I first came across Ann Roselle, an acute care nurse practitioner, via Twitter after reading the extremely personal and brave post that she wrote for the online magazine, Ravishly, which poignantly highlights the humiliation she experienced during one of her numerous psychiatric hospitalizations. Given the stigma that surrounds mental illness, many may feel ashamed to disclose their diagnoses (especially as a professional in the medical field). However, Ann writes so openly about living with postpartum onset bipolar disorder as a guest contributor on several websites and in her blog, Bipolar&Me. She dispels the misconception that people diagnosed with bipolar disorder can’t live fulfilling lives, have a successful career, balance numerous roles and responsibilities (wife, mom of 3 boys, mental health advocate, blogger, to name a few), AND cope with the fluctuations in mood characteristic of bipolar disorder. I am a huge fan of Ann’s writing and am honored to have her contribute to my blog as she discusses her commitment to maintaining stability in her personal and professional life.
“It’s stylish to talk about mental health, especially how we maintain our own.” As a nurse practitioner who lives with a serious mental illness, bipolar I disorder to be exact, how could I not fall in love with a blog with a psychiatrist who talks so frankly about mental health and her practice?
I am a surgical nurse practitioner, specializing in cardiac surgery. I am fortunate enough to be able to be open about my disorder in the workplace. I had fears initially about being open, however with time I believe it has proven to be a positive experience. In my case, living with bipolar disorder never proved troublesome with my training as I was diagnosed after I had been in active practice for six years. So, the questions that beg to be asked are — How does my illness impact my patients or influence my interactions with them? And how do I maintain stability with full-time employment in a stressful environment?
First, it starts with the moment you accept that you have an illness. That you have an illness you are going to need to learn to manage as one manages any chronic illness. And, I won’t lie — accepting the diagnosis is hard. I didn’t want to accept my diagnosis for a long time. I cried and mourned the vision of the life that I thought I was going to have, that I was supposed to have, thinking everything changed in the moment I received my diagnosis. It took a long time for me to realize nothing had actually changed and that the life I wanted and envisioned was still there waiting for me to seize it.
Part of my seizing the day, so to speak, was to commit myself to doing what I needed to do and stop fighting with my treatment team. Stop fighting the need for medication. To stop being the non-compliant patient I would roll my very eyes about as a practitioner. I showed up for appointments, attended groups faithfully in the early days, and took my medications. I played with my diet trying to find a proper nutritional balance. I quit drinking on a regular basis. I became fanatical about ensuring proper sleep hygiene and getting rest. I fully admit that I am not great about the exercise piece as my work hours limit my ability to get to a gym on workdays and I am so busy with my family on days off. I’ll get there, though. Exercise helps mood and I feel infinitely better on the days I’m physically active.
Now, what about nursing practice you ask? What about those patients? Ultimately, if you are in treatment (on meds, working with a therapist, a prescriber, or even have a support group to fall back on) and stable, the disorder has no bearing on your practice. None. I hold the view my bipolar disorder is a chronic manageable condition no different than diabetes or hypertension. I learned (and am still learning) to manage my moods in the same vein that a diabetic learns to count carbohydrates and manage their blood sugar.
Emotionally, I have always had the ability to hold myself together for the hours I am at work and dealing with patients. My patients will never know I carry this diagnosis. I may fall apart once I get home and feel safe to do so, but never within the walls of my employment. I also make it a rule that no matter what happens, no matter the co-morbid psychiatric diagnosis my cardiac patients may carry, I never reveal myself to them. They come for cardiac care and not to hear my story. I do find I have become more empathetic to those who carry psychiatric diagnoses. I discourage staff from saying inappropriate and stigmatizing things both in and out of earshot of patients. There is a huge difference in a patient who is emotionally labile because of a mood disorder and a patient who is emotionally labile trying to cope with their physical illness. I view it as my responsibility to help staff understand such a critical difference. Emotional lability in and of itself does not a bipolar make. I make sure my patients’ home medication regimens are adhered to as closely as possible. And when a patient is acutely decompensating in terms of their mood or mental status, I make sure that medically we have dotted our I’s and crossed our T’s before calling the psychiatry consult service.
I’m not perfect. I have days I need to take a time out and walk away. This is beyond the usual code blue that may have been upsetting for staff or seeing a patient I really cared about suffer from a devastating complication. I have colleagues who respect that need and allow me the moments I need to compose myself and come back calm and ready to do my job.
I am fortunate to do what I do. And I am fortunate to be able to practice with both the patient and provider perspective.
While I am only human, at the end of the day, I think all those I encounter are better for it.