What Happened on Monday

Monday Night

Before I fetched P from crisis stabilization, I went to WalMart and got him a TV and a tablet. He loves The History Channel, and he loves music, and I so want him to have the things around him that make him feel comfortable and at home.

When I arrived at Gateway and rang the bell, I was left cooling my heels for about five minutes. When the door opened, out stumbled P carrying a paper sack containing what is left of the lounging clothes we bought for him while he was there. I took him sweats and tees and socks and undershorts twice, and I think Lawrence made as many trips with similar items. His brown loafers were dangling from the fingers of his other hand. He seemed dazed by the sunlight and didn’t focus on me at first. When he did, his eyes came alive a little.

The attendant all but shoved him in my direction.

“Where is his bag? I asked. 

“Oh, I’ll go and get it.”

“And his wallet?”

“He has it in his pocket.”

“Aren’t we supposed to meet with the social worker and at least a nurse before we go?”

He handed me a sheaf of papers with prescriptions attached.

“No, Ma’am. He’s ready to go and these papers explain everything that you’re supposed to do.”

The door closed and we waited. P finally rang the bell again, and about the time he did, the attendant came around the side of the building carrying the duffel in question.

I had already called June at Active Community Treatment (ACT) to tell her we would be on our way as soon as we had lunch, so we got in the car and drove to Waffle House.  Where else? P’s dental problems make it one of our favorite stops.

As we were about to order, what sounded like a jackhammer  blasted into the usual cacophony of Waffle House dining. Every head in the the restaurant turned toward the clacking and banging sound of compressed air beating into the floor behind the counter. I had to shout to make myself heard.

Then the sound stopped. The typical clanging of dishes was like a sweet hush after the assault on our eardrums. In less than a minute it started again. We debated whether to cancel our order and leave but decided that the racket couldn’t possibly continue for more than a few minutes, not at two o’clock in the afternoon.

We could hardly eat for the noise. It blasted the air like a machine-gun at frequent intervals as all of us amazed customers sat trying to eat or read the paper of just drink coffee. Talking was completely out of the realm of possibility.

Shit, neither of us was anxious enough, I guess. We needed to have our entire nervous systems raped by a fucking jackhammer while we were trying to eat comfort food. Jesus.

The food was comped, of course, and we each managed to finish our food before fleeing the ruckus as fast as our legs would carry us. An omen? A taste of what was to come?

On the ride to ACT, we tried to make small talk, but P’s speech was still very thick and garbled. He lost patience with me asking him to repeat himself and said for me to just stop talking.  So I did.

During the admission process, I couldn't name all of P’s meds so I went to the car to retrieve the bag of bottles I received at Gateway along with the paperwork. That was when I discovered that one of his medicines was missing.  Which one? Why the most important one, the Clozaril, the miracle drug with the dangerous side effects that is supposed to bring P back to us. The idea of driving back to the other end of the county to get them left me cold. All I could think of was that it never would have happened if we had a proper meeting and went over all the medicines before we left. Within minutes, one of the ladies at ACT called the crisis unit and arranged for one of the staff to drop off the medicine on his way home from work. A non-problem, it turned out to be.

The paperwork took most of two hours, but during that time, P saw the psychiatrist and so did I. When Dr. Bernstein asked to see me after their visit, P got paranoid and went and sat in the car. When I got there, he was pouting and said he was confused.

“What are you confused about?”

“I’m the patient, Mama, not you! Why did you have to go in there? Did you two talk about me the whole time? That kind of shit isn’t necessary. I can speak for myself.”

In fact, we talked very little about Parrish. He had forgotten to tell the doctor about two of his medicines, and I filled in those blanks, now that we had them all. We talked more about me and my expectations. Dr. Bernstein agreed to work with our private shrink and coordinate his care with her as long as Parrish is enrolled in ACT. We talked a little about me, about my longstanding and mostly controlled major depression, about what I was doing to help myself during this incredibly difficult transition. Period.

“You may be his patient, P, but I am your mother and your guardian. We talked mostly about me and my plans and hopes for your treatment and care. I know it’s easy for you to think you are the only player on this stage, but you’re not. We are a family, you and I, and yes, your father too. There is no need for paranoia just because I had a conversation with the doctor.”

He seemed satisfied with that answer, and we drove home mostly in silence, driving though at Starbucks for a coffee on the way.

As soon as Honey ate her supper, she was ready to walk, and I was too. I had to urge P to go with us. He said he felt tired and weak and didn’t feel like walking, but I coaxed him into going. We cut the walk short because he complained of begin so tired, but I know the exercise and fresh air were good for him.

Then we set up his tablet and ordered a pizza. By the time were sitting down to eat it, P’s speech had cleared a great deal. His daddy called and was impressed when he heard him. After supper I doled out the medicine - six different pills - and within 20 minutes P’s speech was once again slurred and he wanted to go to bed.

Throughout the evening, I noticed that he isn’t really interested in anything. He’s pleased with his tablet but only listened to one song. He expressed no desire for me to set up his television, even eschewed the opportunity to watch in Marnie’s old room. He had no interest in a copy of Rolling Stone or a book of any description. It’s difficult to watch, but I know it’s the medicine. He needs to be sedated, cushioned from his psychosis and paranoia while his brain rests and heals. It’s not pretty, but it’s not mania, either. This I can deal with.

So, I tucked him in, but in twenty minutes he was up again, scouring the kitchen for snacks. Peanut butter cups seemed to do the trick, and he went back to bed where he has been for about and hour and a half.

Not a bad start, I think, all things considered. The doctor assured me that as the dosage of Clozaril is increased, the other antipsychotics will be decreased and eventually discontinued.

So, this leg of the journey begins. . .

Copyright 2014 cj Schlottman   

The Sun Through Troubled Eyes is the Sun Nonetheless

Vincent Van Gogh

Yesterday afternoon Parrish thought Honey and I had been kidnapped.  He was frantic to know if we were safe.  He was desperate to help us but didn’t know where we were.  I was able to assure him that we are fine, safe at home, but I began to question his readiness to come home on Monday, his target date for dismissal from the crisis unit.

This morning at 6:30 he was in Ft. Lauderdale.  He cancelled his flight, something about hats and a 30 day hold.  I never could understand.  He wanted me to call and buy him a bus ticket.  He said it was all bullshit.

At 7:30 he said to cancel the bus ticket, that he would just wait for me to pick him up there.  When I asked where he is, he said he’s was in Gateway, waiting, counting the minutes until I pick up and get him out of there.

The above is about 25% of what he said.  The rest was unintelligible.  This is Thursday, and Monday is just four days away.  I’m daunted by the prospect of his dismissal, but I’m ready.  I’ve made concrete plans for his care at home.

After P’s dismissal, assuming that it happens as planned, I will take him to the be enrolled in a home care plan.  It’s through a public agency that coordinates with Gateway and provides home monitoring of psychiatric patients who are at high risk for readmission.  His case will be managed by a RN who works closely with the agency’s psychiatrist.  A health care professional will visit at least three times a week, more often if needed. There is a professional on call around the clock for emergencies. 

As P stabilizes, the home visits can evolve into excursions.  A medical pro will be able to pick him up and take him to Starbucks or someplace where they can sit and talk while he or she does the evaluation.  These people will take him to the appropriate meetings at Gateway if we choose for him to go.  We already have a good advocate in AA, and as soon as he is stable and oriented enough, he’ll be going to meetings again.

He is required to see a psychiatrist at least once a month, and luckily for us, he may see a private doctor.  We already have a doctor lined up for him.  My understanding is that the private doctor will manage medication in coordination with the agency’s doctor, that she will have the final say-so about what P takes.  It is  very important to me that, when P is dismissed from home care, he have a doctor he knows and trusts and won’t face “breaking in” a new psychiatrist.  That kind of continuing care is a big part of making this work, I think.

He must also see a therapist at least once a week, and again, we will use a private person so P’s care will be continuous and uninterrupted.

I fought to get Parrish in this program.  The moment Wayne, the social worker at the Gateway crisis unit, told me of its existence, I began doing everything I could to make it happen for us.  I used the word “us” advisedly.  This kind of support will make it easier for me as well as for my son.  It will provide periods of solitude, down time I so need in order to maintain my mental balance, my sense of being grounded, my ability to be supportive.  I enlisted the support of Dr. Snow and tried to stay in close touch with Wayne about it.  On Tuesday, I got the good news that Parrish was approved.

It gets better.  Sophie - I’ve mentioned her before - will come to stay with us for a while.  She is my support person.  She is perhaps the steadiest person I have ever known, and she will infuse this flat with her positive energy, her total lack of judgement.  She will find a way to make us all feel better.

And then there is Lawrence, loving, concerned and willing to help in any way.  His support gives me hope and strength and, knowing that I am not in this alone is a comfort.  Melissa opened the door between Lawrence and me, and to her I will be grateful forever.

No, none of us knows how this will play out.  It will be difficult for every one, especially Parrish.  After all, he’s battling demons I will never know, never understand.  His father and I will suffer with and for him.  But the only way I know to make this work is to believe it will.  If I thought this would end in tragedy, I couldn’t do it.  There is always room for a miracle. 

**********

It is my hope that someone will take hope from the reading of this post.  If you have a loved one in crisis, get involved and advocate for that person.  You may not have a great support system as I do, but there is much you can do on your own.  Obtain guardianship, if appropriate, so you can be an active participant in your loved one’s care.  Either way, plan for the future.  I spent years “putting out fires” and thinking the problems would disappear in the ashes.  They didn't.  Ask questions, and if you don’t get the answers you need, keep asking.  I am astonished at the resources here in this small coast community that I did not know existed.  Do some digging.  Don’t give up.

Copyright 2014 cj Schlottman

And Thus Goes My Day

“Hello.”

“Mahmah?”

“Hey, Buddy!”

Feverish and indecipherable mumblings tumble from the earpiece of the phone.

“Whoa, P, slow down.  I can’t understand you.”

More mumblings.

“Take a breath, Buddy.  I can’t understand what you’re trying to say.”

“Ahinzhail!”

A pause while my brain translates.

“No, Honey, you’re not in jail.  You’re in Gateway at the stabilization unit.”

“Ahinzhail!”

There follow more utterances that I cannot decode.

“Please stop talking and listen to me.  You are not in jail.  You’re in a safe place.  I can see from caller ID that you are at Gateway.”

“Ahmnothinzhail?”

“No, Sweetheart, you are not.”

Wull, they’re gonna pumeinzhail for ahunnrhed days!”

“No, they’re not.  I won’t let them.”

“Ojay.  Icallyamorrah.”

“Good.  Call me tomorrow when you feel better.”

“Iluhyu.  Buh-buh.”

And thus my day began.  Where did yesterday’s progress go?  Was there really improvement or did I just want it so desperately that I made myself believe it? 

I put down the phone and stared at it for a long moment.  Then I picked it back up and punched in the numbers for Gateway only to be greeted by their answering device.  I hung up and stared at the phone some more.  What to do?  The hard truth is there is nothing I can do until someone over there picks up the phone.  Then I can’t really do anything.  I can only inquire about his condition, which I can pretty much figure out for myself.  Would another visit from his father and me help to ground him in reality?  

I ache to put my arms around P and squeeze the crazy out of him, look into his precious blue eyes and will the demons out, suck them out through his ears.  But I am not god.  If I were, this wouldn’t be happening to him.

An hour later the phone rings again.

“Igoh aythunnrhedollus to my name.  Greeksareawarahgin, been goinonfoheons.  Ahnohgoinahprizion!  Scztealinmaclothesahgin.  Kizonnahbeaschdoinheroin.  Yesch.  Hishiplayzapaininmuhass.” 

This is my best translation:  I’ve got eight hundred dollars to my name.  The Greeks are at war again, been going on for eons.  I’m not going to prison.  Stealing my clothes again.  Kids on the beach doing heroin  Yes.  This place is a pain in my ass.”

He rang off with “Iluhyu.”

I immediately called the unit and actually got a person on the line.  The man who answered is the intake person who processed P into the facility nearly three weeks ago.

“I’m concerned about Parrish this morning.  He seems manic and disorganized and delusional.  How so you think he is doing?”

“Well, Ma’am, he’s been moved to a room all by himself because he was up all night disturbing the other patients.  The nurses are trying to get him to lie down and rest but he can’t.  He’s wandering around talking to anyone who will listen.”

“Has the nurse given him anything to help him rest?”

“I can’t say, Ma’am.”

“I really need to talk to Paul.  Is he there?”

“He’s here but not in his office.  Do you want me to get him to call you?”

“Yes!  I’m very concerned.  Please have him call me when he has a moment.”

And thus my day continues. . .

© 2014 cj Schlottman

Tinker's Damn

My funk has lifted, buoyed out of my brain by Music Night and the miracle of understanding friends and the healing power of music and dancing.  The sun is out after a dark and windy morning that brought Honey and me scampering back inside after only a short walk.  We sit by the window and soak up its warmth.

Parrish’s doctor phoned to say he is hopeful, that P’s brain is more organized now, that he is more in the moment and better able to control his impulses.  I thought it was my imagination when earlier this morning, he sounded less scattered though still slurred of speech.

His last dose of Thorazine was 48 hours ago, but it will take a few more days for it to clear his system.  Maybe then he will be able to articulate more clearly, communicate more effectively, get his mouth to do what his brain tells it to do.  He is taking a relatively small dose of Clozaril, but it will be increased starting tonight.  His blood work is good, no decrease in white blood cells.  He is still on Geodon, but the plan, the hope, is to eventually wean P off of it and maintain him on lithium and Clozaril. 

Parrish has been in countless institutions in an effort to tame his psychosis, the racing thoughts in his head, but never has he been in a place where the doctor actually called me with updates and plans for his care.  And this is a public facility.  

Five days after his suicide attempt, Parrish was admitted to a different public facility, Georgia Regional in Savannah.  A week later he was dismissed more symptomatic than when he arrived.  

I almost lost hope, sank into a black hole for a short time earlier this week, but this man, Dr. Shivers, has restored my belief that there are good people working in hard places, people who actually give a tinker’s damn about their patients and families.  I was astonished when he gave me his cellphone number, said I should call him when I need answers or just need to talk.    

There is still concern that the effects of P’s massive overdose of Elavil may linger for months, but there is the real possibility that they will diminish and fade away completely with time.  That process may be accelerated by Clozaril.  

And the sun continues to shine.

© 2014 cj Schlottman

Glass Half Full

Yesterday, when I arrived at Gateway to meet Lawrence and visit with Parrish, I had no idea what to expect.  Earlier in the day, I called to confirm our appointment but had to leave a message.  This is standard operating procedure, I have learned.  I asked for a call back to verify the time but never heard from them.  That kind of thing rankles me no-end.  How much time could it possibly take to pick up a phone and make a 30 second call?  Well, that would be exactly half a minute.

I decided before I left home that I would go into the event with an open mind and a positive attitude, but it was difficult.  The day before, when Lawrence dropped off some things for P, the person to whom he gave the things said it wasn’t a good idea for us to visit on the weekend.  Funny, but Wayne said the weekend was the best time.  

Clint used to call me 1-800-KICKASS when I was angry, and I was prepared to whip out some of that if necessary.  It wasn’t.

The staff greeted us warmly and ushered us into an office.  They delivered Parrish to us within minutes, and a nurse sat with us.  After about five minutes, she left us alone.

P’s pupils were like wide black pools, and he was confused from time to time, floating away to another place and time.  But he was not manic.  I learned from the nurse that he was off all meds except Thorazine, which he gets every four hours while awake.  That would explain the pupils and the faraway look.  It’s a psychotropic drug that has been used for decades in the treatment of severe intractable psychosis.  Today is the day they are going to start him on Clozaril.

P wants to be Lawrence right now, wants to dress like him, so Lawrence brought him some black socks and black penny loafers (Yes, he still wears them.)  Lawrence insisted that he put them on, so P kicked off his Crocs and donned the shoes and socks.  He thanked his father and his mind wandered.

Our visit was unstrained and pleasant, only marred by P’s tangential thoughts and breaks with reality.  He heels were quiet against the floor.  I can’t remember a time his “motor” was not running, so I took some splice in that.  On a couple of occasions, he stood up as though to leave, saying he had to be somewhere or that the staff was calling.  

For the most part, his affect was flat, but his face lit up when he talked of things that interest him.  He knew the day of the week.  His thick-tongued speech was easier to understand than it is on the phone, and conversation was actually possible.  He talked of historical events, those in his life and in the life of the world.  His passion for history is alive and well!

It was easy to bring him back to the present, and I take great comfort in that.  He and his father talked of boats and bridges and navigating the fog.  P is navigating is own fog right now, but he is pleasant.  He expressed slight anger only on the occasions when his paranoia surfaced.  He still thinks people are stealing from him, and he still considers the staff a bunch of morons who don’t know what they are doing.  There are times when I can understand that.

We were with him for about and hour and 15 minutes.  I expected to be completely drained but was not.  I am encouraged.  I can’t be any other way and face the future, P’s future and mine.  Maybe Clozaril will be his miracle drug.  Maybe not.  His brain may be more broken than ever.  I’m not so naive as to think there won’t be more roadblocks ahead, more seemingly insurmountable obstacles on the path we must take, but I am hopeful.  I know how toxic my life can be without hope.

Lawrence is grieving.  He sees this as another loss in his life.  He hasn’t done this before, and I know how he feels.  My journals over the years have been peppered with the horrible thought that P is lost to me in a very real way, almost as though he were dead.  After years of alienation, P is back in Lawrence’s life, but he’s really not present because of his illness.  When we were standing in the yard talking, Lawrence wept openly, shook with sobs.  I wanted to console him but didn’t know how.  

He told me that when P is dismissed and things are hopefully more stable, he will take him to his Island house to spend the night, give me a break from time to time.  I believe him, and I believe “from time to time” will be more frequent than it sounds.  I don’t know how to be skeptical about this.  Why should I, in the words of my Grandmother Parrish, “run down the road to meet trouble?”

Somebody’s glass has to be half full.

© 2014 cj Schlottman 

Angels Abound

On Thursday, I made something of a squeaky wheel of myself and called the main Gateway office and asked to speak to the administrator.  After a pause, the woman who answered he phone asked the nature of my call in order to “get you through to the person who can best assist you.”

I told her my name and explained my situation, that Parrish has been an inpatient in their crisis stabilization unit for ten days, and I have been essentially left out of the loop.  I told her that my only contact with the unit is when I phone them and that most of the times I call to check on P, I get an answering machine and no one bothers to call me back. 

“In ten days, I have not spoken to a doctor despite having requested a call from him on two occasions.  I have not received a single progress report.  I am not only Mr. Gray’s mother, I am his legal guardian and it is my responsibility as well as my right to participate in his treatment and be kept abreast of his progress.  I’ve been extremely patient, I think, but this is unacceptable.”  

After about a minute on hold, she came back on the line.

“Okay, Ma’am, I’ll transfer you now.”

“To whom are you transferring me?”

“I’m connecting you to the crisis stabilization unit.”

“To whom at the unit?  If I get the desk, I will no doubt have to leave another message.”

“I’m putting you through to the supervisor over there.”

And thus I had a conversation with “Julia,” the nurse manager at crisis stabilization.  When I repeated to her what I said to the receptionist at the main office, her tone bristled.

“What exactly can I do for you?”

“You can get word to the doctor that I need to talk to him.  It’s a simple as that.  I need an update on Parrish’s condition, any progress he has made or failed to make, a sense of his prognosis.  Is he better?  Is he worse?  And it may surprise you to know that I may have information about his illness that you do not have.”

“Okay.  I will call Dr. Snow now and see if he can talk to you.”

It was nearly four hours later when I heard from Dr. Snow, and when he did call, he was a source of much information and comfort.  He was under the impression that a person named Wayne had been updating me at intervals about P’s condition and was most apologetic for their failure to keep me informed.

The news was mixed.  Parrish is not responding to his current meds.  (Duh.)  The plan now is to put him on Clozaril, but before they can do that, they have to recheck his white blood cell count because the drug can cause angranulocytosis, a failure of the bone marrow to produce white blood cells.  It doesn’t take a genius to figure out that if white blood cells are diminished, the ability of fighting off infection is compromised.  

Dr. Snow asked my permission to put P on the drug.  His name will be placed on a national registry that monitors patients on Clozaril, and Dr. Snow is required to submit his lab results to that registry.    

Parrish will be monitored weekly for the first six months. If there are no low white blood cell counts, he can be monitored every two weeks for an additional six months. Afterwards, he may qualify for every 4 week monitoring.

Yes, Clozaril a dangerous drug, but in 30% to 40% of patients with treatment resistant schizophrenia or schizoaffective disorder, it is the drug of choice.  It is a difficult decision.

Some PROS:

superiority for positive symptoms in treatment-resistant patients; 2) lower risk for suicide; 3) lower risk for tardive dyskinesia and suppression of established tardive dyskinesia; 4) improvement in cognition contributing to better work and social function; 5) higher quality of life and longer time to discontinuation; and, 6) decreased relapse.***

And some CONS:

1) agranulocytosis; 2) insulin resistance with increased risk of type II diabetes, weight gain, and various vascular complications; and, 3) myocarditis. There are also other unpleasant side effects, such as hypersalivation and increased risk of seizures.***

Yesterday, P called me at six in the morning to say he was going to the hospital because of his back, that he would need surgery and he would call me when he got there.

A little later, he called to tell me he is at the police station, having been arrested with some other people and charged with manslaughter because they had been riding in the car with a man who ran over a woman.

HIs latest call was to tell me he had been researching the Hindenburg Disaster and that it was a terrorist attack.

  

With delusions like this, coupled with his paranoid belief that his things are being systematically stolen from him and that he is being kept in a locked room and only let out to use the phone and eat, all while on a drug regimen that includes two antipsychotics, I am willing to give my permission for Dr. Snow to give P this drug.

Dr. Snow was unaware of the massive amount of Elavil that P took in his suicide attempt, and his first reaction when I told him was utter astonishment.  I have to wonder why this information was not in Parrish’s medical record.

“It’s a miracle that he is alive!  I have known patients who died from half that much.  I’ve even known a patient who died from a buildup of the medicine in her blood while taking it as ordered.”

“Doctor Snow, could Parrish have damaged his brain with such a large dose?”

“There is no way to know.  With that massive dose, there could be ongoing brain toxicity that will fade with time.  That should be our hope and expectation.  It could take two or three months to know for sure.  Meanwhile, let’s wean him off the other drugs and start Clozaril.  I have seen it work wonders.”

He apologized again for the failure of his staff to keep me informed about Parrish’s condition.  He promised me that Wayne, a social worker, I think, would be in touch.

And this morning, I heard from Wayne.  He did not apologize for keeping me in the dark, but what he told me was much more important.  Parrish is now in what’s called a step-down bed, which gives the him two more weeks of impatient care if necessary.  That gives us some breathing room and time to prepare for his dismissal, whatever shape he may be in.

More important, though, Wayne is putting into motion the steps necessary to have P qualified and enrolled in a home care program that is run by Gateway.  It’s designed for patients who are too sick to be followed as outpatients in the regular clinic setting and provides three home visits every week so they can be followed and monitored closely.

It’s not a done deal, but I am hopeful.  I feel as though a gift has fallen from the heavens right into my lap.

And it gets better.  Sophie, my wonderful friend, is coming to stay with us for a while after P is dismissed.  Sophie has been an Angel in my life for 40 years and has pulled me out when I was up to my knees in quicksand more than once.  She looked after me when I could not walk straight or write or drive my car or remember what I said 10 seconds before.  She is the picture of love, and Marnie said it right after she first met her.

“Sophie is the kind of person who makes you want to be a better person.”  

I have nothing to add to that.     

© 2014 cj Schlottman

Layering On The Meds

I wish I cold figure out how to write like Parrish sounds.  It’s almost a different language, so thick and slurred is his speech.

“The Gateway van is broken down, but I have a ride to the hotel.  Don’t worry.  I will call you from there.  I need you to bring me my cashmere sweater.”  

“You’re leaving tonight?

“Oh, yeah.  I gotta get outta here.  This guy’s gonna give me a lift in his truck.”

“Okay, Darling.  Just call me when you get there.”

That was last night around midnight.  He’s not supposed to use the phone after 10:00.

At 6:13 this morning:

“Hey, Mom.  We’re leavin’ for London at 10:00 and I don’t have enough clothes to take.  Could you send me my jeans and khakis?”

“London?”

“Yeah.  I’m pretty excited about it.”

“Why are you going to London?”

“I’m not sure.  I just know we’re going, so please send me some clothes.  I’ll call you when we get there and give you the address.”

“All right, Son.  Call me from there.  I love you.”

And he rang off.  Still groggy from sleep, I shook my head in an effort to wake up enough to tap into my feelings about what I had just heard.  I took a Xanax, then took Honey out.  Before I could feed her or make a cup of coffee, the phone rang.  It was 6:24.

“Hey Mom, howya doin’?  Listen, we’re not goin’ to London after all, so don’t worry about my clothes.”

“Why aren’t you going?”

“Shit.  I don’t know.  They change plans around here all the time with no ‘splanation.  I could use a little cash though, just to buy a Coke or a snack.” 

I know there are no vending machines at Gateway, and I know caffeine is banned, but I didn’t see anything to be gained by pointing out that fact.

“Okay, Honey.  Tell me how you’re feeling this morning.”

“I’m fine.  My mania’s under control so I should be getting out today.  Since the van is broken, you’ll have to come get me.  I gotta go.  I love you.”

“I love you too, Darling.”

I sat and sipped coffee and smoked and worried.  There are so many more questions than their are answers, and I am wearing down and wondering where we will go from here.  At least for now, he’s hospitalized, but the fact that he is so delusional and confused, so much worse than he was a week ago, is more than troubling.  I can hardly make myself write it all down.

At 7:02, the phone rang once more.

“Hey Mama.  Howya doin’?”

“I’m good, P.  How are you feeling?”

“I’m having anger issues.  These people are accusing me of peeing on the floor in somebody else’s room!  You know I don’t pee on the floor, and other patients are coming in my room and throwing my stuff all over the place and stealing from me.  I want you to lodge a complaint against the people who run this hell-hole.  I mean it!  You have to get me out of here and sue these people.”

“Could you be a little manic and maybe not thinking straight?”

“Hell yeah, I’m manic, manic and mad.  I can’t stay here another day.”

“Why don’t you go back to bed and try to take a nap?  Maybe you will wake up feeling better.”

“Okay, I’ll try.  I’ll call you later.”  

I continue to sit and stare and smoke.  I want nothing more than to go back to bed and sleep until this time tomorrow.  What I really want is to hide in the bottom of my closet with a soft blanket and suck my thumb and drink vodka straight out of the bottle.

Later - 1:45PM

P called about 15 minutes ago and said he is being dismissed, that he’s on Geodon now and it would have to be administered by injection.  He wanted my assurance that I would give him his shots.  Knowing that he would not be dismissed on parenteral drugs, I agreed to give him his shots.

I called Gateway and talked to the nurse, relayed to him my conversations with P earlier this morning.  He assured me that no one had accused P of peeing on the floor and that no one had been in his room disturbing his things.  He didn’t have to tell me that the London thing was a delusion.

When I asked about his medicines, I learned that he is not on Geodon.  He is still on Zyprexa, but The Doctor added Cogentin and Haldol to his regular meds.  The Cogentin is for Parkinsonism but is sometimes used to counteract the side effects of other medicines.  

It seems like piling on to me.  And, it gets better.  There are serious drug interactions with Cogentin and Haldol.  Taking into account that Zyprexa alone comes with a long menu of possible serious side effects, one has to wonder how P’s symptoms will ever be alleviated. 

All of these meds cause extreme dry mouth and slurred speech, and they can all cause confusion.  Isn’t he confused enough?  

He just called again to make sure I’m coming to get him.


Copyright 2014 cj Schlottman

He's Not Retarded, You Fool. He's Sick.

The weekend was rocky, but with the help of a wonderful man who took P under his wing at AA on Saturday afternoon and got him to a meeting that night and again on Sunday night, we all survived.  

On Monday morning, Starbucks in hand, we arrived a Gateway for P’s 8:30 appointment, and after waiting almost an hour, we were ushered into to see The Counselor.

While we waited, P was manic and impatient and angry.  He paced, went outside to smoke.  He bristled at the idea of me going into the appointment with him, insisted that he only needed medicine, that he could handle the situation on his own.  

“It’s my responsibility to go in with you, Son.”

“You don’t own me!  If you go in there with me, it’ll just complicate everything.  I’m just going to tell them that I lost my medicine so they will give me some more.  This Abilify isn't working.”

“Did you take it this morning?”

“No.  I’m saving the last pill.”

“For God’s sake, Parrish, it can’t help if you don’t take it.  Your thinking is not rational.  And you can’t tell them you lost your medicine.  You have to tell them the truth about what happened to it.”

“Mama!  They’ll throw me in jail!  But I guess that’s what you want anyway.  You’ve done it before and I have no doubt you’ll do it again.  As soon as I get some medicine, I’m leaving this town, that is if you don’t send me to jail first.”

There were more hostile and argumentative remarks.  He was frightened and all he could do was strike out.

Finally, we were taken into The Counselor’s office

On the way down the hall, Parrish began babbling.

“I can make this simple and easy for you, Ma’am.  I lost my medicine and I just need some more.  It’s as simple as that, so just get someone to give me my medicine and I’ll be out of your hair.  I don’t want or need my mama with me, but she thinks she owns me, so there’s nothing I can do about her.”

Once inside the office, I asked if the information we gave The Counselor would be kept in confidence.  When she assured me that it would be, I told her the truth about the medicine.  Parrish jumped out of is chair and started for the door.

“I’m not sitting here and listening to this bullshit!”

“Please have a seat, Mr. Gray,” said The Counselor.  

“This interview will take some time, so we need to get started.”

Parrish sat and fumed.  He stood and paced.  His heels worked against the floor.  He interrupted with the same questions time and time again.

“How long is this going to take?  Why can’t somebody just give me some medicine?  My mother has no right to be in here in the middle of my business.  I’m ready to get the hell out of here.”

The Counselor was young and pretty and soft-spoken.  She had only been on the job for a few months and thus was not yet jaded.  We went over the history of P’s suicide attempt and his stay at Georgia Regional as well as the events of Friday night.  She was kind but neutral. 

“Is all of this necessary?” Parrish wanted to know.  

I tried to impress upon The Counselor that it was  imperative that Parrish see a doctor.  She agreed and said she would do what she could to make it happen.  I signed what seemed like dozens of papers, some pertaining to my guardianship, some giving permission for them to treat P.  It was a lengthy process as promised.

The meeting had been in session for about an hour and a half when The Counselor made a call to the appointment desk and requested that a doctor see Parrish before we left.  She eventually left the room and was gone for about 20 minutes.  When she returned, she escorted us to the front desk where we were met with blank stares.

A Doctor walked up to the desk to ask about his next appointment, and the receptionist asked him, there in front of us, if he could work P into his schedule.

I had seen this man several times during the morning, out in the lobby where he went to call patients in to his office and in the hall as we were walking to and from The Counselor’s office.  I had to wonder just when he saw his patients.

“When is my next appointment?”  He directed his question to the receptionist.

“Not until one o’clock.”

“He’s new.  It’s 11:45 now, and I will need two hours with him.  I can’t do it.”

“Sir, I will not leave here with my son in this condition.  He is hyper-manic, bordering on psychotic and he has no medication.  There has to be something you can do for him.”

“I suggest you take him to the emergency room, and they can 10-13 (code for psychiatric hold) him to our impatient unit.”

Parrish looked as though he might explode.

“I’m not going to the fucking hospital!  They’ll just send be back to that hell-hole in Savannah.  I won’t go.  You can’t make me go.”

“Sir, I am this man’s mother as well guardian, and I will not leave until some sort of arrangements are made for my his care.”

“You’re his legal guardian?”

“Yes, all the paperwork is on his chart, and he is not new here.  He was processed in back in December and all his records should be in your system.  Why can’t somebody see him?  Can you not see that this is an emergency, that he is in crisis?”

Parrish had walked to the door and was on the way out.

I brought him back to where we all stood, in the lobby where every person there could see and hear what was going on.

Again from The Doctor, “You’re his legal guardian?”

“Yes, I am his legal guardian!  And I’m going to stand here until I know there is a plan.  My son lives alone and cannot be left by himself in this condition.”

The Doctor took my elbow and in a conspiratorial voice said, “Come with me back to my office.”

When we entered his office, his first question to me was, 

“Is he mentally retarded?”

I did not make that up.

“No!” he’s not retarded!”

“Learning disabled?”

“No!  He’s a college graduate with a degree in history with minors in geography and psychology, not that it should a make any difference.  He’s not retarded, he’s sick.  I’m sure you’re aware there’s a difference.”

“Well, since you’re his guardian, you can sign him into our inpatient unit.”  

Really? I thought to myself.

I’ll call over there and make sure they have a bed.”

“Please do.”

Less than a minute later, a bed was secured, and though The Doctor did not know the address or even the street name, he managed to give me directions to the impatient facility.  We walked back into the lobby and I told Parrish what we had decided.

“No!  No, no, no!  I won’t go!  You can’t make me go to any goddamned psychiatric unit.  I just got out of one and look what good it did me!”

“P, go wait by the car.  We’ll talk when we get outside.””

He stormed out and was waiting by the car when I reached it.

“You cannot make me go to that place!  All I need is some medication.  Why do you have to do this to me?  It’s unnecessary and cruel!  I can’t believe you’re doing this, I just can’t believe you would do this to me.”

I let him rage on for as long as I could stand it, then my temper flared.  

“Before you start dictating what will and will not happen here, I want to remind you that you don’t have any medicine because of that bone-headed stunt you pulled on Friday night.  Don’t you dare sit there and act the victim when you brought this whole crisis about.  Hell, Parrish, you didn't even take the one Abilify you have this morning.  You aren’t compliant and you are psychotic right now, yes, psychotic.  Settle your ass down and shut up.  You are going into Gateway, and I am going to sign you in.  We can go directly there and I can drop you off like a package or we can do this the right way.”

“What do you want me to do?  Do you really think I need this?”

“Yes, I do, Son.  Stop and take a breath.  Take inventory of how you feel and ask yourself if this is the way to want to be.  You need to be in a controlled environment where a medical staff can work with your meds and get you stable.  I am no comfortable taking you back to your hotel feeling like you do.  You have to do this.”

“You really think it’s best?”

“Absolutely.  We will get you some clothes and stop for lunch wherever you want to go.”   

So, after a Waffle House breakfast, I drove P to the facility and signed him in.  The staff were friendly and compassionate and I felt good about leaving him there.  I called Lawrence from the parking lot before I left.

On Tuesday, The Inpatient Doctor prescribed Zyprexa.  It’s a second generation antipsychotic, which means it’s not supposed to have the terrible side effects that some of the older meds do.  But make no mistake, all of this class of medications have serious side effects.  Assuming Parrish can tolerate the drug, it will take a week to two for it to reach therapeutic levels. 

On Tuesday and Wednesday, Parrish’s mania continued to escalate and he was paranoid and obsessive.  The Zyorexa makes his mouth dry and his tongue thick, so when he calls me, which he does at least six times a day, it’s hard for me to understand him.  

He reported that other patients were trying to steal his clothes, that the technicians and the nurses were rude and unresponsive to his needs.  He wanted me to bring him a new running suit and some new shirts.  Then he wanted me to come get him, saying he thought he was ready to leave.

Thursday brought no improvement.  The mania and paranoia deepened.  He was angry, accusing me of keeping him there against his will, of conspiring with the doctor to keep him locked up.  His anger exploded on me over the phone, and I had to tell him good-bye and hang up.  He called back again and again.

Yesterday, things got bad enough for the doctor to order a B52 cocktail.  A B52 is an injection of 50 mgs of Benadryl, 5 mgs of Haldol and 2 mgs of Arivan.  It should have knocked him to his knees, but it only slept him for about an hour and a half.  He woke with a terrible headache and a blood pressure of 196/106.  All I could think about was the threat of a stroke.  There was talk of taking him to hospital, but more sedation brought his blood pressure down.  It is still elevated but not dangerously so.

He remains unchanged, still delusional and paranoid and manic.  I have no idea what to expect now, but I am grateful that he is in a safe place.  I have always been able to hang on to the tiniest thread of hope, and this time is no different.  It’s hard, though.  It’s a struggle.

(He just called to tell me the Gateway van is broken down but not to worry, he has a ride back to the hotel and will call me from there.  He wants me to bring him his brown cashmere sweater.)

© 2014 cj Schlottman