Road to Redemption: Return to Critical Care

I’m happy for the opportunity to make amends to the organization, my coworkers, my patients, and the nursing profession. It’s not a privilege I’m taking lightly. I know the rate of relapse. I know this could be my last chance at a blemish free nursing license.

Two point five years ago, I had to leave my position as a nurse in Critical Care due to probably the most shameful and disturbing reasons a nurse can imagine.

It feels nothing short of miraculous that I’ve been given an opportunity to return.

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Fueled by caffeine and ready for orientation

(Although some might say I’m returning to the scene of the crime, and they would technically be correct.)

For nearly five of my 14 years as nurse, I worked in CCU and loved the job, despite it’s flaws. I felt at home in the role. But I completely mismanaged the stress in my life, making tragic and regretful decisions.

For the background on my detour away from “overachiever” into “Real Life Nurse Jackie” check out this BLOG I wrote, publicly declaring myself as an addict.

I was let go from the job, spent three months in treatment and submerged myself in recovery. Since returning to work, I’ve been employed in lower acuity areas than CCU, working my way up – but stayed on night shift because it’s where I’ve always felt most comfortable mentally and physically.

Probably beginning somewhere early last Fall, I felt in my soul it was time to take another step forward. I reached out to key people in administration, asking their blessing to apply for a new position. I also talked it over with my case manager and my sober support system.

I had to ask my case manager because I’m not allowed to work wherever I want. I’m enrolled in a monitoring program for another 2.5 years that restricts some employment, but as long as I remain sober, most doors remain open.

Even though I’m under strict supervision, my nursing license (so far, cross your fingers) is unmarred. That’s a benefit of WHPS; a statewide alternative to discipline program. I wrote all about how it works HERE, dispelling myths and detailing the true nature of this type of probation.

WHPS enables nurses to keep licenses intact, but it can be a substantial challenge to gain employment after being found diverting, stealing/using drugs or even abusing alcohol. This is especially the case if time lapsed between jobs. Too many employers, even in Washington state, simply fire employees on the spot, leaving them to navigate sobriety, employment and licensure on their own. The consequences of this can lead to isolation and suicidal ideation/attempt. Rejection from potential employers, lack of income or insurance to pay for treatment, and the debilitating hit to self esteem can make prevailing in sobriety near impossible. It’s hard enough some days to stay on a sober track when life is running smooth.

I don’t know how to convey this without sounding cliche, but not for a second do I take my continued employment for granted. I’ve done the hard work of recovery, but the support of the organization has been priceless. I can only hope to show this by being accountable and maintaining my integrity and professionalism. Choosing to live “Sober out loud” and advocating to end stigma is a part of my amends as well.

So, I’m halfway through my sentence. I graduate WHPS in August 2021! Thirty One short months! Approximately 133 brief weeks! You can tell I’m joyfully counting down. (I’ll also turn 40 that year – no small feat in itself. I’ll invite you to the party.)

Most nurses in “the program” do not return to the same department, or even the same hospital; for many good reasons. I’ve gone back to the exact department the administration escorted me away from in May 2016. The management has changed, the unit name and skill specialities have morphed, and there’s been a turnover in employees. But physically, it’s the same, with many of the same faces.

I won’t lie, it’s freaked me out a little. I’m worried about the staff being OK with me. I’m cognizant of any discomfort or mistrust that might linger. During my hiatus, interactions with former coworkers were overwhelmingly compassionate and positive. But I wouldn’t blame anyone who feels hurt or hesitant. Fortunately, recovery teaches the difference between guilt and shame; between honoring someone’s feelings and taking things personally. Shame is the worst. I’m lucky to say that it’s possible to find strength on the other side of it.

Of course I have some fear and embarrassment. I’m not impenetrable to the opinions of others; my self esteem’s not fully restored. It’s just that my drive to move forward and enjoy life and my drive to end the stigma of addiction and recovery is greater than any shame, anxiety or doubt that persists. IMG_6302

That sounds brave. I don’t feel brave. I just feel…determined. And brave doesn’t mean fearless anyway. It doesn’t mean I have it all together. It just means I’m doing it despite fear. Recently said by one of my heroes in a women’s recovery group: “Courage, not Confidence”. I’m holding on to that like a talisman.

I worked my first official shift back this week. The night before, I prepared healthy food and packed my lunch bag. Coffee was set to brew at 4:45am, and my favorite scrubs were laid out. (Yes, I’m now working DAYSHIFT! After 14 years on nights. More to come on that soon, trust me.)

Excited, I went to bed early and woke up with enthusiasm. Not that I was mindlessly giddy. But overall I’ve felt really positive about this decision. I really only had one major dread going in.

The nurse who initially reported me still works on this unit.

Let me state very clearly: I am GRATEFUL to this nurse; the role they played was beneficial in my recovery. They did the RIGHT thing. I am solely culpable for the situation and I do not harbor anger toward the informant. I needed help desperately, and probably wouldn’t have turned myself in. Even though I was privately seeing a chemical dependency counselor, I was struggling to stay clean. I am GRATEFUL this person brought attention to the charge nurse. (leaving nurse gender neutral to protect privacy)

Total transparency; I find it difficult to feel grateful for the way this person addressed me publicly at the end of a shift. Regardless of the very positive outcome, that memory brings back anguish and humiliation. The thought of coming face to face is like facing my own atrocities all over again. Seeing each other would be inevitable, but a lot of nurses work there. I figured I’d get into a comfortable routine and eventually we’d cross paths.

This is not at all what happened.

As I walked down the hall on my very first day to approach the very first nurse I’d receive report from; irony laughed in my face.

I was looking right at this nurse.

Out of all the assignments I could have ended up with; out of all the nurses working. I was about to spend 20 minutes with the one nurse I wanted to avoid.

I think I might have said out loud, “You’ve got to be f***ing kidding me”.

(As I write this out, I recognize something I never have before. Experiencing this from their point of view and having to report me must have been traumatizing to a degree as well. They were thrown into this mess by me. They didn’t ask for this. I’m sure they never wanted to be labeled the informant. There’s really nothing left for me to feel but compassion.)

Seeing each other was not as awkward as my imagination had created. I was greeted “Welcome back”; we smiled and acted like professionals.

What can I do but laugh? The one thing I was most afraid of occurred in the first half hour.

Moving on, I was met with hugs and a welcoming atmosphere. I experienced a lightness I’ve not felt in a long time at work, and I settled right in to the practice of patient care.

Why would I ever ever do a drug? I thought.

I feel great. I enjoy being a nurse. I love this feeling of productivity and doing service. I’m not a thief. I don’t even like to be drunk. I don’t like to be out of control. Why would I have done any of those things?

For a passing moment, I felt completely dissociated from the “me” that injected IV fentanyl and consumed a mad amount of Vicodin, Percocet, or Oxycodone. The “me” that put procuring drugs to escape my own pain above everyone and everything else in my life.

I felt like the “me” before addiction. Eager, energetic, balanced and healthy.

I thought: working in Critical Care is going to be perfect. So what if there’s access to drugs? It’s not going to be a problem. I would never commit such a horrible act. I’m fine!!!

Then I thought: Not so fast, idiot.

“I would never” was precisely my mindset the first decade of my career. I’d NEVER cross that boundary. Until I did it myself, I could not wrap my brain around how a nurse would steal narcotics from their workplace. It was a foreign, forbidden, and ridiculous concept.

But a series of events led me to become compulsive and addicted. I know what many of you must be thinking, especially my sober friends.

“Why the F have you returned to a department where you did this?”

“If CCU turned you into an addict, and your sober life is thriving, why would you go back?”

Those are great questions. And you’ll have to stay tuned for the answers. Next time, I’ll share why CCU didn’t make me an addict and what’s different today.

I’ll also detail how it felt to encounter Fentanyl  – my drug of choice – on my first day back.

I feel happier this week than I can recall. I texted one of my best sober friends:

“I might have sang in my kitchen while I cooked this week. Also I woke up at 5:45am all by myself. No alarm. Goddamn post-acute sober pink cloud.”

Getting off nights is a big part of this transformation. So is the redemption my soul is experiencing, finding I didn’t completely destroy my career. I’m happy to have a job that challenges me intellectually. I’m happy for the opportunity to make amends to the organization, my coworkers, my patients, and the nursing profession. It’s not a privilege I’m taking lightly. I know the rate of relapse. I know this could be my last chance at a blemish free nursing license.

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First day back: Full on Critical Care

 

I’m primarily happy that by returning I can demonstrate to employers that rehabilitation reigns over discipline, and offer hope to nurses who are just starting a sober journey.

I hope to give back more than I have ever taken. To tip the karmic scales by showing up every day honest and willing. And for all healthcare professionals that have or are suffering from the shame addiction has caused in their lives – I hope to prove recovery is possible.

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Actual message sent to me by a nurse halfway across the nation that saw my 1 minute video about returning to CCU.

Cheers and Gratitude upon Gratitude,

Tiffany

If you are in need of addiction treatment and you are a healthcare provider in WA state, please contact Washington Health Professional Services at whps@doh.wa.gov or 360-236-2880 for a confidential consultation.

I am always available for anyone looking to explore sobriety. Our conversation is guaranteed confidential. 

And of course – if you’d like to explore working with me as your life or recovery coach – check out my website http://www.recoverandrise.com

Other resources:

www.yesyoucanrn.com (Lists every state that has an alternative to discipline program)

SAMHSA – Substance abuse and mental health services administrations – national helpline

Trigger Warning: Suicide Awareness My Story: A Love Letter to Anyone Who’s Suffered

Alcohol and opiates are strong depressants, and were adding to the problem at the same time they were helping me stay oblivious. I played around with how much I could take and still maintain some function. Slowly, passively, I was still trying to end my life. 

Suicide is the 10th leading cause of death in America. It’s #2 for 10-14 year olds and #3 for 15-34 year olds.

90% of people who attempt suicide have depression and/or have substance abuse issues.

(www.addictioncenter.com)

Trigger Warning: Suicide and Suicide Attempts discussed in light of bringing an end to the shame and stigma surrounding Mental Health Needs and Substance Abuse. 

If you need help NOW, call 9-1-1.

I was 14 years old when I intentionally overdosed on Tylenol. This was my first and only serious planned attempt at showing the world – my family at least – that I was sad enough to try and end my life.

In the days leading up to it, I pictured how it would happen, and it came to fruition exactly that way. Out of compassion and sensitivity to my family and those that may be grieving losses of their own, I’m going to leave out details.

Despite the amount of pills I took, I was fairly sure I would not actually die. I knew my mom would take me to the hospital and she did. The first nurse in the ER that I encountered (or ER tech? I’m not sure) said “Seems like a pretty stupid choice. You knew what you were doing right kid? Looking for some attention.” He was right – I needed attention and felt there was no other way to show what it felt like inside of myself. A physician assessed me and said “This is really the worst way to try to die. You wouldn’t die right away – but you’ll hurt your liver so bad you’ll die slowly anyway.” He didn’t offer any quicker solutions however.

The next 4 days were very confusing. I was able to rest, which felt like a small break from the unrelenting anguish I’d experienced. The doctor prescribed a tylenol antidote which they mixed in Diet Coke. After drinking it, I’d throw up,  which infuriated a particular elderly night nurse. It was so disgusting that I couldn’t drink, or even smell Diet Coke, for the next 10 years.  (Many nurses I know have a story about themselves or a loved one being cared for by amazing nurses. This hospitalization was my first, and nothing about my caregivers made me want to follow in their footsteps. That career choice came later.)

A psychiatrist or psychologist came in and asked weary, uninterested questions. He sat very far away from my bed. His final statement was “I don’t really see what we are going to do for you.” That was the only conversation anyonehad with me regarding my emotional and mental state. As soon as my liver enzymes came back to normal I was sent home.

I began seeing a counselor (not a psychiatrist or psychologist) and was prescribed an anti-depressive by my family doctor that caused terrible panic attacks, so I quickly went off of it. My diagnosis changed frequently – Bipolar, then not. Bipolar 2. Then not. (It was 1995 and seemed everyone was suddenly Bipolar). “Take a pill, see a counselor once a week, and don’t do anything dangerous.” The one time I told a counselor I was considering going to a party with my friends, she said “That’s against your treatment plan. I’m either telling your mom or I can’t see you anymore.” The choice was obvious to me. It also reinforced that I couldn’t be honest with ANYONE.

My treatment was sporadic for a few reasons. I was resistant. There was chaos and divorce in my family home. Then I had a daughter myself at 16 and for years my emotional turmoil sank far under the surface – deeply ingrained but with no outward warning signs for others.

When depression and anxiety resurfaced as an adult, I didn’t fully recognize it. I’d been a mom and nurse for many years. I believed that extreme stress was normal, and that I “should” be more capable. With a perfectionist, overachieving attitude, I added more stress to my life believing that if I accomplished more, I would feel better. Maybe I felt so nervous and dissatisfied because I wasn’t doing enough to feel happy. I went back to school, I got married again, and I took on a supervisor role at work.

And then I began to crash.

I had suffered migraines for years, and when I was prescribed Vicodin, it took away a lot more than headaches. It removed the constant fear of the future; the regrets and dismay of my past. Add alcohol to it and I had found the magic elixir – for awhile. I didn’t know it, but by numbing out everything “bad” in my life I was also numbing out everything good. Alcohol and opiates are strong depressants, and were adding to the problem at the same time they were helping me stay oblivious. I played around with how much I could take while maintaining daily functions. Slowly, passively, I was still trying to end my life.

Sitting across from my counselor about 6 years ago, I admitted “My thoughts are so dark. I constantly picture putting a knife through my chest. I’ll be walking through a grocery store and picture holding a gun to myself. I don’t really want to do this – and I don’t have a gun. But I also don’t want to go on.”

It didn’t occur to me that even as a strong, capable nurse, it would be OK to walk myself into an ER or call a crisis hotline. I couldn’t imagine that I needed – or deserved – that kind of help. I couldn’t “afford the time off” or “show my weakness”. The years went on and the substance abuse – my own personal treatment plan for the emotional and mental pain I was feeling – increased.

I briefly mentioned the anxiety to my physician, but kept the conversation short and light. I knew from past experience that I “shouldn’t” be completely honest with anyone, so I left out any mention of my drug and alcohol use. She recommended a low dose anti-depressant, but I was doubtful. MY depression and anxiety was “situational” I convinced myself. Life was tough! I was going through a divorce. And my doctor agreed. If I could just get a handle on the stress in my life, I wouldn’t feel so bad.

Nobody suggested that it was the opposite – that if I could find a way to stop feeling so bad – learn to accept and cope with painful experiences with self-compassion, learn to love myself and tolerate discomfort – that I would not only be able to handle the stress in my life, I would stop adding to my suffering.

My happy ending is that I did eventually find that formula. In active recovery for substance abuse I’ve learned to change my relationship to my thoughts. Once I was free from the substances, I could begin accepting myself and my life circumstances with love. I began making small daily choices that set me free from internal and external stress: Mindfulness meditation. Self Affirmations. Noticing my inner “saboteur” and working to not believe that voice. Lots of self care. Reducing my hours at work.

I dove headfirst into trusted self-improvement such as Byron Katie’s “The Work”. I found Brene Brown’s research on shame and vulnerability and began to believe that by saying ‘I need help’, I’m actually being my most brave, strong, courageous self. I took Mindfulness Based Relapse Prevention and learned that my thoughts are NOT me, and that I have a choice to let them go and can work towards choosing joy.

And I never, ever feel too proud or afraid to ask for help anymore. 

When I took 3 months off work to go to outpatient substance treatment, I learned that a mom with a full time job and a mortgage can in fact still find ways and means to pause everything and take care of herself.

I learned that no matter how “shameful” it is to be a nurse in state probation program, I can still show up at my job feeling proud that I’m doing the hard work of healing the wounds in my life, and that I still deserve to be here.

When I read the news this morning about Anthony Bourdain I was sobbing before even leaving my bed. For him and his family. (My father loved him – we watched him together many nights). For Kate Spade. For the desperation and hopelessness they must have felt. I imagine they felt like they couldn’t reach out to anyone. Perhaps they couldn’t admit what felt like weakness; that they didn’t want to be a burden. And no doubt they felt like they couldn’t go one more minute with their anguish filled minds.

I cried for myself, at 14. And at 30, for all the days spent visualizing harming myself. For all of the patients whose bedsides I have sat next to in the dark, knowing that they suffered so deeply and could see no other way out.

There are degrees of mental health/illness, degrees of depression and anxiety, and we should all receive individual based treatment. Mine stemmed from childhood trauma, years of self loathing, and a lack of healthy coping mechanisms, along with a strong lineage of depression and suicide in my immediate family. I feel lucky to have found light through my darkness, and hope that if I enter into darkness again I can speak up early knowing that there is hope.

There’s nothing more important to me right now than ending the shame and stigma of mental health disparities and substance abuse. No one should be afraid to say “I need help.” “I want my life to end.” “I’m angry or sad and afraid all the time.” No one should feel shame for “seeking attention” with this desperate act.

Luckily, healthcare is changing, and so is our culture. But it can do better for all of us. Depression and anxiety need to be treated holistically  – not “just” with a pill. Or “just” talking to a counselor. I don’t know the answer, but I want to be a part of finding it.

If you are feeling scared, depressed, anxious or hopeless, know that you are LOVED right now. I am sending you all the compassion in my heart. I have been there – maybe not exactly where you are. But in a similar place. And I have found a new way to live. There is NOTHING wrong with asking for help. NOTHING wrong with saying you’re spiraling out of control and you need someone to help you take of care of yourself. You deserve help. You deserve to love yourself. You are needed and wanted, and if you’re not finding the answers you need, don’t give up. It might be scary to pick up the phone and call the suicide hotline, or you may feel shame about showing up in your local hospital and saying that you’re considering hurting yourself. I promise you, the scary part is temporary. Life on the other side of real help and healing can be worth every scary minute of that first phone call.

Life is very hard, and very beautiful. It’s always changing. Don’t choose a permanent solution for temporary pain. Give yourself every chance to find the beauty.

IF YOU NEED HELP NOW, CALL 9-1-1 OR Call 1-800-273-8255 (SUICIDE PREVENTION HOTLINE).

Make an appointment with your doctor and a licensed therapist. Talk to a trusted family member or friend. Tell someone. And don’t hold back – tell them everything. You’re worth it.

My favorite resources for learning Self Love: 

Mindfulness Based Stress Reduction (find your local classes online)

She Recovers (www.sherecovers.co)

The Work of Byron Katie

With all my Love,

Tiffany