Sunday, February 2, 2014

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  
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