Tag Archives: hospitalization

Lessons I Have Learned: When Going To The Emergency Room For Psychiatric Reasons, Make Sure The Hospital Has A Psychiatrist Available To Assess You

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So last night it finally happened.  Enough became too much and I decided I couldn’t take it anymore.

I didn’t down a bottle of pills or fill up the bathtub and slit my wrists, no, not Ruby.  I very calmly and rationally decided that the way I had been “coping” could not continue, and I drove myself to the nearest hospital emergency department.

Yes, some one specific thing did happen that triggered me last night, but that wasn’t why I reached this point.  I had dealt with the mixed, I’d been dealing with the ultradian, but not in any real, functional sense.  I was gripping tight to the moment, hiding out in my room and watching old comfort films, completely cutting myself off from any and all contact with the outside world, sleeping whenever possible.  That’s the one thing I can say about being on a perpetual emotional rollercoaster, it exhausts you enough to cure insomnia while it lasts.

But last night I realized that even for me, this was getting to be too much.  I don’t have a psychiatrist.  I had a consult with one on Thursday, and though we scheduled a follow-up for a couple of weeks out, I don’t see it working.  I have another consult scheduled for January, and while I have a better feeling about this doctor just from one phone conversation, that’s still two months away, and I could meet him and he could be nothing like I had thought (hoped).  All of the other doctors my previous psychiatrist recommended have declined to see me on the grounds that they feel they can’t help me because my case is too complicated, or occasionally just that they’re not taking on new patients.

Now don’t get me wrong, I appreciate the honesty of the former reason, it saves me and the doctor involved a great deal of time and frustration.  But I am at the point of just Googling psychiatrists in my area and calling random names that come up.  I don’t know how much you lovelies know about Google and the way its algorithms work, but the doctors who show up first on there are unlikely to turn away a new patient, any new patient, no matter how out of their league she is.

Back to last night.  So I thought things through and decided my best option was to head to the ER.  I wasn’t a threat to myself, nor a danger to others, so I knew they couldn’t hold me against my will.  All I wanted was an assessment, some direction, something for my moods (preferably an atypical anti-psychotic, which by itself should tell you something, because those bastards have always been miserable for me in the past), and some Xanax for my anxiety if I could get it.  I figured I would get my consult with someone from the psychiatry department and be on my merry little way – at least merrier than when I had arrived.

Except for one thing.  My nearest hospital doesn’t have a psychiatry department.

It’s no small hospital, either.  It specializes in all sorts of disciplines, has won awards for its achievements, and when I went in for the pseudoseizures (on a Saturday), there was a neurologist available to read my EEG.

But I guess mental health just isn’t really that important.

What ended up happening was this:  The ER doc did a cursory exam, checking my wrists and legs for any signs that I had harmed myself.  I get it, in that situation my word is not sufficient.  I was then made to go pee in a cup.  Drug screen, again something that (apparently) is routine in these situations.  P.S.  While I “get” why these things are procedure, they still piss me off and made me feel violated in a small way.

It was about then that I noticed the gaggle of police officers in the general vicinity of my room.  I had seen them coming in, but I wasn’t really focused.  A little later on the gaggle had dwindled to a single officer, and it was obvious he was settled in for some reason.  It was about then I began to have my suspicions that the reason was me.  The way he would deliberately not look up at me when I passed him coming out of my room, or deliberately not look in when he passed my room – to, I dunno, stretch his legs or something – made it quite apparent he was very carefully watching me from the corner of his eye.  This entrenched my suspicions more deeply.  Was I being paranoid?  I sure didn’t feel that way.  I felt like I was a potentially unstable “mental patient” and he was there to subdue me, should things get out of hand.  Not the nicest sensation I have ever felt.  But, once again, I “got” it.  I had chosen to be there, I had to play by their rules.

To continue with the evening, the “assessment therapist” was busy somewhere else and unable to see me until morning.  I had the choice of being discharged with the information for the place where they could “assess” me, maybe on Monday or Tuesday of next week (Psychobabble for a week, minimum).  At the point and in the state I was in, even a legitimate Monday or Tuesday seemed an eternity away, much longer than I could wait.  I guess the term “emergency” is highly subjective.

My second choice was to be given some Xanax, spend the night there, and see the “assessment therapist” first thing in the morning.  I went with door number two.  The bed was not terribly comfortable (ER beds are nothing like hospital beds, for those of you who don’t know – they’re pretty much a thin plastic mat draped with a sheet), but the nurse was nice and I figured this method would expedite things.  Ha.

The said “therapist” arrived in the morning at about eight.  Boy, did that bitch ever choose the wrong line of work.  She went through her little assessment form (coughing her disgusting old lady smoker’s cough throughout), never once smiling and only glancing up at me a few times. Two questions:  If you have voluntarily chosen this as your line of work, shouldn’t one of your job requirements include the ability to show at least a slight degree of understanding and empathy toward the patient?  And if you’re trying to get a read on someone’s mental state, isn’t it important to take in as much detail as you can?  Body language, facial expression, tone of voice, affect in general? Apparently no and no.

I understand that assessing some crazy chick in the local emergency room first thing in the morning is not necessarily the most fun way to spend your Saturday, but through all of this does in never once occur to her that “there but for the grace of Thee go I?”

I’m reporting that motherfucker if I can get it together to do so on Monday.

And the upshot of it all was that she wasn’t going to put me on a mental health hold (damn fucking straight she wasn’t, I guarantee I could have taken down her and the hospital security guy outside my room – he had been swapped for the real cop in the night, I guess when I was deemed slightly less of a threat – and anyone else who tried to get in my way if they tried to hold me without my consent), and she could get me in to the mental health center Monday or Tuesday, with an appointment with an actual psychiatrist in two to three weeks (Psychobabble for a month to six weeks).  I pretty much told her fuck you, I’m better off handling this one on my own – in only marginally more polite terms.

So I was discharged with a prescription for Xanax and instructions to follow up with my PCP on Monday.  The doctor wouldn’t even discuss the possibility of an anti-psychotic, because they’re apparently “too strong and serious.”  Really?  Because last time I checked, both benzos and anti-psychotics are schedule IVs, with benzos carrying a much higher potential for and incidence of abuse, dependence, and addiction.  The translation here from Doctorspeak would be “I known nothing about atypical anti-psychotics, so I’m going to hand you some benzos.  Those I give out like candy on Halloween.”

I’m not going to say that I regret having gone to the hospital.  It will certainly make a splash with my primary when I tell him.  I have always been very anti-hospitalization (for myself, I know that it can be a good and necessary thing for many people) as far as psychiatric issues, never have I been to the emergency room for them, and in the five years I saw my former psychiatrist, I think I used his emergency doctor on call service maybe four times.  So if nothing else, my PCP might be able to get me in to see a competent psychiatrist very quickly.  He’s a jewel, he takes good care of all of his patients, but he pulls more strings more frequently for me than I think any other patient he sees.  I think I’m kind of like the daughter he never had (two sons a few years younger).  He’s a very good man, and I am very lucky to know a good thing when I see it (and follow it around from practice to practice to practice to practice over the course of more than a decade).

Moral of the story:  Should this situation ever arise again (God forbid), I’m going to drive twenty minutes instead of five to a hospital which has the capability to treat me.  Do your research when you’re sane, boys and girls.  It could really help you out a great deal when you are in dire straits and need good information most.

Note:  If you don’t read this blog regularly, you might gain further insight into this whole period in my life by reading the following posts:  It Was The Worst Of Times, It Was The Worst Of Times, Charting The Course To See Where I Fell Off The Map, I Am Disabled, and I Put The HOT In Hot Mess.

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.

Perfect

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That’s what the shirt I’m wearing says, anyway.  I got it at a Sara Evans show – my dad’s band was the opening act.

But it’s times like now that I have to remind myself how, well if not perfect, then pretty damn spectacular I am.

I think I’ve kicked the mania in the ass with a loading dose of gabapentin, and what I’m told is a high dose of Valium, along with some blasts of Xanax, just for safe measure.  This is a good thing.  Except that when the mania goes away, the depression sets in.  I have meds to treat that, too, but I’m waiting to see how bad it gets, because I don’t want to start a whole rapid-cycling/mixed episode mess.

I have, essentially, become my own psychiatrist.  I don’t recommend that people do this.  But I’ve got the years and the knowledge and the safety net to know what works for me and what doesn’t.  This isn’t delusional or grandiose thinking, it’s fact.  I didn’t go through all of that time in Hell without being wiser for the experience.

I thought about calling my primary care yesterday morning (I’ve got his private cell).  And I even thought about putting in a call to my ex-psychiatrist.  But I know more about psych meds than my primary, and I know exactly what my ex-shrink would prescribe for me, and I won’t take it.  I still thought about calling them, but for a different reason.

All of my life I have been violently opposed to the concept of hospitalizing myself.  My sister thinks of the hospital as a safe place, where she knows she cannot hurt herself and will be taken care of.  I think of the hospital as a prison, somewhere you cannot escape, where you have to eat your meals when they serve them to you (and you have to eat what they serve), someone tells you when to sleep and when to take your pills and when to come out and be social with the rest of the patients.

I can’t do that.  Part of what keeps me alive is knowing that I can run out for a pint of Ben and Jerry’s at two a.m., and I can go to the book store or the mall when I please, I can talk on my phone to whomever, whenever I would like, I can set the social metrics that are right for me, as opposed to the algorithms and treatment plans the books and studies and years of practice have hardwired the doctors to believe are “right for me.”  I need my freedom to stay alive.

But yesterday morning, I sat on my mother’s bed doped up and destroyed from the lack of control, and I discussed with her the fact that maybe it was time for me to voluntarily check myself in, and that I should call up my doctors to get their opinions on good facilities.  I was not a danger to myself or anyone else, I just really felt it was potentially my best option, and going inpatient would at least get some fresh eyes and intense scrutiny on my situation.

Then, thank God, I went into my bedroom, put I Love Lucy on the computer, and slept.  Like the dead, for about nine hours.

But I cannot seem to go up without going down.  So tonight, I focus on the good things about me.  I’m trying, I’m trying, I’m telling myself and they just won’t stick.  Nature of the beast, I guess.

Moral of the story:  ”If all your friends were named Cliff, would you jump off them?” (Jimmy Neutron, Boy Genius)

© Ruby Tuesday and I Was Just Thinking. . . 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and I Was Just Thinking. . . with appropriate and specific direction to the original content. This work is protected under a Creative Commons Attribution-Non-Commercial-NoDerivs 3.0 Unported License.