Saturday, April 20, 2013

The Break and Another Negative Experience at Hospital

"Madness, Mania and Muddlement"" is a continuation of  my blog, "The Red Sweater."  If you wish to go back and read earlier posts, I have provided you a link.
I realize this is very long, and I apologize.  If it's too much, break it up into days.  I'll try to do better about posting on time, but it's hard when I am dealing with P.  Stay with me.  

Friday, March 29

The psychotic break came yesterday afternoon and it was precipitated by alcohol. Parrish talked gibberish and alternately wept and laughed. He hallucinated, mumbling about a fist fight with his stepbrother, who wasn’t here. Vodka was missing from the cabinet in the kitchen. 

There was alcohol involved but the break was real. We arrived at the ER at 5:00, and P was immediately taken to a “room, a euphemism for cell. It looks like this: One enters an anteroom and there is a door on each side of the room. These lead to patient rooms and are metal with three locks on the outside. The one on the right is padded. P was in the room on the left. It is furnished with a single stretcher equipped with restraints and the walls are painted concrete. It is not padded. He was sitting on the stretcher when I arrived. 

 He was angry, belligerent, demanding that he see a doctor immediately and that he be released. There were two security guards at his door, but it was open. I went into the room to sit with P and wait for a doctor to see him. As instructed, P went into the bathroom to take off all his clothes and put on one of those humiliating paper “gowns.” When he came out, he got in a guard’s face, menacing him. “Don’t you touch my mother!”

“Take it easy there, pal. I ain’t gonna hurt your mama and I won’t let anyone else hurt her either.” The guard locked him in the cell.

“Let me out! Let me OUT! My mother wants to take me home! Let me out!” The guard allowed me in with him to help keep him calm. We left the door cracked, and other than numerous attempts on P’s part to leave, everything was quiet. He was up and down every few minutes, sometimes skirting the guards and medical personnel, hustling down the hall. We waited and we waited. Parrish continued to complain and try to get away, but at longer intervals. Things went fairly well.

 Until...........a small boy, maybe 5 or 6, was admitted to the padded room. For nearly two hours, the child screamed and threw himself against the walls and door. There was an attendant in the room to stop him from hurting himself. The continuous screaming and bumping was hard on both of us. P thought the child was going to kill himself. It was awful. I’m not sure of the time, but when the staff needed P’s room for a man who actually required restraints, we were moved to a holding area. The little boy was still screaming when we left. 

In the holding area Parrish continued to get up and try to leave, but there was a woman posted at the door to keep him in the area. Several times, while she was reading the sales fliers from the paper, he slipped past her and went to the desk to make his demands. 

He continually demanded to see the doctor. About 11:00, James, a social worker from River Edge, visited and told Parrish he was working on a plan for him. 

“The only plan that is acceptable to me is to see an MD and be released immediately,” was the reply. 

James took me aside and said the doctor saw P when I was out getting a sandwich and P didn’t remember. He said the doctor wrote commitment orders for P, and he would only be released to a psychiatric facility. He said there were no beds in the hospital and none at River Edge and that he was working on transport to a state hospital. 

Miraculously, at 11:45, a bed opened up on the psych floor of the hospital. James came to Parrish and explained that the doctor wanted him to stay for medication management. I wondered if electroconvulsive treatments would help. God knows we have tried everything else. Parrish went without protest. I was not allowed to go to the floor with him, so I left the hospital about midnight. Sleep was dream filled and restless. I can visit today between 1:00 and 8:00, so I will see him before I meet my friends for dinner. 

Saturday, March 30 

Yesterday afternoon, I changed my mind and did not to go to visit Parrish. I needed a day free of the pressure that comes from being with him, especially when he has experienced a significant psychological event. I was exhausted and dazed and wondering what to do.

Today, when I arrived to visit with him, I found him locked in a closed ward. When I asked the nurse why he was there, locked up like that, she said he was violent. When I questioned her further, she told me that he said he had a fist fight with his stepbrother. It’s not true. I was there. There was no mention of the earlier incident with the guard. 

After not asking me one question in the ER, the morons interviewed the psychotic one, the one was hallucinating and paranoid and extremely manic, the one who was confused and disoriented. Then they believed every word he said. When I suggested to the nurse that the staff could have learned a few things if they had talked to me, her reply was a syrupy sweet and patronizing, “We prefer to work with the patient in our effort to meet his needs. He is our best source of information about himself.”   

She said that. I seethed. 

I am losing all faith in the world of psychiatric “therapy.” It no longer exists. These hospitals don’t treat their patients. They house these unfortunate people for as long as their insurance pays, then release them back into a world in which they are unable to function. Oh, they may tinker with meds and conduct inane meetings where everyone is encouraged to express their feelings and remember to be kind to themselves. I know. I have been to some of them. 

Parrish saw a doctor this morning, a day and a half after he was admitted. I am angry and disappointed and sad for everyone who has psychiatric issues, especially those who don’t have an advocate. What do they do? Who sees about them? 

I was allowed inside the ward and found P relatively calm except for his heels working up and down against the floor at a rapid pace.  He was a little sluggish of speech, and he said his lithium level was toxic. That could have contributed to the break. We talked for about an hour and drank the Starbucks I brought. He said he was tired and needed to go to sleep, so we hugged and kissed and said, “Good-bye” and “I love you,” and I drove home. 

Sunday, March 31 

I spent the afternoon with Parrish. His motor was still running, but he seemed a little more alert than yesterday. We had our coffee and talked for a while about March Madness and who we had in our brackets and who we thought would win the National Championship. 

Then, “Mama, is it true that you want me to have shock treatments?” 

My mouth dropped open. On Friday, I called the unit and asked for a call back from P’s doctor so I could ask his advice and ask him some questions. The nurse wanted to know the nature of my concerns, and I said my main concern is that Parrish’s medications are not working for him. I wanted the doctor’s opinion about whether electroconvulsive therapy (ECT) might be helpful for Parrish. Shocked, “We don’t do that here!”

“Fine. If he recommends the treatment, he can refer us to another facility."  

“We don’t do that here. Seething, I replied, “I understand that.” After our conversation, the “nurse” went straightaway and told P that I was planning ECT for him. Yes, she did that. I didn’t make up any of this. 

So, P and I talked about ECT. I assured him that the procedure is safe and is sometimes used as treatment when drugs have failed. 

“Do you think it would help me? If you do, then sign me up. I can’t live like this with these racing thoughts and mood spikes.” 

We left it there. 

I asked P if he wanted me to stay and watch Florida and Michigan play in the NCAA quarter finals. Okay, I admit that I had Florida in my bracket. I’m a sucker for college basketball. P said, showing emotion for the first time since I arrived, “Yeah! That would be great. I always love watching sports with you.” So, we and all the patients in the locked ward sat around the high definition television set and watched the game. We ate Easter candy out of a pink plastic bucket until the attendant admonished everyone that they were ruining their suppers. 

The game was a blowout and Florida lost by 20 points, but Parrish and I were together and happy for a while. 

Monday, April 4 

I was up and ready when Parrish called early this morning to say he would probably come home today. Later in the morning he called to confirm. His social worker also called and, in that sugary tone, said Parrish would be dismissed this afternoon and she wanted to meet with both of us before he left. 

When I arrived at the hospital, I found P standing in the lobby with his plastic bag that says “Personal Belongings” on the side. He was ready to leave. He was still manic and wearing his manic face - furrowed brow, chin jutting out. His motor was running and he was pacing. I asked him about prescriptions for home, and he handed me four slips of paper. He was back on the exact medication plan he was taking when admitted. Yes, it is true. 

The meeting with his social worker was not what I expected. She wanted to know if we had plans for Parrish after dismissal. My mouth fell open. 

“It is my understanding that it is your job to find placement for Parrish. He needs a safe place to go that isn’t my house.” 

She answered that her only plan was to send him to Salvation Army. She handed Parrish an appointment card to see Dr. Brown* at River Edge on Wednesday morning. Parrish, looking desperately in my direction, said, “I can’t go to Salvation Army. I’m too manic to go there. I’m afraid to go there.” 

I said, “It makes no sense to send a patient from a locked ward directly to a shelter. How do you rationalize that?” Hell. You are dismissing him on the same medication regimen he was on when he got here. We all know that didn’t work. Now you are sending him to a place where he is going to fail. It’s a planned disaster.”

“It’s the only thing we have to offer. Parrish no longer meets criteria for inpatient treatment.” 

 I said, “Look at the man. He can hardly stay in his chair. His meds are clearly not doing the job, but you and the doctor think he is ready for life at Salvation Army?”  

Furious, I waited for an answer. When one was not forthcoming, I said, “You have painted us into a corner where, if P is to be safe, I must make my own plan.” 

 “The Salvation is still an option,” she replied in a flat tone. We stood and I thanked the woman for her time and left. 

“Please close the door on your way out.” 

 I wish I had shot her the finger. The “system” totally failed us.

April 3, 2013 

This morning when we arrived at River Edge for P’s appointment with Dr. Brown, the receptionist said Parrish didn’t have an appointment. In addition, she told us that Dr. Brown didn’t come in on Wednesdays. She gave P an appointment on May 4! The only psychiatrist who has seen Parrish in the one in the hospital. Things are getting worse by the day. 

Earlier this afternoon, Parrish’s “girlfriend,” the woman he was living with in Florida, broke up with him. She has been stringing him along with volumes of emails and facebook messages, passive aggressive pages in which one day she says she loves him more than life and wants to come to Macon to live with him, and the next day she doesn’t know how she feels. 

Today, she sent a facebook message that she is back with her lesbian lover. No shit. Fifteen minutes later she wrote that she couldn’t live without Parrish. He let her get away with this behavior for six months, choosing only to remember the positive messages. 

There were more messages back and forth. She wants to come see P, she never wants to see him again. He finally insisted give him a yes or no answer to the question, “Do you love me?” She tried to continue her blather, but Parrish insisted on an answer. She said “No.” 

 He is devastated and I am relieved. Before we could block her from our facebook pages, she sent me a message detailing her sex life with her lover. The first sentence what a description of what they do with Danette’s strap-on ****. That’s as far as I read. I felt contaminated and violated and I scrubbed the message. We blocked her from facebook, ditto email and telephone. P spends all of his time obsessing about the way she deceived him. He admitted giving her money so she could make ends meet. He, who has absolutely nothing except the clothes on his back, is that gullible. 

April 6, 2013 

It is Saturday and Parrish is washing my car. The past few days have been hard for us. He has rapid cycles of mania and depression are worse than ever. His medication is clearly not doing the job, and he is drinking and hiding it. I have not seen him drunk. He is manic today, more so than yesterday. He just came to me and said he couldn’t live like this any longer. He said he us open to ECT, wants it right away. 

"I have racing thoughts about Marcy and the way she treated me. I am so hurt and tired and restless. Controlling my mania is almost impossible. I will go stark raving crazy if somebody doesn’t do something. Sign me up for ECT, please. Mama, I have never been this miserable. Never.” 

I took the decision to acknowledge his drinking and downplay it. I’m exhausted from beating that dead horse and I fell back on the things I learned at AlAnon over the years. I’m not in the detox business, so I’ll let the professionals take care of that. I’m not sure how everything will shake out, but I believe P should be in rehab as the first course of action in his treatment. He was drinking all along at the boarding house. 

Last night we stayed up late watching funny videos on YouTube. Laugh? Laugh we did, big fat belly laughs that had us grabbing our sides, tears rolling down our cheeks. The laughing baby had us doubled over! Both exhausted, we finally went to bed and this morning Parrish reported having slept the best he has in months.

The stress and anxiety of having P in my house are taking a toll. My neck is stiff and I can only turn my head a few degrees either way. Thank God I can sleep. His perseverating wears me down, especially when he is negative. It is difficult to hear him blame himself for not realizing that Marcy isn’t what he thought she was.  P cannot stop obsessing about that dreadfully vulgar madwoman. He fancies himself in love with her.    

We cope. We just do.
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