) is reduced.  The ecosystem remains. 

The Quiet of the Deep End

I've been thinking about the bottom of the pool.  

Specifically, the bottom of the deep end of the North Pool at Four Seasons Fitness Club off of Oakland.  

My father taught me to dive by having us jump over his shoulder, so that we would avoid jumping or falling "out" and instead learn how to direct "down."  He sat at the edge of the pool.  Maybe we started with his arm to the side, maybe there were other steps first, but I remember the final stage of jumping over the shoulder.  I remember telling him I couldn't do it more than once.  Eventually, I could dive off of the diving board, too, remembering to jump at least a little bit and practice pulling the body into alignment.  Many, many times I would forget to put my head down, feel the pressure of the impact against the goggles on my face as air was forced out and the suction increased.  

But eventually, the water made a steady sound with the splash, wooshing past my arms and my ears between my arms.  And it was quiet.  

The bottom of the deep end is quiet. 

I like to end my lap swimming sessions by diving into the deep end.  The North Pool is warm, particularly compared to the South, where I had swum my most recent mile, and I am suddenly aware of the relative temperature of my body after the exertion.  Sound is deadened around, particularly after the momentum slows and my body naturally wants to float back up to the surface, a scattering of air bubbles as I exhale underwater carving a trail upward.  A few gentle paddles and I can stay longer, surrounded by contiguous pressure and a muffled world.  

Ten feet deep, with the pressure of both the water and the atmosphere above that, surrounding all sides.  The hum of the pool lights several feet away.  Someone else faintly splashing at the other end.  I feel the pressure most acutely at my ears, pushing again against the possible vibrations, a misalignment of resonance.  

The grate at the bottom of the deep end is the lowest part of the pool.  Touching it with my hands, the pressure is as great as it can be in this moment.  Hovering at the bottom of the pool, sculling in place, if only for the moment.  Looking up, the light is dimmed as well, refracting off of the temporary moving roof and distorting the far images of the ceiling.

When I feel the pressure more loudly in my lungs than I do my ears, I reorient my feet beneath my body and propel back to the surface in one clean push while exhaling my remaining air.  Sound restarts instantaneously once the surface is broken, the echoes of the space intensifying even small sounds.  Spreading the arms wide in one long stroke, I hide back underneath the surface--only a foot or two down--just to allow myself a moment to adjust and reverse my arms to breach again.  I may repeat this a couple more times, kicking up to push my body out of the water in order to cast myself deeper and again, pendulating higher and deeper each time.  

And then some gentle treading at the surface.  The sides and the floor out of reach, but accessible in a few strokes any direction.  With two decisive pulls, I dive down again and swim toward the ladder in two wide strokes, curling my body to rise directly with the ladder and out of the water.  

The normal noise of the day is allowed to resume.

So I've been Struggling Lately

Y'all.  I've mentioned in previous posts (Exhibit A) that I have depression, anxiety, and PTSD.  I wear it well, or in more technical terms, I'm very high functioning.  However, I got to a point the last few months where I knew I needed some additional help, some chemical assistance to pair with my other coping strategies.  ...And it was such an important conclusion that I let it set for another couple months before I did something about it.  There are a lot of complex pieces into this, but the current step I'm taking is starting Zoloft to see if that can help take the edge off in a few places.  

I find that the more women I integrate into my care team, the less I feel like I have to prove myself to my care team.  Even though I trust my doctor, I still found myself rehearsing how I wanted to have this discussion with her.  I journal through this blog; I take my dog on walks outside; I swim, Zumba, and have started rock climbing for exercise/endorphins; I have a good support network; I talk to my therapist every other week.  I am aware of many of my different trigger points and can recognize when I'm too activated, sometimes then employing smaller ameliorations (brief grounding/breathing exercise, fidgeting, finding a smaller task that I can complete for a shot of dopamine, venting briefly to a trusted source, etc.) if I cannot completely disengage for optimal recovery.  

All things considered, I felt that I managed both the stressors of nursing school, all of the insurance changes of new jobs, and onboarding of my new job itself fairly well.  I daresay that I manage the stressors of my rather stressful job decently, that there are times that are heightened and times where there is space to breathe and be a person with my patients and my peers.  Some days I leave bone-weary; other days I leave ready to punch a wall to discharge the last of the frustration and then cheerfully meet the rest of my evening; other days I leave tired but spiritually full, feeling a sense of purpose once again.  

And yet.  I was experiencing some low lows, found that I was paralyzed facing some decisions, and felt overwhelmed far more frequently than before or what seemed safe.  When my doctor agreed that it sounded like, yes, a medication might help with the degree of overwhelm and executive dysfunction I was describing, I was relieved, but also then able to acknowledge the low-burning rage that had been sitting quietly on the other side of the latest distraction.  

I'm not embarrassed to be taking an anti-depressant.  I'm not ashamed of my mental health needs.  I am, however, indignant and furious that the current state of our country is so detrimental to my own success in coping.  

• Medical costs in the US are patently absurd.
• There are thousands upon thousands of people in this country that have proved that they will not do the bare minimum to keep me safe, made bald and bold by the COVID pandemic.
• The continued gun worship within our culture routinely sacrifices children and other innocents on its altar, as if it's a normal Tuesday, and otherwise points fingers in any direction instead of addressing the problem.
• Roe v Wade.  The continual erosion of autonomy under the paper mask of one very specific perspective of religious self-righteousness, now forced upon everyone else while insisting consequences could be anything but holy rather than horrific.  
• Roe v Wade, part 2:  Anyone in support of a complete abortion ban may as well tell me that they would gladly condemn me to death, regrettable as it might be.  And then maybe ask themselves why they're okay with that.
• Hand-wringing from people in power who think that maybe extremists will play by the rules again one day and so they should be "the bigger person" using the old channels to half-heartedly attempt change as though tradition might somehow save them.  
• Police violence still disproportionately affecting specific demographics and letting white domestic terrorists walk freely.  Black lives still matter.
• Five people on the Supreme Court continuing to pursue a despicable agenda, with more and more damage amassing while somehow expecting to be free of the consequences.  
• A profound sense of injustice following the growing clarity of events leading up to January 6th, as well as despair that somehow key players have yet to be brought to any kind of meaningful censure.  
• The looming rise of fascism, already mid-stride, and the emboldened bigots who deny the humanity to anyone of different religion, sexuality, gender, or other twisted reasons as reason enough to threaten, physically harm, or torture in some fashion.

There are many, many good reasons to be angry right now.  To be able to be "apolitical" or to turn off attention to the problems for a period of time, that is a profound place of privilege.  And we all need to find spaces to take a breath of clear air from time to time, where we can.  In some ways, my job allows me a bit of escape, because I do not carry my phone with me on the floor and cannot doomscroll during the workday.  

I won't say that the current state of our country is the only reason for my depression; the material point is it certainly isn't helping, and I've long-since depleted a fair bit of reserve.  On the surface, many of my coping tactics seem positive, but my intentions were originating from darker places.  For example, I was exercising as a specific punishment to myself rather than to enjoy the movement or show compassion to my body.  Food was either seen as an annoyance (in which case I did not want to interrupt an activity to go eat something) or an emotional necessity (which was a degree of binging, specifically, with an attempt to punish well-disguised again).  I have denied myself the right to go to the bathroom until I have completed X paragraph or Y task.  I have denied my body rest in the "need" to be busy, which looks like harmless distraction.  So on the outside, I looked productive and that I was working out regularly and such, but with an underlying malicious and unsettling resentment.  

And just to add one more layer on top, starting ANY new medication hits my PTSD like a ton of bricks.  It was a large factor in why I was dragging my feet for so long in asking for one.  Not quite a week in, I am still hypervigilant with my body, dedicating a significant allotment of my daily spoons to running constant systems checks.  Was that twinge a side effect I need to worry about?  Is it working now?  How about now?  Where am I compared to when I started?  Is this my normal degree of low mood to use as a baseline or something with my cycle?  Is this nausea my normal degree of nausea or higher?  The doctor said we could increase the dose if I "felt" I need more, but what are the EXACT PARAMETERS for that?  In short, it's very hard to tell if I feel less anxious and depressed when I'm very anxious and depressed about starting a new medication.  

I also want to add that I am not specifically upset at anyone for not reading my mind to know I have been struggling for a while now--I know I wear it well.  I haven't been ready to talk about it in as blunt terms as these yet, aside from a couple pockets of honesty in trusted spaces that usually end up being a one-off sentence before moving swiftly forward in conversation.  It does mean that I have felt paralyzed in reaching out in some places or responding to invitations, and then the compounding guilt of temporal distance between people I care about.  Shame spirals suck, yo.  

So, actionable pieces:  I will always treasure people who earnestly ask how I'm feeling, what's real to me, etc., whether or not I'm fully ready to delve into those important topics.  It's the demonstration of care that helps, the offer, even if I cannot take it.  It's going to take me a while to sort out whether the medication is working, so I think my general bandwidth is going to be comparatively limited in some places as I recalibrate--thank you in advance for your patience.  And for the larger problems in our world, the least we can all do is vote.  

Thinking About Nicknames

When I introduce myself to my patients, I usually have to repeat my name at least once.  Hell, when I introduce myself to anyone, I usually have to correct away from "Melissa, Marissa, Clarissa, etc."  I've gotten used to throwing up an "L" with my left hand when I'm wearing a mask, to help emphasize on the repeat.  I even have catchphrases around the reply, the first being "Yeah, I don't meet too many of me," and if they compliment my name, I say "thanks!  I got it for my birthday."  Either of them might earn me a chuckle.    

It can be annoying sometimes, but I take it with a sense of humor.  Yes, I never did have pencils or pre-made tiny license plates with that name on them.  After thirty-five years, I'm prepared.  At Starbucks, I'll either say "Andy" since we share a rewards account there anyway or say my name and "however you spell it will be close enough."  In places where it needs to get correct, I have reverted to the phonetic alphabet more than one time (Lima Alpha Romeo India Sierra Sierra Alpha) for absolute clarity.  Every now and again that there's a friend or family member with my name, we have a small bonding point.  I am the only Larissa employed at the hospital, which means that I literally called in to pick up a shift and only had to say my first name.  On the other hand, I cannot blame another Larissa if they were not particularly fond of me.  

My parents have always told me that they chose my name because it means "laughter," which I like to think has proved fitting.  I appreciate my name, spelling corrections aside.  However, that is not to say that I have not found different expressions of it.  I have had many nicknames in the course of my life. 

I can tell a bit about where I knew a person from in my past based on what nickname they call me.  Anyone that calls me "Roo" knew me as a small child.  A couple friends in later elementary called me "L.Roy."  "Rissa" was a lot of junior high through high school.  Both "Rissa" and "Ris" through a lot of college and with some adult friends.  "Lar-Lar" and its derivative "Larizard" came from working at a summer camp.  "Reesie" came from a particular friend.  And then as a professional at Skyward and the hospital, mostly "Larissa."  Sometimes still "Ris," but the folks I met from work still mostly use my full name.  

I'm curious what nicknames I might acquire a little further into my career at the hospital, if my name will organically shorten or change here, too.  I can think of one body from work that has been calling me "Rissie-Ris" which has added to my sense of community, and for others I suppose we simply haven't talked about it yet.  When Andy and I started dating, he very intentionally switched from "Ris" to using my full name, as if marking the transition in his own way.  I don't necessarily have a preference to or away from nicknames, but I recognize the places I have been given them over time, acknowledging the sense of belonging either way, by being given a name or simply by being invited to join.  

And that's the kicker for me, really:  I am not terribly picky about what I'm called (within reason) provided that I am included.  There are unspoken ways that others want to be included, sometimes designating those terms by a preferred name and sharing their pronouns.  I can think of a couple of hurtful names I've been called, too, and how that was exclusionary in itself.  One of the first questions I ask my patients is what they prefer to be called, not taking liberties with the information I already know about them without some degree of consent, a small concession in the power differential between us as clinician v patient.  Sometimes, the answer is "Mrs. Smith" or their middle name or something else that had not been yet updated to my paper, but either way I allow them space to frame how they are to be met in that space.  I choose to include them how they want to be seen.  To that degree, I subconsciously use my full name at work as a way to create space professionally, to mark the role and also help set the space for myself, establishing which version of myself I choose to project.  

My name and its derivatives are snapshots of different facets of me.  Additional ones may spring up in the future, as I continue to meet new parts of myself in new contexts.  And I'm excited to see that growth.