The Right Decision Isn’t Always Easy
Evaluating the effect of mental illness on work
Navigating work and mental illness is never easy. In the earlier years of my illness life, I had a full-time job and would take stretches of time off as needed because of my depression. Sometimes my employers would try to put up roadblocks to me returning to work, but I pushed through and went back to full-time work.
Then a few years ago the wheels really started to fall off. Long story short, I ended up working two casual jobs. The flexibility was good because my illness had become more treatment-resistant and unpredictable. The major downside, though, was the lack of income security. As a result there’s been a dark cloud of fear hovering over me as I wonder what I’m going to do if things get worse and I’m not going to be able to work at all.
Still, there was some comfort in having two different jobs; if one were up to go up in flames for some reason, I’d have the other to fall back on. That helped to keep some of the fear at bay.
Cue the fire starter.
I’m a nurse, and one of those jobs involves seeing patients in their homes to provide regular, recurring medication injections. It was an easy job that has become more difficult over the past few months. The difficulty stems from my lithium-related tremor. I’ve had the tremor for the six years that I’ve been on lithium, but it gets significant worse during time when I’m tired, stressed out, overstimulated, or just generally unwell. Especially over the last six months, my illness has progressed to the point that pretty much as soon as I leave home, I feel overstimulated, meaning my tremor kicks into high gear.
This is a bit of a problem when giving injections. I have a medication I can take as needed to help control the tremor, but it’s become less effective as the tremor has gotten worse. I’ve become increasingly clumsy when preparing injectable medications for administration. It bothered me, because I knew it probably made me look anxious and/or incompetent, neither of which were the case.
I noticed that when I did a couple of injections last month, I was a bit shaky as I was putting the needle into the patients. That was far more concerning than the clumsiness while preparing.
Last week I was doing an injection, and while I wasn’t too bad doing the preparation, my hand started to shake significantly as I was puncturing the patient’s skin with the needle. My heart sank. The patient got her required dose of the medication, and she didn’t say anything, but it had to have hurt.
As I was driving home afterwards, the professional voice inside my head was telling me “You can’t do this anymore.” The rational part of me knew that voice was right; it just wasn’t safe. My illness brain, however, started to catastrophize. I would be losing a potential source of income (even though most of my income comes from my other job). Cutting back to one job would mean losing a safety net, and would push me another step closer to being unemployed and unemployable. The already scary future started looking a whole lot scarier.
Despite my illness brain freaking out, I knew my decision had to be based on patient safety. Writing is always a good way to take on these kinds of decisions, so I wrote a blog post about it. Several readers commented “It sounds like you already know what the right decision is.” Getting that feedback helped, and I went ahead and gave my notice.
Juggling work and mental illness can involve some tough decisions. There are a lot of unknowns, what ifs, and potential roadblocks. In a sense, I’m proud of myself for making what was clearly the right professional decision, even though it plunged me deeper into the darkness of my own fear.
Will I be able to work much longer? I really don’t know, but I have to be prepared that the right decisions probably aren’t going to feel easy. Most likely they will be downright terrifying, and will fly in the face of what my illness voice is screaming. But it can’t just be all about me. No matter how much I may feel like I’m losing my nursing identity, I’m still enough of a professional to know that.