What Happens When My Child/Teen Goes to the ER for Psychiatric Care? (Post 1 of 3)

I am part of a private Facebook group for parents of children and teens who have bipolar or other mood disorders. Many caregivers post a frantic cry for support when their child goes into psychiatric hospitalization. I've also received emails, texts, and private messages from friends and friends of friends asking what to expect or looking for reassurance. I've decided to create a series of three blog posts covering some of the most asked questions and offering information to help educate and dispel some of the mystery.
The three posts will cover what to expect when your child/teen is in the emergency room, what acute/short term hospitalization looks like, and our experience with long term/residential treatment. Please share these posts with anyone who can use them!

What To Expect When Your Child or Teen Winds Up in the Emergency Room For Psychiatric Care:

You've found yourself at the ER with your child seeking psychiatric intervention. There are many ways this can happen: Your child is out of control, or has what the system calls "suicidal ideation", or is self harming, seems delusional; the list is endless. They may arrive by ambulance, in a police car, or under police escort, or simply in your personal vehicle. We have been to the ER many times and have arrived in my car, in my car with police escort, and in an ambulance.

Here is what you need to know:

First- don't forget to breathe. I'm very serious. I know that it's scary, and unknown, and heartbreaking to find yourself in this position, but you have to dig deep and stay calm. Your child needs you more than ever and you will need to be able to rationally answer questions, give accurate history, and most likely, spend a lot of time with your child just waiting. Staying calm might be the most difficult thing you do during this experience, especially if you came to the ER due to any violence or destructive behavior directed at you or your family. Anger is the natural response to that, and yet, for the well being of all of you, you must find a way to momentarily compartmentalize those emotions and be a calm presence for your child.

Be prepared to wait. And then wait some more. This can be an incredibly frustrating part of the process. Many hospitals have specific rooms for mental health patients, and will only utilize those rooms unless it is a life or death situation. With the continually growing mental health crisis in our country, this often means that when you arrive, the rooms are already occupied- leaving you and your child in the waiting room- many times for hours on end. Our longest stay was 27 hours from start to finish- but part of that was waiting on a bed to open up in an acute psychiatric hospital (more on that in the next post).

When you arrive and check in, you will register, give proof of insurance if you have it, then you will wait for triage. After triage (where a nurse asks you why you've come and checks your child's vitals) you will probably be sent  back to the waiting room. Your child may be called again for a blood draw, and if so, once again, you most likely will be sent back to the waiting room. Once called into a room you may notice it's different than other rooms in the ER. It may even be in an area that is closed off from the other rooms. Many rooms used for mental health patients have been prepped- often stripped of any extra instruments or objects that you'd see in other rooms to protect patients from potentially hurting themselves or others.

You can expect to see a nurse, a social worker or mental health worker, hospital registrar, and doctor at a minimum. Each time, your child will be asked if they are having thoughts of harming themselves, and if so, if there is a plan. This is tedious. It feels traumatic to have to answer that over and over, or watch your child have to repeatedly answer those questions. Just remind yourself it's part of protocol. There may be police presence. At our local hospital, there is an officer who sits outside of the mental health rooms. This is again, preventative and for protection, but I'll admit, it can make the process feel further stigmatized and removed from 'normal'.
Your child will be under a strict one on one instruction- meaning, they won't be allowed to be left alone. You will have to stay with them the entire time, and they will have to ask to use the restroom. If your child doesn't want you with them (which happens, and you will have to find a way to stand up under the weight of that pain somehow knowing they aren't well in that moment) then they will have a nurse with them constantly. If they are overly agitated or anxious, your child may be offered something to help calm them.

Prepare yourself to know there won't be a diagnosis in the ER. There will be no 'problem solved' or magic bullet. It can feel anticlimactic after the chaos that sent you there. It can be exhausting in every way, and you will likely experience a myriad of emotions. If you know some of this ahead of time, it can help you adjust your expectations so you don't wind up feeling discouraged.

Generally the goal is to create a plan going forward in order to discharge your child. This may be for your child to return home with instructions to follow up with a psychiatrist. Or, it may be that the next step is acute hospitalization at a mental health facility. In the state of VA where I live, you are no longer allowed to self-admit. You must have a medical clearance first- meaning you and your child may know that he/she wants and needs hospitalization, but you must still go through the red tape of the ER visit to justify it. If hospitalization is the next step, you will be waiting again. Hospitals are packed full and many times you are stuck waiting for a bed to open up at a facility. Often those facilities aren't local to you. The younger your child, the fewer options there are, which can mean a longer wait and possibly a facility that is a longer distance from your home. In our state if you are stuck in the ER waiting for more than 24 hours for a bed to become available, they usually admit your child to the hospital while you wait- putting you in limbo until there is space.
While this is frustrating, and shines a spotlight on the scale of psychiatric care needs, it is normal. Discouraging, yes. But sadly, normal. Most of the time a trip to the ER is a marathon, not a sprint. Try to relax if you can. I've told my son jokes, showed him vines on my phone, watched him try to sleep, played music, and calmed him when his anxiety from the wait overtook him.

The good stuff: Remember your child is in a safe place during the visit. That may be the only consolation for you in the moment, but don't discount it. Breathe it in deeply. If this is your first trip to the ER for this level of care, you are now in a good position to continue to advocate for your child in other arenas; school, counseling, testing, possibly ABA therapy or OT (for children with Autism or sensory issues), the option of getting an advocate or case worker; you have now reached a level of need that makes it obvious how desperately you need a support team. Take advantage of this reality and ask as many questions about available resources as you need to before you are discharged.

Finally: I know you feel utterly alone. You may feel as though you've failed somehow. This is a normal reaction, but it's not true. Many of us have been through this with our children- you don't know only because we aren't posting pics of them in the hospital bed on Facebook and Instagram the way parents of physically ill children often do. We're hidden in plain sight- but trust me; you are not alone. Also, you have no obligation to share information with anyone. You don't owe anyone an explanation, and you don't have to try and defend your choice (or, forced action if others were involved). As hard as it may be, find a way to stay calm and set boundaries. Privacy and space is rightfully yours and you are permitted to take all the time you need to decide what (if anything) you desire to share with anyone other than those intimately involved. You are going to get through this- and you, sweet parent or caregiver- are an amazing and loving person who is doing an incredibly difficult and compassionate thing. Much love!

Family Infected

Every family develops dynamics over time- based on birth order, personalities, external stressors, etc. when one of the members of the family has a chronic illness, the dynamics can be skewed in ways that can become unhealthy in the long run in order to operate in the immediate. 

Samuel is doing better overall than he's ever done. We've had rough days, days that stir up latent anxieties simmering below the surface that come hurdling into our throats when his mood or behavior tastes familiar, and we recall older days when the behavior was so unpredictable that none of us felt truly safe in our own home. But as a whole, he's doing so well. I force myself to remember some of the darker days to contrast how well he's doing now- but the dynamics, the structure of the family, the codependent tendencies linger- and pushing back against what has been our norm for so many years is a daunting task. 

For many years, life in our home was survival in a war zone. He was imprisoned in his illness and the rest of us became collateral damage by default. My younger children learned to both revere and fear him- never sure which mood would surface and if they might become caught in the crossfire. When he wasn't stable- not properly diagnosed, nor properly medicated and treated- his behavior was often violent and aggressive. My son Asher was often the focus of his rage, and if he wasn't, then I was. Many many days I would tell the younger three to run to my room and lock themselves in while I worked to calm the volcano of mood explosions and keep all of us safe. That kind of chaos means that simple family things such as delineation of chores and help never happened. I would create chore charts with all of the hope of a fresh spring day, and within days, the volcano erupted again, and the workload fell to me as the younger ones sequestered themselves out of the reach of aggression. 

The result of living in the moment day to day for years on end means that I didn't have practice parenting over time- I didn't learn as I went- to delegate work load, dole out appropriate discipline, and create strong boundaries. I've come so very far- we all have- but I am acutely aware that my kids don't support the running of the household at the level I believe they should. With Samuel's stability, I've been able to enforce more structure and more boundaries- but as foreign as it is for them- it's equally strange to me. I'm not used to living a life that is planned out past today's activities- save for doctor appointments, therapies, and the occasional fun outing. I have become accustomed to making plans and having to cancel them, or asking for help around the house only to be left doing it alone as everyone hides in their rooms. I want to get better at this- I want my kids to get better at this- I know it's my job to prepare them for life outside of my home, and when I think of all they have left to learn, sometimes I feel the crushing weight of failure. I remind myself that comparison of our family dynamic to the perceived dynamics of others is not only ridiculous, but toxic, and that we have struggles and hurdles that other families don't have to take into account- and to remember how far we've come, how much better we're getting at operating in a more healthy way- but it nags at me. 

I wonder when Asher will need therapy for feeling as though I didn't protect him the way he needed me to, or when Tucker will finally express that he feels that Samuel gets the most attention, or when Ivy will get angry at me for being exhausted at times when she wants my energetic attention. The reality is that we all fail our kids somehow- often in ways we aren't aware of- needs they have that they are unable to express that aren't met and create wounds- life is like that for all of us... so I try and talk to them- to let them know I'm aware of these dynamics, and aware that I haven't done it all 'right', or even to their expectations- that I see their hurt and fear, and that I've shared the same hurt for them, to acknowledge that life with a chronically ill sibling feels so unfair- and that it can be confusing to both adore and fear the same person. My prayer is that those conversations will go down deep and work as an inoculation against bitterness or anger festering inside of their souls. I want to believe that the struggles we've endured will create strong character and incredible compassion- but I'd be lying if I said I wasn't worried at times.

I think that this is an issue for all families with a chronically ill family member. It changes everyone. It alters the fabric of life for everyone woven into the unit. I have no answers other than to encourage those of you in the same place we find ourselves to talk and talk and talk. To choose to call out the pain and injustice and hurt- and give it a place to sit- without judgment, fear, or defensiveness. It's hard, it sucks, it's easier in the moment to avoid those conversations; but somehow, I believe that the ache of the conversations today is far easier than a lifelong sentence of bitterness and a fractured family. If you find yourself here- know that you're not alone, you're not crazy, and doing the best you can is the best you can. <3 

Waiting To Exhale

I keep waiting.

When you've lived in chaos for years and years, you learn to expect the moment when the proverbial 'other shoe will drop'. I hold my breath, wondering when it will fall, when the ease will shift and gusts of harsh winds will blow back into our lives... yet, the atmosphere remains calm.

It's amazing to me how humans can adjust to incredibly overwhelming circumstances; surviving through trauma and danger and stress that you'd expect to level a person. I've written recently about how I found myself submerged in depression last fall, and the heaviness and dark shadows that wouldn't lift. The sun has found its way back into my eyes and when I ruminate on what took me so deeply into the bleak desert, I recognize that while Samuel was away, there was space for me to fall apart. I'd held my breath for 14 years- bracing against all manner of aggression, wildly swinging moods, his sensory overload, the effort to keep everyone safe, and the ongoing fight for the services he needed. When he wasn't there, my brain was able to shut down at some level, preserving itself and refusing to operate at the intensity it had been forced to endure for so long. I'd had high hopes of all I would change and accomplish in his absence; creating the structure and routine in our lives that had been lacking due to the ever changing emotional atmosphere, spending more time being present with my other three kids who have lived under the cloud of mental illness and autism their entire lives, finding space for myself- with yoga and prayer and time in nature. I did some of these things, and we certainly made progress, but by the end of the summer I hit a wall and I couldn't have cared less about much of anything. I had nothing left. I'm an intensely feeling person, and found myself numb to most everything. It was foreign, and only increased the hopelessness.

Bringing him home was scary. He'd done so well in the highly structured environment of the treatment facility and I knew that after 9 months away, there would be many adjustments he'd have to make on a daily basis. His therapist had warned both of us that there was usually a honeymoon period of a couple of weeks and often times her patients would wind up back in the hospital for an acute stay within the first 6 weeks. When she'd said that, my stomach dropped. He's had 5 hospital stays since the age of three, and my naive hope had been that the residential treatment would have vaccinated us against the need to return to acute treatment; yet, I was grateful for the warning. I brought him home with the knowledge that he could completely fall apart in the reintegrating of his life.

Earlier this week he hit the 6 week mark.

The air I'd been hoarding inside my body has found its way out, and the exhale is intoxicating. I've realized that when I've been asked how he's doing, my response is beautiful. He's doing incredible. The work he put in while he was away; educating himself about his illness and autism, learning some of his triggers and how to cope with them or eliminate them, his ability to be self aware of his emotions and the response his body is having to stimuli, his powerfully articulate communication when he's felt hurt, or angry, or confused... it's nothing short of miraculous. Before he left he had been a wreck. He had never had the proper diagnoses- at least, not at the same time- and he wasn't getting the support and services he so desperately needed. He'd unraveled to the place of destruction, and our lives were spent barely surviving the daily trauma of improperly treated mental illness. I'd had the police at our home, he'd been admitted into the hospital after an ER visit that we'd made under police escort, he was failing the 9th grade despite his incredible brilliance, he'd been suspended three times in 5 short months of high school, and he was defiant and mean. I was desperate. Terrified for my child and the road we were headed down.
Residential treatment saved our lives.

I left a broken, angry, ill equipped, improperly treated child with a devastating disease and 9 months later was given a young man who does what I ask him to, serves me even when not asked, is excelling in his new school even in honors classes, and whose laughter that had once died now echoes off of the walls. We've had minor bumps. He's a 16 year old boy after all! But we've navigated them in a way that still takes me by surprise. A couple of weeks after he'd gotten home I'd unknowingly said something one evening that hurt him. I hadn't been aware of it, and had gone to bed as usual. He woke me up before 6 the next morning and said he'd had a hard time sleeping and had to talk. He told me that I'd hurt his feelings, that he knew I hadn't meant to, but he needed me to know. I blinked the sleep out of my eyes in wonder... who is this young man?! We talked it through and had a normal day- free from violence, rage, anger, depression or cursing- old responses he'd had when upset or offended.
Life with him home feels so... normal. Average. Safe. We still work hard, and he has a therapist who comes to the house three times a week for three hours each time. Our lives are still vastly filled with work and school and the management of his illness and autism, but they're also so good. Watching him with his siblings and seeing the anxiety of not knowing what the day would hold for them in regard to his mood begin to fade is beautiful. I'm not living in a fantasy world where I believe that we'll never have another crisis or trauma related to his illness.. Bipolar 1 and Autism cohabiting inside of his brain is a bitch. There's no other way to say it. They work in tandem to exacerbate the symptoms of each disorder; But. I have hope now. I can see the potential for a life for him that isn't driven by chaos and being defined by his illness. I can see the weight lifting off of all of us as we learn to live and love as a family outside of continual trauma and drama. I can see peace in his eyes and his body- peace that has settled deep into his marrow, stilling him and grounding him and allowing him to receive our love. He helped create his own miracle. His incredible effort and positive attitude about getting better fueled the change in him and has been a gift to himself and his family.
I realize I may have a painful post in the future about some possible crisis we may experience- and that's ok, as I know that's how life unfolds for all of us, but for today, for now, the waiting is over, and I can finally breathe in the beauty, and then deliciously.... exhale.

Coming Home

It's been a little more than 9 months; the same amount of time it took for him to grow nestled up underneath my ribs before making his dramatic entrance into the world.

 My first born has been away for 9 impossibly long/short months and today he comes home.
Much like the day I birthed him, today stretches out long before me- packed full with anticipation, anxiety over the unknown, excitement to see his face and finally hold him, and a celebration of the work both of us have done throughout these months to grow him to the place where it's healthy enough for him to join the 'outside' world.

Much like the first time, we'll both have to learn how to live together. The first time I brought him home, I sat him on the table in his car seat- he was blissfully unaware of the world around him- one that had been radically changed just one month prior when the twin towers fell under horrific attack. He slept peacefully; blind trust in my ability to protect and nurture him; and I stared at his chubby cheeks, crown of thick dark hair, and large hands curled at his face and wondered how I would ever be able to be the mom he deserved. As with every new mother who came before me and those who continue to come after, I had little more than my instinct and fierce love to lead me into raising him. When I try to picture the future now, I find that little has changed. 

We'll create a rhythm of life that's new to both of us, and the rest of the family. We'll rise and fall. I expect to hear the beauty of his laughter- the same boisterous delight that pours out of his belly and first took my breath away leaving tears of wonder on my cheeks. I anticipate tears- of confusion, anger, pain and sadness- from both him and myself- as we navigate our new normal- one he's been growing towards for the 40+ weeks he's been tucked away in the womb of therapy, healing, education and treatment.
The difference, between the homecoming 16 years ago and today, is that today I have the reassuring known history behind us of getting through. With the first child, every stage feels like a lifetime- one that lasts forever- and the beautiful seasons as well as the challenging ones seem as though they'll never end. Baby land, toddler hood, preschool days- they can bleed together into a monotony of sorts- the passing of time marked by met milestones, celebrated firsts, and the bittersweet taste of their growing independence. As time passes, each new stage brings joy and challenge.The difference now is that I understand none of the stages last forever; they inevitably shift as he grows and that continual changing is both frightening and freeing.
The first time I brought him home, I didn't yet know that the two of us would become an unstoppable force; stitched together into an abbreviated army that would fight valiantly for our freedom against what plagued him. I had no way of knowing how connected we would be because of pain and challenge and the grief that comes when the reality of his mental illness finds its way to manifest anew.

But this time, I know. The knowing of our strength doesn't alleviate my fear; he still sleeps peacefully, in blind trust that I will protect and nurture him. But I know more now. I know that my instinct and fierce love is enough. I know that I am completely inadequate to protect him from hurt and harm, and yet, somehow also completely equipped. I know that I will fail, and I know that love and the force of sheer will can beautifully and magically cancel out my shortcomings. I know that there are incredible victories on our horizon and there will also be jarring disappointments; but I also know that we will pass through all of them as we always have; working in tandem to wriggle ourselves into the sweet spot- where his piercingly blue eyes meet mine with determination, and we keep pressing on, because, we know.

Labeled

Healing and growing take work- often painful, gritty, I'd-rather-run-away than face this stuff kind of work. But, as with most anything of value, it's always worth it.

A couple of weeks ago, Samuel and I returned to the doctor's office where he had done the ADOS assessment for autism. We were there for the results and to go over the full report from the clinician's observations of how he completed tasks, how we answered one bazillion questions about his development, behaviors, understanding, and communication, and his medical history.
She handed both of us copies of the full report which spanned four pages. We flipped through the papers and scanned the medical description of what has been plaguing him and our family for the better part of 13 years. Her conclusion was Autism Spectrum Disorder (high functioning), and Bipolar I.

The black ink that bore his diagnoses swam in front of my eyes as tears formed. I wasn't so much upset, as relieved. He's had both of these diagnoses before- however- never both at the same time. He was given the diagnosis of bipolar when he was just three years old. It was shocking to me then. It seemed too big of a struggle to lay on shoulders so small, yet, the behavior and moods we'd experienced fit well within the perimeters of the disorder. But, when he was given that label all those years ago, it wasn't enough to explain everything we were dealing with. I knew in my gut there was more to it, but his young age made it difficult to tease out what was going on.
At that age, he'd been hospitalized for the first time. When we were discharged, he left with BP as the main diagnosis, and we were thrust onto the path of psychiatric care. What followed was years of running into dead ends. Psychiatric care is overwhelmed by the demand and not enough providers; psychiatric care for children is even harder to find, and children under the age of 8 are often refused service by doctors. It's not considered 'good practice' to diagnose children with such a heavy label, and for the next 5 years, we were given a myriad of other diagnoses instead- all of which essentially were symptomatic of bipolar. Right when he turned 9, we saw an incredible doctor at UVA. She was highly sought after and we quickly understood why.

Her ability to draw out what she needed from her patients, compile information given to her, and her uncanny skill in understanding family and behavioral dynamics, allows her to dig through unnecessary detail and identify the underlying issues. She diagnosed him with autism. I was relieved. I stopped taking him to the less than helpful psychiatrists. Instead, we stayed with Dr. Anderson (developmental pediatrician), traveling several hours one way for appointments regularly, and she helped us with med management, recommended therapies, and education about autism. I'm embarrassed to admit that because I was keenly aware of how autism was more 'glamorized' (for a lack of a better word) than the 'run of the mill' mental illness, it was easy to latch onto the autism diagnosis and forge ahead. Autism had risen into the collective awareness of our communities, and explaining to outsiders that questionable behavior stemmed from autistic struggles was more easily understood and accepted than sharing the painfully stigmatized information about mental illness. Dr. Anderson was incredible for us. She found a combination of medications that helped immensely- though our lives were anything but 'normal'. Still..... I knew there was more.

To get this combination of diagnoses; explanations of why and how his brain works the way it does, and education on what to expect, how to respond, and the types of support we need was ... a huge relief. The two together answer so many questions. They make life hard. For him, and for the rest of us. The two disorders buck up against one another and can exacerbate many of the symptoms he wrestles with. It's a sobering diagnosis- one that will require him to be diligent for life in taking his medications, eating well, resting and sleeping enough, exercising, and intentional social interaction balanced by intentional solitude. It's a lot for anyone- and certainly for a kid who is weeks away from his 16th birthday- and yet, there is relief. Comfort. Words given to years of hardship and confusing moods and responses. A real, tangible explanation as to why this has been so hard and so traumatic for all of us. Validation that he's not a bad kid, I'm not a failing mother, and our effort to push back the weight of this hardship has been nothing short of heroic.
He's one of the strongest people I know. He's had to live through being my first child- and my early years' lack of understanding about the brain and mental health and illness. He's had to endure my anger, fear, grief and inadequacies as I suffocated under the weight of scathing judgment heaped into my lap by doctors when he was young, and some extended family (who are no longer involved in our lives).

We've grown so much together. I have learned to trust my intuition. I never stopped seeking, begging for help, researching, trying everything I possibly could with the knowledge I had- but I also took on the burden of judgment from others who had no idea what life looked like for us. I allowed ugly words spoken in ignorance take root in my heart and spirit and regrettably, I mothered all of my children from that place of wounding for too many years.

We are survivors. He's done incredible work in the program he's been with for the past 4 months. He's talked, journaled, asked questions, read, participated in specialized therapies, gotten upset, angry, sad; he's engaged in vulnerable conversations with me that are hard to digest, yet powerful in their sharing. He's not a statistic. He's not crazy, or broken, or out of reach. He's a mighty powerhouse of talent, intelligence, ability, compassion, and maturity that comes with walking through the darker places of life.
I'm so proud of my son. We are the faces of people living with special needs and mental illness. We are warriors fighting a broken system, a challenging chronic health problem, and navigating a world that sees mental illnesses as excuses, or humanly inferior, or frightening. Neither of us would have chosen this for him. But it was chosen for us. And both of us are passionate about sharing our experience with the world- to offer hope, understanding, education, and connection.
I'm grateful for his tenacity. And I'm honored by his willingness to pull back places he struggles and share those vulnerabilities with me and others. He's something else- that kid of mine. And I have no doubt that he's going to change the world.

When courage is met with silence

It's been far too long since I left words here in this space. Far too long since I sat and looked inside those places that have stories to offer and experience to share; and, I think far too long that I have been ragged and running and fearful and overwhelmed.

I had an experience this week that I feel compelled to write about- it may polarize some of you, and that's ok as I sometimes think some of the best writing does.
It's about a subject in which everyone has an opinion and many people have personal experience and those who might not have personal experience have opinions anyways.  Life is muddy like that.

This past weekend was a beautiful weekend. A precious friend I've treasured since high school came for a visit and our time together is always rich, refreshing and restoring. We swing from swimming in the deep end of existentialism to splashing in the shallow while we watch stupid videos on youtube and laugh until we fall out of our chairs. She is safe for me, and I for her, and I can say things without censoring and trust that she will dig through the dross to find the silver beneath my careless words.
I had a tough week last week. There are many big changes happening again with my family- and it looks as though we will be moving within the next few months again.  This will be our fourth house in two years, and the thought of uprooting my kids another time does a lot to me emotionally- from the sheer weight of another huge life change, to the basic reality of the work that comes with moving- which I will have to balance on my back that is packed high to the sky with more work than I can get through in each 24 hour block.

Sunday morning I awoke with the familiar sensation of having clenched my teeth as I slept.  My teeth were sore, and it was like a fairly mild toothache. I noticed it, but assumed it would fade into the day and laughter and fun with my girlfriend. She left that afternoon, and while I knew I was anxious about my future and so many weighty things that I'm carrying, I had no idea how badly my body would revolt.  Monday morning I woke up and the pain was stronger.  I was frustrated that while I know my circumstances are beyond me, that in the waking hours I was fairly functional but the truth was revealed in the dark.  It made me sad to begin to realize just how worried I was.  I took tylenol and went about my day, aware but not in awful pain.  And then Tuesday morning came.  I woke up in the middle of the night crying before I was awake.  I became aware of the searing pain my jaw and face and wanted nothing more than to squirm out of my own skin in order to escape it.  I took tylenol immediately and got my ice pack to try and get back into sleep where I could ignore it, but sleep eluded me. I managed to get through the morning at work, and by the afternoon I was in tears. I was tired from the pain, and beginning to be anxious about heading to sleep yet again where I knew my body would betray me.
When I woke up on Wednesday, I felt pain I haven't experienced in years.  I managed to get kids off to school, and my only thought was to see my doctor. At this level of pain, I was ready to do anything to stop it- from running on the street corners begging for narcotics, to smashing my head in the front door. It was some of the worst pain I've lived through in my entire life. In the foggy state of pain I was in, I was able to really begin to see how anxious I had become. The physical pain was a mega phone to the heart and emotional pain i was carrying without even knowing.  While I'm in no way depressed, the reality of the intense level of stress in my life became very clear, and I came around to the decision that I needed to talk to my doctor and ask for some help about managing my stress and anxiety. In the hours before my appointment it was all I could do to stay sane. I wanted to race to the urgent care office and beg for anesthesia. If they could knock me out, then I would get relief. I was in tears, and even vomited several times from the overwhelming intensity of the pain.
Finally it was appointment time, and I wearily sat on the tiny bed encased in crinkly paper waiting for the angel face of my doctor to open the door to relief.
When he came in, he asked what was wrong and I promptly burst into tears. I tried to tell him in ragged, breathless words, what was happening. I explained that I was under more stress than usual, and that I knew it was based in anxiety but I needed immediate help to get through the pounding pain that was taking over all of my head-space (literally). I've never asked for pain medication before, and was hoping that the 'in your face reality' of my pain would let him know how desperately I needed something. I knew he might also give me steroids for inflammation, and I was going to try and push out the words to ask for medical help with anxiety.
Nothing went the way I planned.
I love my doctor. I've been seeing him for about a year for my thyroid and other various minor issues.  I trust him. He's compassionate.
But when I began to speak of pain, and then to try and broach the subject of anxiety, I felt patronized. Not heard. Brushed aside as an overly emotional woman.

He told me he'd give me steroids for the inflammation and to use a heating pad. I sucked in all the air around me and worked to get enough courage to ask for stronger pain medication than tylenol. I didn't need much, just a few tablets to help me be able to rest, and not see stars.  He said no. Told me the steroids would help in a couple of days.  I was embarrassed. I felt as though I seemed dramatic and like a drug user.  I had never asked for anything stronger than thyroid medication, but his response made me feel like my record had just been flagged for asking for pain relief.
I managed to get past that blow and tried to tell him of my anxiety.  I have lost tons of hair over the last months- to the degree that I have balding places in my formerly thick, full head of hair. I had chalked it up to my thyroid being off, and while that certainly may be some of it, I believe much of it is worry and anxiety based too. I didn't quite know what I was asking for, but I knew I was at the place where I needed intervention.  The anxiety of sleep, the worry of not having housing, my ever running towards making ends meet, being the only involved parent and often the only provider for four children.. the list goes on.. I needed medical help. Even if only temporarily.
He recommended three supplements.  I told him that on his recommendation long before, I had bought and tried each one.. for months at a time.. with no measurable results. He told me I could be on daily medication, and I began to cry again.  I told him I didn't want to have to be on something every day, and that depression isn't my struggle; anxiety is.
He said that there were faster acting meds that I could take as needed but they were habit forming and he wouldn't suggest them. Somehow I managed to get the courage to say that I wanted to try anyway.  He told me again they were habit forming. I said back, through tears and embarrassment, that I didn't need much, but could use the immediate relief now, to get through this physical and emotional crisis.
He wrote the script in annoyance, asked me no questions about my life or lifestyle, and then told me I needed to get rid of some of the extraneous stressors in my life. I laughed through my pain.

When I got to my car, the anger began to build.
I had just done something very hard, very courageous, and I was treated with disdain. I had bravely asked for help for the very first time and my request was met with suspicion.

I began formulating an email to him in my mind, and as I was cataloging my stress, I wanted to to shout from the rooftops that not only was I not a weak woman, I was one of the strongest women I've ever known.
I've never done this, never written out or shared the 'list' because I don't want pity-  but I want all of you to see just how serious this was for me:
In the last two years-
My husband reveled an entire other life I knew nothing about- that has lasted for our whole relationship starting before we were even engaged.  Throughout the year after he moved out, more and more information came to light and each revelation was more shocking than the last. The things he had done to me and to our family were no less than hideous.  He then chose to do nothing towards reconciliation except ask me to try again. No apology, no counseling, no redemption. Just rejection and shock, and pain.

In the less than 6 weeks after he moved out, we had to move off of the Marine corps base from our 2000 sq ft house into a 800 sq foot house and we had to give away our family dog. I lost my community, my intact family, my home, any shred of security I had formerly had.

He lost his job in the Marine Corps, money dried up, and I began driving kids back to the base daily so that they could stay in their schools for the remainder of the school year.

We moved again just 7 months later into the basement of friends and lived for a year in 1000sq ft with no functional kitchen. I cooked with a large toaster oven, a microwave, and a small camping-like stove.
The kids started a new school, I tried to figure out how to care for them and work and juggle it all.
I got divorced, had court dates, and wrestled through the revelation that my marriage had been rough the entire time, with lots of treatment towards me that take my breath away to this day.  The reality was dawning that it was never good, nor was it safe. I look back on the scared and weary woman and weep for her lost youth where she never felt cherished, or safe, or truly loved.

My best friend's mother died from cancer, we got two flocks of chickens that were promptly eaten by one of the dogs we were living with (traumatic for my already hurting children), we left our church and began going to a new one, we lost friends, we sold lots of our possessions, and learned to live with far less than ever before. Extended family stopped speaking to us, and rejection piled on top of rejection.

One of my sons was diagnosed with a chromosomal deficit and that began the addition of many more specialists visits who are all located in a town two hours away.

Now, I'm going to have to move houses yet again, I'm working multiple jobs in order to piece together provision for my family without having to pay for childcare, and some months I get no support from their father.
Nothing in our lives is secure other than the love I have for God and my children, and some days the reality of what I hold is so far beyond me that I wonder where my next breath will be drawn from.

My heart is just beginning to thaw and to open again and the fear of hurt and the heaviness of looking ahead at doing this alone for decades to come sometimes feels crushing.

To say that my heart and mind and life are full- and filled with lots of hard things is the understatement of the decade. There has been incredible beauty, and provision, and I'm growing and changing and healing and learning, and really am loving myself fully for the first time since early childhood… but I'm one woman. One woman with no safe place at night to rest my head and relax under the protection of another adult. I'm all of it. Protector, provider, comforter, parent, friend, disciplinarian. God is so incredibly merciful to me, and yet my back bends and sways under the burden I carry around, and I was beginning to break.

To be brushed aside by a doctor when I finally had the strength to eek out the words "Please help me" was crushing. I was given a prescription for an anti-depressant last year by one of his colleagues and I never filled it. I wasn't ready for meds, and truly don't believe I needed anything at that point.  I've been proud of myself that I haven't stayed in bed one single day, I get up daily and do what needs to be done. I'm raising my children, and trying to process each huge change with grace and expectation knowing that my kids look to me for my response to heartache. I know this is the only childhood they get and I want to make it the best I can even in horrible circumstances.

There are lots of conversations happening in our culture about mental health… and I am sad to report that my experience in being brave enough to ask for help was not a positive one.  I don't know what the answer is, and I surely believe there are plenty of people walking around who are abusing the system and making it hard for the rest of us.  I wish I had been received well, and given direction, but once again, I was on my own.  I am the model patient for doing everything right before asking- I've been in counseling, support groups, I have close friends, I eat well, I sleep well, I do yoga, I spend time daily in prayer and mediation, I find times of quiet, I get outside, I take the vitamins and avoid the junk. But the stark reality is that sometimes, all of the good is still not good enough. And it's ok to need help. It IS. There is no shame in it, and there should be no stigma. My brain and heart are weary.  And rightfully so.
I'm going to email that Doctor.  He can still choose to ignore my words, but I pray that as he reads through my story he will begin to see just how much courage it took for me to ask for help in a way I wish I didn't have to. I pray that the next crying woman who needs someone to look in her eyes and tell her it is going to be ok will be given that gift. And I will keep asking, until someone hears me.

Living in the Tension

Yesterday a few guys came to the house to help me truly move in.  The other family moved out in the middle of July, but I wanted to paint some, and needed some muscles to move around our furniture and to bring in some large pieces that I had in the garage.  Until yesterday, we were all still living downstairs for the most part. 
 I scribbled their names onto a box in my calendar for August 6th. They came to serve me with kindness and skill and in a few short hours, the house was looking like home. 

After they left, I sat at my antique farm table and stared out through the big front window.  The amazing reality of giving my children their own space again and moving into my own bedroom for the first time in 20 months was settling in.  I breathed deeply with the realization that we are truly on our own, and sat in the serenity for about 3.6 seconds before anxiety tried to barrel in with guns blazing. 

Nothing about my life makes sense on paper right now. Financially, my life is a mystery. I do the best each month with what I have, I do the work I'm given to do, and somehow, by some incredible miracle, each month everything is taken care of that we truly need. I have yet to get to the end of my resources and I haven't yet had to ask for help. We've been without my ex-husband now for 22 months. Some months have brought surprise money in the mail from friends who felt like sending me a bit extra. Other times, I've received food, or gift cards, hand me down clothing, or toys. Several times, I have even opened the mail box to find a care package filled with treats and surprises for me to encourage my weary heart.  Somehow, God takes the little I have and stretches it in such a way that there haven't been any cracks. But our minds can be a scary place to linger, and in that moment after the guys had left, and my kids had scattered to their own spaces, I began to rehearse how utterly ridiculous I must be to think that I could do this alone.  The joy of being in my own space was robbed by the anxiety that lurked, ready to pounce into massive disastrous thinking.  In the span of a few seconds, the track record God has in my life of providing for us was smashed under the weight of the fear I let descend upon my heart.  

I talked with a dear friend later in the day. She has been a single mother for several years now after a 25 year marriage dissolved when he chose to walk out.  She has been an example to me of learning to do with less than she ever dreamed and yet seeing her needs be met as she goes.  I told her that the fear of knowing tomorrow could hold complete financial disaster was a heavy burden to bear.  But as I spoke the words aloud, I finished the thought by saying, the reality is all of us are one moment away from disaster or destruction. None of us are immune to difficulty or struggle, it is just that living the lives that we have, we are more acutely aware of it on a daily basis.  We live in the tension of the now.  We don't have the luxury of planning for much, or banking the excess for future calamity.  We have the responsibility of weighing this day's choices and needs against the near future that we know will bring more want.  Just today I was faced with the decision of whether or not to buy the epipen I now need to carry as this year has revealed a bee allergy.  It was hundreds of dollars, and I've put off picking it up because the amount made me anxious. Today I had the money. So today I chose to get it.  I know that in one month I might wish for the money I spent today, but knowing the power in that life saving medication, and having the money for this day, I made the best choice I could make for today. I'm slowly learning the lesson of doing the best I can with what I have and trusting that I will get enough grace, enough mercy, enough provision for the next day, and the next, and the next.  

My Dad sent me this quote today, and it's an eloquent statement about living in the now, in that tension of living as we go:

"The heart of spirituality isn't safety and security. Instead, it is what Dorothy Day called 'precarity.' In the mind of most, precarity (or precariousness) is a bleak state of uncertainty and danger. The word connotes instability, poverty, marginalization, and the absence of a safety net....It also suggests radical dependence: the Latin 'precarious' is the state of being dependent on another's will, being upheld or sustained by another's force. So a spirituality centered on precarity acknowledges the radical uncertainty or contingency of human existence and our utter dependence on God." — Kerry Walters in Jacob's Hip: Finding God in an Anxious Age

The beauty of living in precarity is that I am faced with a simple choice. Either I trust that God is who He says He is, and He will provide for me and my family, or I fight it and try to conjure up miracles for myself. I don't have a good track record of creating something out of nothing. I haven't yet figured out how to open doors for work and influence when there seems to be no knob on the door. I do have almost 2 years and a notebook filled with line after line where I've documented the incredible ways my family has been seen, cared for, loved, and provided for. I still don't know how this will work. My rent is up now in this house, and I'm truly on my own. But each day brings what I need for that day. Each job I'm offered, each bit of mana I'm showered with has been enough. My Mother's heart longs to race ourselves out of this place of precarity, and yet the beautiful, miraculous story that is being written is one I would never have experienced otherwise. I'm learning to sit in that tension of precarity, and choosing daily to fling my hope and faith on the one who has seen me.

My own Amen (which also means... So Be It)

I'm sitting in a place in my life where the only way out will have to be fairly miraculous.  Within the next few months, my living expenses are going to rise considerably, and I will have to find more ways to bring in income.  Just in time for the kids to be home all summer, and me not to have any child care options.  I have to continue to find non-traditional ways to provide for them, and on paper things look anything but attainable.

The truth is, that I don't have all the answers. I haven't fully figured it out and I am not sure what our lives are going to look like over the next months and year.

But I have a deep resounding peace.  I have wondered, at times, if my peace is just an illusion, possible denial, or avoidance, but I really believe in the depths of my being that we are going to be ok.  God has shown in so many ways over the last year and a half that I am not forgotten and that I will be provided for.  Nothing is impossible with Him.

However, I'm also aware that my circumstances are complicated, looming large, and overwhelming.  When others hear what I need to do to take care of my children and how big it is, they often become concerned for us.  I have found myself worrying and being anxious for the benefit of other people.

Have you ever noticed that the work of worry and anxiety can mimic forward motion?  The act of being concerned, and anxious looks like action and involvement.  Conversely, sitting in peace and surrender can look a lot like inaction. avoidance. delusion. laziness. 

I'm having to navigate the path of working hard behind the scenes to set in place the pillars of support that will enable us to live in this area for the next months and years to come.  But doing that without anxiety, and without outward displays of fear can look suspiciously like I am not driven enough, not motivated enough, or not sufficiently afraid.  Somehow, my fear and worry comforts others who are worried for me. It's as though my concern lets them know that I have not forgotten how big this is and that I am scared enough to admit it is beyond me.

I don't know what our future will hold. I have no idea how this will all fall into place to take care of our needs and work into the structure of my big family; but I do have an undergirding of peace. Of just knowing that we will come out on the other side.  It might be messy.  I'm quite sure that it will look completely different than it looks for other families, but I believe that it will also be beautiful, and miraculous, and hard, and good.

I'm choosing to follow advice given by Glennon Melton from Momastery that I heard this last weekend at the Womankind conference- to just Let.It.Be.  To stop trying to make my circumstance be anything other than what it is.  To allow the path designed for us to unfold ahead of us, and though I can only see a few feet ahead, I will trust that the path won't suddenly disappear, but will rather continue to be formed ahead of me leading me into the life meant for my family.  I am ready to walk it. To turn from worry and anxiety that I have coddled for the comfort of other people and rather move inside of the gift of peace.  To work, and pray, and rest, and just Let It Be.

bigger than me

I'm in a place where i need God to be big.  bigger than I've ever seen Him.  i need to be able to provide for my family over the next year (and beyond) in ways i never dreamed I'd be providing.

I have always been an anxious person.  Worry was a way of life for me. I spent a huge part of my life projecting into the future and planning out each road that life may possibly take.  Now, I am in a season where there isn't much I have control over.  I am being forced to live each day as it comes, and enjoy that day for what it is.
I am blessed to be living in a place now where my living costs are down. But, by next spring (summer at the latest) my expenses will go up quite drastically, and I have to figure out how to pay the bills.
The incredible thing is that I can see the thread of His provision throughout my entire life.. and over this last year He has come on strong in such incredible ways that I can't doubt his care for me.  I know without a doubt that He has made a way for me through this year. I've kept a notebook of the amazing ways He has provided, and they knock my socks off.  One day, I'll share some of them here...
the incredible thing is that because I have seen Him make a way so practically and perfectly over this last year, my anxiety is almost nonexistent.  On paper, I know I should be terrified, but deep in the dark places of my soul where fear and doubt try to dwell, I have solid peace. Knowing that though this is bigger than me, it will be ok. I remember telling Him in prayer one evening when I didn't know where I would be living and needed to find a place quickly, that because things were so desperate, I knew without a doubt that the way out would have to be through Him.  He didn't disappoint.  He created a scenario for me and my kids that has been better than I could have manufactured on my own.  I'm blown away by the way He has cared for the details, and am overwhelmed with the knowledge that this newest need is not lost on Him.  I can't wait to see where it leads, and I know again, that however I get out of this will be clearly an act of God.  We'll watch and see.