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