Chapter 5 and 6 - Chest Pain and Hangin with Nihit

Pt arrived on time. Last seen one week ago. Initially reviewed medical updates. Pt had another episode of chest pain last night and took Nitroglycerin (later able to potentially connect to watch video with high emotional content). No further episodes. Messaged cardiologist but has not heard back. Had sleep medicine MD appt with machine setting updates and recs to increase activity. Will get a new C-Pap machine in several weeks. Chronic back pain has worsened to the point it is interfering more with activities. Reviewed messages with PCP. Looking for referral/recommendations. Previously has seen specialist for procedures which were helpful. Reviewed updates to daily schedule - starting each day with MyFitnessPal, which she has been using for two weeks. Feels it is working well so far. Has two people online who are also doing it. Moved on to discussion of writing. Continues to take workshops which have been helpful in generating an organizing structure "concept index." Feels this will be helpful in planning her writing projects. Looking forward to next set of workshops. Continued discussion of daily journal - updates to question/prompts and options for integrating concept index - allows for notetaking in prep for writing projects. Reviewed goals for the week.

Pt arrived on time. Started with taking medications. Pt had a good morning hanging out with N. Reviewed updates to medical status. Had frustration with response from nurse, asking to come in before getting a referral for back pain. Reviewed process and options. Walked through making an appointment with specialist directly. Was able to call and set up appointment in session. Reviewed updates for son's upcoming wedding - planning for events, getting clothes from tailor. Had some lower moods the last couple of days related to different schedule with online friend, N. The time spent hanging out has been helpful for keeping moods up and without them has noticed a difference. Reviewed alternatives given current schedule. This led to discussion of returning to the quilting. Reviewed current state and work needed to finish it. Discussed options and challenged negative assumptions about process and work load. Reviewed self-talk/reframing. Set goal to look over the quilt today to decide next step.

Transcript

1. #2022-09-13 ## 2022-09-13 - Evidence 5A – Another Episode of Chest Pain ### Dr. Marvin Comments 9-13-22 Pt arrived on time. Last seen one week ago. Initially reviewed medical updates. Pt had another episode of chest pain last night and took Nitroglycerin (later able to potentially connect to watch video with high emotional content). No further episodes. Messaged cardiologist but has not heard back. Had sleep medicine MD appt with machine setting updates and recs to increase activity. Will get a new C-Pap machine in several weeks. Chronic back pain has worsened to the point it is interfering more with activities. Reviewed messages with PCP. Looking for referral/recommendations. Previously has seen specialist for procedures which were helpful. Reviewed updates to daily schedule - starting each day with MyFitnessPal, which she has been using for two weeks. Feels it is working well so far. Has two people online who are also doing it. Moved on to discussion of writing. Continues to take workshops which have been helpful in generating an organizing structure "concept index." Feels this will be helpful in planning her writing projects. Looking forward to next set of workshops. Continued discussion of daily journal - updates to question/prompts and options for integrating concept index - allows for notetaking in prep for writing projects. Reviewed goals for the week. Global Improvement (CGI-C): Minimally worse Assessment: - Moods stable to suicidal ideations lower this interval. Several medical conditions worse this week. - Working to maintain progress with writing projects and balance with other activities. - Able to contract for safety. Assessment: - Able to respond and address medical appointments appropriately. Schedule/journal helping prevent getting stuck in negative thoughts.
2. - Review of home videos ongoing. Goal remains to process smaller pieces of the video as time allows. - Continues to work to balance time online with reading/household tasks. - Looking to return to larger writing project (trauma narrative) - goals/product/audience. Current online writing workshops assisting with structure to writing. #2022-09-15 ## 2022-09-15 - Evidence 5B - Productive Journal Sections ### Morning Pages It is 7:39AM now ... how many other productive journal sections can we write? Can we get into some of Dr. Marvin's threads? ### Good Morning Today we woke up with a jar ... Rich was scolding Ginney for trying to lay down on my chest. The problem part was not that as much as we forgot what we were dreaming about. We should have remembered with a slower, less abrupt start to the day. Oh well, there will be other mornings, right? We got through the night with only getting up once. I do not recall falling asleep. Last thing we remembered? Hmm, do not know ... do not remember what we watched with Rich. Seth Meyers. Ok, thanks. - We get to talk to Dr. Marvin this morning. YAYYY! That is a good part of our week. I do not think we have been really on track in that there are just a few things recorded in our journal. I think we have been talking to Nihit about making small improvements and that started some of our journaling time yesterday. We will take the time with Nihit any time. We are having a little more difficulty after the lunch period. We know that it has been good that Nihit has been getting a better night's sleep ... He is taking Melatonin. BUT we must readjust our time as well. We
3. watched yesterday about 3 hours of videos (3) mostly on diving deeper into Trump sagas. When Rich came home, we got up to get our kiss, but we did not want to eat out in the sunroom, and we were clearly depressed. We must do better for ourselves than that. We did go out and eat with him. I do not recall the conversation, but we are clearly not into all the talk about his work. It is rare that he asks about me. I think we did tell him that we had a doctor's appointment. We told him the night before that we had had communication with heart, lung, and regular doctor about back. I do not think he had much to say. I do not know how much syncs in. This is part of our depression. We just are not making a particularly good impression or indent on him. We have a very casual relationship. Ok, stop feeling sorry for yourself. - One phrase to rule them all → I would like to be conscientious about improving our day/time. We can talk to a few doctors ... why do not we make the best of it. Just means we must take our shower on time AND get Ginney in the right position at the right time. - I can be cautious about - Going out of the house and fears about that could trip me up. Plus, we keep dreading the walk from the handicap space to the doctor’s office, where we may or may not have to wait in a line to see a receptionist that may or may not be quick. That whole series is hard on us, PLUS we do not know the doctor we are going to be seeing AND we might have to face the dreadful nurse that keeps being hostile to us. BLAH! Her name is Heather. We DON'T like that she is doing such an excellent job keeping us from talking or hearing from Dr. Dorman. - Eagle's eye view → Try not to worry about things too much. You have set out a plan and now just must follow through. It is going to be ok, promise! #2022-09-15 ## 2022-09-15 - Evidence 6A – Hanging Out With Nihit ### Dr. Marvin Notes 9-15-22
4. Pt arrived on time. Started with taking medications. Pt had a good morning hanging out with N. Reviewed updates to medical status. Had frustration with response from nurse, asking to come in before getting a referral for back pain. Reviewed process and options. Walked through making an appointment with specialist directly. Was able to call and set up appointment in session. Reviewed updates for son's upcoming wedding - planning for events, getting clothes from tailor. Had some lower moods the last couple of days related to different schedule with online friend, N. The time spent hanging out has been helpful for keeping moods up and without them has noticed a difference. Reviewed alternatives given current schedule. This led to discussion of returning to the quilting. Reviewed current state and work needed to finish it. Discussed options and challenged negative assumptions about process and work load. Reviewed self-talk/reframing. Set goal to look over the quilt today to decide next step. Global Improvement (CGI-C): Minimally improved Assessment: - Moods lower to more irritable this interval. Connected to schedule change and ongoing medical conditions. - In session, able to progress medical appointments and make plan for quilt. - Working to maintain progress with writing projects and balance with other activities. - Able to contract for safety. Assessment: - Change in schedule with online friend, N connected to change in moods. Able to reflect/process in session. - Review of home videos ongoing. Goal remains to process smaller pieces of the video as time allows. - Continues to work to balance time online with reading/household tasks. - Looking to return to larger writing project (trauma narrative) - goals/product/audience. Current online writing workshops assisting with structure to writing. #2022-09-16 ## 2022-09-16 - Evidence 6B – Nihit is Being In and Out
5. ### Morning Pages We are worrying that we are not going to see Nihit much today because of being in and out. We are having some problems adjusting to the point where we KNOW he must get regular sleeping hours in. We are so proud that he has taken the steps through psychology/psychiatry to be taking care of himself. We are going to need working on it together so that we both achieve our goals AND still get time to spend together. There is a lot encouraging his family moving to the US. I so hope that he is going to be "local" soon. It is too much to think he is going to be here and possibly a visitor in the guest room, but I must admit that is what we are hoping for. I cannot imagine how much fun that would be! AND then Rich and he would get to know each other. WooHOO!! ### Good Morning Sleep was very terrible ... We woke up at various times during the night ... we went to the iPad and slummed around on Facebook and news. Twice during the night Ginney got sick ... Rich and I were both up and we held on to her while Rich cleaned up. We were worried about things we talked to Dr. Marvin about. Mainly feeling sorry for us. We must do better. We forgot in the meantime ... we did not get to checking out the quilting project. That is something we really want to be doing now. We worried about putting our information on Dr. Marvin's appointment in Guilded ... without being there to make sure Nihit was ok. I did not want it to seem that he was in the way of our quilting. We were worrying that was how he was going to take it. The thing is that we would always prefer to talk to him, but as a second best we are trying to move back to the quilting so he can be guilt-free in getting his sleep accomplished. - Hopefully, we will be over the part where we will be taking care of our dress preparations. We wrote a note to Nihit of our morning schedule. This is it. I am NOT saying I am excited about this, but we are excited that we will be moving past this. Schedule for this morning. It is now 8:30AM ... At 9:00AM we need to take a shower ... At 10:10AM we are driving to the dress tailor ... At 10:30AM we are meeting with her to try on wedding dress ... At 11:00AM we will be going to Dunkin Donut ... And about 11:30-12PM we will be home :) Yesterday ... we did not go to the dog store, but we did get our new medicine. AFTER that we stopped at Dunkin Donut (520 calories). At 8:36AM we are a mess. Do not want to do anything :( - One phrase to rule them all → Guild free - I can be cautious about - Something that might trip us up today is that something happens with the dress trying on and that it does not work at all and there will not be time to fix things. I am not sure if we wrote about it as well, but a couple of days ago we talked to Maury. He said that he talked to his Dad and Jacky and that she will have to be going in for Cancer surgery about a week before the wedding, so that they will not be able to make it. Maury sighed and said that we were going to be the only old people there of the parent group. I was not sure how to take it, but we teased back and were like ... holy crap! We are going to get by then with murder! We will not be in competition with the other parents. Had to like that. He knows we were teasing, and I hope he really took it like that. We were trying to levitate his possible negative feelings that
6. his father, and Erin's mother would not be there. Erin's mother does not leave her space and does not exactly recall who her children are. It is a sad thing. We do hope that we represent the family well. - Eagle's eye view → You are going to be ok ... AND try on the new bra ... it is strapless, and we have feared putting it on, but today is the day it MUST work! You can do it! - Daring Task → Remember that Maury's wedding is something that is going to be glorious! We can do it AND the ribbing has begun ... yesterday, we told Nihit about Ginney boarding at the vet while we are at the wedding. #2022-09-18 ## 2022-09-18 - Evidence 6C – Feeling a Little Grumpy ### Cerebrate 07:55 → We decided not to go to today's meeting. I am not sure why, but if we were to guess, we would say we are having trouble not getting time to talk to Nihit and feeling a little grumpy. I know it is going to be ok and it is for a good reason. We need to do our part in helping Nihit get normal sleep patterns according to his own time zone. But it is hard. We are going to be ok overall ... just for the moment ... it is hard. We can be a good friend ... just got to keep the end goals in mind ... We would do anything we could for Nihit, and this is part of it. We are going to be ok ... HEY you! Stop being so dependent. Our relationship will stand the best test if we can be INDEPENDENT WITH him! We will learn to make the best use of time together. Right?
7. #2022-09-19 ## 2022-09-19 - Evidence 6D – Seasick over Nihit ### Morning Pages We are trying not to think of Nihit. We do not want to be overly seasick over him. We want him to do good, so we do not want to be overthinking the time he has for himself to, or to at least let go of the time that was slipping by anyway. Same for ourselves. Yesterday we watched an awful lot of stand-up comedy ... could not even remember who today. we could look up that one comedian. Kyle Kinane - Trampoline in a ditch Tommy Ryman - A Night at Dry Bar Al Siddiq - The Domino Effect Kermit Roosevelt III - The Nation That Never Was (Commonwealth Club) Shoot the other couple guy must have been? Do not remember something starting with Eng... or something AHA Found him - Bill Engvall - Just Sell Him for Parts. The latter was the best storyteller. ### Good Morning - Today the Royal funeral processions will be over. And there are some extreme weather things going on. These are not happy excitement things but adding to the tension of the day. It is going to be ok, right? Why don't we gear up now ... going to get excited about Laundry, right? - One phrase to rule them all → I want to think somber is ok, and so would being happy. Just not sure what happiness is about. Tomorrow we are going to be getting our hair cut and dyed. Not sure about that AT ALL! Try today not to be scared. Too much.
8. - I can be cautious about - Too much obsessiveness over the funeral and not being able to turn off the TV. I could deal with that by turning it off. It has been 10 days of mourning ... that is a lot. Ok, we did a medium. We left the TV on but turned off the volume. Ahh, and for a bit we put on some easy pop, because it was a little too quiet. - Eagle's eye view → If someone were looking down on me, they would say ... we can appreciate you writing this morning and trying to establish a morning we could respect. All of us. - Daring Task → Just remember the ABCs of your/our day ... You got this! ### Cerebrate - 07:16 → Today, we are hyped-up because yesterday, we got our new "bike." That is what Nihit and us are calling the pedals under our desk ... Eh. It works Hehe. We did 15 minutes yesterday and 15 minutes today ... we are a little confused in that the meter says we did 7.0 miles, but the REAL miles I think are on the online thingy and that only says 2-3 miles. I will have to look at the words more carefully next time it is up. Ahh here it is ... the 7.0 miles is Display distance and the 3.2 miles is road bike distance. Not sure why that is different though. Maybe because we were only doing an average torque of 10.7 miles, or watts of 15.1 (power), or tangential force of 3.0 lbs. And NO, do not know what that means except to know we are on level 1 of 10 ... not too much there Hehe. - 09:39 → Not much yet ... although we are here writing and that is positive. We have also kept ourselves from taking out the diet. It is 9:40AM and we had breakfast around the time Rich was here. One of the tough things other than mood in food eating is that we have Chinese ... there is not a whole lot of General Tso's Chicken left, but it seems like it would be good. Let us celebrate a delicious meal! ### Consume - 08:32 → Saying good-bye to the Queen today ... There are those for and against the Queen and all the Royal stuff. BUT ... must admit - the Brits know how to throw a good party! - 08:32 → We have been having the final funeral procession on CNN for Queen Elizabeth. I have not really been in love with it, but we should have this in the back of our head somewhere. It is a major upturning of Royalty as she lays. King Charles is going to be in for some trouble after the Queen laid to rest. There is a good amount of well-wishing with her, but NOT so much with what we are calling the Cranky King. - 08:49 → We were feeling down when Rich finally came out to sit in the living with us for a few moments before he left. We have been down some time ... and unfortunately have been putting it to the reason of not knowing what to do without being able to talk to Nihit as often as we had been. Our thinking on that level seems to be all off. Nihit says he is so happy, and so sad at the same time. Not fair Nihit! - 09:29 → We're now listening to Jake Tapper on "Author of explosive new book reveals what Trump told her Susan Glasser, "The Divider." But this is now another argument on whether TX or FL did right or wrong in sending people from their states to Northern states without warning to bring press to their situation. They have a couple republican's and its back too hard to listen to. I remember what I heard
9. this week about CNN going more right with the new boss. It is true. A lot of disagreement that is hard to listen to. Blah ### Connect - 08:36 → I had a nice talk this morning with Rich. After we got up, we went to his office, and we had to accomplish a task. A couple of days ago, we were able to finally print out the two sheets - one each for Rich and Us to get ready for mail-in voting. They say the first day to accept was August 10, 2022, and the last day to accept is November 3, 2022 ... so we are in decent shape. the date of election is November 8, 2022. AHA! Just checked ... 10 days or September 29th is the first day we can send in the early voting ballots and that goes up to November 7th. I say basically because there is a grace period of one day to hand in voting. Was that confusing? Anyway, we filled out all the paperwork - the mail for the "applications." We are good for that right now and even put in stamped envelope. We assured Rich took them with him ... we are going to need checking with him then to see if he mailed. *sigh* - I am glad we got this part of the voting done. We will be happy. I want to ASSURE that we do our part. This is the first MAIN part. Second part? I do not know if we could help ... the kind of stuff they need is to bother people by email or phone, and I am not so sure we want to do that part. We also do not know who the people are, except the difference between Dems and Republicans. We could read up on that. Hmm, interesting ... we will think about it. - 09:24 → We were just listening to a video called, "Donald Trump’s New Lawyer for Mar-A-Lago Search EXPOSED as foreign agent of Venezuela." It is by a new station we are listening too called, "MeidasTouch (network)." I do not know the guy’s name, but I have loved him. He is cool, calm, and collected. This is what this video is about ... just went out today. "Donald Trump had his political organization Save America PAC which is under investigation by the DOJ pay $3 million to hire a Florida lawyer named Chris Kise. It now turns out that Kise is a registered foreign agent for the government of Venezuela according to the FARA filings. This is particularly disturbing since Kise is seeking access to the top secret classified records that the DOJ obtained in connection with its August 8 search warrant." - 12:32 → Today we connected with Nihit and had a so-so time. He thought and we agreed it was time for us to be a little more thoughtful of the relationship between the British Royalty and others subject by them. > Starting laundry before 9AM would have been better ... but hey ... we are doing it right? > Ok, Nihit ... you are just messing with our minds, right? I would say to tomorrow me ... "Hey you! Getting a haircut today! Do not worry about the color ... let us trust someone at least as far as we can throw them, k?" > Hey Nihit ... happy you stopped by. You could be making our day! Let us have a less depressed day, right? Hey, is it not Monday!?? You are being stable! That is a good thing Nihit ;).
10. #2022-09-20 ## 2022-09-20 - Evidence 6E – Feeling Mopey AND Cranky ### Day In Review Today we were being mopey through all Dr. Marvin's appointment. We kept feeling stuff, and then we would talk about whatever and then we would be cranky. We talked about getting the hair taken care of, and then Nihit going down a healthier trail, and then about being grouchy around Rich not wanting to do things except watching standup comedians. One of the things that got us to smile because it was so silly ... funny of Dr. Marvin to recommend, but he suggested that we had to act out what we are wanting to do but are avoiding like washing dishes. And, then the funny part was that he said we should talk to Ginney the whole time. Really get out what we are angry and frustrated about ... like being good for Nihit. BAH! Anyway, that is what he said! - 15:48 → We went around the house and did the bare minimum of work so that Rich would not trip over dishes. There was not enough to do to start the dishwasher. AND we did not continue the dryer. It will have to sit one more day ... throw THREE big wet towels in there to get all the wrinkles out while we start the machine again. - We are ready to put Ginney in the kennel in 3 minutes. And we have supported ourselves the best we could today. We have lists Hehe - one for the general hair style, and then with Ashley's advice, we found a site for women over fifty. They featured eighty hair styles. I collected the top five.