Urgency-emergency

Last night I realized I have been slowly poisoning myself for about 8 months with concentrated liquid zoloft because nobody ever told me that I am supposed to dilute it in water. I have had issues with my bloodwork recently and now it is all making sense.

I put a call into pdoc yesterday anyway because my depression is getting worse again and I have had some suicidal thoughts. T thought maybe my medication needs to be adjusted.

I know you are wondering what do these two things have to do with therapy but it goes like this.

When I called pdoc's service yesterday, there are two options, one to leave a message that he will return and the other to get the operator and have him paged. I was trying to decide which option to choose and got switched to the operator so I just left a message with her to have him call me back regarding my medication. She asked, "Is this an emergency?" I said no, and she said she would deliver the message.

T and I have been around the world regarding phone calls, when it's appropriate and what is an emergency/what is urgent, when it's necessary, etc., etc.

It occurred to me this morning that I have no clue what an emergency is. I thought that if T had that kind of operator I would never speak with him outside of session-ever. What I mean is that I will never ask someone for help and say it's an emergency. It's not because of pride. I think it goes deeper. I think it's because I have become accustomed to relying on myself. It's not that I don't react--- So, for example, if someone in my family were sick I would simply call the ambulance. Done.

But if I have suicidal thoughts--I don't think it's an emergency. By the same token I don't get what urgent means. It's only urgent if a wrecking ball is aimed at your head--other than that, c'est la vie.

The flip side of this is that I admit I have been guilty of calling T between sessions when it's not truly necessary, such as--"Hello T? I have a hangnail that's really bothering me and I think it reminds me of some past trauma." But what is truly happening inside is some anxiety I can't put my finger on.

I told T that I would never call him for an external emergency--like something was happening at home because those emergencies I can handle. It's the internal ones that make me call him.

This sort of reminds me of Hanginon's thread about boundaries. Those blurry lines are so hard to read, aren't they?

I am one confused kid.

Hi Miss Charlotte,

I can really relate. I am all business when it is someone else that needs the help - get them the help they need, get it fast, get it done. But when it is me, most of the time I just don't see it. That's awesome that you can see that that's what is happening. I hadn't thought of it that way until I just read your post, and then I was all "ohhh familiar!" I hope you can get some help with the medication issue. That's awful that you didn't get the proper instructions!

vienna

Miss c, Are you ok now with the medication thingy?

(((miss charotte)))))))))))))))))))
I think its ok for you to call your T this time
Having thoughts like that means Ok to call
infact its good self care for you imo
your friend
muffy

I agree with Muffy....suicidal thoughts/ongoing med overdose = emergencies.

I'm with you, I would have a hard time figuring out what an "emergency" is. But from the outside, those seem pretty clear to me.

Be safe, Miss C.

I don;t have a pdoc so I wouldn't know when to call or not - but I would sure call someone - please take care of yourself.

I would look at it like this. If you were the caregive for someone who was in your situation would you want them to call you? They both seem very very urgent to me. I have suicidal impulses and if I cant control my thoughts away and it seems to go the other way then I try and call my T's. The meds thing seems scary and why didnt anyone explain this to you????? You may have to wean yourself down slowly.

(((((((((((((((((((Miss C))))))))))))))))))))))

I looked up liquid zoloft on the internet and it seemed like the dilution was to make it more palatable, otherwise it burns going down?? Not that I know anything about zoloft, but I hope that is reassuring...

(((((((MissC)))))))))))),
I'm kind of having difficulty formulating anything coherent, but I just wanted you to know that you are in my thoughts. Take care

Miss C
Did you contact your T, if so is everything ok?

(((((MISSC)))))))

Hangingon

i am like you - unless it's a life/death matter, i don't think it's an emergency. e.g., suicidal thoughts aren't an emergency for me. however, if i started to act on them, i might call my pdoc.

these are the rules i've figured out with my pdoc: like yours, you can either leave a message, or get an operator to page him. he's told me to always leave a message, because he doesn't trust his reception girls anymore (they sometimes won't pass a message on if they don't think it's an emergency). and besides, he never interrupts appts to take calls, but always checks in between appts. so he will get the message/page at the same time anyway, and it is probably better for him to have a brief idea of what is happening.

he has told me he is always happy to receive a phone call from me - emergency/urgency or not. what i do is to leave it up to him whether he calls back. so, e.g., i can say, "i'm having suicidal thoughts, but i don't have a plan" or "i'm having suicidal thoughts and do have a plan, but not going to act on it just yet" etc. once (years back) i actually called him and said "i'm just having a crap day. need a friendly voice". definitely not an emergency!! but he knows me enough to know that if i do make contact, then it's because i really am struggling, so he called me back. he has said some of his other clients call all the time, and he has to base his decisions on whether to call back on a different set of rules, because if they said the same thing, chances are they weren't at the same level of distress i was at.

i have the same prob with an emergency number i was given - unless i had actually done what i was thinking about - in which case it would be to late anyway - then i wouldnt ring - MINIME makes an excellant point - think if this was someone i cared about what would i do or advise them to do - JMO but i think you should ring your T - this is just the kind of thing he gave you his phone number for.

Take care P7

ps you should be able to ring your local pharmacy for advice about the liquid Zoloft.

Hello, hello.

Maybe it's not as extreme as: is this an emergency, or not?

Maybe it has more to do with: What comes up for you in session that you could handle on your own vs. what can you not get through without reaching out to T?

I guess you would really have to give yourself the opportunity to see how much you have internalized him, and how much strength you really have that, maybe, you are not giving yourself credit for.

Hi everyone. Thank you all for your support.

Ummm, well I called Pdoc and I haven't heard from him yet. I called the pharmacy and they said it was no big deal. I have an appointment with my primary care doctor on Saturday morning. A friend of mine called another pharmacy just to check and they basically said the same thing.

I did not call T because there is nothing he can do for me right now. I spoke with him yesterday about the suicidal thoughts and we discussed increasing my anti-D since I am on a super low dose and not getting any therapeutic benefit.

I am not in danger right now so I don't have to call him. I can handle this, AND I am seeing him on Friday. In a way, Pink is right about T--calling him is not about emergencies--it's about when I need contact because I have lost him internally.

I still don't know what an emergency is. I simply reflected on that theme because of the question that pdoc's answering service asked. For me, suicidal thoughts are not an emergency but they do require attention. If they feel very intrusive or I feel I am not in control then I call T. But I still don't think of it as an emergency. However, having said that, Pdoc did say to call if I have the S-thoughts again, so I did. I think he probly would have wanted me to say yes to the emergency question but it just didn't feel like one.

So, to me, an emergency is an immediate threat--like if you just got hit by a truck?

Anyway, yeah, thanks to you all and Happy New Year!

No, that would not be an emergency. You'd just be screwed.

MIss c, Im glad your not in physical danger because of the med mix up...I have never phoned my T as phone isn't my "ting", but if I desperately feel I Need contact with her I email and am emotionally honest saying such things as I have no real emergency accept I feel I need to connect to you and she always replys to acknowledge she as recieved the email and read it...would your T do that?

I am not sure what is an emergency either. I think my T would want me to call 911 or a crisis line if it were a certain type of emergency--I was having a heart attack, I had a plan to seriously hurt myself and intended to do it, etc. I think if I had a death in my family, such as my H or one of my children, this would be a reason to call him.

MissCharlotte, I'm relieved to hear the Zoloft dilution issue is not one that could cause harm to you.

this is a very good point, sunrise. i have often thought to myself, that i would only call pdoc at home if i was an immediate threat to myself, but then his mobile goes straight to voicemail (he returns calls when he can) and i've worried that i might not be able to hold out for the half hour or so it takes for him to get back to me.

i am a bit scared of emergency services and stuff but i guess it's a better option that nothing.

I'm clueless too.

My T's phone message on her machine includes the usual Call 911 if it is an absolute emergency and If you need to speak to me immediately you may call my cell phone at...

I usually call in crisis but other times have just left a message. Usually a post-session message because I react after session instead of in session. If it's a crisis I ask for a call back, otherwise I do not.

Her message makes me decide if I need to talk to her immediately. I have only once called her cell (not counting the time I accidentally called it at midnight! eek!) and even then I felt I should not. I do not think I am important enough to have immediate needs, for one. And resisting calling is a way I practice emotional regulation. I'll journal instead and after writing I may call and leave a non-crisis message that we talk about next session.

I'm glad you are okay and that you found out about your medication sooner rather than later

I am wondering...could people ask their T's "what exactly is an emergency?" and maybe have some guidelines??

I am allowed to call T whenever I want and leave a voice mail, and I can ask for a call back...but I rarely do ask him to call back.

Right NOW, he has a message (because he is on break) saying "if you are a current client and this is an emergency, leave a message and if I haven't called back in 20 minutes you can assume I haven't retrieved your message and you should call 911" - so right now, I get that an "emergency" is something I would actually call 911 about. Pretty serious stuff. I can still leave a message just to blah, blah, blah at his voice mail and he'll call back when the break is over or I'll just talk to him in session.

I DO think it would be helpful if when the boundary of "call in an emergency" is given, there are some guidelines about what they consider an emergency. I know I would be GRILLING my T on that "well, if my dog dies is it an emergency? what if I'm really really sad? what if I have a flashback? what if my kids make me crazy and I have to lock myself in my room? what if? what if?"

It's unnerving to not understand where the boundaries lie.

I did ask and she "leaves that up to" me. lol
which is kind of good in a way, it's like saying that if I feel it is urgent.. then it is.
if only i could allow that myself.

My whole dilemma precisely!

LOL

Hi Mouse-Happy New Year!

My T does not do e-mail. Actually, I never asked. He told me to call him if I need him and gave me all his phone numbers.

I don't think I could handle e-mail as well-lol. I get into enough trouble trying to decide when to use the phone.

Oy

EM
OMG This sounds like me...remember my poem? It's about THIS!!

(((earthmama)))

((Everyone))

You see guys how this whole dilemma gets played out? We all have differing view of what constitutes an emergency and we all interpret T's instructions differently. I torture myself and T about this regularly--and I might add, he tortures me too by being ambiguous. One minutes he's slapping that cell phone number at me and the next he's questioning the urgency of the call.

So, yesterday for a minute I thought I was in a big emergency with the meds. What if I had called T and then it turned out it wasn't an emergency? ?????????

I am sure this is a HUGE transference (sorry to those who don't like this word but it really applies for me in this instance) issue for me. I could spend about 12 sessions just discussing what it means to call and not get a response.

Maybe that should be my January agenda.

Love you all.
Peace and Love in the New Year!



PS Recent phone activity: Session on Monday; meltdown and phone call on Tuesday resulted in reassurance and a 3 minute phone call. After hanging up I knew I was in need of more so I left another message telling him I needed a phone session. Later than day-voila! He calls and I have a 20-minute phone session. Soooooo, if I articulate what I need, he responds. I don't get it. OMG I think I'm going to go out shopping and buy T a teeny phone charm present.