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?”

“Nothing.”

“Nothing?”

“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









Post a Comment