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

Possibilities

A journal entry morphs into a blog post . . . 

I have Lillia’s manuscript in my possession. It arrived yesterday but I have not started reading it because I continue to feel tired and weak. I can’t even concentrate on fluff, let alone on Lillia’s book. I want to get this job done right, really right. Reading this book is my opportunity to begin earning the credentials I need to convince others what I already know, that I am a damned good editor.  I know I can do it. I just need a chance to prove myself.

I haven’t written a word in two days. I can’t stay awake and focused long enough to get my thoughts down on paper in a way that makes sense. I don’t think I was this sick two years ago before I had my nervous breakdown. At least I don’t remember feeling this bad for this long. My chest wall and head ache from the debilitating cough.

Yesterday, when I was hungry for the first time in days, I thought the end was in sight. But I ended up taking cough syrup twice and floating through the day between naps. I am forcing myself to stay awake right now.

Parrish, the same man who stole two-thirds of my cough medicine last weekend, who ten days ago took money from my purse and without benefit or permission or a driver’s license, took my car to the store to buy beer, has been acting like someone I don’t know. Since trying to pawn a watch on Wednesday in order to get money for beer, he has come about-face.

Wednesday afternoon, when I warned him once more against the kind of behavior that would get him evicted, he didn’t seem to understand. I couldn't tell that he even heard what I was saying. His father called, and in Parrish’s presence, I told him that I was discouraged and exhausted at P’s unwillingness to do anything at all to help stabilize his moods and control his impulses. I explained how hard I have been trying to give him some tools with which to help himself, how I have directed him to web sites where he can express his feelings without fear of rejection, where he can communicate with people who understand his illness. I told him how, every day, I urge P to exercise his brain and his body. While I was on the phone, P sat across from me looking as though he were in another world.

After that conversation, I gave in to a feeling of helplessness, a sense that things would never change, that we would find ourselves reliving the past forever. I surrendered to the depression that is always lurking in the back of my brain, waiting for any entrée into my consciousness. Coupled with my physical illness, it ushered me back into that eerie comfort that distancing myself from reality brings. Having already retreated to the bed, I remained there, searching for insulation in wasteful pursuits like Facebook and solitaire. I worked cryptograms until my vision was blurred, napped at frequent and fitful intervals, hid behind the haze of hydrocodone that quelled my cough if only for a while. 

I refused to write, telling myself there was nothing new to put into words, that writing had failed me and left me to tread water in a sea of sadness. 

This morning as I started to write this post, intended for my journal, it came to me that while I have been in this funk, the usual stressors in my life have been absent. Parrish has been helpful, even proactive in doing the things that I ordinarily have to remind and cajole him into doing. The kitchen is clean and orderly for the first time since he moved in. There is fresh water in Honey’s bowl. The recyclables are where they belong instead of in the trash. Yesterday, when I wanted to eat, he cooked me a frozen pot pie and served it to me in bed. 

Parrish has been following world events with interest and enthusiasm, coming to me from time to time to share ideas and observations. Just a few minutes ago, when I asked him to update me on the situation in Crimea, he sat with me and pulled up a map of the region on my laptop. While he chronicled the recent geopolitical events, his passion for history was palpable. He wasn't manic. He was on subject. His thinking was clear and organized. 

He asked me to download Lumosity to his iPad and immediately immersed himself in it. Yesterday, we watched Mercer defeat Duke in the NCAA tournament, and he didn’t talk the whole time. He walks Honey without having to be reminded. He is reading a book by Stephen Ambrose.

What happened to the self-absorbed and manic man of the last two weeks? Where did he get this ability to focus? Where did he find this desire to help himself? Where did the self-pity go? Could he have processed his options and decided on some level that his only chance of staying here is to work on himself, to be a part of the solution? Could he be asking himself the same hard questions that I have been asking him? Could it have occurred to him that his life could actually be easy and pleasant?

It is possible. There is always room for a miracle. It is also possible that this shining new man will revert to the disorganized and self-serving person I have come to accept if not respect. It is possible, in fact probable, that this is the quiet before the next storm. I can’t stop myself from remembering how totally normal P seemed on the day before he tried to kill himself. I’m publishing this because I want my readers to understand that life isn’t always hellish for us. We have our moments, in this case, our days, and I am grateful for them. 

Copyright 2014 cj Schlottman

Life as a Sine Curve

Disclaimer

I don't know where these tacky click ads came from, and I am trying to get Blogger to make them go away. Please ignore them and rest assured that if they continue I will move to another domain. Sorry.

Wednesday, March 5

For the first week after coming home, Parrish slept little, woke at frequent intervals, and could only string together about three or four hours of sound sleep at a time. After he took his first dose of Adderall on Thursday, he didn't sleep at all that night. He was manic over the weekend but went off with Lawrence on Saturday and did well. The rest of the time, on Saturday and Sunday, he was talking to me nonstop.

He was still stuck in the past, talking about every dog we ever had, naming his favorites, Lucy and Baby, saying that he had to admit that Honey is the prettiest. Saying over and over what a good time he had with is daddy on Saturday. He obsessed time and again about Lawrence's BMW, asking, "Can you believe he has that car? He's got five goddamned cars!" He was back in college, telling me for the hundredth time about coming back to his dorm and finding Michael slung up in the waterbed with four girls watching The Young and The Restless. He could not shut up about how much money everybody has, or he thinks they have. He obsessed about getting a bike, not just a bike but an expensive touring bike. He told me several times that he needs an allowance, and he bragged and bragged about how happy he is and how much he loves his room. Knowing full well that it's not an option, he asked me if I thought he could take up golf again. Then he gave me a blow-by-blow of his swing. I counted four separate times that he asked me what we were going to do on Monday. 

I made him come in my room and watch TV with me, but I had to kick him out because he wouldn't shut up. Then he went into his room and wrote me a letter telling me what a piece of shit he is and how sorry he is that he is sick and how he doesn't want to be the way he is. So I had to deal with that.

That night, I insisted he get to a meeting, so a friend from AA took him and brought him home. He was still manic but less so. He went to bed early, was up and down several times before I went to my room. When I woke on Monday morning, he was sitting in the den waiting for his medicine.

P saw The Therapist for the first time on Monday afternoon. He was extremely anxious before the meeting, but afterward he seemed relieved to have gotten the process started. I dropped him at an AA meeting that night and when I picked him up, he was in a bad mood, saying it was the strangest meeting he ever attended. He wanted only a small supper, and after we finished dinner around ten o'clock, he said he was still tired and wanted his medicine so he could go to bed. I sat up writing and fully expected him to be up several times before I went to bed, but he never appeared.

During the night, his door periodically slammed against the jamb because his window was open and the wind was whipping through his room. It woke me up, so I went to his room to see what was going on and stop the noise. While I was closing the window and securing the door, he snored loudly and showed no sign of being aware of the noise or my presence in his room. 

Yesterday morning, he was still in bed at ten o'clock. He appeared in about half an hour, shuffling and sluggish, and fixed himself a bowl of cereal, ate it and went back to bed. During the day, he was up every few hours just to eat or get something to drink, and I had to make him get up when The Addiction Counselor arrived. His speech was slow and sleepy, but we could understand him. He separated himself from us when she asked me to explain how he ended up in crisis stabilization for a month. He went to his room and filled his lower lip with snuff and sat across the room. We talked for a short time, then he stood as though to end the meeting.  The Addiction Counselor left, and he went back to bed.

When I woke him for dinner, he shuffled out of his room and muttered something indecipherable. He acted drunk, staggered a bit getting to the table. When I asked him to repeat what he said, his tongue was as thick and his speech as slurred as it was when he was in the crisis unit. My first reaction was to ask him if he were drunk, but of course he wasn't. There is no alcohol available to him, not even mouthwash. The liquor and wine is under two keys with his medicine. He appeared to be having difficulty holding up his head, couldn't follow simple instructions and couldn't find the place mats. He had trouble distinguishing left from right. He ate the oysters and green beans I prepared for him with some relish, leaving dribbles of food on his chin and shirtfront, but the minute he finished eating, he went back to bed.

I was witnessing an impressive bipolar cycle manifest itself in him. There was mania for three and half days followed by this dramatic downturn. I used to think these symptoms were alcohol driven and that if he'd just stop drinking and take his medicine, they would go away. I was wrong. Alcohol free and medicated, I saw the same signs in him that I saw when he was drinking. He denied being depressed, but the signs were unmistakable, down to the fact that he said he felt like he had the flu and was hurting all over. After dinner, he went back to bed and didn't get up until this morning when I woke him at eleven-thirty. 

He had a meeting at the ACT offices, so I sent him to shower. After he dressed, he fell back in bed and was asleep in moments.

On the way to town, I asked him to repeat himself so many times that he finally stopped saying anything at all. I realized he wasn't alert or articulate enough to participate in any kind of social interchange. We continued on to the ACT office because since he was scheduled to go in for the meeting, The Nurse met us there to draw his labs. He stuck Parrish four times and never drew blood, so we came home. He will come tomorrow and try again.

I had the opportunity to tell both The Nurse and The Addiction Counselor about the events which began on Monday night. Having seen Parrish the day before, The Addiction Counselor was able to recognize the breathtaking changes in him. I'm not at all sure The Nurse has great powers of observation, but even he could sense the change. I couldn't speak to The Psychiatrist. He was out of the office, but The Nurse promised to tell him about the changes in Parrish.

When we arrived home, P once more dove under the covers, forgetting about his midday medicine. I had to wake him to give him his lithium, but I held the Ativan.  I can't explain why, but even with these signs of lethal depression, I don't think he wants to hurt himself. For my own sanity's sake, I'm going to music night and check in with him from there. Honey will snuggle with him and keep him company until I get home.

Just because you got the monkey off your back...

"Just cause you got the monkey off your back doesn't mean the circus has left town." ~ George Carlin

For the first two and a half days after he got home from crisis stabilization, Parrish didn't appear to have any thoughts at all. For two days, nothing. He had no energy. There was very little conversation and a whole lot of sitting and staring and absentmindedly stroking Honey’s back. I prepared his favorite home dishes but he wasn’t hungry. There was an eerie sense of inertia about him, an almost palpable ennui. There were no tears and no smiles. Maybe he was so overwhelmed by racing thoughts that he couldn’t do anything but sit and listen to them spin in his head, but if he was, there was no external manifestation of it. His heels were quiet on the floor, his hands relaxed in his lap. His speech gradually cleared and was almost normal by Thursday morning.

He woke up on Thursday in a state of muted mania, if there is such a thing. He was anxious about is first visit with his new psychiatrist. It was as though there were a monkey inside his brain that could jump out at any minute and start chattering and climbing trees and throwing up crazy all over the place.

We arrived fifteen minutes early for the appointment, The Doctor’s first of the day. The morning sun was hot on our backs as we waited on the sofa under the window of the tiny reception area. An inane radio program, just loud enough to interfere with quite conversation, emanated from a speaker under the end table. We both tried to read but it was impossible, so we sat with our hands in our laps and tried to tune it out.

We had been sitting in the waiting room with the radio piping blather into our brains for thirty-five minutes before The Doctor finally breezed into the office. A slender woman with a mass of blonde curls furled out behind her and a backpack slung over her shoulder, she looked to be about Parrish’s age. She disappeared behind a door and within thirty seconds, called P back into her office. I sat in the too hot and too loud waiting room and tried my book again, but there was not hope of escaping into it.

I addition to the nitwittery pouring from the radio, I could hear but not understand the voices from The Doctor’s office. Her door must have been open, and it occurred to me that the prattle pouring from the speaker was a sort of buffer. Why the hell couldn’t she just close her fucking door?

After twenty-five minutes, P was back in the waiting room, prescriptions in hand. The Doctor added Adderall and Restoril to the long list of things he is already taking. Yes, she prescribed an amphetamine to take every morning and a sleeping pill to take every night.

P started campaigning for medicine for his ADHD a couple of days before the appointment, reminding me about a dozen times that Ritalin got him through college. He said he needed something to control his racing thoughts, something to help him focus and stay on task. What tasks? He spent most of the first two days in bed, and when he did talk to me, he was focused only on the past, mainly the difficulties and not the good times. I tried unsuccessfully to bring him into the present, center him in the moment, but he continued to drift backward in time. He could not concentrate on a book. His television sat mute and dark. This man who loves music as much as I do wasn’t even interested in learning how to create a playlist on his iPad.

On the way home we dropped the prescriptions at CVS and went across the street to Starbucks for a coffee. For the first time since I picked him up at Gateway on Monday, P was animated, chatty but not loud, excited but controlled. I had been denying him caffeine at home, thinking that after being off of it for four weeks, there was no need for him to start back on what is, after all, another drug, but Dr. DaVanzo gave him permission to take it in moderation. 

I began to wonder about her. First, the prescription for amphetamines, then the caffeine thing. This woman saw P for less than half an hour and really knows nothing about him except what he told her. In the days leading up to their visit, he was confused about his recent history, and I am not yet convinced that he is an accurate and complete reporter of the events since January 10.

“What’s with the speed?” I thought to myself.

Parrish was in crisis stabilization for a month because of extreme mania and psychosis and is taking three antipsychotic meds. She's The Doctor, I know, but why not try weaning him off some of the downers instead of putting him on an stimulant? At her direction, P took an Adderall as soon as we got home, and within thirty minutes, he was talking and essentially did not shut his mouth until he went to bed. 

“Don’t you think I’m doing better? I used to think that if I took my medicine, all of my problems would disappear. Now I know I have to work on them. Aren’t you proud of me? I’m proud of me! Aren’t you glad The Doctor is sending me to see a therapist? I wonder what she will be like. I think this medication is what I’ve been needing all along, don’t you? I can’t tell you how happy I am to be here with you. I haven’t been happy in years. This sure beats living on the street. I am so grateful to you to putting up with me and my craziness. You will never know what I’ve been through. Daddy has our back, you know. He’s standing by for whatever we need. Isn’t it bizarre that he’s back in our lives? It feels strange to me. Don’t you think it’s strange? Don’t you think I’m doing better? I mean, really? What is the weather supposed to be like? Daddy is an expert on the weather, keeps track of it with NOAA radio. You know I can’t help being sick, don’t you? I didn’t ask to be this way! You do understand that I love you more than life, don’t you? What do you think my therapist will think when I tell her my story? I’m nervous about going to see her. You don’t blame me, do you? I’ve never been to a therapist before. I’m sure she will be shocked. I hope I like her. I hope she likes me.”

And on and on..

I exhausted myself trying to answer his questions, assuage his anxiety, assure him that his father and I both love him dearly, that we are proud of him, that there is no shame in being sick. I urged him not to question his father’s presence in his life, not to try to figure out why but instead accept it with gratitude. I turned on television and tuned to The History Channel, thinking he would get absorbed in a program. He could not concentrate and continued to make the same statements and ask the same questions repeatedly.  

I finally started playing solitaire on my iPad. He didn’t notice, and it didn’t slow down his constant stream of chatter, which continued until he took his sleeping pill and went to bed. An hour later, I was sitting with my laptop having little luck organizing my thoughts to work on a poem, and he came out of his room, fixed a bowl of cereal and came and sat in my corner of the room and started talking.

I said “good night” and went to bed.

Copyright 2014 cj Schlottman