#I've worked with dementia patients

[beeseverywhen]

Nothing quite prepared me for how humbling playing any part in raising a teenager is

[beekeeperspicnic]

I've got this colleague at my day job who keeps saying infuriating things, but they are so funny in the context of the fact that evenings and weekends I'm making a Sherlock Holmes computer game.

Me: Oh yeah I'm learning Javascript at the moment. Him: Pff you don't want to do that. You're an artist and graphic designer, that's where your strengths are, I think you'll find computer programming really boring, it's not for everyone. Me: *looks at fourth wall and shrugs*

Me: I read this really interesting paper about a project working with dementia patients, where they guide them through making a memory map of familiar places. Him: Ooh, like Sherlock Holmes and his mind palace. Him: See, Sherlock Holmes has a mind palace. Him: But I'm sure you don't read those sorts of books, you wouldn't be interested. Me: *Sitting on a zoom call, with my collection of Strand magazines and signed picture of William Gillette very visible behind me. Opens mouth. Decides I don't have the energy. Closes mouth.*

[macgyvermedical]

I've got a question about your inpatient psych stay if that's ok.

You mentioned the patient companions and I'm a little interested about that. I assume they stay with you 24/7 in shifts, but what are they *doing* in the room with you? I feel like it would be unnerving for the patient and boring for the companion for them to just sit and watch you. I assume they make small talk, are they allowed to talk about deeper issues with you or would they try to direct you to a specialist with more training?

If you're calmly working on something for awhile and not an active risk to anyone are they allowed to pull out a book for some parallel play or do they need to be Full Attentive All The Time?

I feel like I have an interesting perspective on this because I both have worked as a patient companion (before I was a nurse) and have had a patient companion in the hospital.

Patient companions are staff members whose job it is to keep a particular patient (or patients) safe for their shift. This can be because the patient has expressed that they are having thoughts of suicide, because they have dementia or delirium and may be trying to pull at wires or lines or get out of bed, or even because they require such intense nursing or basic care that the staff cannot accommodate it without someone to pay attention to that specific patient.

Patient companions are indeed there 24 hours per day, even when the person is sleeping, and even when the person is doing an activity other than trying to harm themselves or others.

Most hospitals do not allow the companion to play on personal phones, but I've spent many a shift watching someone sleep while reading or doing homework. Conversely, I have spent shifts where I've barely had time to pee because of how intense my patients were being.

I say patients because I worked at a hospital that had 3- and 4-bed co-ed rooms, and they'd put all the people that needed companions in the same room so they only had to use 1 sitter. That went about as well as you could expect. Some days I'd have one person trying to pull out their NG tube, a second person trying to escape, a third person pooping constantly and a fourth crying while masturbating and have to figure out a way to intervene on all of it without something bad happening.

[punsmaster69]

5/MAR/20XX

tori is out, and one of her kids is fresh on wheels. so, i've been put on monitoring duty for a while.

making my job that much easier, papyrus has eagerly agreed to help "watch" flowey and frisk.

...it's in quotes because what he's 𝘳𝘦𝘢𝘭𝘭𝘺 doing is turning the backyard into a racetrack with frisk and undyne.

(it was mostly undyne's idea.)

as always, the kid will never outright say it, but he seems to like having those wheels.

"havin' fun with your newfound mobility, huh?"

"It's fun-"

"Functional. At best."

"breaks working fine?"

"This thing hasn't thrashed me yet."

"cool."

"you remember how to detach 'em?"

"Press these in."

"then?"

"Unlatch these, and lift myself out."

"Yeah, yeah. I remember. I'm not some dementia patient. You don't have to quiz me."

"maybe you are and you've forgotten."

"...That I'm a dementia patient??"

"yup."

"How could someone forget-"

".........."

"exactly."

"That's idiotic!"

"If I had dementia, I wouldn't be able to remember watching all your friends turn into DUST at my-"

"......."

"...Hands."

"......."

"..........."

"....gotta 𝘩𝘢𝘯𝘥 it to you, kid. you sure know how to change a mood quickly."

papyrus, undyne, and frisk called him over.

"FLOWERY! WE'RE DONE WITH THIS SECTION!!!"

"Come test it out!"

"It's time for SPEED!!!"

flowey gave me a look i couldn't quite decipher the feeling behind.

"go on. hang out with those same friends."

"......"

"even if nobody but you remembers what happened, you can still make it up to them by being better this time."

"be a good friend, alright?"

"......"

"..Or what? You'll kill me?"

he didn't like the face i gave him.

"...You wouldn't. Toriel would kill YOU. Papyrus would never forgive you. Asgore would have you-"

"you're right. i wouldn't."

"but you wouldn't do what you did again either."

"so, let's just forget the whole thing."

"What, gonna say it was dementia?"

"that'll work."

"now get a move on, petals."

i rolled him slightly backwards with my foot.

"you're holdin' up the fun."

he gave me a scowl.

"Flowey, are you scared or something?! Get over here already!!"

"I'm going, already! Don't you three have an OUNCE of patience between you?!"

frisk answered completely flatly,

"...No."

topping it with a slight smile.

"We wanna watch you FLY around this thing already, dude!!!!"

"ARE YOU READY, FLOWERY?"

flowey rolled onto the track, and papyrus started a countdown.

[am-i-the-asshole-official]

AITA for barricading the bedroom door?

For context, I have been staying with my partner. We live with his mom and grandma. Grandma has dementia, and cannot be left home alone. I am a very introverted person and I heavily value my alone time.

One of grandma's symptoms is checking up on us regularly. She's a very sweet, giving person, and is checking on us to make sure we're not hungry or to see if the dog has been fed or making sure we're generally comfortable.

Due to her diagnosis she does not remember that it has only been a few minutes since she's checked with us. If she hears us talking, watching a video, playing a video game, or anything through the walls she's checking on us. For reference, in the morning she usually keeps to herself. By midday she's asking my partner about w/e she's focused on about every 20 minutes. By the evening she's "sundowning" and will check with us every 5-10 minutes or so.

Both my partner and I are patient and kind with her about this as she can't control it and it is definitely not her fault, but it does get very tiring very quickly. It's almost impossible for he and I to hold a conversation or watch anything or have "alone time" (in a few ways).

So, this leads to my dilemma.

When my partner is at work (I work morning-afternoon, he's afternoon-evening), she'll come knocking. She knocks twice and if she hears no response she'll open the door looking for him. About 95% of the time I'll answer her but I'll admit to having hung out in another room to avoid her.

Recently I got a few storage totes for the stuff I have here. There are 3 of them and they're pretty full so fairly heavy. I've found myself several times over the past few months pushing them in front of the door and not answering when she knocks. She'll try to open the door but assumes it's locked when she can't and goes back to what she had been doing.

Mind you I don't do it often. I do cherish her and the gratitude she extends towards whoever she's communicating with. Sometimes though... I get overloaded and need a break for a few hours. I never have headphones in during these times and am always listening to make sure she's okay and will check on her if I hear anything suspicious.

What are these acronyms?

[jacksprostate]

Part 1 Part 2 Part 3

The five days Tyler's stolen my voice from me, I spend watching. The commons, group therapy. I visit my cave with my eyes open. Mills should get used to the cold. I've heard if it drops below 50 while your respiration is this depressed, you go to sleep and never wake up.

Valley of the Dogs.

An orderly with fresh bruises peppering his temple lets me take my walk in the same time Mills is carted around. This is how I must've looked for months. Glazed. Drooling. At this point they probably have to use elephant tranquilizers on me, the tolerance I've built.

God, his petty ass, we meet up for one on one and he says he has to give me some bad news.

No, it's not about Mills.

Tyler, whatever.

He is giving me the bad news, of the passing of one Marla Singer. Everyone seems to think this is bad news. Found dead in her apartment because she didn't pick up any Meals on Wheels for her neighbors for three weeks, and they worried about those little old ladies, up there all starving alone since their angel in black stopped showing up.

Her corpse was found, instead. I imagine it all waxy, tits rotted off just like she said, at some point you're so sick even the bacteria in your gut won't bother decomposing you. I imagine Marla's skin pulling back, fleeing, away from her eyes, her teeth, like a mummy. Dried out as all her collagen rots.

Paper clutched in her hand. A will, sort of hasty and half-assed.

Marla's many worldly possessions all fit on a hotel notepad.

Many other worthless things go to a small number of worthless people Marla has mentioned leaving behind in her life, and god says, Marla Singer has left me something.

That's the entire reason I get to know all of this.

If not, I would've never known.

The world could blow up, and you'd never know in here unless it was in someone's will to tell you.

Marla Singer left me her dildo.

Oh, Marla.

Addressed me in the will half the time as Tyler.

I wonder, did the cancer spread from her tits to her brain, like the cancer I didn't have. It's everywhere now. God says they're working out treatment. I wonder if it matters.

Without Tyler between us, I don't really know what connected me and Marla.

What kept her calling.

I liked her. Another psycho boyfriend in her stories. There will never be another, unless she's gone to Heaven, the real one, and they've got some sort of exchange program going on for her to have fun with.

I think Marla might deserve that. She deserved better than this.

I wonder if it was pills. There was no Tyler to save her, this time. No one to listen to her death rattle. I don't have the voice to ask.

I won't be getting her dildo, because you don't get possessions in a psych ward. It'll get dumped in some other landfill to persist for time immemorial with all the other plastic iconography of our stupid, stupid lives.

Released back out to pasture, I watch Mills. His wife was murdered. Murdered, you see, it's an action, and it's solvable. Mills solved it.

You can't solve the slow death. Not really.

I think about how empty Mills is.

Am I empty?

An unidentifiable amount of time ago, Marla called me again, and she told me all about what happens at the new support groups she goes to, since I ruined the old ones for her. They were willing to rally behind her for the whole blowing my brains out show, and she only would've had to wait them out for six months or so, but she decided to just find new ones. A new church, with new temptations like Living With Angels, a group for those caring for severe dementia patients, and Recovery Road: a program for those trying to rebuild their lives after a loved one blew them up. She said, when I got out, we could both go to that one, and I could talk about Tyler, and she could talk about me, and we could have fun getting kicked out together.

Marla was always talking about that. When I got out.

I wasn't ever hearing any of it.

Mills, they've let up on him, finally, you can see his eyeballs aren't floating with all they've juiced him up on. He's watching me, back.

I wonder if he knows about Marla.

Would Tyler care?

Tyler had said, don't call this love.

Does it need to be?

When I get my voice back, I bury my thoughts on the subject and Marla and everything in a relentless campaign to needle Mills until he looks like a voodoo doll in a shitty tourist trap.

[stinalotte]

Season 5, Episode 6: The Shrine

I said I had to gather my thoughts before I would be able to write something coherent. I still don't know if I can do it justice. It's weird, but I hesitate to call The Shrine my favorite episode because it's so devastating. It's very shippy, it has phenomenal acting from everyone, the story is heartbreaking, it should be perfect - but it just hurts so much. If this is my favorite episode, what kind of masochist am I? (Don't answer that, that was rethorical.)

I'm placing this under a cut because this is gonna be long.

The cold open on this one is just brutal. Rodney is already pretty far gone, and he calls himself "Mr Rodney McKay" instead of Dr, because "doctors are smart, and he's not smart anymore". To know what's happening to you, to slowly lose your mental capabilities and to be able to still process what's happening, that's cruel. And then he's calling for John, and that's when I had to pause the video for the first time because the tears were already coming. The title sequence hadn't even started.

Fuck.

I lost my grandmother to Alzheimer's a couple years ago. She had a slow and steady decline and thankfully, it was one of those cases where she just forgot more and more, but without the mental anguish. She wasn't panicking, or aggressive, or even agitated. Just a smiling, sweet old lady, who in the end didn't remember how to sit or eat or breathe. When she died, I couldn't cry. I was too busy consoling my mother and aunt at the funeral. The first time I cried was when I rewatched The Shrine, years later. It just shook something loose in me. It's also the point where I decided that if I ever got diagnosed, and was still in a state to do something about it, I would end my life on my terms. I'm not putting anyone through that.

I remember Kate Hewlett saying in an interview that a lot of people on set where crying during those scenes because they had family members with dementia, and that she had to leave the room at one point because it hit close to home for her too.

At first I thought it was mean that everyone was like, "Yeah I realized something was wrong when Rodney was being nice to everyone", but then I thought, no, that's actually a good point. Because his friends were uncomfortable with alternate universe Rod (who was too suave and cool) and they're uncomfortable with a Rodney who is uncharacteristically nice. They love him as he is, not a polished version.

I know everyone is giving Dr Keller shit for not wanting to try the Shrine, but I really think it's because she's a doctor. I work with doctors, and almost weekly I have discussions about respecting a patient's advanced directive. I've had a doctor wanting to install a gastric tube in a patient who was at the end of their life. We had the advanced directive that CLEARLY stated they didn't want that. When I confronted the doctor, she was almost angry. "But they will starve! I can't let them starve!" Yes, you can, and you will, and you have to. The hardest thing for a medical doctor is to have to sit back and not be allowed to do something that might help the patient. I think that where she's coming from. There are treatments to be tried, and if Rodney is taken to the Shrine, all those other options stop. I still think she was wrong and I don't like her approach, but I think it's an explanation why she was acting the way she was.

And then we have Rodney running to John's room in the middle of the night because of course that is the first and only place he'd go. It hurt to watch him be so frantic and desperate. And John is right there for him, grounding him, telling him, I'm not going anywhere.

Beer On The Pier. Yes, you have to write it like that because this scene is a fixed point in time and a goddamn cornerstone of this ship.

Rodney, knowing this is probably the last night he'll be this lucid, wants to say goodbye. And John doesn't let him. Because Rodney's stuck with him until the end. He's not going to turn away, no matter how ugly it's going to get. The very thought of saying goodbye is so foreign to John that he doesn't even want to discuss it. "That's final."

(Also, just for aesthetics alone, the night shots of the city are beautiful.)

I'm trying to be a bit less rambly, but what can you do when you have this masterpiece of an episode?

In the cave, when Rodney is intense pain, John has his arm around him the whole time and doesn't let go until he is himself again.

I love how everyone is so caring and surrounds him with love.

And ugh, the surgery - with fucking power tools. Barbaric. But necessary. But man, to hold your friend's head in your hands, holding him still, while a literal drill is going into his skull? I'd have passed out.

The only tiny little thing that was a bit jarring was Rodney's confession to Jennifer at the end, and just because for me, it came a bit out of left field. But I am nothing if not good at ignoring things that I don't like, so I'll just refer to fanfics that fix this. No harm done.

And finally.

David Ian Hewlett.

Holy fuck, dude.

HOW are you not buried under a shitload of Emmys? How is there not a whole wing of your house dedicated to housing the tons of awards you should have gotten for this? (I know he did get quite a few, but I'm talking custom built shelves in at least four rooms. Minimum.)

Everyone brought their A game acting wise, but this guy knocked it out of the park. It was heartbreaking, moving, extremely believable, and just jaw-dropping. David is, in my opinion, one of the best, if not the best actor of the franchise, and I don't say that lightly. I have a massive crush on Joe Flanigan and he's great, same with Amanda Tapping, but David is just fantastic.

So yeah. There you have it. My very concise, totally normal opinion of this episode. I doubt anyone reads all of this, but hey, this is my tumblr and I do what I want.

If you did indeed sit through all of this, I'd love to hear your thoughts. Feel free to tag or reply or add stuff.

[elwolfen]

Alfred Molinathon Day 10

Nervous Energy (1993)

Ira Moss

His Role: Supportive and undergoing inconceivable pain of having to watch his dear Tom slowly go through the trials and tribulations of AIDs. Someone you'd hope to have by your side in sickness and in health. Patient while understandably tired. The unprompted trip to Glasgow without him going or being properly discussed must have stung quite a bit, but he let Tom go, even knowing that it wouldn't go nicely. It's what Tom wanted.

His flashbacks to the past were... interesting, to say the least. There are two types: first meeting and them being much closer (if you catch me). Seeing him meet Tom, who was a biker at that point, filled me with much glee from hoping there would be a scene where Tom would take Ira for a ride, and he'd hold close to him. They do ride, but Ira doesn't cling to him sadly. And the other scenes? No full-on sex but very sexual undertones. You see plenty of naked Tom (past and present), plenty of ass and full frontal nudity. I'm sure plenty who haven't watched it but are a A.M. fans are curious about Ira's percentage of nudity (I see you)... the most you see is him laying in bed with his dear Tom and see all but his pecker. Which I'm thankful for, for me, seeing genitalia makes me uncomfortable for reasons not entirely known to me (my aro?/ace ass). So, seeing Tom's was a jumpscare.

Anyways a scene where, after going to the bar with his friends, sits and sings to himself while seeing a vision of Tom crying out in pain and begging for Ira made me tear up a bit. At the time of these reviews, I'm dealing with my cat's sickness and at times, I've thought about the idea if that if he could talk, would he be constantly begging for help and yowling about the pain? Obviously, he still could, but the thought of not being able to help with one's serious and fatal situation is heart-wrenching. I know a person going through AIDs and a cat going through Lymphoma are different, but this is how I relate. Ira has Tom, and I have my Sandy.

Seeing him go through and making a list of music for Tom's funeral was jarring. We forget what loved ones do for a dying person, getting all the arrangements, booking the funeral itself, and even the little details like the music. It just it me. Seeing him quietly work on that while Tom is in the hospital, not knowing if he's still fighting or trying to let it take him. All he knows is that Tom doesn't want him there.

He also abandons his radio hosting duties to be at the hospital with Tom. It's brought up a few times about the fact that Ira was going to interview someone that Tom was a fan of, and after all that happens, he stays with Tom. Someone else interviews him. A sacrifice, I'm sure he's willing to make time and time again.

When Ira finally gets the news that Tom is okay, it'll take weeks for him to come home, but he is still surviving. All Ira can think is that "he's coming home?" He breaks down crying at the thought of him being home with him. I'll admit I wanted to see him cry, just to see he acting chops, but it was so damn touching. Everyone at that hospital was so supportive.

In the end, it's just the two of them, in a hospital bed. Talking. Throughout the movie, we learn that Tom doesn't like kissing on the lips. But here, he wants to kiss Ira. I'm sure Ira would've loved that, but he knows his Tom. Instead, he says he wants to hold him, which is a relief to Tom. Holding each other close after a tumultuous time in Glasgow must have felt like heaven on earth. That's the last we see of them. The funeral is postponed, but we know the date will have to be made eventually. For now... all that's matters is each other.

~~~

The Rest of the Film: Tom was really going through the ringer of AIDs and everyone terrified that he's developed dementia (which I didn't know was possible). Going on shopping sprees, buying the wrong thing, and lashing out when told such and just knowing it's his expertise, brutal. Watching his sweaty spiral didn't give me much hope for the end of this movie. Yet I was surprised. He doesn't die at the end, but it is heavily implied that it will happen eventually. But it was a pleasant surprise.

Also, why does everyone keep letting him drive!? He drove into a hedge!

~~~

His family seemed kind of supportive at first. His mother really was the highlight out of all of them, she genuinely cares about her son and I'm glad. His father was hesitant about all of it, but he has been researching about his son's aliment. And Ian, his brother, was calm at first, throwing some shade until the point he snaps. This man really thinks his brother is just being a "theatrical wee shit"...

When Ira inevitably arrives and hears out Ian, Tom's brother, on what happened. While I understand his and his wife's discomfort; Tom messed up her kitchen twice, he went back to cook again while still naked (her very young daughters giggling) and he drove a rental car into their hedge. It was still crossing a line when he attacked him (one hit and brief crying but still), threatened death, and kicked him out in the morning. His brother is very clearly sick and disoriented and yet still does so. I do appreciate that he showed some care, but he needed more patience. What made Ian and his wife really snap? The fact Tom and Ira fucked in the shower? Really? That's what starts half his family bashing him for being born!? Wow.

When Ian turns up later to the hospital that Tom ends up after everything to visit. He still thinks he's being over the top. But Ira has had enough! He rightfully snaps at him, but still in a reigned in manner. He's tired of seeing everyone abandon this poor, suffering, and confused man who's been their for his friends, and his father and brother abandoned him ten years ago when he broke his leg. Why? Because they saw him with many gay men in the same room, I believe wearing leather.

I can't understand why Tom would want to forgive them. But it's not my place to do so.

~~~

Tom's seemingly fairweathered friends. Again, this is a difficult situation, I understand. Yet they still have the gull to dine and eventually dash as soon as things get too difficult and embarrassing. Ira bringing up the fact that his friends are way more reliable, a bit of a diss even before the abandonment, but he's not wrong.

Thankfully, after being rejected yet again, this time by a leather Dom, Tom begs Ira to call his ex-teacher at four a.m., and she takes them in for the night. She seems really nice and singing was lovely but little too much for my sensitive ears. A thing, though, all this moving around could have been avoided if Tom allowed Ira to book a hotel room. But for some reason, he didn't want to stay at one. Anyways, we get a conversation between Ira and Rosetta, which is really devastating. Ira hasn't been tested for AIDs. He thinks he may have it, but not knowing if that's the case or not makes him feel stronger. Strong enough for him and Tom. He doesn't want Tom to be concerned with it, he wants to deal with it on his own. Just like what's Tom has been doing throughout the film. They both don't want to be weaker, they desperately want to be strong enough. But it's ok to be overtaken by the overbearing pain and devastation of a disease. It's not your fault.

As soon as they get back home to London, who shows up? All of their London friends! As soon as they get off the train, they are swarmed by them and head straight to the hospital. It was heartwarming to see the true family they have there. Nothing but helping and patient.

Heads up! A Romani slur is dropped near the beginning of the film. Very brief yet there. Also, mentions of Antisemitism!

[n0ts0phism]

I'm feeling exhausted and frustrated as of late. I've been trying to find a job, but not only do I lack qualifications for the ones available, but my pool of options is limited because of my living situation. I only have an Associate of Arts to my name, as I did not transfer to another college after completing my time in the local community college. I have to stay close to home to help manage a dementia patient. With my mental bandwidth spent worrying about my family most of the time, it's difficult to work through these emotions and mental hurdles. The dementia patient is growing difficult to work with in many ways.

I'm also a type 1 diabetic with autism and anxiety, so my stamina is inconsistent at best. I'm not unhirable. I've held a data entry position for a non-profit organization and two retail jobs. But there were always ableist coworkers or superiors who made my life harder. A few high blood sugar episodes later, and they wanted me gone. It's probably because I live in the South, where everyone fetishizes this bootstrap-pulling mentality that my disabilities prevent me from fulfilling. Pardon me for having to stop and take care of myself... If given no other option, I'd take up another retail job until my living situation drastically changes--namely, when the dementia patient finally passes away, and we can expand our horizons past this house. But at this rate, I'm more tempted to work freelance. I have skills in writing, data entry, and even some illustration (though I could afford to up my output a little on the latter). These are all things that I work on during my free time, and I'm well-versed enough to make a living off of those skills...

But the prospect of making a job out of any of the three seems daunting. I wouldn't mind blogging as an option, hell, I would even become a YouTuber if it would pay the bills and if I find something I'm passionate about enough to discuss. But I don't know if the content I want to create could be monetized. The only thing I know for certain is that I want a job where I can afford to go at my own pace, ensuring enough self-care to function at my best.

I wish I had a properly defined answer. I really do. If anyone is out there with some insight, especially if they have a similar experience to mine, I'd love to hear it.

[severalowls]

There was a lot of staff hurrying around and speaking in hushed voices outside the room of the woman who would say "oh!" to herself while watching tv next door to my granny's room on Monday, and then on Friday it was all cleaned out. I'm in absolute awe of how the staff can keep going and stay calm as to not upset the other patients. At the hospital you could really tell when there was a medical emergency, but the care home has to deal with that regularly and maintaining a calm environment for dementia patients. My granny called for her painkillers and one the nurses, who I'd just overheard grimly whispering about "She was just eating a minute ago..." came through and was able to put on a smile and explain to her that the pain nurse would be through soon... and yet everybody I've ever known who's worked in one gets paid a pittance and made to handle the work of 3 or 4 people. Insane. Fucked. They should have to do this for like 6 months tops and then be allowed to retire forever.

[norbezjones]

I've been thinking a lot about something concerning Romance The Backrooms, so I wanted to write it down and share it.

Content Warning: Discussion of suicidal thoughts, self harm, mental health issues, and homelessness. There is a hopeful ending.

I got the idea for RtB in October, when I was living on a friend's couch and trying to find permanent housing. That ended up being a really difficult month for me, because I self-harmed for the first time in months and, as a result, I went to inpatient.

I was there for a while, and I got better. With all the time I had in thee, I worked on creative things, and really fleshed out RtB. I couldn't live with my friend anymore after October ended, but the social worker told me that she would find me a group home.

However, when I was transferred to a different wing of the hospital, I was given a new social worker. And this one said that I couldn't get into a group home, and he was going to discharge me into a homeless shelter asap.

That resulted in a spike of suicidal thoughts. Why had I come this far, only for this to happen to me? Should I just end it? But, no--if I did that, who would be around to make Romance The Backrooms? If my light snuffed out now, that game would never be made.

I've been suicidal since I was 10 years old, and it's usually not big, grand things that make me want to stay alive. It's the dogs I would never pet and the movies I'd never be able to watch that make me say, "One more day." And RtB became my "One more day." It became the reason why I persevered.

After I was discharged, my friends told me that I still needed inpatient help & psychiatric care. So after toughing things out for a few days, I brought myself to the ER and was admitted. A few days later, I was brought to another inpatient, and two weeks later, that inpatient sent me to a short-term residential program.

It was a wonderful program, and I met some fantastic people there. I also worked more on RtB--I figured out all of my love interests, and drew them for the first time. On the characters profiles, which you can view here, there are drawings with the description, "Concept art from when I was in treatment in December 2023." These were all done while I was at the residential program.

I was able to scrounge up some money to be able to get an Airbnb after I discharged--it was cheaper than other options, and would hopefully be temporary while I searched for permanent housing.

Unfortunately, finding housing is difficult when you haven't worked in 2 years (mainly thanks to pseudo-dementia, which I've documented extensively in this game here), and don't have the money for a security deposit. I also wasn't poor enough or disabled enough to get help from the government. Very unfortunate.

Long story short, I ran out of funds to stay at the Airbnb in 2 months. I was able to get into a short-term housing program for homeless folks with mental health issues. That was when I met Kevin.

Kevin told me he could help me get hotel & housing vouchers if I went with him after our time at the program was done. I had no other options, so I did. I spent the money I had keeping us afloat at a motel while we waited for the voucher, and went across the state to a different one when Kevin told me the one we were at wouldn't accept the voucher. When he left to retrieve it, I waited very patiently for him to return.

He never did.

I suspect the whole thing was some sort of scam all along, and even though part of me knew it could be, I went with it because it was either go with Kevin, or go to the homeless shelter.

The next day, I had to check out of the motel--I had literally no money left. I gathered my bags and sat in the lobby--well, I say lobby, but there weren't any chairs or tables, so I was basically sitting on the ground in the corner of the room, with sun from the window scorching my back--while I tried to come up with a plan.

I made a lot of phone calls to people who might be able to help me, but nothing came through. Even 211 had nothing, because the homeless shelters in the town I was in were full.

I became suicidal again at that moment. Again, the eternal question: why had I come this far, only for this to happen to me? Should I just end it?

No, goddammit. If I go now, Romance The Backrooms will never be made, I thought to myself. I want to be around to make it. I want to be around to see it through. Come on, Bez. Things looks like shit, but let's keep going anyway.

Not long after that thought came to my mind, another person entered my head, someone else I could call. I wavered, but eventually decided to try calling them, and they answered. They were able to help.

It's thanks to them that I am where I am today. I have housing for a while, and I got a job that I'm satisfied with.

Best of all, I'm working on Romance The Backrooms.

I'm so happy I stayed around to see it through.

[topazadine]

Writing Research Notes: Bipolar Disorder

I was diagnosed with bipolar disorder at age 19 and had a psychotic episode at age 21, so I'd like to say I know a bit about what I'm talking about. And I'm a writer! So today, I'd like to provide some facts about bipolar as a jumping-off point for your research.

Things we'll discuss:

A note of caution

Types of bipolar disorder

Phases of bipolar

Warning signs of mania

Symptoms of mania

Symptoms of psychosis

How bipolar is treated

Common myths about bipolar

Characterizations to avoid regarding bipolar

How to create an authentic bipolar character

This is just my opinion as someone who has lived with bipolar for a long time. Everyone experiences bipolar a bit differently, so not everything I mention will apply to everyone, and my own story may not reflect every single bipolar person. With that disclaimer, let's go.

A Note of Caution

This is a guide to help people who want to write about bipolar. It should NOT be used for self-diagnosis or to diagnose anyone else.

If you think you have bipolar, you need to speak to a professional as soon as possible. Bipolar disorder is not a cute quirky accessory. Both mania and depression literally cause brain damage, as I've discussed in my post about the Myth of the Martyr-Artist.

This is not something to play around with or to use to build street cred or whatever. It is a serious, severe mental health condition that causes untold hardship for sufferers, including increased risk of suicide, homelessness, addiction, and even dementia.

So please don't read this and go "oh I probably have bipolar lol." If you do read through this and go "oh shit this sounds like me," then get thyself to a physician as soon as possible and go through a real, actual, professional screening.

Alright, anyway, let's get into it.

Types of Bipolar Disorder

Bipolar is typically separated into two types. What kind you have depends on your predisposition to either extreme: mania or depression.

Bipolar 1

People with Bipolar 1 tend to have more severe manic episodes and less severe depressive episodes. They are more predisposed to experience psychotic episodes, though psychosis can happen in Bipolar 2 as well. Bipolar 1 patients may only have very brief depressive episodes or they may only experience their "baseline" and mania. (As an aside, I have Bipolar 1.)

Bipolar 2

People with Bipolar 2 lean more toward depressive episodes. They may experience hypomania, which is a less severe form of mania, but their primary symptom will be depression.

It's important to note that while many say Bipolar 1 is more severe because of the manic episodes and risk of psychosis, this does not discount the extreme suffering that can result from Bipolar 2. Patients with Bipolar 2 have just as many struggles as Bipolar 1 patients.

Phases of Bipolar

Depression

This works much the same as the typical depression that people with Major Depressive Disorder experience, but bipolar patients may be more agitated, self-destructive, and aggressive when depressed.

Hypomania

This is the "less severe" version of mania. In the chart above, it's demonstrated by DIG-FAST: distractibility, impulsivity, grandiosity, flight of ideas, activity increases, sleeplessness, and talkativeness. These happen in full mania too, but to a greater extent.

Many people with Bipolar 2 welcome hypomania because, well, it feels a lot better than the depression they are usually stuck with. However, it's important to note that hypomania, like mania, can cause brain damage. It's not something to screw around with.

Mania

A more severe, destructive version of hypomania: everything is dialed up to 11. People may become hypersexual, spend money they don't have, destroy relationships, make inappropriate comments at work, or even fly into destructive rages.

Mania can be terrifying, both for the sufferer and for those around them. You can be so extremely happy that it's almost painful, or so angry that you feel like you're going to tear your own skin off.

Psychosis

This typically is the "end result" of mania which happens to about 50% of people experiencing a manic episode. It is typified by delusions and hallucinations. We'll discuss these a bit more later.

Contrary to popular belief, psychotic hallucinations are typically auditory, not visual, though visual hallucinations can occur as well. Other strange and less common hallucinations include olfactory (smelling things that aren't there), gustatory (tasting things that aren't there), or sensory (feeling people touching you).

Euthymia 

This is the normal, calm state in between depressive and manic episodes, where one has a sense of well-being and stability. It is the goal of therapy and medication management.

However, experiencing euthymia doesn't mean that the bipolar disorder is gone: it just means that it is in remission. Bipolar patients must always be on alert for warning signs of mania and be active participants in their own care.

Warning Signs of Mania

Manic episodes often come with prodomes, symptoms that appear before full-blown mania.

Bipolar patients and their families should be on alert for these warning signs and, if they continue to occur for more than a week or so, schedule an appointment with the patient's psychiatrist to see if they need a higher medication dosage.

Here are some common signs that happen before full-blown mania:

Feeling either really great or really terrible for no reason. Sometimes you can feel really great and really terrible at the same time. It's a very weird feeling.

Functioning well on little sleep for days on end. Not just one sleepless night, but being able to go to work and function on like 4 hours of sleep night after night.

Increased or decreased appetite. Either you hate food or it's the most important thing in your life. Can fluctuate day by day.

Increased productivity. You're getting soooo much done and so quickly! (It probably sucks but we'll put that aside for now.) You just want to work on your passion projects constantly.

Sudden interest in multiple new hobbies all at once, and throwing yourself into them with such passion that it's scary.

Weird physical symptoms. You may find yourself locked into a position and not want to move, or your skin may feel odd, like it's too tight or prickly.

Sudden bouts of tinnitus. It sounds really weird, but it's been proven to be a sign of impending mania along with the skin symptoms I mentioned before.

Your eyes look different. Your pupils are always dilated.

Not everyone will get all of these, but most people will have at least one trigger that happens to them every time before a manic episode. For me, it was hypergraphia (because of course it was).

Symptoms of Mania

Not all of these symptoms will happen to everyone, and every manic episode can be a little different. It all really depends on who you are. Now, I must say that anyone, bipolar or not, can have these symptoms. It is the intensity of them that defines mania. A manic episode can ruin your life because you just get. so. extreme. about whatever it is.

Becoming extremely focused on random things and projects. For me, it was cleaning the house: I started throwing out old photos that I thought we didn't need because I didn't want any clutter. I would sweep the floor for hours at a time. Sudden and intense interest in random subjects. I got really obsessed with Neolithic Scotland of all things. Now I can't even remember half the shit I learned. Spending way too much money. Many people will go into extreme debt because of their mania, especially if they don't have family support. I spent like $300 on a kitchen knife set despite having a full set of perfectly serviceable kitchen knives. I also bought a professional-grate ukulele that I very much could not afford and very much did not need. Worsening of any addictions or developing new addictions. Especially seen in gambling addictions because, well, you already want to spend a lot of money and it's an extreme dopamine hit. Sudden and intense aggression or emotional volatility. Normally calm and relaxed people will go off the deep end about pretty much anything: screaming, throwing things, and then bursting into tears out of guilt. I'm normally a pretty chill person, but one time I threw a phone at my mom's head because she pissed me off so much. I can't even remember what she said to make me mad. Feeling invincible. Manic people are convinced that nothing bad could ever happen to them and they can do whatever they want. Think of someone running into traffic, sure that no one will hit them. Or, on the other hand, feeling terrified of everything. This can happen to the same person, sometimes simultaneously. You may believe everything is a threat, even when there is no clear and obvious threat. Being physically incapable of sleeping. It's not insomnia like normal people experience, where you pop a melatonin or do some breathing exercises and manage to fall asleep. You cannot fall asleep. Normal sleeping pills do not work. You may need heavy-duty tranquilizers. One time, I combined like five Benadryl and a whole bottle of whisky and STILL couldn't get to sleep. I was crying because of how tired I was. Talking extremely fast and in an extremely disconnected way. This is called flight of ideas; you start jumping from one discussion to another in ways that other people can't follow. Your brain has made that leap but can't articulate it for other people. Shiny eyes. You really can see mania in the eyes; it's very unsettling. Manic eyes look dark, wide, and shimmery. Hypersexuality. I did not have this problem, but I have talked to bipolar people who wrecked their marriages because they could not control their urges. That's not an excuse, of course, nor does it lessen the pain that the other person felt. But it can indeed happen. Unintentional pregnancies, STDs, and a whole lot of bad feelings can come from this. Kleptomania. I also did not experience this, but I have heard of other bipolar people who felt an uncontrollable urge to steal things they didn't even need to: they could afford it, they just wanted the thrill of stealing it.

Mania can cause amnesia afterward, and the person may not remember large swathes of what happened, or it will feel "dream-like" and confusing. Of course, they've got some major damage control to do that can plummet them into depression.

Symptoms of Psychosis

Again, just like with mania, not everyone will experience all of these. If a person has multiple psychotic episodes, each one may be a bit different every time.

I'm going to separate this into several sections: common delusions, common hallucinations, and Other symptoms (which are often not discussed as much).

Common Delusions

Delusions can shift throughout the course of a psychotic episode, seamlessly morphing from one to another without clear cause.

With psychoanalysis, one can often find that there are "seeds" of a delusion in the person's everyday life, and they may be connected to current events. For example, someone may think they're the reincarnation of a previous president during a presidential election.

Being god or a reincarnation of a famous person

Extreme religiosity

A belief that they have found the "key" to the universe and that everything is connected by some vast conspiracy

Being surveilled by a government entity, sometimes with the belief that they have had tracking devices installed without their consent

Being stalked, harassed, or tormented by unknown entities or by strangers (gang-stalking)

Being persecuted for a certain identity

Having some special role to play or a special status

Being a member of a special community

Having special knowledge or insight into issues, like world affairs

Being ill with another disease, like cancer or dementia

Being ageless, immortal, or invincible

Having a special connection with a celebrity, famous person, fictional character, people you know, or even strangers

A sense that loved ones have been replaced with clones or copies

Believing that there is a secret "play" going on and other people are playing along with a secret "script"

Believing other people can hear your thoughts, or that you can hear theirs

Common Hallucinations

Repeating noises, words, or phrases, often in distinct voices

Spectral, unhearable music

Environmental noises that don't exist, like train whistles or construction sounds

Repeating jingles or "ear-worms" that get stuck and may continue for days or weeks off and on

Humming, whirring, or ringing

Mutated or blurry faces, even of people you know well

A sense that a person's face is not their "real" face and they are wearing a mask

Haloes or auras around people or animals

Sparkles, flashes, and black spots

Colorful lights, ribbons, or strings

Seeing people you know who could not feasibly be there, like old coworkers, old partners, or deceased relatives

Vague blurry shapes, or distinct monster-like entities

Strangely shaped or mutated animals or people

"String people" or "stick people"

Black "void people"

Shadows that aren't there, typically around doors or windows

Skittering bugs, rodents, or snakes, often black or blurry

Bugs or small creatures crawling on the skin

Itchiness or grittiness on the skin

Light feathery touches along the skin, especially on the back or hands

Goosebumps with no clear cause that don't go away

Bad smells, like feces, garbage, body odor, or burning plastic

Good smells, often those from childhood

Losing sense of smell or taste

Sense that the mouth is full when nothing is there

Prickly tongue

Metallic taste (may be a medication side effect)

Other Symptoms

Muscle stiffness

Catatonia

Slurred or fast speech

Lack of appetite

Weight loss

Migraines

Parkinsonian symptoms (tremors)

How Bipolar Is Treated

Bipolar is treated in a few ways, with the most important and prominent being medication.

Medication

Bipolar is typically treated with mood stabilizers, which is a vague class that includes anticonvulsants, SSRIs, SNRIs, and other groups of medications. (The medication I use, Lamictal, is an anticonvulsant.)

Psychiatrists must be very careful when prescribing antidepressants for Bipolar I patients because too much can bring on mania. Bipolar 1 patients will often have an antipsychotic added to their regimen as well. There are new classes of drugs that combine antidepressants with antipsychotics for a one-and-done deal.

Bipolar patients may also have antianxiety medications added to their regimen.

Psychosis is a medical emergency and must be treated as soon as possible. Fast-acting antipsychotics can be injected in the emergency room to stablize a psychotic patient. They may also use tranquilizers to calm a paranoid or combative patient.

Like with schizophrenia, patients who are not medication-compliant may opt for a long-lasting antipsychotic injection that only needs to be done once a month or once every three months.

Therapy

A history of trauma is one of the things that predisposes a person to bipolar disorder, so working on this can help reduce symptoms. EMDR therapy can be a safe and effective way to process trauma for bipolar patients.

However, Cognitive Behavioral Therapy (CBT) doesn't work very well for bipolar patients because, well, their cognitive distortions are brought about by chemical changes in the brain, not just seeing the world "wrong."

Dialectical Behavioral Therapy is a better choice for bipolar patients because it helps them become more aware of their thoughts and, therefore, better able to manage their emotions.

Other options include equine-assisted therapy (my favorite!), art therapy, and family therapy to help build a stronger support system.

Lifestyle Changes

All the stuff that helps "normal" people can help bipolar patients, too. For example, having a set routine, eating well, setting and keeping a bedtime, getting exercise, and eating well are all crucial for managing bipolar, in addition to medication and therapy.

Weight management is a critical component of bipolar treatment. A lot of antipsychotics and mood stabilizers can cause weight gain, even when someone isn't overeating; they can also cause cravings for sweet foods or an increased appetite.

Because bipolar is often comorbid with other conditions worsened by excess weight, such as diabetes, heart disease, and PCOS, care must be taken to keep one's weight down. Excercise, because it has neurogenic benefits, can be enormously helpful in helping to heal the brain.

Some medications also cause vitamin deficiencies because they affect the way that the body processes nutrients, and they may block absorption of certain nutrients. Multivitamins can counteract this and even reduce symptoms because some deficiencies have a marked impact on mood.

Bipolar people should not drink, as it reduces the efficacy of medications and can lead to nasty side effects. They also should NOT smoke weed, especially if they have a history of psychosis. Yes, marijuana-induced psychosis is very real and far more likely for a bipolar person.

Additionally, bipolar people should nurture their support system, as having family support is a key factor in whether a bipolar person can stay stable.

Common Myths About Bipolar

Bipolar people are dangerous. Not necessarily true, though common media depictions show this as if all bipolar people are roving murderers.

In fact, bipolar people are more likely to kill themselves than anyone else: it has the highest suicide rate of any psychiatric illness, about 20 to 30 times more than the general population.

Medication is a crutch and bipolar people can get better by themselves. Wrong. Just like someone doesn't magically get better from Type I Diabetes without treatment, bipolar people need medication.

Bipolar can be treated just with lifestyle changes. Again, just like someone with Type I diabetes, you can't just will the bipolar away. You need treatment. No amount of supplements or sunshine will fix it. It's a brain disorder.

Medication turns bipolar people into emotionless zombies. Incorrect, with a caveat. The wrong dosage or type of medication very much can make someone into a zombie; I've certainly felt that way before. However, the correct treatment allows bipolar people to thrive and stay stable for years to come.

A bipolar person can never become stable and will always have symptoms. Sorta not true. Bipolar comes with other issues, like executive dysfunction, that cannot always be managed or treated. BUT bipolar people very much can become stable and mostly asymptomatic with the right treatment.

Bipolar people are always having some sort of crisis. It can feel that way, but once a person is stable, they can look just like anyone else.

Bipolar can go away. No. Even if you are in remission, you still have bipolar disorder and can relapse at any time. It is a brain dysfunction that causes measurable structural differences in the brain which do not go away.

Once you snap out of psychosis/mania, you're right back to normal. Wrong. You don't just wake up and are not psychotic anymore. It takes time for your brain to equalize and come back to baseline. I remember it as feeling like I was rising out of a long, long sleep. Once someone is stable, it's like nothing ever happened. Mania or depression causes brain changes that can last years after the episode. On average, the brain damage from mania exists for up to seven years after the last episode, and it worsens with each subsequent episode.

Any fluctuation in mood is a symptom of bipolar. This is so, so, so annoying. Bipolar people are allowed to have bad days just like anyone else. If I'm having a shitty day but I'm not throwing phones at people, then I'm probably just having a bad day. If I'm really happy, it doesn't mean I'm manic.

Bipolar people can't help it and shouldn't be punished for their actions. No no no. What I like to say is that my bipolar doesn't excuse my behavior, but it does explain it. If you hurt someone while manic, you still hurt someone and it's still your fucking fault! Never use it as an excuse to be an asshole.

Everything about bipolar is terrible. Wrong! Bipolar can have benefits like creativity, empathy, good problem-solving, and a unique perspective on life. A stable bipolar person can be a delight to be around. But these don't discount the downsides and should not be a reason to refuse treatment.

Characterizations to Avoid Regarding Bipolar

Roving maniac. Kind of a duh. We have a bad enough rap anyway.

Evil murderer. Same as above.

Abusive evil spouse. I mean, yeah, a bipolar person can be abusive, but they're likely abusive because they're a shitty person and bipolar is just a side effect.

Manic pixie dream girl. Don't romanticize bipolar either.

Miserable cinnamon roll. We're people, okay? Complex, multifactorial, interesting people. We're not constantly miserable.

Total trainwreck. If you're going to show someone's nervous breakdown, please please please show them when they are stable too. Please don't just distil the bipolar person down to their symptoms. Show us as who we are: complex people just like you or anyone else.

Drama magnet. Frankly, a lot of bipolar people don't want to get involved in other people's shit. We've got our own stuff going on. We're not out to wreck your life, we're just trying to get through the day.

How to Create an Authentic Bipolar Character

Do your research. Read a mixture of medical journals, stories from bipolar people, and good depictions of bipolar disorder in the media. Go beyond what I have discussed here and seek out good, peer-reviewed research.

Don't add bipolar just for shock value. Annoying and shitty. If you're thinking of making an evil cruel murdermonster, stop. We have it hard enough and you're going to make it worse.

Create the character first, then add the bipolar. Every bipolar person is different, just like every person is different. Get a feel for your character and then determine how they might act when manic or depressed.

Use an array of symptoms. Don't just go for "ooooh scary monster in the corner of my eye" because that's boring and overdone. Look through the list I provided and consider how you can fit a few of them in there.

Remember that it takes time to recover from an episode. You should not just have your character wake up one day and be cured. They will feel "off" for a while after an episode, like a very very long hangover.

Consider medication symptoms. Decide what medication they will use and then look up the symptoms. Demonstrate how this makes them feel and whether it makes them want to continue treatment.

Think about how a character feels about their bipolar. Some people don't think it's a problem because they like the energy, and others are terrified of relapsing. Some see it as a challenge to be overcome, and others find it to be a burden that they want to be rid of. And many will feel all of these at different times.

Show the impact on other characters. Remember that your other characters are seeing and reacting to this. They may be terrified, frustrated, hurt, dismissive, or not want to deal with it.

Demonstrate times of stability, too. Too many people use bipolar as an "ooooh soo sad" (especially psychosis) and don't show the character just being a normal human being.

Show the ableism bipolar people face. Yes, we do face ableism. People calling us crazy, denying us medical care, passing us up for jobs, or my very least favorite, "have you taken your meds today?" UGH SHUT UP YES I HAVE LEAVE ME ALONE.

Remember that many people are not medication compliant. Medication compliance is one of the number one indicators of whether a person will stay stable long term. If your character refuses to take their medication, then they are more likely to relapse.

People have many reasons for not accepting treatment: they don't like the way it feels, they're embarrassed, they don't see it as a problem, or they can't afford it (some of these meds can be hundreds of dollars a month even with insurance). So make sure to explain why they are medication non-compliant.

I've created a masterlist of writing resources that you can peruse at your leisure, all for free.

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[macgyvermedical]

I have a question about sitters as well. Hopefully all this is okay to answer, its not... im sorry. This is mostly a questiondump bc i read your thing and now my brain is sparking with loads of questions. Is it bad to say that sounds kinda fun being that intense.... anyway do people ever try and manipulate the sitter to let them do something or escape, or when they turn thier back do they try. And do the patients ever say its a little weird being watched all the time even if they are sleeping or does it make them feel safer? Also you mentioned people both trying to pull out tubes and cables and escape... how does a sitter actually stop them? Do they have to do it all by themselves or get security or a doctor to put a tube back in.... do they restrain them if they're hurting themselves. Just genuinely how do they do it. And while they pee do they get another person to watch em for 5 minutes. Is most sitters one on one or like the room you described with 3 or 4 patients? Thank you (: hope your doing better lovely!

I'll go one at a time here:

I've never had a patient attempt to manipulate beyond asking repeatedly to do something. It doesn't mean it can't happen, but most people who need a sitter aren't mentally organized enough to be successful manipulators. As for trying to escape yes they absolutely do but they're usually pretty obvious about it. Even if for some reason the sitter isn't paying attention, the bed alarm will go off.

Some of them do, but for people who are there for suicidal ideation most of them are fine with it. The people there because they're manic and on a writ of detention sometimes take issue with it. The people with dementia usually either forget who we are and ask a bunch of times or decide they do or don't like us and that's just how the rest of the day goes.

It depends on the hospital whether a sitter can actually touch a patient. Where I was we definitely could because we were also doing all the patient care. But a lot of it is verbal redirection. You generally can't physically prevent someone from doing something because that is considered a restraint. But you can talk to them, distract them, find them something else to do, it's a lot of verbal gymnastics. If they're going for something like a PICC line (a line that's difficult to replace), I'd move their hand away to give them some time to really think about what they are doing, but not everyone's comfortable with that.

If someone's in danger or physically leaving and they can't stop them with verbal redirection they'll call security. For people with dementia/confusion who are pulling at lines or tubes sometimes you can get a doctor's order for soft restraints, which are really easy to squirm out of, but buy time for the sitter to intervene. Security are the only ones who can place hard restraints and those require a doctor's order as well, and usually a new one every 4 hours. Someone in hard restraints requires a sitter at all times.

Yes, if the sitter has to leave for any reason they get someone to cover.

Most hospitals it's 1:1 sitter to patient. I was just at the redheaded stepchild of the hospital system I worked for, and they had some questionable staffing practices.

[i-am-thornqueen]

Give me a moment to scream into the void, okay?

I have managed a small triumph after being spitting mad for a whole week.

Drug-related pharmacist rant below.

There are a few drugs in this world that carry the label "do not fuck with me" and I happen to specialize in one of the areas of medicine with a gigantic 'do not fuck with me' drug: clozapine.

It's an antipsychotic, and it is more or less one of the biggest guns we have for treatment-resistant schizophrenia. But it is also a drug that needs to be treated with respect. It can do its job, and it can do it really fucking well, but there are trade-offs that require close monitoring in the beginning because if you don't, there are consequences.

This drug means so much business that when you start it, you have to be registered with a monitoring network of the brand of clozapine that you are started on. In the beginning, you need to be monitored for things like myocarditis (inflammation of the heart muscle, can be fatal), ileus (intestines stop moving, can be fatal), agranulocytosis (white blood cells basically disappear, can be fatal), among a host of other things.

It SOUNDS terrifying, I know, but the risks are low and we monitor patients to ensure that the moment it looks like anything is happening, we intervene IMMEDIATELY.

So imagine my ever-loving shock when I get a heads-up from my hospital that a clozapine patient's been admitted and they're not registered to any monitoring network. I called ALL of them. No one has eyes on this patient. I call the community pharmacy and find out they have failed to do their bare minimum due diligence of making sure the patient is registered and monitored.

Come to find the prescriber is not a psychiatrist, just a generalist.

We are not treating for treatment-resistant schizophrenia or any other severe condition which would necessitate the use of a big gun drug that requires massive amounts of monitoring.

No.

We're treating dementia-related agitation.

Dementia. Related. Agitation.

Who the FUCK prescribes clozapine - CLOZAPINE - for dementia-related agitation????????????????? You guys didn't even try anything before that??????????? There are so many things you could have done before you resorted to the nuclear option!!!!! Literally, you could have tried ANYTHING. There is TONS of information available for non-pharmacologic and pharmacologic recommendations to address agitation before you resort to clozapine, of all drugs. Literally, clozapine has an increased mortality risk in patients with dementia-related psychosis, so like, you have to think real long and hard before choosing this one.

But this random-ass doctor with no specialization in psychiatric medicine went 'nope, fuck it, common sense out the window' and reached for clozapine before he tried anything else.

And then the pharmacy went 'yeah, sure, that's completely normal' and started dispensing the med without making sure the patient was registered and appropriately monitored.

And now they're my patient.

So for a week, I've been trying to get this poor old patient sorted out with any semblance of sense to his medications and monitoring. Community pharmacy been giving me the run around. Prescribing doc is AWOL. The doctors in my hospital understand that you need to treat this drug with the respect that it deserves, so they've been wary to touch it.

Step by fucking step, I've been making headway. First, got the blood work ordered so I could prove to myself and god that SOMEONE was going to do the blood work. Got the drug placed on hold because, come to find, the spouse hasn't even been giving the clozapine as prescribed and was giving such a low, low, low dose that it probably wasn't even having any therapeutic effect - which, unfortunately, means nothing when myocarditis and agranulocytosis are not dose-related conditions. They just fucking happen.

And THEN when a new doctor tried to restart the med, I intervened and went to bat for this patient. Like, NO, you are NOT giving them the nuclear option antipsychotic at such a low dose it will have no effect but will put them at risk for every terrible thing under the sun. It's for AGITATION for god's sake, and the patient isn't even agitated!

So it goes back on hold.

Now, today, I do all my follow-ups and find the community pharmacy fucked off again. The monitoring networks still have not heard of this patient. I decide I'm making a call on this. Enough is enough. Patient has not had the drug in over a week. It's basically gone from his system. There is no sign of agitation to the degree that they require chemical restraints. They got dementia, that's it. Can be addressed in a more reasonable manner.

Call up the doc. Plead my case. He agrees with my assessment, orders clozapine to be discontinued, HALLELUJAH, he'll monitor for agitation and treat with a more appropriate drug, like QUETIAPINE (still not a fave, but gold-plated next to clozapine in this instance). Doc PROMISES to make it clear on the discharge that clozapine was discontinued.

I breathe a sigh of relief I've been holding for a week.

I have accomplished one (1) thing today, and it was worth it.

Moral of the story is: don't fuck with clozapine in my town and let me find out about it. I will hunt your pharmacy down, your doctor down, your family down, your monitoring network down, and I will chew through a fucking brick wall to make sure you stay SAFE and ALIVE.

[angelmichelangelo]

Hey there!! :)

Saw your post, and decided to pop in!

Sooo I have a few questions.

1. Who is your favorite TMNT brother to write/draw?

2. I read that you work as a nurse! First off, thank you for your service 💙 Second, do you have any favorite whump/hurt fics that you’ve written? And does it bother you when you read medical inaccuracies in fics? ;)

3. Do you have any pets?

4. (As a nurse) what would you say is peoples biggest phobias when it comes to being in a hospital setting? And how do you usually help them? (If you’re not comfortable with answering this question, that’s totally fine and there’s no pressure!)

5. What’s one of your favorite memories that always makes you smile or even shed a happy tear? :)

Hope you’re doing well!! 😁

~ Melissa

hi and thanks for the ask :3

for sure either mikey or leo. i have a real soft spot for them, and so naturally i kind of just.. unleash all my feelings onto them making them both my personal stress ball haha :')

thank you! ik i said i hate it a majority of the time but it does indeed have it's perks :) i recently wrote a 2k3 pre-sainw fic where the boys had to chop mikey's arm off and whilst i've never done anything of the sort irl (that would be. traumatising to say the least lol) i do enjoy the nitty gritty bits of real hurt/comfort. i did consider working on ER for a bit buuuttt im actually a huge baby and get stressed VERY easily so a high paced setting like that is not good for me! and for medical inaccuracies, i can get over it pretty quick unless its like JARRINGLY obvious, im cool with fic just being fic yknow:) its stressful trying to write something 100% accurate when youre not totally sure about the material itself haha

yup i sure do!! i have two dogs and a cat that are all the best babies in the world !! <33 im about to move out into my own apartment with my cat, as she's mine and im debating on whether to get her a little orange friend or not just to keep her company when im at work

i mostly work in elder care! which brings its challenges and also means i work with a lotttt of dementia patients. i'd say the worst thing for them is the lost feeling they get? because hospitals and such places can be scary! and then when you're already confused and lost? extra scary:( it really breaks my heart when i'll be talking to an elderly patient that does NOT wanna be there, and all they want is their mama :( i actually was gonna write a 2k3 splinter fic about dementia just cos im surrounded by it almost daily, but i wasn't sure how many people would be interested in a fic like that, so i just kind of abandoned it haha but yeah, trying to reassure people that they're safe and in the right place is a Lot especially when they're so lost within themselves. and sundowning is my biggest Bitch ever lol

oooohh best memory?? very random but when i was like 5 years old and me and my grandpa sat in his kitchen on a really cold, wet winters morning and he made me chocolate oatmeal and we sat and ate it together. he passed a few years after and i didn't get to see him much as we lived in separate countries but it's a really strong, happy memory in my head that i think of all the time when i have something warm and yummy on cold, sad days :)

[alotofteez]

6:55 AM on October 14, 2023, my Mamaw took her last breath surrounded by so many loved ones. Having not experienced loss like this before, I have had a hard time processing this. Some days, I accept that she's gone, and other days, I question why this time. I hold dear to my heart my lifetime of memories with her and regret the ones I will miss out on. She is no longer in pain and in a constant state of confusion due to her dementia.

She was a very talented seamstress. She didn't need a pattern; she could freehand anything and everything. I remember staying the night at her house, looking through all her sewing stuff, and not understanding why anyone would purposely work with needles. Now, as an adult, I have picked up sewing. I never got to show her any of the things I've made, so I made her a little pillow that reminds me of the ones on the bed in her extra bedroom. With permission from my grandmother, I placed it in her casket to be buried with her.

The character "Nana" in Sphallolalia is heavily inspired by my Mamaw. She comes up more later in the story, so it might be a little while before I continue working on those chapters.

I apologize and ask you again to please be patient and look forward to the next story update❤️