Hyper-Mania Reigns

Monday, January 27

Since his return from Savannah last Wednesday, Parrish’s mania has escalated exponentially.  I keep thinking back to his admission lab work when he went to hospital because of his overdose.  His lithium level was negative.  Given that, it’s hard to believe him when he says he takes it every day as directed.  Not taking it guarantees instability, even with his other meds. 

Though he had been in hospital in Savannah for a week and was supposed to be properly medicated, Parrish was manic on the day he was dismissed, a fact that I pointed out to the social worker and the discharge nurse. 

When released, he barreled  through the door to the waiting room, actually an anteroom with a couple of chairs in it, and was trying to push open the outside door before I could get his attention.

“Whoa!  Slow down, P.  We have to meet with the nurse and the social worker before you can go.”

“Let’s just go.  I can’t take any more of this bullshit.  There’s a patient in there throwing chairs around.”

He was loud and could not focus or hear what I said unless I repeated myself.  When I looked at him I saw a sick little boy, out of control and not knowing why he felt so bad inside.  His eyes danced with anxiety and fear and false bravado, and I wanted to swaddle him and bundle him close to my chest and sing to him and make all the crazy go away. 

“Take a breath, Son.  Take a breath and sit down while we go over your discharge plan.”

“I don’t need a discharge plan!”  I’m going to see my own shrink in a week.”  

He was up and down, in and out of his seat, pacing around the space.

“Can we get something to eat?  I’m starving.  Pigs shouldn’t have to eat the food they serve here.  This place is a travesty!” 

My observation that he was unstable and manic was met with blank looks from the social worker and the nurse. 

“The doctor has decided he is stable and can go home.”

“Look at him, please!  He lives alone!  He cannot sit still, and when he does sit down, he works his heels against the floor so fast that they are a blur.  He can’t stay on topic.  He has scattered thoughts.  What is stable about this behavior?”

Our “counseling session” was taking place in the anteroom.

“He’ll be more relaxed when you get him home.”

The nurse proceeded to give Parrish a five-day supply of Abilify, Valium and lithium, carefully explaining to him that he should take them exactly as ordered.  She sat there and told a psychotic man that he should follow the rules!  But it gets better.  She then handed him printed prescriptions for another month’s supply of the drugs.  They included one for 60, count them, 60 Valium tablets, 10 mg each, more than enough to kill him.  

“You’re going to send this man, a patient who has been under suicide watch for 12 days, out of here with a prescription for enough Valium to kill himself?  Is this your idea of a discharge plan that will work?”

“The doctor thinks he can handle his medicine.”

Deciding to take control of the Valium myself, I got us out of there as fast as I could, knowing all the time that P was not stable and should be in a controlled environment but also knowing that Georgia Regional would not or could not meet his needs.  He received no therapy and never saw a doctor, only a nurse practitioner, if you can believe what he says.  I am going to request the records and find out for myself.  At that moment, I held fast to the knowledge that he had an appointment on the 29th with a private psychiatrist here on Saint Simons.  

Parrish’s mania escalated on the drive back to Brunswick.  He obsessed about coming to live with me.

“I can’t live alone, Mama.  You should have figured that out by now.”

“And you know as well as I do that living with me is not an option, Son.  Is there any real need for me to go over all the things that went wrong when you lived with me?”

“But now you have control of my money!  You’re responsible for me because you are my guardian.  If you can’t make yourself take care of me, your guardianship over me is going to be revoked as soon as possible!”

I chose to ignore that remark, not bothering to remind him that he has no voice in whether or not I am his legal guardian.

Conversation was spotty, and there was an undercurrent of anger in his words.  He demanded that I give him some money, said he couldn’t walk around without money in his pocket.  I reminded him that, when we were giving him money to eat and wash clothes, he spent it on alcohol and God knows what else.  Every item of clothing he owns was dirty when I cleaned out his efficiency, and there was evidence of alcohol use.  

“No, Parrish.  I will not give you any money.”

“But how will I eat and wash clothes?”

“I will wash your clothes and your daddy and I will make sure you are supplied with groceries.”

“This guardianship thing has got to go!  As soon as I get out from under it, I’m leaving this town.”  

When we arrived in Brunswick, he insisted that we stop at CVS to fill his prescriptions.  Since he had a small supply medication, I didn’t think it was necessary, but in view of his mania decided to humor him.

On the way to the drug store, I told P he would have to let me keep the Valium and that I would give him enough for two days at a time.

He bristled.

“I am fully capable of handling my medication!”

“No! You are not.  I gave you a bottle of Elavil and less than two weeks ago you took every one of them in an effort to kill yourself.  You will have to give me control of the Valium.”

“But I’m fine.  And I need some money.”

“You were fine 8 hours before your suicide attempt.  I will not let you have enough Valium to try it again.”

Sulking, 

“Okay, Mama, have it your way.  You always do.  I have never won an argument with you, so do what you want to do.  I need some money, though.  I can’t walk around without any money.”

P was only in the store a few minutes before he returned to the car and got it.

“The drugs won’t be ready until day after tomorrow.  They have to order some of it.”

“They don’t have Ability and lithium and Valium?  I find that hard to believe.”

“Well, that’s what the man said.”

Something seemed wrong, unsettling, but I couldn’t put my finger on it, and as long as he didn’t have the medicine, I decided not to worry.

“We’ll come back on Friday.”

I checked P into a decent hotel, helped him unpack and put his things away.  His mania subsided and we made plans to go to the grocery store on Friday.  Before I left, I promised to order a pizza for his supper.

I called his father and left a message that P was back in town and installed in a hotel, but I didn’t speak to him personally.

I talked to P several times on Thursday, and I was concerned that his tongue was thick and his speech was a little slurred, both signs of alcohol use but also signs of mania.  I knew he didn’t have any money, so I encouraged him to get out and walk, work off some of the extra energy he was producing.  That night, I called his father to tell him I was concerned that Parrish’s mania seemed to be escalating.  I left a message.    

On Friday morning, I got a call from Lawrence thanking me for the message and promising to call me later when he had time to talk.  I took Parrish to the grocery store and we went shopping for a new winter jacket for him.  His jacket was one of the several things, including his Kindle, that were not in his efficiency when I cleaned it out.  He was manic but not extremely so.  I could tell his anxiety level was high, despite the Valium he took in the morning.  I was uneasy about leaving him alone and even considered going back and spending the night with him.

Shortly after I arrived at my flat, Lawrence called.  

“I’m concerned, too,’ he said.  “A little while ago, I got a call from him demanding that I bring him some quarters for the washing machine.  He was very insistent and his speech wasn’t right.  I hesitated because I was there earlier to take him the medicines he asked me to pick up at CVS, but I went anyway and his room was empty.”

“My God!  He has 60 Valium pills!  That’s enough to kill him if he takes them all!”

“I’m going back over there right now,” Lawrence wheezed.  I can get there faster than you can, and I’ll call you from there.”

I held the phone and stared at it for a few minutes before the tears welled up and the sobs began.  Had he done it again?  I felt as though I might implode, fall in on myself and get lost in the darkness.  Paralyzed with dread, I sat and stared and smoked until the phone rang about 20 minutes later.

“He’s not here.”

“Look around and see if you can find the Valium, the other drugs, too.”

“There’s nothing here except a full bottle of lithium.  What are we going to do?”

“You go home and rest up for work in the morning.  I’ll go over there and wait for him in his room.  If he doesn’t return within a couple of hours, I’ll call the police.”

I arrived at the hotel at about 7:30 and searched the room thoroughly.  The only suspicious thing I found was an empty 24-ounce can of an alcoholic beverage that was 12% alcohol, roughly twice the potency of beer.  Everything else was in order.  I worried and tried to write.

Lawrence arrived a little after 8:00 to wait with me, and we decided that we would give P until 10:00 to show up before contacting the police.  At 9:30 he staggered in.

“What are you doing here?”

“Your daddy and I have been waiting to see whether you would show up or be found dead somewhere.  No one has been able to get in touch with you since you called him this afternoon.”

“I’ve been out.”

“How much have you had to drink?’

“I haven’t been drinking.”

“Of course you have.  You reek of beer and can hardly stand.  Do yourself a favor and don’t embarrass yourself by trying to convince us that you have been out for a stroll in the cold for several hours.”

“I haven’t been drinking.”

“Look at me, Parrish.  Look into my eyes.  This is me, not some doctor who knows nothing about you, not your daddy whom you used to get all the Valium that is now missing from this room.  Where is the Valium?”

“I don’t know.”

“Where is the fucking Valium?”

I didn’t look at Lawrence, but I could feel him cringe at my language.  At that moment, I didn’t give a shit what he thought about it.

P pulled the bottle out of his pocket, and I jerked it out of his hand and opened it.  There were seven tablets left out of the 60 that were dispensed just the day before. 

“Did you sell these or trade them for alcohol?”

“No.”

“You are lying.  Tell me what happened to all of these pills.  If you took them, we need to take you to the hospital.  Did you sell them or trade them or take them?  Do not play with me, P.  This is not some game.”

In a whisper, “I traded them.”

“To whom and for what?”

No answer.  He tried to change the subject.

“What are you doing here, Daddy?” 

“Son, I’m here because I love you and I’m worried about you.  If you keep this up, you won’t have to kill yourself.  Somebody’s going to do it for you!”

“Why in he name of God did you think you could drink, Parrish?  You know you can’t drink.  What is wrong with you?” I asked.

Lawrence kept trying to defuse Parrish’s crazy rantings, so he talked him into trying on a snow suit he brought him earlier.  Yes, a snow suit.  He thinks P should wear it when he is out walking in the cold.  Parrish was so impaired, his daddy had to put the suit on him. 

After laughing like a hyena, P started weeping openly and lamenting his situation, trying to convince us that his life is essentially a piece of shit, that he has nothing.

“You have two parents who love you.  You say that’s all you ever wanted.  Here we are, both involved in your life and trying our best to make it better.  Where would you be if your daddy and I weren’t paying for this hotel so you have a place to live?

Finger to his temple, “I’d be dead!”  If you two think you can keep me from killing myself, you don’t know shit.”

“Don’t play the suicide card with me, Parrish.”

“I’m no playing anything.  I’m telling you the facts.  You’re going to kick me out on the street again.  You’ve done it before and you’ll do it again.  I’ve never been right since you divorced Daddy and took me away from him.” 

“That’s enough, Son!  Your mama has never been anything but a good mother to you.  There is nothing more precious than a mother’s love, and you have repaid her by giving her more hell than any woman deserves.  Now you just stop that kind of talk.”

And so it went until Lawrence took his leave.  I assured him that I would stay with P until he went to sleep.

“I’m not tired.  I don’t want to go to sleep and I don’t want you here.”

“I’m staying.  Get used to it.”

I lay down on the day bed under the window and started watching Modern Family.  P came over and sat on the side of the bed and pushed his face next to mine.

“I need to tell you something, need to be honest with you about what happened tonight.”

“I’m listening.  You know you can tell me anything.”

“I walked to his hotel to see The Famous Writer.”

I waited.

“I told him I had some Valium and I would give him some if he would buy me some beer.”

“You went to The Famous Writer?”  

I was incredulous, unable to understand why P would seek out The Famous Writer for any reason after their confrontation last month.  I suppose there are no extremes to which a mentally ill person will not go to quell his urges.

“What in the name of God made you go to there?  Did you go there with the idea of trading Valium or did you go there to pick a fight with him?  This is hard for me to process but I can believe it.  Why?  You could have sold that Valium to anyone.” 

Out of left field, “Did you know he has a car now?”

“I heard it through a mutual friend.  Did you get in the car with that drunken madman?”

“He was going to the island to get a hair cut, and he took me with him.”

I didn’t believe him.

“Where does he get his hair cut?”

“A place in Redfern Village.”

“And he took you with him?”

I know where The Famous Writer gets his hair cut.  I took him there myself once, and it’s in Redfern.

“What did you do while he was getting his hair cut?”

“I sat there and waited.”

“And where did he buy you the beer?”

“He went to the liquor store across from the airport and bought himself a case of wine and me a six-pack of beer?”

“One six-pack?”

“Maybe he bought more than that.”

“I see.  You didn’t get in this shape by drinking one six-pack of beer.  I’m surprised that you think I might even consider believing that.”

“I took some Valium, too.”

“How much?”

“Two 10 mg tablets.”

“Really?  Two?”

“Maybe more.”

"Then what happened?"

“He drove us back to the his hotel and started telling me all this stuff about music.  His wife kept calling him and he shouted into the phone and called her a cunt and hung up on her.  Then he went psychotic and started ranting and raving about how much he hates everybody and how he has no use for you.  He told me you owe him fifty dollars.  I said if he called you another bad name, I would hurt him.  Then he told me to give him the Valium and get out.  I asked him to bring me back here, but he said ‘no’.”

“And you actually gave him the Valium?  How much?”

“All but what’s left in the bottle.”

“We’ve talked about this long enough.  You need to get some rest.  Let’s get ready for bed.

A look of utter amazement crossed his face.

“You’re going to stay with me?  You've never done anything like that for me.”

“Of course I have, P.  I let you live with me last year until it became clear that the arrangement was bad for both of us.  I will be happy to stay over.  Honey’s in her kennel and should be fine.”  

P was calmer, and we went out by the pool in the freezing cold and smoked a cigarette and shared a Dr. Pepper.  Over and over, he thanked me for staying with him.

“I’m in crisis, Mama.  I need you.”

“I am here and will spend the night, so stop worrying.  And stop thanking me.”

Once back inside, I convinced him to eat some of the vegetable soup I brought him earlier in the day.  Then he heated up some chili and ate that.

I tucked him in, wondering how we got to the place.  He was one of the happiest little boys who ever lived, the kind of kid who loved everybody everybody loved him back.  He made friends with the garbage men, for goodness’ sake.  In a moment he was snoring.  

I settled down with a cup of tea and some Ibuprofen and a crossword puzzle, then went to sleep myself.  I woke at 4:30.  My bones were aching so I took some more Ibuprofen and tried to sleep.  At 5:50, I woke P and told him I was going home.  He roused momentarily and thanked me and dropped back off to sleep.

When I arrived at my flat on Saturday morning, Honey was barking.  She never barks when she's crated up, but she chose last night to start.  I could tell she was in great distress.  She had pushed the tray completely out of the crate and was wet around her mouth and chin from anxiety.  After a quick bowl of food, she was asleep at my side.  We went for a walk in the park, and as exhausted and sore as I was, I didn’t want to go to sleep.

The weekend was nothing if not hellish and I am tired in my body and in my soul.  I haven’t felt rested or completely relaxed since Cuz died on the fifth of this month. Parrish’s suicide attempt followed seven days later.  Writing is hard for me when I don’t get proper sleep so it may take all week to write down the events since Parrish’s release from Georgia Regional last Wednesday.  The only helpful thing the staff there did was make Parrish an appointment at Gateway, the local public mental health center, so this morning I was up 

early to get him there for his 8:30 time slot.  I knew the day would be hard but never expected it to be so torturingly draining.

To be continued…..

© 2014 cj Schlottman

Handcuffed and Shackled

This afternoon, when I returned to Parrish’s hospital room after fetching some clothes and shoes for him, the nurse told me that he was to be transferred to a psychiatric facility shortly, but she said she didn’t know exactly where he was going.

“Don’t be ridiculous!  Of course you do.  You can’t transfer him out of here without knowing where he is going.  You know that and I know that.”

In a whisper, “He’s going to Georgia Regional in Savannah, but we don’t want him to know.  He says he doesn’t want to go there.”

Her eyes were wide and she was visibly perspiring.

“So you lied to him?  He may be mentally ill, Ma’am, but I won’t lie to him, and you are wrong to withhold the truth from him.  I will tell him the what is going on; he deserves that much respect.  Why are you so afraid of him?  He has been nothing but a perfect gentleman since he was admitted.”

I pushed past her and hauled his bag into the room and quietly explained to P that he was going to Georgia Regional, that there were no other beds available, that it would be okay, that he should not worry.

His mania had escalated in the hour that I was gone.  He was unable to sit still, clearly fearful.  Who in the hell tells a psychiatric patient who attempted suicide that  he is going to be transferred to an unknown facility?

"I don't want to go, but if it's the only choice, I will cooperate," Parrish said.

I hugged him tight.

Lawrence arrived in 15 minutes.  A few minutes after his departure for work, I heard the clanging.  Peering through the window of the room, I saw The Deputy walking onto the unit, jingling the shackles like Christmas bells.  He stopped at the desk, then came to the door.

“Mr. Gray?”

“Yes, sir.”

Parrish stood and offered his hand, but the The Deputy did not shake it.

“You are not under arrest, Mr. Gray, but I have to do this.  Please face the wall and put your hands on it.”

“Don’t panic, P.  This Draconian procedure is standard, so try not to panic,” I said.  

He turned and placed his palms on the wall of the hospital room, and I watched as the The Deputy frisked him thoroughly.  He wrapped a thick leather belt around P’s waist and buckled it and slid the buckle around to the front.  He locked it in place and then stooped down and shackled both of my son’s ankles. 

“Try to stay relaxed, Buddy.  He’s not going to hurt you.”

“Turn around, sir.  Take off your hat and hand it to me.”

The Deputy took the hat and crumpled it into a wad, handed it back and ordered P to replace it on his head.

Parrish did as instructed.

“Raise your arms out in front of you, palms down.  Now turn your palms inward.”

Again, P complied.

“Now bring your hands to your waist.”

He applied the cuffs quickly and locked them to the belt.

The contents of my stomach leapt into my throat and I swallowed hard.

“Don’t worry, son.  Try not to worry.”

“Is this his bag?”

“Yes.”

The Deputy started walking P toward the door.

“Wait just one minute!  He will not walk out of here like that.  Put him in a wheelchair and cover him with a blanket.  You will not walk him through the hospital looking like a prisoner.” 

The wheelchair and blanket arrived and The Deputy picked up P’s bag and dropped it into his lap.

I took his face in my hands and kissed his cheek.

“Lipstick tattoo!”

He smiled wanly as I looked into his eyes, dancing with mania and fear.  I wanted to stuff him back into my womb, give him a do-over.  I wanted to wash away his psychosis with amniotic fluid, protect him from the world that does not understand that his brain is broken, that crazy is not a choice.

As they left, I fell into Melvina’s arms and sobbed.  Sweet Melvina was with him both days he was in the step-down unit, and I can now count her among the angels who walk in this world and look after me.  She is the reason I could come home and sleep in my bed at night, the reason I didn’t have to worry about him.  She gave me her phone number in case we need her when P gets home, saying she will sit with him if we need her. 

The days between the time P came off the ventilator and his transfer to Georgia Regional were uneventful except for his confusion and disorientation.  During that time, I wondered if he had damaged brain irreparably, but today he could tell me the day of the week and the date, so I am encouraged.  He was not medicated for his psychosis, and as time passed, he became more manic and afraid.  I wish he were not in Savannah, wish he were closer to me, but I am glad he is finally in a place where his demons can be faced down and he can get the medicine he so desperately needs.

Thank God it's music night!  I have a new Cabasa!

        

Another Nightmare - P Attempts Suicide - Again

This afternoon, before sitting down to finish a post about Cuz and his passing, I picked up the phone to call a friend.  There was a message waiting.  The call came at 3:46 this morning, when I was hard asleep.  I didn’t hear the phone.  When I listened to the message, I heard Parrish’s voice over a line with almost deafening static. 

All I could make out was, “I’ve taken every pill I can get my hands on.”

I called his room.  No answer.  I called his father.  No answer.  I called the hospital.  Not there.  I called the police.  There was a raging thunderstorm parked over us, and I knew they could reach him before I could, assuming that he was at home.  I answered all their questions and was assured that police were dispatched to perform a “wellbeing” check.

I called Melissa, and she was able to reach Lawrence on his work phone and send him to P’s efficiency.  He arrived, a man ill-prepared for theses kinds of things, as paramedics were working in the room.  They would not let him in and would not tell him anything about Parrish.  So there he stood, trying to stay out of the rain and out of the way, helpless. 

At 4:50, the police dispatcher called me and said P was en route to the emergency room, that his breathing was depressed and paramedics were opening his airway.  She said his father was following the ambulance to the ER.

I cried.  No, I cried like a crazy person.  Then I brushed my teeth and pulled up my hair and jumped into some clothes and dried my eyes.  Honey and I were out the door in 10 minutes.  The rain had slowed down, but the causeway was dangerously foggy.  It felt as though it went on forever.  About three blocks from the hospital, it occurred to me that P might be dead.  Why I did’t think of that before is a mystery for all time.  No, it’s not.  It has a name and her name is denial.  I arrived at the ER at 5:30.

My first glimpse of Parrish was from the door of the ER room where he lay, respirator set at 18 breaths per minute and surrounded by, count them, six medical personnel.  His ashen face was flaccid.  His eyes were almost closed, so I asked someone to close them.  They looked at me like I had just grown another head, and I don’t blame them.  Mothers can’t be nurses of their children.  He had a gastric pump in place and, of course, the endotracheal tube. 

I started babbling that he didn’t want to be kept alive on a ventilator.  I played the “I’m his guardian” card.

Then I saw Lawrence at the end of the hall and went to him.

“He’s not going to make it this time,” I sobbed into his shoulder.

“Now, don’t talk like that.”

“13 hours elapsed from the time he called me until I tried to call him back!  It was another 30 minutes before he was intubated.  He’s finally succeeded.”

There were more assurances from Lawrence, which is odd because he’s always the “glass half empty” person.  I, the “glass half full” person, was falling apart all over the poor man. 

For the first time since P’s diagnosis of Bipolar Disorder about 18 years ago, I had the luxury of falling apart.  Until now, every time I was with him in hospital for a suicide attempt or alcohol toxicity or uncontrolled mania, I was completely alone.  Now I have his father for support.

A police officer called me aside and began questioning me about the event.  All I could tell him was that yesterday, P and I ate at Longhorn and went to Winn-Dixie.  He was fine.  We laughed and talked, genuinely enjoyed being together.  The officer asked about his medicines, so I told him what I could.

Back in the room with P, we found only one nurse.  She was hanging IV fluids and checking lines.  

“Are you keeping him alive with that ventilator?”

“We have started him on Versed to make sure he’s in a medically induced coma so he can rest.  His brain function is uncertain, but we will know more if he starts to try to breathe on his own.”

It was about two hours later that P took a breath on his own.  I told Lawrence it was a good sign, and we sat their like two fools staring at the vent settings to see if he would do it again.  He thrashed in bed.  We were encouraged.

Melissa arrived shortly thereafter, and I was glad for Lawrence.  I was also glad for the Starbucks she brought me.

Two hours later, when he was transferred to ICU, he had not moved a muscle.  I’m choosing to believe that’s because of the Versed.  He’s having some cardiac arrythmias, probably caused by the almost-full bottle of Elavil, an antidepressant, that he swallowed.  His urine test for drugs also showed benzodiazepines (for which he had no prescription), so I can only assume he bought them on the street.  The level in his blood was high.  He also had a small amount of alcohol on board as well as cocaine.  He knows what will kill him, and once more, he tried to die.

After P was safely installed in ICU and we had an opportunity to talk to the nurse, and with her assurances that she would call with any change, we all went home.  I will return in the early AM.

There is nothing to do but pray.  However and to whomever you pray, just pray.

© 2014 cj Schlottman