Wednesday, November 4, 2015

What if . . .?

A short article in the January, 2015, issue of The Atlantic, caught my attention. Entitled “Should the U. S. Bring Back Psychiatric Asylums?” the piece cited an article in The Journal of The American Medical Association, that made the case for doing just that.
The article struck a tender nerve in me. When Parrish was alive, his father and I often lamented the dearth of long term facilities for patients like him. He couldn’t manage his own life, and all the love and support in the world didn’t make his life easier for him—or for us. He needed to be in a sheltered environment where he could be monitored and medicated and treated humanely. Originally, the word “asylum” was associated with shelter and safety, a refuge of compassionate care for the chronically psychotic. 
Historically, state run asylums were reportedly places of less than optimal care. There were instances of neglect, brutal treatment, and dehumanization of patients. I know of what I speak.
In 1968, in nursing school, I did a psychiatric rotation in a mental hospital in Florida and was so traumatized by it, I blocked out most of the memories. In a recent visit with a wonderful friend who was in my class, she reminded me of the naked and caged patients who were systematically herded into a group shower and washed down with a garden hose. I remember assisting with electroconvulsive therapy (ECT or shock treatments) that was administered without anesthesia or even sedation. The patients were treated like animals, some of them kept naked because they tried to eat their clothes. 
I remember vividly the conversations with other students about the abject cruelty of some of the staff, not to mention the draconian treatments being administered by medical doctors. We all came away with a sense that such places shouldn’t exist. There had been those who agreed with us for quite some time.
Just a few months before he died, President Kennedy signed into law the Community Mental Health Act of 1963. The act earmarked $150M (a little over a billion dollars in today’s economy) for the establishment of community based mental health facilities. The civil rights movement of that era, along with the newly enacted law and the withholding of federal Medicaid funds for long term psychiatric facilities, began the wholesale dismissal of severely mentally ill patients into the general population. 
The outpatient world was not ready for the influx of chronically psychotic patients into its care. The shiny new community based treatment centers were not yet in place. Many patients were admitted to nursing homes and hospitals where they received intermittent and inadequate care that was much more expensive than inpatient care. Many become homeless and unmedicated, overwhelming halfway houses and homeless shelters. Hospital emergency rooms were overrun with patients waiting for psychiatric beds. Violent behavior among the sickest of the sick increased, and incarceration of psychotic patients became the norm. 
50 years after the passage if The Community Health Act of 1963, there are still not enough community based centers to facilitate the treatment of those who need them. In the state of Georgia, there are 20 facilities scattered over the state, which has 159 counties.  
According to The National Alliance on Mental Illness (NAMI) web page, “Approximately 26 percent of homeless adults staying in shelters live with serious metal illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.” Furthermore, “Approximately 20 percent of state prisoners and 21 percent of local jail prisoners have a ‘recent history’ of a mental health condition.”
Again, according to NAMI, “The lack of safe and affordable housing is one of the most powerful barriers to recovery. When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters and hospitals.” 
Many severely mentally ill persons, as did Parrish, rely on Social Security Income (SSI), which averages only 18% of the median income in the United States. Many—in spite of medication—are incapable of holding down a regular job because of their mood swings. When housing is available, the rent is adjusted to the patient’s income, but it is difficult to obtain. When patients are incarcerated or hospitalized, SSI is suspended, and when they are released, it can take months for the flow of money to begin again. Without resources, they are again forced into homelessness and many are cycled back through the criminal justice system.
Parrish was not only schizoaffective, he was addicted to benzodiazepines and alcohol, a syndrome not uncommon in chronically psychotic patients, who even when taking their drugs as prescribed, self-medicate their symptoms. He was intermittently homeless for the last several years of his life.
While homeless and living on the beach in Miami, in 2009, Parrish incarcerated on the notorious 9th Floor of the Miami-Dade County Jail, its “primary psychiatric unit.” In his book, Crazy: A Father’s Search Through America’s Health Care Madness,” Pete Early describes it in vivid detail. Because of his psychiatric disability, Parrish was imprisoned there as the result of stealing a 12-pack of beer from a convenience store. Conditions there were not unlike those in the asylums that were shut down decades ago. 
In his book, Early reports, “The first six ‘suicide’ cells each contained a combination sink and stainless-steel commode. They also held a bright-blue hard-plastic bed that was built so prisoners could be strapped spread-eagle onto it. There were no sheets in these cells, no blankets, no pillows, no other creature comforts.”
Mercifully, Parrish was turned around and dismissed within three days of his jailing. By a stroke of luck, he met with a counselor who, seeing in him something more than his mental disability, networked him into an outpatient program. He was by far the exception to the rule. 
When Parrish returned to Georgia in 2012, we quickly learned gaining access to the community based behavioral health centers is difficult. Months-long waiting periods for assessment and treatment as well as a paucity of inpatient stabilization beds are the norm. In the absence of funds for private care, the hospital emergency room became his de facto psychiatric care provider.
His life continued to be driven by his schizoaffective disorder and attendant alcoholism and drug addiction, and in January, 2014, he attempted suicide for the second time in less than a year. He was revived on a ventilator, and when he had been in the hospital for five days, the doctors at the hospital refused to send him home with me, insisting instead on transferring him to Savannah Regional Hospital, the community based facility which incredibly serves 24 counties. I was granted full guardianship of Parrish in April of 2013, but no one honored it, not even the doctors charged with his care. That doctor broke the law by not allowing me to make Parrish’s health care decisions, and I was powerless to do anything about it. Having heard Parrish’s descriptions of his treatment in the very facility he was being discharged to, his father and I would happily have admitted him to a private facility if given the option—damn the cost of over $800.00 a night.
Parrish was carried away by a sheriff’s deputy in handcuffs and ankle chains, like a prisoner, not a patient. He was in Savannah for a week, and when I picked him up, he had no discharge plan, but he did have a prescription for the very medication he took in his suicide attempt. He also had one for enough Valium to kill himself. Not stabilized on his medication, he ended up spending a month in the crisis stabilization unit of Gateway, the local community based behavioral health facility. 
After that stint in the stabilization unit, I made the decision, with the full support of his father, to bring Parrish home with me and find a way to make it work. I was terrified he would succeed in killing himself, or worse, be killed by someone else.
After his dismissal, Parrish was admitted to an outpatient program called ACT (Active Community Treatment). He was assigned a team composed of a psychiatrist, social worker, peer counselor, nurse and addiction counselor, was somewhat effective. The psychiatrist saw Parrish twice a month for a while, trying different medications. The team members were a mixed bag. His addiction therapist was the strongest member of the team, and she often saw him more than the required once a week. His social worker wouldn’t come in the house because she was afraid of my small dog. The nurse came in fits and starts, and Parrish saw his therapist once a month for a few minutes. That level of care may be sufficient to keep some patients at home, but it wasn’t for Parrish. He needed long term inpatient treatment. We tried, we really did, but here were frequent visits to the emergency room for symptoms of severe mania. 
There is an unmistakable pattern in this story. Not only was Parrish marginalized by the “system,” I was also. I was systematically denied my rights and responsibilities as Parrish's guardian. Doctors and law enforcement personnel routinely broke the law when they refused to allow me to speak for him. Once, I was prevented from being in the room with him by a police officer in the emergency department.
He was hospitalized several times during 2014, mostly in a private facility, but his final admission, after an extended period of extreme mania and another encounter with the police (who refused to even glance at my guardianship papers), was to the Gateway crisis stabilization center on January 7, 2015. I will forever regret that decision. 
He was heavily sedated, which is not uncommon in the stabilization of mania. The hope is to sedate the patient and gradually decrease the medication over a few days or weeks, hoping he will cycle out of the manic phase. I believe the staff at Gateway, charged with his care, failed to monitor Parrish’s condition closely enough. Late in the morning of January 7, he was discovered to be in respiratory distress and taken by ambulance to the local emergency room. He died less than 12 hours later, connected to a respirator.
According to the autopsy report, Parrish died of pulmonary edema secondary to a multi-drug overdose. Pulmonary edema is the build-up of fluid in the spaces outside the blood vessels of the lungs. It is almost always caused by a heart problem, but Parrish’s heart was healthy. Autopsy revealed that both of his lungs were so congested with fluid, they each weighed twice as much as normal.
I am not equating Parrish’s treatment with the horrors I witnessed as a young woman, but it is clear to me he wasn’t monitored as closely as he needed to be. His condition might have been recognized earlier if anyone had routinely listened to his chest. Gateway certainly failed Parrish and everyone who loved him. But it wasn’t only Gateway who failed him. There is a sound argument for having in place facilities for the long term, even permanent, care for the severely mentally ill who are not functional. 
Yes, I am advocating for bringing back the asylum. There are those who cannot, even when they try as hard as they can, manage their own lives and whose loved ones are unable to cope. Ours was a classic example of such a calamitous and intractable situation. I don’t think I’ve ever felt as powerless as I did during the last year of my son’s life.
    What if, in 1963, some of the monies earmarked for community based centers were instead used to close down the worst of the asylums and clean up those remaining? As Parrish got sicker and sicker, what if his father and I had the opportunity to provide him access to a place of sanctuary, refuge and compassionate care? I certainly don't support the wholesale institutionalization of the mentally ill. In today’s world of better medications and therapies, it’s simply not needed for most patients. But I believe Parrish would have benefited from long term, and not necessarily permanent, inpatient care. I believe it would have saved his life.

Copyright 2015 cj Schlottman

Friday, July 3, 2015

Fire the Paralegal and Hire Me

I had thought to end this blog with my last post, but the story of Parrish is hardly written. For the last two months, I have been trying to learn what happened to him, why he died so suddenly of what was apparently a total body shut-down. 

At first I was too sad and tired to even try. I spent 10 weeks hiding from the inconceivable truth that my son, my only child, was dead and no one could explain why. I discovered Netflix and spent hours—day and night—binging on dramas that were so sick and violent, they took me outside of my head. I drank more vodka that I should have. I stopped getting dressed and wearing makeup and ate Reese’s Peanut Butter Cups by the pound. I gained weight. I cried a lot. I was a mess. I woke in the night, my head aching as though there were rocks rolling around crashing against my skull.

About two months ago, I woke up. I got mad. I got “I want to kill somebody” mad. I started actively working to learn something—anything—about what happened to P. I checked with the law firm and learned they hadn’t received any of the records they requested. I began to work at getting the information myself. I left messages with the coroner and the police officer who opened a case on the night of P’s death. None of my calls were returned. I became obsessed. It was as though I didn’t exist to those people. 

I, the grieving mother, couldn’t even get anyone to take my calls.  I continued to obsess. I called five separate numbers for the facility, three of which dead-ended at voice mailboxes with no names and that were full. I Googled the acting director and called his number. At least the voice mail greeting included his name and the box wasn’t full, so I left yet another message.

Miracle of miracles, I got a call back in less than an hour. I made my request to the clerk on the other end of the line, and she assured me the records had been delivered to the law firm. I asked her to send them again. That was Friday afternoon. The records were delivered via fax on Monday morning.

Feeling empowered by my small success, I continued to call the coroner’s office, and on every occasion, a very nice woman said she would have someone call me. No one did. I finally, at the suggestion of a friend, called the Probate Court to see if they could help me, as P’s legal guardian, get my hands on his autopsy report. The very kind clerk didn’t have any tips for me, but she did provide me with the name and phone number of the president of the Coroners Association of Georgia. 

So, I called him. I called him and ratted on the son of a bitch who refused to respond to my requests. I squealed on him like a little pig. The kind man expressed surprise at the treatment I was receiving and promised to look into it. 

Then I got in my car and went to the police department to get a copy of the report of the case that was opened on the night of P’s death. Police reports are public record, and anyone can obtain copies as long as the cases are not active, a fact I learned from surfing the web looking into the Georgia Open Records law.

I tucked the paper into my folder of notes, and as I was walking toward the door, turned and asked the clerk how I could go about getting a copy of the 911 incident report generated when P was taken to the hospital. She directed me to the fire department, which was conveniently located two doors down, and guardianship documents in hand, I presented myself there. 

The fire department made copies of my papers and my driver’s license. They were kind and sympathetic, but their computers were down. Paranoia bloomed in the back of my brain. What this yet another roadblock being thrown up in my face? I almost started crying. The clerk took a look at my face and called a lieutenant from the back to talk to me. I spilled my story all over him, and, astonishment in his eyes, he promised to call me the minute they could print out the information I needed. 

Then I asked him if he knew how to get my hands on the autopsy report. He didn’t know but promised to look into it and call me the next day. I left, feeling a little spark of hope, and turned back toward The Island. My phone sounded before I got to the causeway. It was the nice lady who answers the phone for the coroner! She suddenly had information for me. Did the president of the Coroners Association give them a ring? I’m choosing to believe he did. She gave me the name and number of a clerk in the medical records department at the hospital.

"Just call her, honey. She can help you."

It was too late to call when I got home, so I had to wait until the next morning. Before I could make the call, the nice lieutenant from the fire department called to say the 911 report was available, and he also gave me a name and a number in medical records. When I called, the clerk told me to bring my ID to her department and sign a form, and the autopsy report would be mine. Who knew? Why in the name of hell didn’t the coroner’s phone-lady just tell me that when I started calling her weeks before?

I decided to drive out to the fire department first. Report in hand, I returned to my car and sat in the parking lot reading it. After three lines, my mouth fell open. By the time I finished, I was weeping as violently as I did on the night of January 17, when P’s heart stopped. Air conditioning blowing into my face, I dropped my head on the steering wheel and wept until I was all wept out. All of my wounds were ripped open. I thought my heart burst. A full ten minutes later, I could see well enough to drive to the hospital.

It only took a few minutes to get the autopsy results. I slid the form into my folder, afraid to look at it until I could get home and pour a vodka. I read it through, then I read it through again. My paralyzing sadness morphed into a rage I have never known. I snatched a pillow from the sofa and screamed into it. I screamed until I was out of breath and the pillow was wet with drool. Then I collapsed onto the sofa and the tears returned. 

I woke in the night, unfolded myself and sat up. For a moment, I wondered where I was. It struck me in the head like a physical blow—the  reports, both of them. I stumbled to the bathroom and brushed my teeth before climbing into bed. I slept fitfully and woke early. I reread the material. 

Because we have engaged professional legal advice, I can’t share any of the facts I uncovered. I can tell you, though, that I have an unsigned death certificate that in no way bears out the facts learned at autopsy. My next project is to go back to the police department and demand to see a detective. I want someone to explain to me why the “case” opened on the night of Parrish’s death was closed the next morning.

I need a break, and I’m leaving in the morning to attend Rosemary Daniell’s Annual Zona Rosa Writer’s Retreat on Tybee Island.

Happy Fourth of July.

Copyright 2015 cj Schlottman 


Monday, May 18, 2015

What Happened?

Nearly a year has passed since my last post on this blog. After two suicide attempts during the first four months of 2014, Parrish’s mental health declined. As hard as I tried to convince myself that things would be better, his manic episodes became more frequent and severe. He asked me to stop blogging about our life. He was ashamed and embarrassed about his illness, so I agreed.
In spite of his brain syndrome, schizoaffective disorder, there was a palpable goodness about him. He was kind and gentle and generous and had impeccable manners. He was a Southern Gentleman plagued with a mental disorder that sometimes masked his goodness. Everyone who knew him as a child remembers him as the happiest little boy imaginable. Nonetheless, his illness was progressing.
He used alcohol to treat his manic episodes, and for a while we used a breathalyzer to discourage drinking. Before long, though, when I asked him to blow into it and he had been drinking, he exploded with paranoia and began railing against me for all my past sins, real or imagined. I spent too much energy being angry, not just at Parrish but at his disease—the unfairness of it, it’s intractable hold on him, the toll it took on me. I am ashamed of how many times I lost my temper.
I resorted to putting a deadbolt lock on my bedroom door and wearing the key on a plastic spiral bracelet in order to make sure he didn’t get his hands on any unauthorized medication. All this I did in an effort to protect him from himself, to throw roadblocks in the way of his efforts to treat his pain, his unrest, his feelings of guilt and unworthiness. But I was as powerless over his bipolar symptoms and his drinking as he was.
The summer was hard. Parrish took long bike rides around The Island, trying to burn off some of the energy, the manic force that filled his head with racing thoughts and the desire to drink. Sometimes he got relief, but at others he arrived home in the same state of unrest and confusion he had tried so hard to overcome. 
He saw a therapist and an addictionologist every week. There were medication changes and short periods of improvement, but his internal battles continued. When we moved into this house, he often told me it gave him a sense of belonging. I thought he would stabilize and feel grounded, and have a sense of permanence, and for a while, it seemed to be. 

There were good times. Often we drove to The Village Pier to see Lawrence, his father, the senior active harbor pilot for the port of Brunswick, board the pilot boat and go out to sea and bring in a ship. One day in July, we rode 12 miles out with him and watched him climb the ladder to the ship’s elevator, which would take him to the wheelhouse to assume command of the ship. Parrish was very proud of his dad, but it was a bittersweet pride. He felt guilty because he wasn’t able to become a harbor pilot, a profession that is traditionally passed down from father to son. While in college, he was a boatman for his dad, but he wasn’t emotionally equipped for the dangerous job. We were never able to assuage his feelings of not having measured up.
We frequently drove down to The Village for yogurt and ate it on a bench overlooking Saint Simons Sound. We had supper at a restaurant overlooking the water at least once a week.  I have always believed in the healing power of the ocean, it’s steadfastness, the negative ions it produces that soothe our souls and calm our minds. Every now and then, this sweet and tortured man’s spirit could be lifted by the salt air.

There were also periods of dark depression when he spent days in bed, sleeping almost around the clock, arising only to eat a bowl of cereal or some other snack. And there were angry outbursts, periods of confusion and days without sleep. I armed the security system at night in case he got up and left the house without realizing it. It sounded at 4:00 AM one morning early in September, and when I found him standing in the carport, he had no idea why he was there. 
October was a sine curve for us—extreme episodes of angry mania graphed against low troughs of depression. By the third week of that month, Parrish’s behavior was so erratic, I was afraid for his safety. So, his doctor admitted him to a private behavioral health facility, where he stayed for nine days. At first he was heavily sedated and monitored carefully. Then the sedation was gradually lifted, and he came home more in control, more himself, though he continued to struggle.
One day soon after he got home, when he was sober, he sat down in the chair across from me in the sunroom, where I was reading the paper. Manic, his heels worked furiously against the floor and he shifted in his chair.
“Mama, I know you get mad when I drink. I don’t blame you, but you just don’t understand. It’s not about you. I love you more than anything in the world, and I never want to hurt you, but I end up doing it anyway, because I am so sick!”
He took a long pull on his cigarette. I remembered other times when he told me much the same thing. Maybe he was right. Maybe I just didn't get it.
“Nobody wants to feel the way I do—nobody. When I’m manic, I can’t concentrate long enough to read a book or watch a TV program. Who would want this? I feel guilty that I live at home with my mother at age 45 when I should have a decent job and a family of my own. All I want is to be halfway normal. When the noise in my head gets so loud I can’t think or hear or focus, I will do anything to make it go away, even for a few minutes. I can’t smoke a whole cigarette without putting it out and looking for some other distraction. I can’t sit still or have a clear thought about anything because of the tornado in my head.”
I sat across from him and watched helplessly as he knuckled tears of frustration from his handsome, tortured face. 
“That’s when I drink. At the risk of damaging my relationship with you and Daddy, even at the risk of my own safety, of going to jail, I drink because for a little while—just a little while—the noise in my head goes away. Even if it only lasts a few minutes, it’s worth it. But then I can’t stop drinking, and you know what 
happens next. I’m just drunk and angry and sad and sick and manic, and the noise is back. Sometimes I want to die; I really just want to go to sleep and not wake up. You think if I just don’t drink, everything will be okay. If everything was okay, I wouldn’t need to drink! Don’t you see? My brain is broken in a million pieces.”
I got up and walked over to where he sat, heels still pounding the floor. He stood and gave me a halfhearted hug. It was the best he could do.  
“I’m so sorry, P. I’m so very sorry. You’re right. I can’t know how you feel. But I can accept what you say. It’s your reality, your truth, and I’ll try to be more patient. I know it’s unfair for me to get mad at you and lose my temper when it’s your illness I hate, not you. I couldn’t love you any more than I do, but I’m beginning to understand that loving you won’t make you well. We can’t give up, though, we have to keep looking for a plan that will work. And you know I have to ask, are you feeling suicidal now?”
“No,” was his reply, and he dismissed my suggestion that he call his psychiatrist. 
There is something so wrong about not being able to help one’s own child. I was overcome with helplessness and, yes, guilt. Earned guilt? No, I didn't make my son sick, but the mother in me grappled with the notion there was something I was missing, something more I could do to make Parrish’s life better. I never stopped believing if I just loved him enough, there would be a miracle.
There were a few weeks, from mid-November until mid-December, when P was sober and focused and calm. Always attractive, he was even more so without alcohol in his system. He dressed every day in crisp khakis and colorful shirts and sweaters that made his blue eyes sparkle. On cold mornings, he delighted in building a fire for us to share. I can’t explain why we were given that time, but I will forever be grateful for it. He was on a new medication, and maybe that’s why we had that incredible, peaceful reprieve. Our friend Marnie came for Thanksgiving. Friends from high school, they fell in step and really had a good time. We had friends over on Thanksgiving night, and they were taken by Parrish’s charm, his impeccable manners, his sense of humor and his obvious intelligence. It was the best Thanksgiving for me in many years.
I was hopeful we had found the answer, the right medication, but in mid-December, he started drinking and was soon in crisis again. So, he went back to the hospital on December 20, for three nights. He was little improved when he was dismissed, but we all wanted him home for Christmas. His dad came over, bringing gifts (which were carefully chosen by his incredible wife, Melissa), but Parrish was unsettled, unfocused, suffering an inner turmoil that was visible on his face. He couldn’t enjoy the day, the time together or the gifts. When the paper and ribbons had been stuffed in the trash and the gifts organized, he excused himself and went to bed. 
On January 5, Parrish rode his bike across the Torras Causeway, a four lane road that spans the salt marsh between Saint Simons Island and the city of Brunswick on the mainland. Motorists routinely exceed the 50 MPH speed limit, even when crossing its five bridges, one of which arches a half mile across the Mackay River. It’s a dangerous ride, even with the bike path that’s provided. He presented himself at the hospital emergency room and asked for help to calm his extreme mania. 
He was released to me after an inadequate dose of medicine and was just as sick when he got home as when he arrived there. Two days later, having not slept since returning from the ER, he had a manic episode that once again sent him for impatient stabilization. That time, he was admitted to the state-run facility in Brunswick.
We spoke on the phone every day. He was deeply sedated and thick-tongued, but he could organize his thoughts a little, and with some effort, I could understand part of what he was saying. He never hung up without telling me he loved me, and I always told him back. It was something we did, even when things were at their worst. I was concerned about his level of sedation, but when his doctor called me to report on Parrish’s progress, he assured me he was decreasing the medication dose and Parrish would soon be more alert, and he could start thinking about letting him come home.
On January 17, ten days after admission, his doctor called to say Parrish’s respirations were rapid, and he was sending him to the ER for evaluation. It was a little after 11:00 in the morning.  Going to the emergency room had become part of our life, and I wasn’t alarmed. It’s not uncommon for bipolar patients to have rapid and shallow respirations, even hyperventilate. I waited a reasonable length of time for the staff to get him settled, then called to check on his status. His nurse said couldn’t talk; she was busy taking care of him. 
There was no trace of urgency in her voice, but as I hung up the phone, my breath caught in my throat. Something was wrong; I could feel it at my very core. Anxious, adrenaline pumping, skin prickling, I grabbed my purse and drove to the hospital and repeated to myself, He’s okay, he has to be okay. He’s always okay, not matter what happens, he’s always okay. He survives, always survives. 
I arrived at the ER to find my son in a coma, a tube snaking out of the side of his mouth, taped to his cheek and connected to a ventilator. Monitor wires and cascades of IV tubing cluttered the space above him. His wrists were tied to the sides of the bed with thick brown leather restraints, and his abdomen was grossly distended and hard. He was completely unresponsive, even when I climbed under the tubing to kiss is sweet face and put my lips to his ear and assure him everything was okay.
“I’m here, P. It’s Mama. A machine is breathing for you so you can get better. You’re going to be just fine.”
As a nurse, I could see from the numbers on the monitor his blood pressure was barely enough to sustain circulation and his oxygen saturation was too low to support his vital organs. A chill shot through me. I opened his right eye and saw a spark of hope when the pupil reacted to the light in the room.
“What happened?” I looked at the nurse who stood on the other side of the bed, eyes fixed on the bedspread. “What in the name of God happened to him?”
She looked up. “He has severe pneumonia and an intestinal obstruction. I’ll get the doctor for you.” Her face was kind and sad.
I climbed back under the tubing and reached for Parrish. I held his tethered hand and leaned close to tell him how much I loved him. It didn’t occur to me to ask why he was tied to the bed when he was clearly unconscious.
The doctor stepped into the room, his expression solemn and drawn.
“What is this? What could possibly have caused this shutdown?” I croaked.
“Mr. Gray’s lungs are completely filled with pneumonia, so we’re breathing for him. He has an intestinal obstruction, but he’s too critical to operate. We’re going to move him to ICU and see if he can rally. It doesn’t look good, though. He’s a very sick man.”
The voice in my head chimed in. He has to be okay, he’s always okay. He’s been near death before.
“But how did he get so sick so fast? I just talked to him yesterday.”
He just shook his head and said, “We really have no way of knowing at this point.” 
Shoulders sagging, arms dangling at my sides, I stood and stared at this man who offered me so little hope. My stomach lurched at the wave of realization that this time could be different. Parrish might not come back from this sudden and devastating medical emergency.
“But what happened?” I repeated. I was too stunned to formulate the questions that would give me meaningful answers. Did Parrish stop breathing in the ambulance or after he arrived at the hospital? Was he conscious when he  got there? Did he say anything? Was he in pain? What caused the obstruction? Utterly alone and terrified, I stood mute, paralyzed. I cradled my face in my hands, then looked back up at the doctor, whose voice had become distant and faint. What was I hearing?
“Should I call my family?”
“Yes.” he said. “I’m very sorry.” Then he was gone.
I stood in the doorway of Parrish’s room and punched Lawrence’s number into the pad on my phone. I told him where we were and about the ventilator, but I didn’t say I thought P was dying. I wasn’t sure I believed it myself. He came right away, and while I waited for him, I called my brother and some other family members who all repeated the question that was whirling around in my head. What happened? 
While the staff moved Parrish to ICU, I waited in the parking lot for Lawrence. When I saw his car pull into a parking space, I ran to him and all my resolve to stay calm melted away.
“He’s not going to recover this time,” I blurted into his shoulder. “His lungs are so full of pneumonia he can’t breathe and he’s going to die.” My heart was swollen with fear and shock and disbelief at my own words. My breath came in short spurts punctuated by deep sighs.
In his gentle way, Lawrence said, “There’s probably something they can do for him.” His face was pale, and I could read the same fear in his eyes that I am sure was in mine. 
“You should call Melissa and tell her to come,” I squeaked.
“Maybe they can do something . . .”
“You’ll understand when you see him,” was all I said.
We went to the waiting room to sit and wonder. We spoke in whispers as though saying it all out loud would make it true. I tried to prepare Lawrence for the sight of his son, completely unresponsive, skin dusky, belly distended, tubes everywhere. Melissa arrived, kind and comforting, the strong one we both needed. Time passed, I don’t know how much, but I finally got up and walked down the hall and rang the bell of the intensive care unit. A nurse responded and said we could all come in. Lawrence stopped in the doorway of Parrish’s room and a sob, almost a keening, rose from his throat, and I thought he might collapse. 
“Take a breath,” I said. “Go over and take his hand. Talk to him, tell him you are here. You too, Melissa. He needs to know we are all here.”
And we took turns talking to P, assuring him that he would be okay. I know he heard everything we said. I am absolutely certain of it. Every time one of us talked to him, his blood pressure and oxygen levels improved marginally, then returned to their unpromising baselines. Yes, he knew we were there.
Denial is a powerful emotion. I could not process the truth and instead began to prepare for a long siege in ICU after which P would be coming home. Melissa drove me to my house, and I gathered a toothbrush and my medicine and dropped them in my purse. I sat down on the blue loveseat in the den and smoked a cigarette, made a couple of calls, caught my breath. It never occurred to me that Parrish might die before we got back to the hospital.
We had been home for about 45 minutes when we started back to the hospital. Five minutes into the drive, my cell phone buzzed. It was the nurse, urging us to come back quickly.
I rushed into the room to find P still alive but with monitor readings indicating he was fading. We continued what was by then, undeniably, our death watch, taking turns with Parrish, doing everything we could to comfort him and one another. The nurse came in and untied P’s hands. Why were they tied in the first place? Was he struggling in the ambulance or after he arrived at the ER? I sat at his side and used the tail of his hospital gown to blot my tears and wipe my nose.
We tried not to weep, but we did, our faces stricken with shock. We held one another. None of us could sit down for more than a few minutes. The three of us shared one Coke, and we never finished it. I couldn’t keep my eyes off the monitor. I wanted to throw a blanket over it, or better yet, hurl something at it, break it. But I kept staring, thinking I could will the numbers to change.
I have never missed Clint as much as I did that night. I wanted him there to wrap me in his arms and protect me from the unthinkable reality of P’s dying. I wanted to cry on his shoulder, bury my face in his neck, feel the incredible warmth and love of him. Even with the love and support of everyone in the room, I felt hopelessly alone.
A few minutes after 9:00, face buzzing with fear and feeling as though my head would explode if I didn’t get some air, I took the elevator downstairs to the cold air of the parking lot and lit a cigarette. After two puffs, my cell phone sounded, and I knew. 
“Come quick,” Lawrence whispered. His numbers are worse.”
I scrambled back upstairs to find that Parrish’s heart had stopped beating at 9:15. I wanted to crawl in bed with him, put my ear to his chest, listen for any sign of life. The nurse lowered the side rail for me, and I kissed his beautiful face, lay my head on his silent chest, felt as though my own heart would stop beating. Overcome with a sadness so profound I almost forgot to breath, I felt as though I would melt into him.
How could he be dead? How could he possibly be dead when he was alive this morning, when I talked to him yesterday?
I went to Lawrence and we wept into one another’s shoulders, barely able to stand. Melissa embraced us both, but there was no comfort, only shock and despair. 
We stayed with Parrish until the staff was ready to move him to the morgue. Not wanting to see him transferred to a stretcher, covered with a sheet, and wheeled out by people who knew nothing about him—who had never seen him smile or laugh, people who didn’t know he once won $500 in a trivia game because he knew the zip code of the Pentagon, and he could name every county and county seat in Georgia. They didn’t know that underneath all his sickness, he was a sweet and generous soul. We didn’t want to see him carried away by strangers.

I didn’t sleep that night. Four months later, I am still awakened in the night by the vision of my only child on an ICU bed, dying before my eyes. We still don’t l know why he died the way he did. We finally got some professional help to look for answers, but the question remains, “What happened?”

Saturday, May 17, 2014

Red Sky at Night

Photo by James Calemine

Spring began in earnest for Parrish and me about 10 days ago. As the air filled with the fragrance of jasmine and ligustrum, and lilies began to bloom, his head began to clear. His thoughts took on an order I have not seen since he was a young man. The fog of paranoia and anxiety lifted, and his thoughts became more clear and organized. The black smudges of fatigue disappeared from around his eyes, the cables of tension in his brow melted away, and his perpetual frown lifted.

The change seemed to happen overnight, but there were struggles. Two weeks ago, he was drinking, and there ensued the usual aftermath of resentment and paranoia and mania. We were all, including Parrish, ready to give up this fight, feeling as though there were nothing left to do, no way to escape the toxic fallout from his mental illness and alcoholism. We were exhausted by it’s debilitating negative energy, and even my dog, Honey, was skittish and fractious. She refused to let P take her to walk, and when he was at his worst, she hid on the floor between my bed and the wall. I was wading in the edge of an ocean of depression, in danger of being pulled down by its currents into the unthinkable black place I have visited in the past. My eyes were as dark and hollow as his, and his father wore a startled look that smacked of dread and fear. Parrish was riddled with guilt, unable to control his urges to drink. For weeks he hadn’t slept more than two hours at a time, and he often he didn’t sleep at all for several days. As a result, I was sleep deprived as well. 

Thus we arrived at the decision to challenge Parrish to stay sober or find a way to make it on his own. 

“I can live with your mental illness, but I can’t do crazy and drunk. I simply cannot do it any more,” I said to him. 

“Buy a breathalyzer! I need a serious motivator,” he pleaded. “If I know I’ll be tested every time I come in the door, and that I will be asked to leave if I’ve been drinking, it will help me fight the urges. At this point, fear is about the only thing that will stop me from drinking -  if I can stop at all. God! I wish that shot would take effect.” 

Two weeks before that episode, when he was in the Crisis Stabilization Unit (CSU) after his most recent mania-driven suicide attempt, Parrish’s doctor changed his medicine yet another time, still searching for the right mix of drugs for him. He gave him a injection of Abilify Maintena, a time released anti-psychotic that is given once a month. Because of his involvement with Gateway, the local public mental health organization, he the shot was free. The retail price is just under $1600.00. The doctor ordered oral Abilify for him to take for two weeks, hoping to get the drug into his system sooner than the expected waiting period of one month.

Despite not drinking, insomnia continued to be a problem. Parrish’s psychiatrist prescribed sleeping pills, but they didn’t work. After three days, he prescribed a different drug, but it failed as well. Finally, he ordered a trial of Rozerem, a medicine that is relatively new, having been approved for use in the United States only six years ago. The first night, Parrish slept four hours without waking, and we were encouraged.  There followed a succession of nights when he slept longer every night, and he slept for nine hours last night, awaking only once.

Parrish had surgery last week to remove all of his lower teeth. There can be no doubt that pain is activating and that brain chemicals are powerful enough to override sedation and analgesics. That fact was borne out after the operation. Although he was relatively calm before the procedure, he emerged from anesthesia in a frenzy. In spite of the anesthesia, he was in pain and could not relax. 

“Drive through at McDonald’s, please! I need a milkshake.” 

He slurped down the shake in a matter of moments. I hoped the cool liquid would ease his discomfort and perhaps help stem the steady flow of blood oozing from his gums, but the gauze packing in his mouth was soon soaked. He kept taking it out to talk.

“I am so damned glad that is over with! I’m just so damned happy.” 

He repeated that statement a dozen times while his gums continued to bleed, and no manner of encouragement, or even castigation, from me could calm him. He was elated to have the procedure behind him, and his joyous mania overrode any self control he might have had under different circumstances. When there was blood dripping onto the front of his white tee shirt, leaving a pattern of red rose petals, he changed the packing. That shirt made me think of all the times he has flung crazy up all over our flat when drinking and manic, creating a virtual Jackson Pollack painting in angry flames of color. 

When the packing was drenched, he used the box of tissues in my car to stem the flow of blood until we got home. As soon as I unlocked the door to our flat and before I could set down my purse and keys, in a fit of brain overload - mouth still oozing blood - P took the mailbox key and went downstairs to fetch the mail. 

When he returned, I medicated him, but Lortab had little affect on his pain. Extra Xanax did nothing to assuage his anxiety. Medicine doesn’t work on a brain that is as agitated as his was. He continued to bleed, and his daddy and I took turns soaking tea bags and applying them to his mouth. 

48 hours passed before P’s pain was under control and the bleeding stopped completely. At one point, thinking I smelled alcohol on his breath, I had him blow into the breathalyzer. He said he had rinsed his mouth with mouth wash, a brand which is supposed to be alcohol-free. The machine registered  a small amount of alcohol in his breath, and he insisted I rinse with the wash and blow into the device myself. I also tested positive for alcohol. I sagged under the weight of enormous relief. What would I have done if I had tested negative? Kicked him out three days after surgery? 

Since the turmoil that followed his oral surgery, P has continued to improve, and every day I see a calmer, more organized and self reliant man. Yesterday morning, he spent nearly an hour on the phone with Social Security - 45 minutes of that time on hold - to iron out a problem with his disability benefits. He made not so much as a glance in my direction for guidance. A month ago, it would have been impossible for him to handle that situation. He is more composed and less moody. He recognizes changes in his frame of mind and works to minimize them, using exercise and breathing techniques. He continues to experience spontaneous tears even when he doesn’t feel sad.

So, what happened? I believe it was a combination of his will to stay sober - and thus remain living here with me - and the coming together of the medicine in his body in a way that works for him. He is also taking Prozac for social anxiety, and we both see improvement there. A month ago, he couldn’t go anywhere - for any reason - without being overpowered by anxiety. Yesterday afternoon, we went to the Pier Village to meet his father when he climbed up the ladder from the pilot boat after taking out a massive ship. Parrish was excited but not inappropriately so. Before his dad arrived at the pier, we ate an early dinner at the top floor of a restaurant with views of the sound, an activity that up until now was out of the question. The last time we tried to go out to eat was two months ago, and we ended up taking our food home with us because the proximity of so many people drove P into a state of panic and mania. But yesterday, we had a leisurely meal and left the restaurant and walked a few steps up the street to the yogurt shop we now frequent. We got so comfortable that we missed P’s daddy coming off the pilot boat. We were walking down to the pier when he pulled up beside us in is car wanting to know where we had been. It is miraculous that we can go off together and enjoy ourselves so much that we lose track of time.

As for me, I have taken on what feels like a pall of depression, which is temporary, I believe, and not doubt a result of the pressure being off. For months I was the benevolent prison warden, dressed and made-up every day in order to be prepared for the next crisis. Now that I can relax in my own home, I am sleeping 12 or 14 hours a day, writing when I can, doing some editing work when I can. I am choosing to believe that I’m simply exhausted and now have time to give in to my fatigue, let it roll over me like a wave, take me back to myself.

Yes, spring has begun for us. I have been watching a spider lily bloom over the past several days, and it gives me great hope that we are at the edge of a new beginning. Two days ago, the sun dropped down over an horizon that was painted in brilliant scarlet and orange, foreshadowing fair sailing.

On Tuesday, I start art classes.

Copyright 2014 
cj Schlottman

Friday, May 2, 2014

Sunday through Tuesday, April 6 - 8

After a manic Saturday, Parrish slept away most of Sunday. He was depressed and groggy and apologetic, not unlike every time he crashes. He was still depressed and sleepy on Monday, and he didn’t go with me to run errands. He got out of bed when I returned from the grocery store about six o’clock, and he was showing signs of increased restlessness within an hour. He asked for Xanax, and I gave it to him. His mood continued to swing upward and I could sense his desperate attempts to tamp it down. While I peeled shrimp and cooked a pot of grits for his favorite supper, he did exercises on Lumosity, racing through the puzzles.

After a late supper, he tried several times to go to bed but could not relax. So, at around eleven, at his request, I gave him another dose of medicine. He continued to feel energized and too alert to sleep and was up and down numerous times. I gave him his sleeping pill. It didn’t help.

When I went to bed at one o’clock, he was in bed but awake and watching TV. He woke me around seven o’clock on Tuesday morning, saying he had not been to sleep at all. He had finished the kitchen cleanup from last night. He wanted to fix me some breakfast and bring it to me in bed. I asked for a little more time to sleep, and it was nine before he woke me again.

He wanted some Xanax and I gave it to him.

I called The Doctor’s office and secured an appointment with her at three o’clock that afternoon. I am not impressed with her and have since fired her. After she changed P’s medicine and foolishly prescribed Ritalin for him two weeks ago, she went on vacation and was not back in the office until the day we saw her. She left no one on call to care her patients, and we were hung out to dry. I went in with Parrish for the first part of the visit, needing to convey to her what a hard time he was having. Even though I was planning to let her go, I needed to use her for a stop-gap solution while he search for a new doctor.
She looked at me and said, “So, what do you think he needs?”
I had to will my lips to remain closed as my jaw went slack.
“Latuda is clearly not helping his mania,” I said.  He’s been on it for two weeks and has steadily gotten sicker. Can we wean him off it while we start something new?” 
“I think we should double the Latuda and give it more time. I’ll write for two milligrams of Xanax three times a day instead of the Ativan he has been taking and I’ll write for the increased dose of Latuda. Call me tomorrow if he’s not appreciably better.”
“Is there nothing I can give him when he feels the mania coming on, something to knock it down before it gets out of control? We need a plan B.”
“Go ahead and give him another dose of Latuda today, and if he’s not better tomorrow, call me.”
While this conversation was going on, Parrish was squirming on the sofa like a worm in hot ashes. Anyone could see that he was far from okay and in all likelihood would be no better in 24 hours, not without a change in his treatment.

And that was that. So much for a solution. We found ourselves  in much the same situation as when we walked in the door. I left the room so P could have the rest of his time with the doctor. I had sat down on a chair in the lobby and was reaching into my bag for my Kindle when he came through the door, prescriptions in hand. The entire appointment lasted less than fifteen minutes. I paid and we left.
When we stopped at the drug store to fill the Xanax, I gave P his debit card to pay for it, but I went into the store with him. He was too manic and unstable for me to send him in alone. He took the prescription to the pharmacy counter and returned the card to me, saying there would be a twenty minute wait. He milled around in the store, clearly on the edge of a increased mania and was showing signs of paranoia, saying the clerk was rude to him. After a few minutes, he brought the card to me and said he was too nervous to stay in the store with so many people there, that he was going to wait in the car.
I was relieved. When the prescription was ready, I paid for it and we drove home. After I gave P a dose of it, I locked up the Xanax with his other medication. I also gave him his extra dose of Latuda. He continued to soar higher, and by late in the afternoon, he appeared to be drunk. He was confused and delusional and paranoid, accusing me of planning to call the police and have him thrown in jail. I asked him several times if he were drinking but he vehemently denied that he was.  
I assigned him the task of taking down the trash and recyclables, and it took him two trips to the garage to deposit all the items that had piled up in the laundry room. He wanted to take Honey for a walk, but I was afraid for him to leave the building alone and insisted on going with them. He couldn’t sit still or concentrate or focus. He couldn’t eat. He was up and down and moving about the flat at random, dropping into a chair on the balcony or onto the sofa in the living room and bouncing back up. I felt sure he was drunk, but when I searched his room, I found only an old beer bottle that I missed on the last inspection.
During the course of the day, I asked him several times if he were having suicidal thoughts. The last time I asked him, he said, “Hell, no! If I were suicidal, I would walk off the dock into the river and disappear.”
At seven o’clock, I decided to take my laptop to my room and lie in bed and try to write. Parrish was in and out of my room despite my closed door and request for privacy. When I heard a crash in the laundry room, I found him standing on a ladder taking boxes off the top shelf. He said he was looking for his blue sweater. He had unhinged the moulding at the top of the cabinet while dragging boxes down. I talked him down and began to try to formulate some sort of plan.
His father called to check in with us, and after a jumbled conversation with P, he asked to speak to me. I asked him if he thought Parrish were drunk, and he agreed that he certainly seemed to be. All the while I was talking to his father, P was pacing around and accusing us of plotting to send him to Georgia Regional Hospital in Savannah, a hell-hole that he will never again see the inside of, if I have any say in the matter. He began dropping the fuck word and continued to accuse of us of plotting against him. His dad heard Parrish’s outburst and demanded that I hand him the phone.
Their exchange was less than satisfactory. His dad was angry and worried about both of us, and he gave P a stern lecture, telling him to settle down and behave himself. We all know that recriminations are ineffective in dealing with psychotic behavior, but there are times when we reach a tipping point beyond which we, the supposedly sane ones, lose sight of that fact and react in anger. We are all human. I had already lost my temper with Parrish.
After a few minutes, P hung up on his daddy.
“If I’m such a piece of shit and such a fucking disappointment, call that son-of-a-bitch back and tell him I’m going to put both of you out of your misery and take every Ativan I have -  all ninety pills!”
“Don’t be ridiculous, Son! I have all of your medication locked up to prevent your doing just such a thing. Don’t make idle threats about suicide. It’s not a subject to throw around casually.” 
“I’m not making an idle threat! Being dead has got to be better than this. I feel like a piece of shit. You are going to have me arrested, so I might as well die. I will die before I go back to jail!”

“I am not going to have you arrested! The only mention of police has come from you. And you don’t want to die.”
“Yes, I do. I heard you on the phone with Daddy, plotting to have me committed to Georgia Regional.”
“We were not plotting anything, Son. We were trying to figure out how to help you through this without going to the hospital. He are both afraid for you right now and want you safe.”
He walked back into his room and returned a few minutes later. I was sitting at my end of the room in my writing space talking to his dad, and P stood in the middle of the flat, pulled a pill bottle out of his pocket and turned it up into his mouth. I hung up the phone, but before I could reach him, he swallowed about half the contents of the bottle. I grabbed it out of his hand and looked at the label. Ativan two milligrams, 90 tablets - dated that day!

I called 911. Still convinced that P had somehow been drinking all day, I knew that the combination of Ativan and alcohol could be lethal. Then I called his father.
P went into his room, donned his socks and shoes and announced that he was going for a run.
“No! You may not leave this apartment. You must stay here and wait for help.”
He was reeling, barely able to stand, but he was determined to go out the door. So I locked it and stood in front of it so he couldn’t pass. If there is one constant in his behavior, it is that he will never hurt me. He made a crafty effort to get out the door, though. He approached me and asked for a hug. Knowing that he would pick me up and put me down out of the way, I refused his embrace.
A police officer arrived. 
“This is not a police matter, sir! This is a medical emergency. No crime has been committed and we don’t need law enforcement.”

“Ma’am, I am not here to arrest anyone. It’s standard procedure for an officer to respond to medical emergencies. It’s my duty to stay with you until paramedics arrive, make sure you are both safe.”

“Well, I suppose I should let you in.”

“Thank you, Ma’am. Do you feel threatened?”

“Absolutely not. My son may hurt himself, but he will never hurt me.”

Parrish was becoming more sedated and unsteady on his feet, so I guided him to the sofa to sit down. He groused at me, once again accusing me of wanting him to go to jail. The Officer tried to reassure him, as did I, but there was no mitigating his anxiety and anger and delusional thinking. He continued to slow down, though, and became quiet. The Ativan and alcohol had him in their grip.

By the time paramedics arrived, P was semi-conscious, eyes open only a crack. He was slouched back into the pillows on the sofa, his bright green Livestrong shirt glowing garishly against his pale face. His blood pressure was very low. The oxygen level in his blood down. But he roused himself enough to say he would not go to the hospital. He was still convinced it was all a ploy to get him readmitted to the state the hospital.

“Well, Parrish,” said the Man in Charge, we can all sit here and wait until you go out, then load you on the stretcher and take you to get the medical attention you need, or you can agree to go with us.”

“I am his legal guardian! Take him to the hospital!”

“Ma’am, he has to agree to go.”

“No, he doesn’t! As his guardian, I may seek medical attention for him when he is incapable of making a rational decision for himself. Do not let my son slip into a coma right before my eyes.”

“I’m sorry, Ma’am, but the decision is his.”

“Do you not understand what guardianship is? It is not only my right but it is my responsibility to safeguard his well-being. Please take him now! This is my decision, not his.”

“Shu-uh, Mama. You jush wanna puh me away. I hur you onna phone,” Parrish mumbled.

I went to him but he wouldn’t look at me.

The paramedic stood firm in his decision to allow a psychotic man to make this a life-or-death decision.
I fumed visibly and continued to protest, which did not endear me to the EMTs. I didn’t give a shit.

“Parrish, please go with these men. All they want is to help you - please.”

He tried to stand but was unable to. The men held him up and hoisted him onto the stretcher. I went to him and tried to kiss his forehead but he turned his head away.

“Don’ tush me.”

And after he was safely buckled onto the stretcher, they were gone.

So, where did Parrish get the Ativan? Before we went to see his (now former) psychiatrist, he called in a refill to the drug store. When he took the new prescription to the counter, he paid for the refill and put it in his pocket. That’s when he returned his debit cad to me and wet to the car. He was planning all along to take another overdose, but fortunately he got so psychotic and angry that he took it in front of me. Had he remained in his room and taken the pills and gone to bed, I would have left him alone and not known about it until I did my nightly bed check, and it may have been too late. His psychosis saved him.

And the alcohol? His blood level on arrival at the emergency room was 0.225, the equivalent of nine drinks. All the alcohol in my flat is locked under two keys. I can only surmise that he had some hidden in the garage and was drinking every time he went down there. Where did he get the money? He must have stockpiled it before we stopped letting him have any money a couple of weeks ago. And when did he obtain the beer? I have no idea. He could have left the apartment on Monday afternoon while I was out. We may never know. He may not remember. Later, in the the hospital and clearly psychotic, he could not answer my questions about it.
He spent the night in the hospital and was transferred to crisis stabilization on Wednesday afternoon, this time without handcuffs and shackles, thank God. The same Deputy who took him, bound at the ankles and wrists, to Georgia Regional in January, swaggered into the room.
“You Mr. Gray?”
P stood. “Yes, sir.”
“Am I going to have any trouble out of you?”
“No, sir.”
The Deputy frisked P.
“How are you feeling?”
“Better since I got my medicine.”

“You took your medicine? When?”

“About an hour ago.”

“Am I going to have any trouble out of you? Because if I do, I’m going to have to do what I have to do.”

“Officer,” I interjected politely. “He’s not a criminal. He’s sick.”

He shot back, “You the patient?”

“Of course not. I’m his mother.”

He did not make eye contact with me and instead continued to glare at Parrish. His father stood and assured The Deputy that restraints would not be necessary. Ignoring him altogether, The Deputy took Parrish by the arm and walked him out of the room and down the hall. He did not say they were leaving. He did not give us a chance to say good-bye. He did not acknowledge that we were even in the room. I called after them and asked to say good-bye, but he didn’t break stride. I had to trot after them and kiss P goodbye on the fly. 

It rankles the living shit out of me to be ignored when I am the only person who really knows anything about Parrish and his illness. Is everybody in law enforcement and health care unaware that, as his legal guardian, it is my responsibility to speak for Parrish when he cannot speak for himself, even in police matters? And why is mental illness a police anyway? I could have driven P across town and delivered him safely to the crisis unit without all the rancor and drama. I understand, of course, that there are instances when restraint is necessary for everyone’s safety, but why are these people not taught to listen, use their judgement in individual cases? If they don’t have enough sense to assess a situation and act accordingly, they need to be in another line of work.

What happens to mentally unstable patients when they have no one to advocate for them? They are bullied and humiliated by officers just like The Deputy. They are treated as though they are stupid, less than human. Where is the ACLU when this is happening to all the patients they so cavalierly advocated to have turned out of state the hospitals and onto the streets in the early 1980’s, creating an entirely new population of homeless people - the untreated mentally ill? Those the hospitals should have been cleaned up, not closed. Are the civil liberties advocates now too busy protecting the rights of criminals to have time to protect those of victims of a mental health care debacle that has failed them completely? 
Are public servants so jaded, or in the case of The Deputy, possibly racist, (and I understand that racism is an equal opportunity monster) that they won’t listen to a person who might know a little more about the situation than they, a person who has information that could make things easier for everyone? I eats at me that mental illness is criminalized. No wonder the public continues to stigmatize the victims of their own brain chemistries. We are supposed to be an enlightened society, but I have witnessed fear and discrimination from two of the public institutions that are intended to protect its citizens - health care and law enforcement. And then there are the pharmacists who dispensed to a patient they know to be bipolar, two benzodiazepines in large enough quantities to kill him.

What the fuck?

Copyright 2014 cj Schlottman