Chapter 2 - Reports feeling relief and positive

Pt arrived on time. Reports feeling relief and positive feelings for writer's return. Pt had sent email with update from the time of writer's leave that summarized activities and interactions with supports and covering therapist. Used this as a starting point for review of activities. Discussed meeting with covering provider and one set of triggers. Moved on to more current content by reviewing updated obsidian journal. Reviewed use of platform, how she is using it and refining it to better meet her goals. Discussed interpersonal interactions with online friend [N]. They have been working to assist each other with getting tasks done. They negotiated several expectations/boundaries. Explored process and outcomes. He plans to visit the US later in the year and might be able to visit. Briefly reviewed goals of joint meeting, set short term goal for pt and N to discuss and set goals of meeting. Ended session with summary of time away. Pt did not have any SI thoughts during the time or acting out. Feels it was productive.

Transcript

1. #2022-08-30 ## 2022-08-30 - Evidence 2A ### Dr. Marvin's Notes Pt arrived on time. Reports feeling relief and positive feelings for writer's return. Pt had sent email with update from the time of writer's leave that summarized activities and interactions with supports and covering therapist. Used this as a starting point for review of activities. Discussed meeting with covering provider and one set of triggers. Moved on to more current content by reviewing updated obsidian journal. Reviewed use of platform, how she is using it and refining it to better meet her goals. Discussed interpersonal interactions with online friend [N]. They have been working to assist each other with getting tasks done. They negotiated several expectations/boundaries. Explored process and outcomes. He plans to visit the US later in the year and might be able to visit. Briefly reviewed goals of joint meeting, set short term goal for pt and N to discuss and set goals of meeting. Ended session with summary of time away. Pt did not have any SI thoughts during the time or acting out. Feels it was productive. Global Improvement (CGI-C): Minimally worse
2. Assessment (Depression): - Moods stable to slightly unsettled following writer's leave and partner's vacation. Was able to engage additional supports well, maintain productivity and schedule. - Continues to be active with several projects. Working on balancing home and online activities. - Able to contract for safety. Assessment (DID): - Some triggering thoughts/feelings with writer's leave and events over interval. Able to process in session. Maintained schedule and progress on projects. - Review goal 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. - Validated/reinforced pacing/timing with reading/writing projects, home tasks, interpersonal interactions. - Writing project (trauma narrative) on hold given work on schedule. Current online writing class assisting with structure to writing. #2022-08-31 ## 2022-08-31 - Evidence 2B ### Day In Review
3. Corey: The day is going well. We can consider this our quiet time if Nihit was going to get some sleep. Ann: This is the mothering part of us. We like it when he is fresh and not running on fumes. Lissa: We are happy that we get to see Dr. Marvin again tomorrow. Anniemi: But standing here, holding on to ourselves, we are making it ... it is the flow of the day. Now we can say it more quietly. We are a little more tired. We fought to not take a nap. But the Echo singer is saying, "Sinking in the sofa getting some sleep." For Anyone listening! - 14:10 → Sarah: I should be eating less, and I should look to see if we can get a copy of food labels to the bottom of the page. Corey: Ok, Processing that! - Casey: Getting stuff done ... here we are! ### Morning Pages Jamie: What time is it? Anniemi: Ok, we are good ... almost 2PM though and we did not clean the dishes yet. Sarah: That would be coming up, after having a four-day streak of showers!!? ### Good Morning Corey: Sleep, sleep ... how was it? Anniemi: Not sure if I remembered most of it. We fell asleep watching Major Dad when Jillian called. Ann: We found ourselves curled up to nap and cannot remember Rich ever getting off the phone. This morning we asked how she was. He just said fine, plus added a few trivial things. Jamie: I got up and down during the night as usual. Anniemi: I woke when StarKinder came in the office to say Good morning. Jamie: It was a little bit of a shock to our system, but I did not get up fast enough to catch her. KC: We took care of washrooms for both Ginney and us, we both ate - of course all separate, took our medicine, Ann: and then we went into Rich's office and talked a few moments. Casey: OHH! And before … We got to see him dress a little bit. THAT was worth noting. WooHOO! - Anniemi: I can get excited that Nihit gave me this opportunity to write in this new prompt journal ... this and being able to learn about Amazing Marvin and other Obsidian tools. I feel like we are breathing it in! - One phrase to rule them all → Sarah: Today, I want to be someone who enjoys life. Ayn: Nihit reminded us of this week about music. We have the tv on mute so we can glance and get headlines, but in the meantime have light pop on in the background. - I can be cautious about - Kelsie ... weight. Damn the pretzels are fine! Must leave the rest for Rich and hope that the mustard we poured out of the near empty container is enough. We would have to face the consequences if that happened but right now, we are massaging the balanced ration of pretzels to mustard! Jamie: Doing well. - Eagle's eye view → Corey: I think that any high-level person looking at me from above would be saying ... hey, you, time to be getting to work if you want to be a writer. You must write - and make it most the day, except the time you are learning, reading, and meeting with people. Ayn: Nihit might need to pay Dr. Marvin attention with us. Dr. Marvin put out a reminder that we cannot support others if we are not helping ourselves. That is not exact but has close enough meaning.
4. - Daring Task → Jamie: Hey what? Four days of showers in a row? Sarah: AND do not forget Two shots at Walgreen's tomorrow, and Ginney groomed on Friday ... Jamie: Finishing the week with a bang! Boldly Go Annemarie and company! ### Cerebrate - 10:21 → Ann: I fixed my own Obsidian problem by myself. I am so proud of me ... I had a notion because of all the movements Nihit had done, and then I assessed it out and WALLAH! It has done ...Henry: it is just that Nihit had changed the root directory, and had not changed the same for the Obsidian Vault app. Corey: I LOVE IT Usually; I can only ask for help and wait. Ann: Ok, write my little fingers off! Anniemi: Ann is wonderful! AND we are having an enjoyable time hanging out with a new person, Jett, at the office. Kelsie: Keep going girl - we are going to be here and doing our own work at the same time. Sarah: It feels fabulous! - 12:51 → Corey: Today, we have cooked the fact that we are incredibly happy to be where we are with our life - especially with family, friends, Ginney, and other conversations. Anniemi: Part of that, of course, is through Co-x3. We are still meeting people and happy with turnover even if it is only a few at a time. I realize, I see group processes, and say, "Hey, I can do that too!" We decide our fate! Corey: We are now talking to Nihit and Dr. Marvin about writing from the format of these prompts that Nihit, Us, and through us, Dr. Marvin - for the Obsidian Vault content. This morning Nihit was talking to us about bringing bits and parts of what we have set up already through multiple vaults to the newest vault. Kelsey: I still want to finish Milo's work before being overconcerned with having just one main, trimmed down vault. I like though where Nihit is going. Corey: On a good day, we will get through all the prompts, and have time to do more studying. I can do this! Casey: One success after another! Ann: Hey girl ... keep going. Be proud to be your sons' Mom! She is nailing the hell out of it! - 14:25 → Corey: We cerebrate with Nihit and Dr. Marvin. They are our dream team ... ok AND Rich. Ann: Could we add the boys for substitutes? ### Consume - 10:30 → Lissa: We just finished reading a few stories from the Washington Post. Sarah: The first is "Coronavirus boosters targeting omicron get FDA blessing for fall push," Laurie McGinley in the Washington Post, Ayn: and the second is "Online creators are de facto therapists for millions. It is complicated," by Tatum Hunter in the Washington Post. Kelsie: The third story is, "The photo of classified documents at Trump’s Mar-a-Lago resort, annotated Image without a caption," Analysis by Philip Bump at Washington Post - 12:45 → Corey: We are back again. We have someone talking about Trump in the background and during lunch we caught up on what is happening in news CNN and YouTube. Kelsie: The important thing today is a picture of Trump's office floor where the government has placed for evidence all the documents from Trump's room. Lots of Top-Secret stuff. Kate: Of course, they took those boxes with him when they left but it is impressionable.
5. - 13:17 → Kelsie: Wow! What a fortune! We decided to try out Rich's cupboard on a whim. It is up ridiculously hard for us to reach but against all odds, we found the dipping pretzel sticks. KC: And then, we had to get around to the part that the horseradish mustard container was low and exceedingly difficult to open. The pickles? Casey: The new jar just popped open ready for us :) - 14:24 → Corey: I have learned this morning that we can take control of our life if we work at it. We buy the frame AND the picture! ### Connect - 13:01 → Corey: My nicest talks are with Nihit, because they are abundant and wonderful. We do want to note another conversation that was after we had finished writing. We talked to Dr. Marvin. I am going to try from memory constructing our thoughts there, and then I am going to leave a list that was the last 7 minutes of the meeting. Dr. Marvin gave us a few of the key words, and then I developed them into questions that Nihit will help me make prompts from - like this paragraph “### Connect.” Corey: The first 7 minutes were on the situation with the nurse-practioners response to our comment on her cleavage. We are going to need working through with Dr. Marvin that it is still making us feel like a Karen. It edged out most of anything positive of the meeting her except that we liked writing to her. Ayn: Therefore, this journal has had such good attention - the notes helped us in the urge to write again. Corey: The middle 46-minutes of the session is going to be a little tougher. I was able to talk it through with Nihit last night, and a little this morning. I know a lot of the time was watching the script go past as Dr. Marvin read. Jesse: There was a lot of reading. We were fortunate that he had skimmed the document sent over the weekend. Anniemi: We had captured all the correspondence and professional notes between us and kristina. The conversations about all that in general felt sublime. Corey: I do not recall a lot of talking. Mostly skirting the notes. Casey: Sometimes I would get to see Dr. Marvin's face. Lissa: We are always appreciative of his interest in reading us. He was reading the last four days of these notes. Corey: We are truly short “of a summary” ... for years we have talked about it but is about the complaint where our head hurts to think so much. It is like a hardship to bring all our hour together, so we know what happened. We must rely on the parts' work, and that we do not all know what the whole knows. Once we come into those areas, we can hope the ones remembering the conversation can come and fill in our joint world. I am so grateful for Dr. Marvin ... he holds most of the pulled together life of us. After Dr. Marvin and our session Tuesday, 8-30-22 Corey: We wrote from our Dr. Marvin notes, Nihit … this is what we were able to write from Dr. Marvin and our conversation - the last 7 minutes. • Ideas for questions: o Ayn: Writing - what are some cues to start, or give us ideas of what is important to ourselves or others about reading Multiplicity, trauma, and getting better? o Corey: How is each day of new Nihit/Ann conversation being a gift? o Jamie: Do we have any riveting goals today? o Kelsie: What could I commit to toward exercising today?
6. o Sarah: Which food labels do we need to add to our journal today? Jessie: What have we done (and can do) to balance our activities (assure household, piano, and quilting as well)? • Corey: Dr. Marvin teased Nihit in calling him my life coach complete with personal problems KC: Hehe • Corey: No, I HAD TO discuss this! And YES, we had to discuss cleavage! • Sarah: Dr. Marvin said directly that Nihit did GREAT helping to support us, but that he had trouble for himself. It is common to want to help others but should not be a distraction toward self-care. • Corey: He also said that we should talk between us (Nihit and Annes) about what we could accomplish by both talking together with Dr. Marvin. • Corey: Then he said we did an excellent job helping each other, and that we all worked together Anniemi: and rallied! - Corey: I liked what we added to the conversation, in that, although the terms are Dr. Marvin's, I was able to construct the first questions on my own. Jamie: It is going to take Nihit a bit to add them to the prompts because he is doing other major things with the prompting journals. Anniemi: Hmm, I like that name ... that is what we will name the next Vault? You know the one collecting everything. Corey: We will see. - 14:23 → Ann: We played with Rich today, and conversated with Nihit - who also encouraged both of our working modes. Jamie: Proud of him AND US! Anniemi: We are a working team! #2022-09-01 ## 2022-09-01 - Evidence 2C ### Morning Pages
7. Corey: Needing to take more care of self as I believe Nihit is taking better care of his own focus. Whoops forgot I had closed him down ... Time to catch-up! ### Good Morning Jamie: Sleep last night was particularly good. I know we woke up once to use the washroom, but it was for a truly short amount of time. We had a little trouble at first because our feet were hurting. Sarah: We took a Tylenol 3, and by the time Rich was putting on his tent/rain music we were fast asleep. Jamie: No memory of dreams/nightmares - Corey: We have been with Nihit's extended family this morning. We are going to miss them while he visits his Mom and Dad, but we will see them too! - One phrase to rule them all → Sarah: Today, we want to be very conscientious of what we are eating. We still want to eat, but not go over our numbers. I would think a downward swing on the scale would be one of our best indicators. We have been weighing ourselves with “substantial amounts of time” in- between. The results have been disastrous - each time we quickly visit. I want to be the kind of person that can put a stop to it - I can be cautious about - Anniemi: I will be cautious about Dr. Marvin’s appointment. What and how and why he says stuff has a lot of extra meaning for us. We should avoid deep conversations. We would be better off because we are not able to fit all that in properly. Corey: Sorry feeling confused. Anniemi: It is ok. Anniemi: Also, it is not Dr. Marvin's statements that give us unrest, it is what we are thinking we did or did not do. Corey: Ok, I am getting it. You are watching our time, and it is not Dr. Marvin that is confusing, it is not understanding some of the things that we are doing, and in the meantime, you want to get the most you can get out of Dr. Marvin’s meeting in that time – and sometimes it feels like a struggle. Anniemi: Good enough. Thanks for trying Corey. Corey: One other thing that might trip me up is medical. I have things going out with records for back – toward surgery with Dr. Wemhoff, heart due to chest pains this week - with Dr. Cheema and breathing issues with Dr. Photowala. Dr. Marvin has given me extended medical time and attention to better understand things and how to balance them. Sarah: We did not have written responses from heart or lungs ... so we followed-up with another note. Our heart people said they sent a message by phone ... we rarely check it. Corey: Mostly junk mail. We asked to have our responses through mychart. Kate: Dealing with the medical things by keeping a close eye on it, then discussing with Dr. Marvin, Nihit, and Rich. This is a good application of utilizing our resources well. Bright smile! - Eagle's eye view → Jamie: If I were someone from an elevated level looking down on us, we would say, "You are doing great." Even when Rich questioned our morning behaviors (Corey: he hung around until 9:00AM). Jamie: We gave him exactly our plans for the day, including that we now use this hot time in the morning to write. He left slightly deflated. BUT cannot have him micromanaging my day unless we fall short with his damn dishes or clothes.
8. Sarah: We just got an appointment with Dr. Cheema for heart issues on Monday, December 7 2022 @ 12:30PM. High level person would be saying EXCELLENT! AND be appreciative that the doctor will see me. - Daring Task →Corey: 4 or so minutes to shower/dress. Sarah: GO Annemarie and tribe! Follow the pleasure of free-flowing water and music! You can do it! ### Cerebrate - 07:52 → Corey: My brain is cooking on the pleasantness of listening to Aanya and Nihit singing. They both know the words! Wow! Now Nihit is speeding up ... awe could he be a little of a show??! KC: Yah! Corey: We just had a little talk ... he and the kids are having a wonderful time ... Aanya is coloring, Nihit will write, and then do his packing so he can go home for a few days. Vitty just stopped by to show Aanya something on his computer. Now Nihit and Aanya are playing us Hindi music. I am a little nervous ... I do not think he is bringing his computer. Jamie: We will see. He will have his phone and his what's app ... that is not my preference, but we will deal with it. Corey: Ahh, he IS bringing to his Mom and Dad’s home his computer. All is well, and now he is talking about visiting both his parents, grandparents, and cousins. Ann: I like this already! Corey: Today is a mixed day ... we will have to take a shower by 9:30AM ... Dr. Marvin at 11:00AM- 12:00PM, and then at 1PM we have the shots. The day could have gone better. Rich is still here and will leave about 9:00AM. He must visit customers downtown. Kelsie: Grrr. Would rather hang by my computer. ### Consume - 08:00 → Right now we are listening to the chimes. It is 8:00AM. We are doing good in that we are already working on the journal. Sarah: We had been reading information on MyFitnessPal (MFP). We are back on-track to be using it again. We just sent Nihit the email we got back from MFP this morning. Jamie: The only way they would give us a special price - would be if we joined, they are beta program, but one of the losses is that they ask you not to post images of what they are doing until it rolls out. BUT that is one of the reasons we want the program - is to post images of it to our Journal. So, maybe not. Corey: Nihit must read his email! Anniemi: Hehe he is overreading us! Ok, giggling about that with him. We matched conversation for a second. Sarah: The hard part of doing the MFP was that we could not find the micronutrients, but as we explained the problem to Nihit ... aha! There it was! Great! I want to make sure charting the nutrients from the over-the-counter pharmacies is going to be effective. And indeed, it is showing in a chart over time. So that is a magnificent view. - 08:33 → Ann: We just had a nice short - 3–4-minute conversation with Vitty. He said he had just eaten two-bananas when we asked him why he was so jiggly. Anniemi: Then we imitated him bouncing up and down. Corey: He became overly conscious, and then distracted with something else. Within a few moments he had to go because he was helping Aanya with her map. He did come in with a “slight”
9. against his uncle after Vitty accidently bumped something ... Ann: Nihit’s desk, but Nihit seemed to overcorrect? Jamie: Not sure ... Just shrugged my shoulders, and said, "You know ... Nihit..." ### Connect - 08:06 → Ann: We had a nice chat with Rich this morning. We both woke up at 5:00AM and he was not in a rush to go to work. We talked until about 6:00AM when he went in his office to take care of paperwork. Ann: The conversation was on MFP and in how we were going to need changing up our goals again. We started with telling him, we no longer wanted muffins for mornings, OR desserts. Anniemi: Then after a discussion we figured we were going to try two scrambled eggs and a light peanut butter toast. We can precut some onions and tomatoes. Sarah: We will see. I cannot make this too complicated. Some shredded cheese ... I am concerned. That adds protein, but also fat. Sarah: Then we talked about adding nuts, and that seemed ok. He thought mixed nuts. Lissa: We had listened to our phone talk about protein in various nuts. And, we added that we would measure them out, so we did not overeat. Ann: Rich is going In the grocery store later today. Jamie: I told him we were on a free one-month subscription to MFP. It is the best obviously that we can keep it up. We will for sure, need Dr. Marvin’s help. Corey: I like that we can copy, paste, and then add the completed chart daily to this journal. Overall, a good chat BUT we did not get to the part we later checked our weight. Sarah: We are up to 288.5 lbs. We are in crises mode, and we can tell the difference in mobility. I believe MFP has us charted for now at eating 1600 calories a day, and of course the goal is always to beat the number. Ann: Dr. Marvin is going to appreciate that we are watching food intake again like this, AND it is better than the last obsidian one we had. Henry: Yes, for example, we can use our phone to record foods eaten, or add one at a time, and we can group common meals (even group of nutrients from over the counter). Anniemi: There are hundreds of other reasons the program is good as well. Corey: We then went over a little of this with Nihit. He is very quick to understand what we are doing with this. He wants to use MFP too. - Jamie: We were able to contribute that we were going into the food journaling with some concern, but, jumping in with two feet forward. Sarah: We just confirmed with Rich that we ate our last blueberry muffin, and that we are going into 2-eggs, scrambled (light milk) w/a little precut onions and tomatoes, plus 1-lightly peanut buttered piece of toast. Corey: Furthermore, we are going to do a dry run tomorrow morning. Anniemi: We contributed our enthusiasm and willingness to better self-care, and nobody is arguing against that. It started with Dr. Marvin reminding us that he liked when we were watching what we were eating. Anniemi: Shoot. He is serving dry toast with hard egg on top. I am not going to whimper.