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

Wednesday, April 9, 2014

Just so you know....

The last two weeks came straight out of hell and culminated with another suicide attempt last night. P is stable and breathing on his own. He sneaked around and got a refill on Ativan, even after the medicine was discontinued by his MD. I had no idea he had them. He took between 40 and 50 of the two milligram tablets. He was semi-conscious when paramedics arrived and is in hospital awaiting transfer back to the crisis unit where he spent the four weeks in January and February.

I have been writing all these days, just did’t publish anything. My book is getting thicker by the day.

Saturday, March 29, 2014

Surviving the Psychiatrist

It was a week straight out of a story book. Parrish was appropriate and entertaining and attentive. He took care of Honey and me, policed the kitchen, loaded and unloaded the dishwasher. He even wiped out the refrigerator and the cleaned the pantry shelves.

He talked at length about his experiences when he was homeless and unmedicated. We discussed my planned memoir, and he offered to help by recording some of the episodes in his life that took place when he was homeless and I didn’t know where he was. He wrote pages of beautifully crafted words about the time he was on The Ninth Floor at the Miami-Dade Correctional Department, a fancy name for the eighth largest jail in the United States. He is no longer embarrassed by his mental illness and is anxious to share his story. I am going to help him do just that. 

On Wednesday, he had an appointment with The Doctor, and at his insistence I am sure, she prescribed Ritalin. For a long time, P has had it in his head that because Ritalin was the magic pill that got him through college, he needs an ADHD medicine now. The first time he saw The Doctor, she prescribed Adderall. I was delighted when he stopped taking it after only ten days, saying it made him too sleepy.

When he got in the car with his appointment card and prescription, I was disappointed and more than a little miffed that The Doctor had ordered another stimulant. Is she the doctor or is Parrish? Does she always allow her patients to decide what they need? He had an unprecedented week when he was able to focus and concentrate well enough to start writing down episodes from his difficult past. But he didn’t tell her that. He told her he needed Ritalin, so she gave it to him.

On Thursday morning, about an hour after he took the a Ritalin tab, there was a marked difference in Parrish. I could sense the mania building in him and warned him to be alert for triggers. He said he was going to walk and burn off some of his extra energy, and I agreed to let him go. 

I was still physically ill with bronchitis and returned to bed and fell into a deep sleep. Parrish’s voice woke me. He was on the phone with his father and his voice was so loud, I was afraid the neighbors could hear. I roused long enough to shush him but couldn’t stay awake. He woke me to say his dad was coming to get him and take him off for a while. Relieved, I went back to sleep and didn’t wake for two hours.

I had been up for about an hour when P came in the door, tears streaming down his cheeks. When I asked him why he was crying, he said he didn’t know. 

“Why didn't Daddy come in to say hey?”

“He said he needed to go to Winn-Dixie.”

P handed me his log book from the early nineties when he was running the pilot boat for his father.

“Where did you get this?”

“Daddy gave it to me. There’s a letter in there from my uncle.”

I recognized the book. It’s been in Parrish’s trunk for twenty years. His father never had it.

“What did you and Daddy do this afternoon?”

“We went to Five Guys and ate hamburgers. Then we went by the cemetery and drove by the docks downtown. Then we went over to Colonel’s Island and Daddy showed me one of the car ships that come in here from all over the world. It was awesome. You won’t believe how big those ships are.”

He embellished his story with quotes from his father.

“Daddy told me I don’t need a driver’s license. He said I shouldn’t even be driving a tricycle!” He laughed hysterically.

He was euphoric one moment and despondent the next.

The story sounded familiar but I couldn’t say why. Then it came to me that P was recounting an afternoon he spent with his dad three weeks ago when I was in Savannah. Had they spent an identical afternoon?

P continued to repeat the events of the afternoon, and I reached a tipping point, couldn’t sit quietly and listen and try to be understanding and accepting for one more minute. So, I got up and went to the kitchen and started stuffing some eggs I boiled earlier. While I was lining them up in my Tupperware deviled egg dish, P picked up the phone and called his daddy. They spoke only a few sentences and P brought the phone to me. 

“Thank you so much for taking him off my hands for a while this afternoon,” I whispered into the phone. “I was exhausted and couldn’t stay awake.”

“I haven’t see Parrish today!”

“Oh my God. You won’t believe this, but there was a moment after I woke up that I wondered if he were really with you. I almost broke my rule and called your work cell to see where you were.”

“I can promise you that I have been home all afternoon and have not laid eyes on Parrish.”

I recounted P’s story.

“We did all that while you were in Savannah the other week.”

There followed some conversation about what could have precipitated this manic event, and I immediately knew it was Ritalin. Lawrence and I rang off and punched in the numbers for The Doctor’s office. Already closed for the day. I hung up, frustrated.

Then I sat P down and explained that he had not been where he thought he had. 

“Well, where the hell was I?”

“That’s what I want you to try to remember. We know where you haven’t been, so think hard and tell me anything you can recall. We know you spent some time downstairs going through the things in your trunk. What else did you do?”

“I stopped at St. Ignatius church and read about its history. Do you know it’s been there since 1880? They have prayer services every morning at eight except for Sunday, when they have a service at eleven o’clock.”

“Good. You remember that much. What happened to the rest of the time you were gone? Think hard.”

“I stopped at the school and watched soccer practice, but the coach blew me off so I moved on.”

“What else can you remember?”



“I have no idea where I went or what I did.”

Well, thank you, Doctor! Not only have you carelessly prescribed a stimulant to a patient with schizoaffective disorder, said stimulant caused a manic episode that resulted in delusions and a blackout. He could have been hit by a car, could have have gotten lost, he could have decided that someone else’s house was ours and wandered in for a snack. Hell, he could have jumped into the river.

On Friday morning, I phoned The Doctor’s office again only to learn from a recording that she is just in the office on Tuesdays, Wednesdays and Thursdays. She apparently doesn’t take call because there was no alternative number. I called the ACT program to give a report to the psychiatrist there who is supposed to be coordinating P’s treatment with The Doctor. He was out of the office and they didn’t know when he would be back.

So, I searched around for P’s appointment card, and finding an email address on it, shot her off a message explaining what happened and that I would not give P any more Ritalin under any circumstances. I became his guardian so I could, well, watch out for his best interest. It’s hard when I’m not included in treatment decisions.

So, what am I to do? Yesterday I spent a long time calling around to find another shrink. The Doctor came recommended by two psychiatrists I trust and respect.  What if the others are worse? Besides, the ones who are actually taking new patients have months-long waiting lists. I have just about decided that, since she is so easily led, I will email The Doctor before each of P’s appointments to inform her of what is really going on with him.

Parrish crashed about eleven on Thursday night and slept most of yesterday. Today he is himself, and he wrote down some more of his story. He has talent; all he needs is a good editor. I have been trying for years to convince him to write as therapy, and now I’m sure he has a book in him. 

We continue to struggle to find adequate and appropriate mental health care for P. I just didn’t expect to have to fight for it in the private sector. 

Copyright 2014 cj Schlottman

Saturday, March 22, 2014


A journal entry morphs into a blog post . . . 

I have Lillia’s manuscript in my possession. It arrived yesterday but I have not started reading it because I continue to feel tired and weak. I can’t even concentrate on fluff, let alone on Lillia’s book. I want to get this job done right, really right. Reading this book is my opportunity to begin earning the credentials I need to convince others what I already know, that I am a damned good editor.  I know I can do it. I just need a chance to prove myself.

I haven’t written a word in two days. I can’t stay awake and focused long enough to get my thoughts down on paper in a way that makes sense. I don’t think I was this sick two years ago before I had my nervous breakdown. At least I don’t remember feeling this bad for this long. My chest wall and head ache from the debilitating cough.

Yesterday, when I was hungry for the first time in days, I thought the end was in sight. But I ended up taking cough syrup twice and floating through the day between naps. I am forcing myself to stay awake right now.

Parrish, the same man who stole two-thirds of my cough medicine last weekend, who ten days ago took money from my purse and without benefit or permission or a driver’s license, took my car to the store to buy beer, has been acting like someone I don’t know. Since trying to pawn a watch on Wednesday in order to get money for beer, he has come about-face.

Wednesday afternoon, when I warned him once more against the kind of behavior that would get him evicted, he didn’t seem to understand. I couldn't tell that he even heard what I was saying. His father called, and in Parrish’s presence, I told him that I was discouraged and exhausted at P’s unwillingness to do anything at all to help stabilize his moods and control his impulses. I explained how hard I have been trying to give him some tools with which to help himself, how I have directed him to web sites where he can express his feelings without fear of rejection, where he can communicate with people who understand his illness. I told him how, every day, I urge P to exercise his brain and his body. While I was on the phone, P sat across from me looking as though he were in another world.
After that conversation, I gave in to a feeling of helplessness, a sense that things would never change, that we would find ourselves reliving the past forever. I surrendered to the depression that is always lurking in the back of my brain, waiting for any entrĂ©e into my consciousness. Coupled with my physical illness, it ushered me back into that eerie comfort that distancing myself from reality brings. Having already retreated to the bed, I remained there, searching for insulation in wasteful pursuits like Facebook and solitaire. I worked cryptograms until my vision was blurred, napped at frequent and fitful intervals, hid behind the haze of hydrocodone that quelled my cough if only for a while. 
I refused to write, telling myself there was nothing new to put into words, that writing had failed me and left me to tread water in a sea of sadness. 
This morning as I started to write this post, intended for my journal, it came to me that while I have been in this funk, the usual stressors in my life have been absent. Parrish has been helpful, even proactive in doing the things that I ordinarily have to remind and cajole him into doing. The kitchen is clean and orderly for the first time since he moved in. There is fresh water in Honey’s bowl. The recyclables are where they belong instead of in the trash. Yesterday, when I wanted to eat, he cooked me a frozen pot pie and served it to me in bed. 
Parrish has been following world events with interest and enthusiasm, coming to me from time to time to share ideas and observations. Just a few minutes ago, when I asked him to update me on the situation in Crimea, he sat with me and pulled up a map of the region on my laptop. While he chronicled the recent geopolitical events, his passion for history was palpable. He wasn't manic. He was on subject. His thinking was clear and organized. 
He asked me to download Lumosity to his iPad and immediately immersed himself in it. Yesterday, we watched Mercer defeat Duke in the NCAA tournament, and he didn’t talk the whole time. He walks Honey without having to be reminded. He is reading a book by Stephen Ambrose.
What happened to the self-absorbed and manic man of the last two weeks? Where did he get this ability to focus? Where did he find this desire to help himself? Where did the self-pity go? Could he have processed his options and decided on some level that his only chance of staying here is to work on himself, to be a part of the solution? Could he be asking himself the same hard questions that I have been asking him? Could it have occurred to him that his life could actually be easy and pleasant?
It is possible. There is always room for a miracle. It is also possible that this shining new man will revert to the disorganized and self-serving person I have come to accept if not respect. It is possible, in fact probable, that this is the quiet before the next storm. I can’t stop myself from remembering how totally normal P seemed on the day before he tried to kill himself. I’m publishing this because I want my readers to understand that life isn’t always hellish for us. We have our moments, in this case, our days, and I am grateful for them. 

Copyright 2014 cj Schlottman

Thursday, March 6, 2014

Life as a Sine Curve


I don't know where these tacky click ads came from, and I am trying to get Blogger to make them go away. Please ignore them and rest assured that if they continue I will move to another domain. Sorry.

Wednesday, March 5

For the first week after coming home, Parrish slept little, woke at frequent intervals, and could only string together about three or four hours of sound sleep at a time. After he took his first dose of Adderall on Thursday, he didn't sleep at all that night. He was manic over the weekend but went off with Lawrence on Saturday and did well. The rest of the time, on Saturday and Sunday, he was talking to me nonstop.

He was still stuck in the past, talking about every dog we ever had, naming his favorites, Lucy and Baby, saying that he had to admit that Honey is the prettiest. Saying over and over what a good time he had with is daddy on Saturday. He obsessed time and again about Lawrence's BMW, asking, "Can you believe he has that car? He's got five goddamned cars!" He was back in college, telling me for the hundredth time about coming back to his dorm and finding Michael slung up in the waterbed with four girls watching The Young and The Restless. He could not shut up about how much money everybody has, or he thinks they have. He obsessed about getting a bike, not just a bike but an expensive touring bike. He told me several times that he needs an allowance, and he bragged and bragged about how happy he is and how much he loves his room. Knowing full well that it's not an option, he asked me if I thought he could take up golf again. Then he gave me a blow-by-blow of his swing. I counted four separate times that he asked me what we were going to do on Monday. 

I made him come in my room and watch TV with me, but I had to kick him out because he wouldn't shut up. Then he went into his room and wrote me a letter telling me what a piece of shit he is and how sorry he is that he is sick and how he doesn't want to be the way he is. So I had to deal with that.

That night, I insisted he get to a meeting, so a friend from AA took him and brought him home. He was still manic but less so. He went to bed early, was up and down several times before I went to my room. When I woke on Monday morning, he was sitting in the den waiting for his medicine.

P saw The Therapist for the first time on Monday afternoon. He was extremely anxious before the meeting, but afterward he seemed relieved to have gotten the process started. I dropped him at an AA meeting that night and when I picked him up, he was in a bad mood, saying it was the strangest meeting he ever attended. He wanted only a small supper, and after we finished dinner around ten o'clock, he said he was still tired and wanted his medicine so he could go to bed. I sat up writing and fully expected him to be up several times before I went to bed, but he never appeared.

During the night, his door periodically slammed against the jamb because his window was open and the wind was whipping through his room. It woke me up, so I went to his room to see what was going on and stop the noise. While I was closing the window and securing the door, he snored loudly and showed no sign of being aware of the noise or my presence in his room. 

Yesterday morning, he was still in bed at ten o'clock. He appeared in about half an hour, shuffling and sluggish, and fixed himself a bowl of cereal, ate it and went back to bed. During the day, he was up every few hours just to eat or get something to drink, and I had to make him get up when The Addiction Counselor arrived. His speech was slow and sleepy, but we could understand him. He separated himself from us when she asked me to explain how he ended up in crisis stabilization for a month. He went to his room and filled his lower lip with snuff and sat across the room. We talked for a short time, then he stood as though to end the meeting.  The Addiction Counselor left, and he went back to bed.

When I woke him for dinner, he shuffled out of his room and muttered something indecipherable. He acted drunk, staggered a bit getting to the table. When I asked him to repeat what he said, his tongue was as thick and his speech as slurred as it was when he was in the crisis unit. My first reaction was to ask him if he were drunk, but of course he wasn't. There is no alcohol available to him, not even mouthwash. The liquor and wine is under two keys with his medicine. He appeared to be having difficulty holding up his head, couldn't follow simple instructions and couldn't find the place mats. He had trouble distinguishing left from right. He ate the oysters and green beans I prepared for him with some relish, leaving dribbles of food on his chin and shirtfront, but the minute he finished eating, he went back to bed.

I was witnessing an impressive bipolar cycle manifest itself in him. There was mania for three and half days followed by this dramatic downturn. I used to think these symptoms were alcohol driven and that if he'd just stop drinking and take his medicine, they would go away. I was wrong. Alcohol free and medicated, I saw the same signs in him that I saw when he was drinking. He denied being depressed, but the signs were unmistakable, down to the fact that he said he felt like he had the flu and was hurting all over. After dinner, he went back to bed and didn't get up until this morning when I woke him at eleven-thirty. 

He had a meeting at the ACT offices, so I sent him to shower. After he dressed, he fell back in bed and was asleep in moments.

On the way to town, I asked him to repeat himself so many times that he finally stopped saying anything at all. I realized he wasn't alert or articulate enough to participate in any kind of social interchange. We continued on to the ACT office because since he was scheduled to go in for the meeting, The Nurse met us there to draw his labs. He stuck Parrish four times and never drew blood, so we came home. He will come tomorrow and try again.

I had the opportunity to tell both The Nurse and The Addiction Counselor about the events which began on Monday night. Having seen Parrish the day before, The Addiction Counselor was able to recognize the breathtaking changes in him. I'm not at all sure The Nurse has great powers of observation, but even he could sense the change. I couldn't speak to The Psychiatrist. He was out of the office, but The Nurse promised to tell him about the changes in Parrish.

When we arrived home, P once more dove under the covers, forgetting about his midday medicine. I had to wake him to give him his lithium, but I held the Ativan.  I can't explain why, but even with these signs of lethal depression, I don't think he wants to hurt himself. For my own sanity's sake, I'm going to music night and check in with him from there. Honey will snuggle with him and keep him company until I get home.

Tuesday, March 4, 2014

Just because you got the monkey off your back...

"Just cause you got the monkey off your back doesn't mean the circus has left town." ~ George Carlin

For the first two and a half days after he got home from crisis stabilization, Parrish didn't appear to have any thoughts at all. For two days, nothing. He had no energy. There was very little conversation and a whole lot of sitting and staring and absentmindedly stroking Honey’s back. I prepared his favorite home dishes but he wasn’t hungry. There was an eerie sense of inertia about him, an almost palpable ennui. There were no tears and no smiles. Maybe he was so overwhelmed by racing thoughts that he couldn’t do anything but sit and listen to them spin in his head, but if he was, there was no external manifestation of it. His heels were quiet on the floor, his hands relaxed in his lap. His speech gradually cleared and was almost normal by Thursday morning.

He woke up on Thursday in a state of muted mania, if there is such a thing. He was anxious about is first visit with his new psychiatrist. It was as though there were a monkey inside his brain that could jump out at any minute and start chattering and climbing trees and throwing up crazy all over the place.

We arrived fifteen minutes early for the appointment, The Doctor’s first of the day. The morning sun was hot on our backs as we waited on the sofa under the window of the tiny reception area. An inane radio program, just loud enough to interfere with quite conversation, emanated from a speaker under the end table. We both tried to read but it was impossible, so we sat with our hands in our laps and tried to tune it out.

We had been sitting in the waiting room with the radio piping blather into our brains for thirty-five minutes before The Doctor finally breezed into the office. A slender woman with a mass of blonde curls furled out behind her and a backpack slung over her shoulder, she looked to be about Parrish’s age. She disappeared behind a door and within thirty seconds, called P back into her office. I sat in the too hot and too loud waiting room and tried my book again, but there was not hope of escaping into it.

I addition to the nitwittery pouring from the radio, I could hear but not understand the voices from The Doctor’s office. Her door must have been open, and it occurred to me that the prattle pouring from the speaker was a sort of buffer. Why the hell couldn’t she just close her fucking door?

After twenty-five minutes, P was back in the waiting room, prescriptions in hand. The Doctor added Adderall and Restoril to the long list of things he is already taking. Yes, she prescribed an amphetamine to take every morning and a sleeping pill to take every night.

P started campaigning for medicine for his ADHD a couple of days before the appointment, reminding me about a dozen times that Ritalin got him through college. He said he needed something to control his racing thoughts, something to help him focus and stay on task. What tasks? He spent most of the first two days in bed, and when he did talk to me, he was focused only on the past, mainly the difficulties and not the good times. I tried unsuccessfully to bring him into the present, center him in the moment, but he continued to drift backward in time. He could not concentrate on a book. His television sat mute and dark. This man who loves music as much as I do wasn’t even interested in learning how to create a playlist on his iPad.

On the way home we dropped the prescriptions at CVS and went across the street to Starbucks for a coffee. For the first time since I picked him up at Gateway on Monday, P was animated, chatty but not loud, excited but controlled. I had been denying him caffeine at home, thinking that after being off of it for four weeks, there was no need for him to start back on what is, after all, another drug, but Dr. DaVanzo gave him permission to take it in moderation. 

I began to wonder about her. First, the prescription for amphetamines, then the caffeine thing. This woman saw P for less than half an hour and really knows nothing about him except what he told her. In the days leading up to their visit, he was confused about his recent history, and I am not yet convinced that he is an accurate and complete reporter of the events since January 10.

“What’s with the speed?” I thought to myself.

Parrish was in crisis stabilization for a month because of extreme mania and psychosis and is taking three antipsychotic meds. She's The Doctor, I know, but why not try weaning him off some of the downers instead of putting him on an stimulant? At her direction, P took an Adderall as soon as we got home, and within thirty minutes, he was talking and essentially did not shut his mouth until he went to bed. 

“Don’t you think I’m doing better? I used to think that if I took my medicine, all of my problems would disappear. Now I know I have to work on them. Aren’t you proud of me? I’m proud of me! Aren’t you glad The Doctor is sending me to see a therapist? I wonder what she will be like. I think this medication is what I’ve been needing all along, don’t you? I can’t tell you how happy I am to be here with you. I haven’t been happy in years. This sure beats living on the street. I am so grateful to you to putting up with me and my craziness. You will never know what I’ve been through. Daddy has our back, you know. He’s standing by for whatever we need. Isn’t it bizarre that he’s back in our lives? It feels strange to me. Don’t you think it’s strange? Don’t you think I’m doing better? I mean, really? What is the weather supposed to be like? Daddy is an expert on the weather, keeps track of it with NOAA radio. You know I can’t help being sick, don’t you? I didn’t ask to be this way! You do understand that I love you more than life, don’t you? What do you think my therapist will think when I tell her my story? I’m nervous about going to see her. You don’t blame me, do you? I’ve never been to a therapist before. I’m sure she will be shocked. I hope I like her. I hope she likes me.”

And on and on..

I exhausted myself trying to answer his questions, assuage his anxiety, assure him that his father and I both love him dearly, that we are proud of him, that there is no shame in being sick. I urged him not to question his father’s presence in his life, not to try to figure out why but instead accept it with gratitude. I turned on television and tuned to The History Channel, thinking he would get absorbed in a program. He could not concentrate and continued to make the same statements and ask the same questions repeatedly.  

I finally started playing solitaire on my iPad. He didn’t notice, and it didn’t slow down his constant stream of chatter, which continued until he took his sleeping pill and went to bed. An hour later, I was sitting with my laptop having little luck organizing my thoughts to work on a poem, and he came out of his room, fixed a bowl of cereal and came and sat in my corner of the room and started talking.

I said “good night” and went to bed.

Copyright 2014 cj Schlottman