sleeplessness

I have to be up and out of the house in six and a half hours, and instead of letting me sleep my brain is treating me to a parade of my self perceived failings and flaws in a seemingly endless loop. I’m tired, my Husband is out of town for work, and I didn’t work out today, so I’m less physically spent than normal, so my body is not winning the war with my brain and letting me rest.

I don’t know if this is true insomnia – chances are, once I close my iPad, turn on a book on tape, and try to let my mind drift off into the story, I will fall asleep sometime in the next two hours. Thankfully I function well on <5 hours of sleep, and make up will take care of the dark circles, so no one need be the wiser.

The endless parade of situations where I’ve decided I wasn’t good enough, should have known better, shouldn’t have said that, could have made a better decision… it keeps going in the back of my head even as I write. Nights like this I realize how much I rely on being physically exhausted in order to sleep. Tomorrow I will get up, go rowing, and probably walk with a friend then erg in the evening, so that, coupled with my likely minimal sleep tonight, should result in my brain shutting off as my head hits the pillow. But tonight, despite working nine hours and attending an AGM after, I didn’t do enough physically to trump my brains need to self evaluate and find myself wanting.

The CBT helps – I can at least push the negative spiral away far enough to recognize, objectively, that it comes from my depression and is not representative of how I actually am… but that requires focus, and me being awake enough to give it that focus, so using the tools at my disposal is not conducive to sleep.

I’m almost tempted to get up and work out, just so that my body is forced to stop, but then I realize that I need at least an hour to wind down post workout, so it’s unlikely to actually make anything better, and very likely to result in a shitty row tomorrow morning. Logic prevails.

So instead, I try to make some sense of the spirals, then push them away, while insulating myself as much as I can. For every “you’re worthless” I counter with “what I do has value”, and “you’re unlovable” with “I am loved”. I struggle to counter “you don’t deserve love/attention/affection/support”… I don’t have really a response to that one, and it is currently the loudest. I desperately want to reach out to my support systems, but I also know I can’t handle a rejection right now. So I have a choice between staying inside my own spiral, alone, or trying to reach out to be pulled out, and risking having my reaching hand slapped instead of held.

Tonight, it is late, and I need to at least try to sleep. Tomorrow, I need to start working on learning to deserve that which I willingly give those I love.

-Me

Work Grumpiness.

Its been a big couple of weeks professionally. One of the clinics I work at has elected to end our mutual contract – which is not a huge deal, I had been debating how to end it myself since September 2016, because it’s been a waste of time and financially uneventful, but it still hurt that they pulled the plug before I did. Especially because part of the reason I had stayed was because they had asked for my patience in building a case load. But there were a lot of promises not kept there, so ultimately, once I get over the feeling of “But I wanted to dump YOU first!”, it’s for the best. The second, more pertinent professional upheaval is that two of the other therapists I work with (there are only four full time therapists at my full time clinic), are leaving on the 31st. One, a very good friend of mine, gave a months notice and it was not a surprise. The other, my manager, who has been amazing and a true support system, just gave two weeks notice, so she can go and open her own clinic. Both losses are going to hurt. Not because they will have any impact on my case load, but I will miss having them around.

For the past year, since the manager started, the clinic has become a really positive oasis. It helps that she went through, and came to terms with, her own struggle with unexplained infertility, so she is really the only person I know personally who knows exactly how hard some days are. She’s also just a natural leader: She understands how to motivate, support, and engage her employees. In short, she is an excellent manager, and took a clinic that had been slowly failing and was falling apart and made it into a thriving, positive work environment. I am going to miss her more than I want to admit – both personally and professionally. She is someone I admire as a therapist, and I love as a friend.

Although I will miss him a great deal as well, the friend who is leaving the same day will be less jarring – he only moved back into town in January after being gone for over a year, and our friendship has already survived living thousands of Km apart. He’s an amazing person, and my favourite hiking buddy, but not having him at the clinic won’t be the end of our relationship at all.

Both are leaving because the giant country-wide company I work for treats their employees like they are expendable. Never mind that we are the commodity they are selling: It is our skill set, personality, training, and client care that is being marketed and purchased. It is our clinic environment that keeps the same clients coming back when they get re-injured. And unfortunately, my discipline as a Kinesiologist is not covered by most private health care plans, so it is harder to find a full time job here… the Physiotherapists have a much easier time finding a new position elsewhere when they are fed up. So the two leaving this week are the 9th and 10th physios I have worked with in this one clinic in less than 3.5 years. You would think I would get used to the constant change, and I suppose I have, to some extent. But it is still utterly exhausting to have to re-build professional relationships with each new batch of physios, fully expecting that in another 6-10 months, I’ll be doing it all over again.

I love what I do for a living. I love helping my patients learn how to move again, and guiding them through the rehabilitation process. I find it fascinating to discover each individuals personal needs and priorities, and to build a program that fits their life, not the ideal that is arbitrarily set by their insurance adjustor. I get a window into the most private, painful, frustrating part of my patients lives… and if they let me, I try to find a way to make it better. And I am very good at it. I don’t know if I am more empathetic than normal, or if I get lucky, but I am able to understand peoples needs and to build positive therapeutic relationships. I also love my patients – they matter to me, their wellbeing is important. And lets be honest, on days when I don’t want to get out of bed, I will do it for them even when I can’t do it for me. However exhausted I feel at the end of the day, however emotionally drained, and however much I know I cannot make everything better for every single person, if I can make one person feel slightly better, then my day is worth working. There is a reason I don’t take much in the way of holidays – I discovered years ago that too much down time and I get in my own way. Work gives me a sense of purpose, and I find meaning in my vocation.

All that being said, I hate the company I work for. I hate feeling undervalued, and slighted, and the constant revolving door of colleagues because for some reason, they cannot recognize how much more it costs the company to constantly be hiring and scrambling for qualified therapists instead of just keeping the ones they have happy. The regional manager is a doofus (an excellent therapist, but a doofus as a manager), who basically functions as a scapegoat for the area manager’s folly. The area manager is …. oh, I don’t even know how to describe them. They have been trained how to “manage” but don’t understand the basics of human interactions, or the value of basic respect.

Sometime this week, I have to put together my final assignment of this semester – the theme of which has been interprofessional collaboration and teamwork. Basically, I have to put together a powerpoint for a specified target audience regarding how teamwork functions best in a health care environment. I am tempted to put together a slightly tongue in cheek presentation with the upper levels of management in mind, highlighting what they currently do, and they research that suggests that they are idiots. It might happen… I might not get an amazing grade (It will meet expectations, and I will pass, but I somehow doubt a pointed jab at upper management is likely to earn me high praise), but it might be worth it just to take out some of my ire at this stupid company in a way that won’t actually affect my employment. I should point out that I only have to put together the powerpoint and specify my intended audience, the upper management will never see, or even be aware of, the presentation. I won’t get fired, but I might get some peace of mind.

I just have to believe that if I continue to work hard, focus on my patients, and adhere to my own code of ethics, all this shit will eventually work out.

-Me

Sensory Overload

I overextended my energy resources this week. It was a bit of an intense week at work, and I had a lot of clients who needed to draw on my emotional resources, which is fine, the psychological component is a huge one for my job. And then I had a date night with my Husband, which was actually really lovely. Except that I realized that I have built up some serious walls even where he’s concerned. Namely that I didn’t realize until last night that I have never fully elaborated on exactly what I do at work – I have never actually explained to him the types of patients I work with, the magnitude of the job, or what it actually requires from an energy/focus perspective. I think i’ve started to take for granted the effort that badly injured, emotionally fragile patents take, and I forget that that’s not necessarily something that is readily apparent to most people. On the surface, my job is quite simple: Identify the area(s) of injury, and build a reconditioning program to address them. And that part, although it requires some creativity, is pretty easy.

The more interesting and difficult part of my job are the social/mental components. My patients are going through the worst time in their life: They are injured, and some of them are not going to recover completely, and often they know that… or need to be able to accept that. There are brain injuries, loss of function, and a loss of  sense of self. Not to mention that often they may have just faced their first real experience with their mortality. Add to that that the rest of their life doesn’t simply stop to allow them time to recover – relationships go on, or die. Children still need attention, parents develop dementia, and work wants you to just do the job required. So my patients are under a host of stressors, some emotional, some financial, and all important. My job becomes trying to find a way to get them invested in their own recovery treatment while adapting their program to fit the life they actually live, not the one I would want for them.

I don’t talk a lot about my job at home. Some of that is because of confidentiality – This area is not so big that it would be hard to connect a set of circumstances to an individual if enough details were disclosed. Also, sometimes it’s nice to have an apparent mental separation between work and home. It’s not that I don’t think about my patients when I’m at home, but not talking about them allows me some space to leave work at work, and be present at home. But my work is a huge part of my life, so not including my Husband in any part of the discussion, thought process, or at least the depth of what I do means that I’ve been unintentionally shutting him away from myself for years.  Last night, without giving him personal details, I outlined the depth of what I actually do. It might be the first time that he has understood why some days I get home and ask him to leave me alone for a while to decompress and talk to the pets. Unfortunately, the act of actually letting him into that part of my life was, in itself, taxing. And since my week with my patients had already plumbed the depth of my resources a lot, I didn’t have a lot left.

Then, today, I had agreed to meet a friend of mine to help promote some rowing stuff – something I was excited to do, and was actually really fun. However, it took place in a large gym space with a sporting event happening in the middle of things as the main draw, so it was loud, and there were a lot of people, and …. oh wow, did I not have a lot left. We got to introduce rowing as an option to a bunch of totally awesome kids ages 12 and under, which was really cool – including a bunch of really neat little girls who were eager to participate in conversations about how girls can work hard, and be muscular, and not take shit from anyone – and I am so glad that I went and helped where I could. However, it took pretty much everything I had left to deal with the crowd, and the noise, and by the time I made my excuses and left, I was done.

I sat in my car and cried, and then cried most of the way home. I don’t even totally understand why – I just know that I was emotionally and physically done. Thankfully my Husband is having dinner out, so I get the house to myself, to snuggle with the furballs, write, and regroup. Some of the issue is that my Husband just wants me to be ok. So badly. He know’s i’m hurting, and he knows that I am struggling a lot right now, and he wants me to feel better. Unfortunately, however unfair it is, I just feel his worry as additional pressure to perform. Whether it’s part of my insecurity, or just a basic part of my personality, or all of the above, I do not like to take my emotional shit out on the people around me, or to be an energy suck for them. Along with this making me quite unwilling to reach out and ask for help, it also means that when I see someone who cares about me affected by my issues, I will do everything in my power to shield them from me. It makes it easier to talk to my therapist, or frankly to any stranger (or to vent in an anonymous online forum) because I don’t see the aftermath, or feel like i’m forcing myself and my baggage onto anyone.

I have all day tomorrow without any expectations on my time. I think i’m going to take my dog and go somewhere alone for a few hours. Once I’ve been out and about and alone for a day, I think that will be enough to make me feel like I can get through another week.

-Me

Rambling

The last few weeks have brought some changes that I have no control over. I particular, there are changes coming at work that have a direct affect on my career, and he environment in which I work, and I have no power to change how the changes happen. One of my good friends and colleagues has been head hunted and will be switching to a second clinic – happily enough, it’s a second clinic where I already practice, so I will still see him. The changes are not necessarily bad, they just have the potential to change my life and I don’t get to choose how.

I am less distressed by this than I would have expected to be. Some of that is probably because I recognize that no amount of agonizing on my part will make a difference. Some of it is just general exhaustion, I don’t have the energy to get upset about this stuff and tilt at windmills.

The CBT has been good. I do not always find it particularly easy to give myself the arguments that do not support the negative self talk, or to believe the information I present to myself, but overall I think it is getting better. I have also made a concentrated effort to reach out to friends for support, and the feedback has been overwhelmingly positive and loving. It’s reassuring to be able to trust in my support systems, and the act of asking for help, although humbling, is also cathartic as I realize I can do so without loosing myself in the process. That doesn’t make me like doing it more, but it does make me more willing to try.

One thought that keeps resurfacing I can’t quite use the CBT to address: As a woman who cannot get pregnant, I feel like a failure on a very basic level. I don’t think that women need to have children to feel validated, far from it. But to try, and have my body betray me/fail me is… hard. I think the reason that the CBT techniques are ineffective here is that there isn’t evidence to the contrary – my body is failing me on a very basic level. What I need to do is find some way to reconcile with that fact and to stop the deep self loathing and cruelty I dole out on myself at every opportunity. I don’t really understand why I am as mean to myself as I am… I can take a step back and recognize that it’s a) not productive, b) not how I would treat anyone else in this situation, including people I don’t like, c) that it does me harm… And yet here we are.

I am working towards some level of self compassion. I plan to talk to my psychologist about this when I see him next week. What I am fighting with is the fact that my temptation becomes to hone in on other things so that I don’t have to pay attention to what is actually going on. I can feel myself getting restless as I delve deeper into myself and start to work through the actual issues, instead of just glossing over them and skating on. I start to plan intense workout regimes, vacations, new work ideas, to learn to play the cello, my next degree… anything to distract from what is actually at hand. I love the Awkward Yeti’s portrayal of the heart vs. the brain. It’s not exactly where I’m at, but the idea of parts of a whole being at odds with one another definitely rings true.

-Me