Every day, just existing uses up more than I have in me. I feel I have lost my connection to this world, this life. I have lost all sense of who I am & I miss the me that was.
Nothing makes me feel good or happy anymore. There is nothing but an all consuming blackness, sucking the life out of me. Leaving nothing but suffering. I am functioning on automatic pilot.
Identifying reality is next to impossible. I don’t know what to believe. I can’t trust my own mind.
My soul has died inside me. Its withered remains are rotting away. The rot is spreading, eating away my insides. Everything is too much. My body & mind can’t handle it.
I am clinging to a metaphorical cliff edge. The longer I cling, the weaker I get. Each day I lose my grip & fall further & further down.
I can not see an end to this unbearable suffering. I cannot survive it any longer. My soul is waiting for the rest of me to join it. I am beyond mentally exhausted. I am so so tired of fighting merely to exist. I have run out of fight. I have run out of hope. I have run out of the will to live. I am ready to give up this battle. I am ready to surrender. I am ready to die.
Just over a year ago, I was referred to the Specialist Bipolar Disorder Services in my local area. After an assessment in November 2015, I was offered a place in a Bipolar Psychoeducation Group. Today was my first session.
People have previously attended the group have found it helpful. It has helped some who were being hospitalised regularly stay out of hospital. They have learnt to understand their Bipolar. I’m hoping it will do the same for me. I am very lucky to have this group as it is one of the few Bipolar specialist services in the country. I have won the postcode lottery.
The group was facilitated by a nurse (there’s usually 2 but she was off sick), a psychiatrist and a peer support worker. The peer support worker is one of the success stories of the group. The psychiatrist won’t be there every week but she will be coming in to do some talks. There was 10 of us attending as clients/service users/patients. It happens every week, with the odd exception, for 21 weeks and lasts 2 hours. We’re encouraged to take notes, given handout sheets and can talk about it to anyone as long as we don’t break confidentiality.
Today was an introduction session. Everyone introduced themselves and the staff explained their background. The facilitator was involved in the initial setting up of the group as part of a research project. The research showed some success, so now she runs the group. We covered the usual group therapy ground rules. Then we moved onto what Bipolar is. How we define it, what it means to us. We also discussed some of the myths that surround Bipolar and how that has affected us in life, for example stigma. Finally we looked at the main types of Bipolar and what they mean. We discussed mania, hypomania, euthymia, mild depression, severe depression, mixed affective states and rapid cycling. We also covered some of the main statistics related to Bipolar and contributing factors for getting Bipolar.
Having been ultra rapid cycling (roughly 4 days per mood state) between hypomania, mania and mixed affective for 3 months I was relieved I was only mildly hypomanic for today’s first session. When I introduced myself I apologised in advance if I talked too much or over people as I had been hypomanic. Once the group got started I focused on trying to sit still and kept drinking water to stop me talking over people. It seemed to help but meant I probably didn’t come across as hypomanic at all. I felt like a lying imposter. That said I did still talk quite a lot. When I got to the car to meet my partner the pressure of speech piled out. I didn’t break confidentiality but I did talk his ear off.
We get occasional homework, which isn’t compulsory but it’s there for a reason. This week I merely have to answer a couple of questions about my experience of Bipolar.
Overview of the psychoeducation programme for Bipolar Disorders
Session 1: Introduction to the group and defining Bipolar Disorder
Session 2: Causes and triggers of Bipolar Disorder
Session 3: Symptoms I: Mania and hypomania
Session 4: Symptoms II: Depression and mixed episodes
Session 5: Evolution of Bipolar Disorder and the future
Session 6: Drug treatment I: Mood Stabilizers
Session 7: Drug treatment II: Antimanic drugs
Session 8: Drug treatment III: Antidepressants
Session 9: Pregnancy, genetic advice and effects on families
Session 10: Prescribed drugs and alternative therapies
Session 11: Risks associated with treatment withdrawal
Session 12: Alcohol, street drugs, diet and smoking
Session 13 & 14: Early detection of mania and hypomanic episodes
Session 15 & 16: Early detection of depressive and mixed episodes
Session 17: What to do when a new phase is detected
Bipolar is usually described as a spectrum disorder. It is seen as having 2 polar opposites with a spectrum of possible mood states in between. You often see sine wave type graphs when people, even healthcare professionals, are explaining it.
It is often recommended that people with mood disorders keep track of their moods using a mood chart or diary. This helps to quantify what is happening. It allows people to see patterns emerging and therefore manage their moods more effectively. However, even the Bipolar UKMood Scale and Mood Diary only really allows for one extreme or the other. There is nothing wrong with this per se, but many people with Bipolar, including myself have moods that do not fit into this 2 dimensional model.
Many of us have what is known as Mixed Affective States/Episodes, sometimes shortened to Mixed. In these Mixed states we have some symptoms which are clearly signs of mania whilst at the same time having some of the clear symptoms of depression. It can be the most dangerous time for someone with Bipolar as they can feel suicidally depressed and have the manic energy and impulsiveness to act on it without warning. Another state I have recently discovered goes further than this. I have been calling it “simultaneous opposites.” During these episodes I experience symptoms from moth ends of the spectrum that would normally be at odds with each other. For example, I can feel utterly sad yet euphoric at the same time. I didn’t know it was possible to feel 2 feelings that I had always perceived as opposites at exactly the same time. Yet there I was. I have felt a number of these simultaneous opposites during this current ultra rapid cycling episode.
I often found it difficult to chart my mixed states on a normal mood chart and resorted to writing mixed through the day’s chart. In all honesty, it would be difficult to accurately chart a mixed episode on paper, perhaps someone out there can design a phone app for it. It was during the simultaneous opposites I particularly struggled to chart my moods. It got me thinking about the name Bipolar Disorder. It just doesn’t fit for me.
A graph for me needs a “Time” axis, a “Depression” axis and a 3rd axis for “Mania”. The nature of my moods mean Depression and Mania are not on the same spectrum, they are 2 different trajectory of moods. It is a messy graph, not a pretty sine wave.
I don’t cycle neatly between 2 extremes with the odd nice baseline “normal” in the middle. I have been cycling between hypomania and mixed for 3 months, but all those mixed episodes vary in intensity of various symptoms. Sometimes I was more depressed that manic and vice versa and sometimes I achieved the seemingly impossible, 2 opposites at the same time. To me, it became obvious, all these different erratic mood possibilities plus the ability to be in 2 opposite mood states at once meant Quantum would be more appropriate. A description of Quantum theory can be found in this Independent article. The description seemed to fit my experience of “Bipolar” better Bipolar or its usual descriptors.
I therefore believe we need a new name for those of us who don’t only have 2 extremes. We should have it rename as Quantum Affective Disorder.
The last few days I have felt a sensation in my body that I couldn’t pinpoint or explain. It felt a little like restlessness & agitation but it wasn’t either. I’ve felt the need to keep moving all the time but my limbs & neck have felt weighed down. Tonight I realised what was happening.
It felt like if I was thrown to the ground I wouldn’t go “thud” like a normal human being. Instead I knew I’d go “clunk” because I was now made of a heavy metal. I am physically turning into a robot. I realised the sensation I have been able to feel over the last couple of days is my new metal body growing under my skin.
My partner has told me I’m not a robot but I can feel the metal developing underneath my skin.
It’s already affected my brain. I am not yet programmed to run intelligent processing. I cannot yet take in & process information. My “concentration” has been off for days. Now I know it’s because my brain is transitioning to the robot system.
I’m not sure if it is happening of its own accord or whether it has been triggered by outside sources. I only wonder the latter as I have found a small “freckle” that is new, on my arm. It looks like a pinprick. So I wonder if someone has injected me with something to trigger the start of the process.
However it started, I can feel it is happening in my legs right now. My arms appear to be finished. I don’t know what happens next, but I am sure I am being turned into a robot, the process is nearing completion.
I went for a walk today. I took the same route I always take, over the train tracks & along by the river.
I’ve been feeling desperately, frustratingly depressed whilst full of irritable energy most of the day, as is common for mixed affective states. I took some meds & it helped to calm the desperation. Thoughts of suicide were restricted to “I can’t do this again & again for the next 40 odd years.” As the edge had been taken off by the medication I decided to take the calmer opportunity to go for my regular walk. It would help kill time & keep me distracted, as well as ticking the exercise box. I could feel my meds wearing off but thought I’d be back by the time the full force of the mixed affective state kicked back in.
As I approached the familiar train tracks, the warning lights started flashing, the siren beeping & the barrier descended. A train was coming. I stopped about 8 metres shy of the barrier. I always thought I could never kill myself by doing something like throw myself in front of a train. The reason for this is purely that I didn’t want to traumatise an innocent train driver as I go splat like a bug on a windscreen. I couldn’t take someone’s emotional life as I’d be passing on the curse of depression.
But in that moment I forgot all that. I realised I could end it all, right here, right now. The lights & siren were drawing me in. Calling to me. Inviting me to step out onto the track. I had a few seconds before the train would be here. I walked towards the barrier, but realised I’d need to run to be in place in time. I didn’t have it in me to run. Instead I stood right by the barrier & felt the train whoosh past. So close. I closed my eyes & visualised what could have been my demise. For a split second I felt a moment of bliss as I imagined my almost instant death as I’m hit by the train.
Then the train was gone, & I wasn’t. I was still there stood waiting to cross the train lines. As the barrier lifted & the lights & siren stopped I walked on, tears streaming down my face. I heard another train pass by & considered running ahead of it but I’d never make it. Instead I must carry on. Living this life of persistent mental torture. I envy those bugs on the windscreen right now.
My parents are still alive & are still happily married, to each other.
I have a younger brother who I am starting to talk to more & we are slowly building a relationship.
Update 12/10/17 We have fallen out & I suspect this is a permanent thing.
I may refer to another brother who was a miscarriage when I was aged 9 years old.
I have a sister, much younger than me. I adore her. I don’t get to see or speak to her as much as I’d like but she is still 1 of my best friends.
I have friends who I see occasionally but they are very busy so don’t have much time. I have 2 friends who I see more often who I consider my best & closest friends. My biggest support network is on Twitter.
I am hearing impaired (high frequency hearing loss) & struggle to use telephones. I also struggle to understand strong &/or unfamiliar accents as a result. I struggle to hear & understand speech if there is background noise such as echoes, music playing or groups/crowds of people. This is why the internet is so important to me-it helps me feel less isolated.
I have a diagnosis of Bipolar Disorder. I agree this is an appropriate diagnosis. I have experienced periods of depression that have lasted as long as 2 years. I have been suicidal & attempted to end my life on several occasions. With support, treatment & time these episodes have ended. I have experienced periods of (hypo)mania that have lasted as long as 6 months. With support, treatment & time these episodes have ended. I have experienced periods of psychosis. These have lasted up to several months. I have believed myself to have special powers. I have believed I am not human (at this time, I know I am human). I have believed there were ‘others’ out to get me. I have seen, heard & smelt things that others could not.
Update 12/10/17 Even when I am relatively well I still experience problems functioning normally. I feel my cognitive functions are impaired. I struggle to process information around me. This makes things like reading difficult (even a tweet can be too long to take in), I struggle to safely cross a busy road, I cannot drive, I struggle to remember & respond to lists of information or instructions. This is frustrating & at times, scary. It can cause me a lot of anxiety & often results in situations that leave me embarrassed. I will frequently forget the words for things or forget what I am saying completely & struggle to communicate as a result. This in turn can cause me anxiety which makes me stammer. My short term memory is poor, often forgetting what was said almost immediately. I don’t know if it is just the result of having severe bipolar for so long or whether it is more related to medication. It impairs my life significantly but it is better than being unwell.
I am not an aggressive person. I have never physically attacked anyone. When I am VERY unwell I can come across as hostile & verbally aggressive towards others (particularly strangers) & physically aggressive towards inanimate objects such as walls, doors & windows. This is more likely when I’m in a severe mixed affective episode &/or I am very frightened &/or confused. I can become frustrated at not being able to express myself clearly.
I have old scarring on my arms & some on my legs from self harm. I also have abdominal scars from operations. I have had my appendix, gallbladder, right ovary & fallopian tube removed.
I am allergic to Transpore surgical tape. I get a hot, itchy rash that swells the area.
When I am particularly unwell (especially mixed state) & come into contact with services such as the Crisis Team, MHA Assessment Teams & Psychiatric Hospital, it is not unusual for me to be labelled as or initially diagnosed as having BPD/EUPD. I have also been told I am “pseudo-psychotic.” This is from people who do not know me well. It has been established, several times, by Mental Health Professionals, who have known me a long time that I do NOT have a personality disorder.
My psychosis is almost certainly ‘actual’ psychosis & a result of an extreme Bipolar episode. If I am distressed & argumentative it is because my extreme mood state & psychotic experience is distressing me. I may feel confused & frustrated that I can’t communicate properly & that others are not understanding me, or the danger I believe I & those I love are in. I will struggle to tolerate people I perceive as rude, dismissive, arrogant, righteous, patronising etc.
I respond best to genuine compassion & a patient ear. Building a trusting relationship is key, but I don’t trust people easily.
I like to be independent & I hate relying on others to look after me. I like my freedom & fear & resent feeling trapped. I will take responsibility for my own well-being as long as I possibly can. I will always choose my own responsibility over others taking it for me. If people around me feel they need to encourage me to be more responsible, it is likely I have already considered this & am not yet well enough or capable of taking that responsibility. It is also likely when I’m that ill that my idea of responsibility is dangerously different to what healthcare professionals consider responsible. As soon as I am able to safely take responsibility for myself…I will, without prompting. Handing over responsibility for my safety to others is often the most responsible thing I can do.
When I am depressed, I struggle to talk to people, especially people I don’t know. I fill with self-doubt & do not believe I am worth the effort. I will probably feel like a burden & I won’t want to waste your time. I will probably think I’m not ill enough to warrant attention. Therefore, despite needing & maybe wanting help, I will be too afraid to come forward. When depressed, I am generally quiet & keep to myself. I struggle to keep occupied/distracted with activities. I struggle to concentrate or focus. My thinking slows & jumbles. I struggle to express myself clearly. I can get frustrated with myself for not being able to communicate & others for not understanding what I’m saying. I feel heavy, like my limbs are made of lead & move slower & struggle to lift my limbs. I am tired all the time & need at least 10 hours sleep to even begin to function. I struggle to eat. It feels burdensome but also I hate myself so much, I don’t deserve food. I hate the way I look, food makes me fat & hideous. I feel like there is so much pressure inside me, like the whole universe has been sucked into & is now trying to exist inside my chest. Like gravity is so extreme an actual black hole has been created within me.
I may have urges to release the pressure & will desperately want to cut myself. The sight of the blood seeping makes it feel like that pressure is being siphoned out. I get urges to ligate. The buzz of the dizziness & the few moments where I feel nothing & do not know who, what or where I am draws me in. Frustration, anger & confusion can cause me to punch myself &/or head bang. It relieves the feeling of pressure in my head temporarily & releases some the frustration. I also feel like I’m knocking some of the bad/evil stuff out of my head. I may also punch or kick solid objects to release the feeling of pressure & anger. I will probably cry a lot & get angry with frustration of feeling desperate.
I can become jumpy/on edge. Loud noises & busy environments (movement & noise) can terrify me & I become confused & disorientated. I lose my train of thought & become bemused by the overwhelming stimuli.
When very depressed, I may well become suicidal. I will usually try to talk about this in the early stages. However, the longer the feeling lasts the higher the risk. I am generally not impulsively suicidal when depressed (mania & mixed is different). I will have built up a plan & likely have a plan b. The day before a suicide attempt I will probably try to act normal. I become deceitful in order to be able to carry out my plans. I will have been desperate & will see no other way out. I will genuinely believe everyone will be better off with me gone. I will believe I have ruined lives by existing. I will feel despair over the prognosis of Bipolar. Once I have decided to kill myself I will probably keep trying to complete it until I either succeed or my mood is significantly improved. I will not believe my mood will improve or will focus on the fact that even if it does improve, I’ll end up back in the same position again soon anyway. I have a history of attempting suicide by overdose & ligation. Both are still very big risks. Overdose, ligation/hanging & throwing myself off a large bridge/building are my most likely methods.
If I am psychotic I am unpredictable, so I may be at risk of throwing myself in the river or in front of a train. I may also have increased anxiety.
When I am manic, I talk a lot. I can’t stop talking & struggle to hold the words back. This sometimes manifests as excessive tweeting if there’s no-one around. Every thought seems desperately important & has to be spoken. My thoughts race so fast I struggle to grasp on to them. It feels like a part of brain is spinning so fast it might go into orbit. My speech gets fast often to the point of incoherency & I can be exhausting to be around. My words often start to slur into each other. I get easily distracted & this is often reflected in my ramblings. I can change subject randomly & without warning, often mid-sentence. I become very animated, literally jumping up & down randomly & may use my whole body to gesture as I speak. I may stop mid-sentence as I completely lose the thread of what I was saying. I can walk unnecessarily fast & get frustrated with people who don’t keep up with me. This also applies when they speak too slowly for me & they can’t understand what I’m saying. I may dance down the street or in the shop. I may struggle with inhibitions & not recognise I am being inappropriately physical with my partner in public places. I may feel so elated, happy & giddy that no-one can bring me down. I feel magical. Invincible. I lose perception & judgement, I struggle to recognise when to cross the road without being run over. I am unable to concentrate or focus on anything for more than a few minutes. Everything interests me then just as quickly bores me. I struggle to sit still. I become silly & playful. I find everything funny.
I can become confrontational, arguing with any point & refusing medications. If I am having a “positive” manic experience I may not believe I need medication & may well refuse PRN. I will become defensive & argumentative about it. I may say “You don’t want me to be happy” & I will genuinely believe there is nothing wrong with me & that you just want to control me. As my judgement is impaired, I may believe I can do things without considering the consequences. I will likely want to buy lots, that I can’t afford. I am at risk of booking flightsabroad. I often have the urge to go out partying & get very, very drunk. I also get agitated. Every thing winds me up, especially when things are too slow. I get restless & irritable. This can build to irrational/random anger & even rage. I mostly shout or take my anger out on solid furniture. The rage can leave me trembling & desperate to hit or throw things.
If this is not all recognised & managed quickly, it can rise to, what I call, my “manic panic.” Here I end up feeling like there is so much cosmic energy trapped inside me, I can feel it literally buzzing/fizzing inside of me. I feel like my body cannot physically contain this energy & it is trying to explode out of me. I start off itching, I will pace & scratch at my skin until eventually I will start trying to rip/tear my skin off my body. By this point it is all too overwhelming & distressing & I will probably have an almighty panic attack involving sobbing & hyperventilating…& still trying to peel my body away from the energy. I can become impulsively suicidal at this stage & any method to hand is possible.
When I am in a mixed state, I can sometimes experience a very confusing combination of “opposite” symptoms simultaneously, such as elation & sadness, excessive energy & lethargy. I can rapidly cycle between elated euphoria to irritable anger to agitated depression. I can go through a variety of these states in a single day. I can be restless & easily frustrated. I can be excessively bouncy, happy & talkative but become irritable & even suicidal. I can be fidgety, unfocused & short tempered. I will feel guilty for getting angry for no obvious reason & can become very weepy. When I am in a mixed state, my risk of self harm & impulsive suicidal tendencies increases dramatically.
I have a history of psychosis, usually related to extreme mood states. Much of my psychosis is based in paranoia. Initially I usually get an increased sensitivity to smell. Strong smells can be overwhelming. I then hear voices &/or music coming from ‘somewhere else,’ e.g. behind or next to me or another room. I may start to see things, usually shadows of people. I have seen fully formed people, animals, insects, water & anthropomorphous objects start to talk, such as a talking “frog” sink. If I am manic or mixed, I can experience ‘delusions of grandeur’ where I believe I am someone special such as a goddess. My psychosis when I am depressed is more paranoid & deprecating, such as ‘evil’ & ‘torturing’ hallucinations & voices.
A recurrent psychotic element for me is a paranoid & persecutory delusion. I can believe ‘alien’ beings that somehow take people’s souls to torture them can take over the human body like a parasite. I become fearful (for various reasons) that they are after me. I may also be concerned for my family & friends’ safety. When I am experiencing this, I am generally terrified. Making jokes or belittling my experience is likely to make me believe you are one of ‘them.’ I associate the colour yellow with ‘them.’ ‘They’ all wear yellow, but not everyone wearing yellow is one of ‘them.’ I can believe that yellow vehicles are surveillance vehicles for ‘them.’ I call them the Yellow Ones or YO’s. I have believed that they have infected me & that they have put a tracking/transmitting/controlling microchip implant inside me. I have attempted to cut the ‘microchip’ out of my chest. I find purple to be my ‘safe’ colour as it is opposite to yellow on the Colour Wheel. I feel protected by purple & will wear purple clothing like armour. I may surround myself with purple items. I will often wear a purple hat when I feel most threatened by ‘them.’
I take 800mg of Lithium Carbonate (Priadel) every night (about 10pm). This helps to keep my moods stable & less severe. I take 0.5-0.75mg (depending on availability) of Haloperidol 2 times a day (12noon & 6pm) plus 1 available for PRN. This helps to keep my moods stable & takes the edge off mania, agitation & extreme distress. I take 100mg of Quetiapine at bedtime. This helps to stabilise moods, minimise psychosis & enables sleep. I can use 25mg as PRN when Haloperidol has not been sufficient. I take 7.5mg of Zopiclone every night at bedtime to aid sleep. I cannot stay asleep without it. I am prescribed 2mg of Diazepam up to 4 times a day as PRN. This is used for severe anxiety, severe distress, ongoing agitation & to calm symptoms of mania.
10-20mg of Citalopram has been an effective anti-depressant, bringing me out of severe suicidal depression in as little as 10 days. But it must be stopped as soon as my mood levels out or I am at extremely high risk of swinging into mania.
Edit 6/11/16: Current medication is 800mg Lithium Carbonate, 250mg Quetiapine modified release (reducing by 50mg per week) PRN diazepam
Edit 6/11/16: Citalopram had no effect on recent depressive episode. Currently on anti-depressant 125mg Nortriptyline.
I need 1-2 sachets of Movicol (or similar) a day whilst taking Quetiapine as it makes me very constipated. I cannot take Trifluoperazine as it causes severe tachycardia.
Update 12/10/17 I take 800mg Lithium & 125mg Nortriptyline. I require 1-2 sachets of macrogol every day. I have PRN Diazepam. I also use PRN 5mg Procyclidine to deal with side effects such as tremor from the Lithium & Nortriptyline.
Food & Drink:
My eating can become disordered. I may stop eating & find it a particular struggle to eat in front of other people (especially strangers). I am unable to eat onions, peppers & unprocessed/uncooked tomatoes. They give me bad stomach cramps, excessive gas, severe indigestion, bloating & often diarrhoea. I cannot eat banana including banana extract as this causes stomach cramps, bloating, nausea & even vomiting. I do not like mushrooms, broccoli/cauliflower or cabbage.
I struggle with textures. I enjoy the flavours/juice of oranges & pineapples but the actual fruit texture makes me gag.
My favourite foods are pizza, burgers, cake & ice cream.
I like to drink Pepsi Max, or diet Pepsi/coke, water, orange juice (no bits), apple juice, mango drinks & milk. I do not like tea or coffee. I will sometimes enjoy hot chocolate or Horlicks light.
Drugs & Alcohol:
I have never smoked & have no interest in it. I do not like being around smoke as I struggle to breath for several hours afterwards. I tried 1 puff of marijuana once when I was 18 but had an allergic reaction to it. I have never touched any other illicit drugs.
I do not drink alcohol unless my partner & I agree together that I have been stable for a while & that a drink or 2 is safe for me.
Interests & Employment:
I enjoy doing arts & crafts, in particular I enjoy colouring in. I also enjoy reading or listening to audio books. My favourite book series is Harry Potter. I also enjoy watching films & TV series. My favourite TV series in Charmed. I do not have a favourite film but I enjoy fantasy/magic based stories & comic book based films such as X-Men & the Avengers series.
I like to listen to music & have very varied taste. I particularly enjoy music by Rachmaninov, Queen, Pink, Sandi Thom & Epica.
Update 12/10/17 My main interests are swimming, going to the cinema & playing tuba in a brass band.
I love tattoos. I have 5, 1 on each wrist/forearm, 1 on each upper arm & 1 on my chest over my heart.
I have a music degree which I studied for 4 years in Cardiff. I play(ed) the viola. I was a violin teacher for 18 months before I stopped enjoying it & I became too ill to work. I have worked as a Healthcare Worker in forensic mental health. I completed my 1st year of Adult Nurse training before becoming too ill to continue.
I am hoping to be a volunteer in a day centre working with people with Alzheimers. I would like to continue my nursing studies one day, but would be content being an Auxiliary Nurse. I would also like to study to be a Rodent Health Advisor (RHA) & eventually a Rodentologist (GBAR)
Update 12/10/17 I became too unwell to work as a volunteer working with people with Alzheimer’s. I also realise that my goal to return to nursing may be unrealistic. I would like to work with animals in some capacity.