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| - Sylvia Plath - |
... as a patient.
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| - Shel Silverstein - |
What happened? The short answer is, "It's complicated," or, "I don't know, really," or, "Everything?" Maybe there is no clear why. Maybe it was a perfect storm of biopsychosocial events all merging and I was swept up in the hurricane. Maybe it's the past 30-ish years, and attachment work in therapy, and giving psychotropic medication a try and tweaking dosages and types of medicine... leaving a job and starting a business and passing a big exam and settling into the realization that my husband didn't die (but came frighteningly close) and finding deep and meaningful friendships and...
Thawing.
I lived for so very long in such an exquisitely controlled manner. Practically perfect in every way. I mean, shit completely together at all times, regardless of what was going on. Frozen. Completely frozen, because it's safer that way.
But thanks to the grueling work of therapy, I've started to slowly, slowly thaw. Emerge. Bloom. It sounds so nice when you put it that way, doesn't it? Therapists love metaphors like that. Look around your therapist's office and I bet you'll find something to signify this "becoming" process. Butterfly figurine? Artsy seed sprouting or flower blooming picture? Awww. So pretty.
So. Painful.
Because, what does "becoming" even mean? I don't know everything, but I know from my own experience as the patient and the therapist that meaningful change doesn't often happen without some work and pain.
For me, it's involved giving myself permission to own my story - first intellectually, and then to feel it. The cavernous longing for secure attachment. The difficulty trusting anyone. The paralyzing fear and confusion that arises from sexual molestation. The shutting down, concealing, and disengaging with the emotional world. How pretty it looks from the outside, though, that control and focus and drive. But how it eats one up from the inside. I got to the point, after a year or so of therapy, where I could intellectually acknowledge it all, and I thought, "Go me! We're done!" But then it was like a complete re-processing to even contemplate feeling my story.
I waded in, slowly. I started taking an antidepressant to help me stay afloat in this sea of feelings, in which I was absolutely convinced I'd drown. The medication didn't help quickly enough. We upped the dose. We cut the dose. We switched medications. I tried self-medicating. At the beginning of April, everything got incredibly cloudy and confusing. I started having regular intrusive thoughts of suicide. Then, one day, I felt compelled to die. I was unequivocally convinced that to die would mean relieving those around me of my presence. I was impulsive and absolutely determined. I tried four times in the course of a couple weeks. I talked about it, and I always promised everyone I wouldn't do it. I went to therapy I think 8 times during those two weeks. I cried. I didn't eat much. I slept.
The last time I tried, a friend found me. Literally saved my life. And friends watched me all night. When I woke up, they told me I was going to the hospital. I cried and begged and pleaded not to go. Jonathan came. The entourage accompanied me to my scheduled therapy session, and Jonathan sat beside me on the couch in Neil's office while I cried and begged and pleaded to not make me go. Jonathan cried. Neil calmly explained the options and various procedures. He and my psychiatrist could call the Magistrate and have me involuntarily committed, which would mean a Sheriff would come and handcuff me and transport me to the ER. Or my friends and family could take me to the Wake Crisis Center, where basically the same thing would happen. Or they could take me to the ER themselves, thereby avoiding the handcuffs and isolation bit. We talked about my disdain for UNC Hospital following my awful NICU experience there, and we talked about a different inpatient option in the area known for slapping a diagnosis of Bipolar Disorder and some heavy-duty meds on everyone as a welcome gift upon arrival. I resigned myself to it and said, "Fine. Take me to UNC."
So we did. We all went to the Emergency Department at UNC Hospital. There was a man behind a computer at the check-in desk and he was asking me why I was there and I couldn't talk, so someone spoke for me and they took us all straight back. But the triage room for suicidal people is tiny and sparse - one molded, soft plastic chair, bright lights, white walls, nothing else. The female nurse told me to change into scrubs and a gown, and Jonathan and my friends waited in the hall. She took my blood pressure and it was something like 250/190. So I was basically about to stroke out (and a couple weeks before, I went for a regular check-up and my doctor said my blood pressure was looking really good, so... maybe I was a little distressed). The female nurse said she'd get the main nurse, and was going to let my people come in to be with me, but then the main nurse was coming in and he asked them to wait in the hall while he talked to me.
Brace yourself, because this is the low point. I used to think Sussy in the NICU would take the cake as world's worst nurse for telling me that I should stop crying and be happy when I was trapped in the NICU with Gideon. But this ER nurse? He gave Sussy a run for her money.
I don't know his name (yet - I'll be requesting my complete medical records associated with this adventure if only to find out his name), but the nurse who came to do my initial assessment was horrible. It was as though he read a book on what not to say to suicidal people, and he decided to say ALL THE WRONG THINGS. So I'm there in the soft plastic chair in the barren room in the hospital scrubs, staring at my feet and alternating between silent weeping and ugly sobbing. And manscape-happy nurse starts in with his pointed questions and heavy-handed lecturing. Here are some highlights as I remember them.
Nurse: "Tell me what's going on."
Me: "I have just been really depressed, and I've been feeling these really impulsive urges to kill myself."
Nurse: "Have you tried to kill yourself?"
Me: "Yes."
Nurse: "What have you tried?"
Me: [details, with assurance that with every example I was fully determined to die and not engaging in self-harm as a release or grounding mechanism]
Nurse: "So you haven't really tried to kill yourself."
Nurse: [squats down in front of me so he's right in my face] "Look at me."
Me: [look up a bit]
Nurse: "Suicide is the most selfish thing you could ever do. Aren't you thinking about your family? Your children?"
Me: [ugly ugly ugly crying]
Nurse: "What do you think happens when you die?"
Me: "You go into the ground. That's it."
Nurse: "How can you be so sure?"
Me: "None of us are sure. That's what I believe."
Nurse: "Well I don't think you really know."
(As an aside, I still wonder what he was trying to accomplish with that last line of reasoning. Was he trying to get me to say I believe in heaven or hell? If so, was he going to then reason that I'd go to hell if I killed myself? Is proselytizing really the best way to prevent suicide when you work in the ER and you have a distraught person asking for help right in front of you?)
I guess I finally said the right things, or stopped saying anything at all, and manscaped asshole nurse finally left. And Jonathan got to come be with me. And they told us we were moving to a room in the ER. Jonathan got to stay with me, for which I am eternally grateful, because the place you go when you're a psychiatric patient in the ER is perhaps the most desolate and depressing place I've ever been.
You're behind a series of locked doors. I was somehow assigned to the most pleasant of the entirely unpleasant options - a private, tiny, windowless, padded-wall room with a gurney and soft molded plastic loveseat. A couple of the lights were burnt out. There was a biohazard bag with something in it on the floor, and an abandoned toothbrush, and lots of dirt. But this was the best of the available options, because in the room one had to walk through to access my tiny room, there were three other psychiatric patients and their support people, and we could hear everything they said. And they were all agitated. One was talking about beating his girl (but it was totally fine, because he never used a closed fist), and one was loudly and repeatedly insisting that she was going to die if she didn't get her Xanax, and they were all talking about how many hours and days they'd been waiting there in that room. I shit you not, people wait in the ER for days (and sometimes weeks) to be admitted, because there is an extreme shortage of inpatient psychiatric beds available.
I tried to tune it out. They gave me valium and kept checking my skyrocketing blood pressure. They did an EKG and never told me the results. They brought me a chicken breast for dinner and a plastic spoon with which to eat it. And finally, some relief. The psychiatric resident on call for the ER came to talk. He and his colleague sat on the loveseat and asked me to tell them what was going on, and I did, reluctantly, but they were so incredibly kind and patient. The resident didn't say any of the horrible things the ER nurse had said. He was compassionate. He listened when I told him that I thought the system was broken and lamented at putting a suicidal person in the most depressing room on earth. He explained the various psychiatric units available at the hospital. He answered my questions. He gave me the slightest sliver of hope to cling to, which is precisely what I needed.
And then, somehow, through a series of incredibly fortunate events, they told me that there was a bed available and I was going to be admitted soon. I wasn't going to stay in the depressing room forever. Jonathan got to stay with me while they moved me to another waiting area, which was much more of a typical ER-type open ward with partitioned waiting areas. They had a female police officer use a metal detector wand to make sure I didn't have anything on me with which to kill myself, and they gave me some other medicines to knock me out, and I slept and slept with Jonathan beside the bed. We'd arrived at the ER around 3:00 PM, and I was taken up to the Crisis Stabilization Unit (one of the inpatient psych wards at UNC) around midnight. I don't remember how I got up to the Unit. I do know that Jonathan wasn't allowed to stay with me after that.
When I got to the Unit, they took me to the "porch" (which was really just a room with lots of windows - no fresh air or access to the outside) and I had to tell my story to the nurse. I was so tired. I felt like I'd already told everyone everything... twice... because I had. They told me that I couldn't be alone, they gave me some tiny hospital-grade bottles of all-purpose soap and some towels and showed me to the room I'd be sharing with another woman. The nurse sat in the doorway watching me all night. When I woke up the next morning, she informed me that she had to stay with me while I took a shower. So began Day 1.
Breakfast was delivered, and I got to see the people in the Unit with me. They seemed friendly with each other and I immediately sensed a patients vs. nurses vibe. A sweet elderly lady came over to me at breakfast and introduced herself, and asked if I had children, and I started sobbing and couldn't stop and she apologized and went away. I didn't look at anyone for a while after that. I didn't talk. They forgot to bring coffee with everyone's breakfasts. Well-dressed, bright-eyed med students started buzzing in and out, pulling people one at a time for morning rounds.
Morning rounds. In the psych unit, they pull you into the TV room (oddly named, because all of the common rooms had TVs - much to my dismay), and there are somewhere between 5 and 10 med students, residents, and fellows sitting in a sort of semi-circle of couches and chairs. There's the attending psychiatrist, always over to the right side and noticeably distanced from the lower-level physicians, leaning back in his chair looking all Freudian with his white beard and detached, pensive expression. And you, lowly patient, get to sit smack dab in the middle and face your judge and jury while they ask you to explain what happened. Again. For the fourth time. And while you're sitting there, crying, and trying to explain it, some of them take notes. Some of them ask a few questions. None of them react in any readable way. They just look at you. And then they say, "Okay, thank you." And you leave. And you wonder how Carl Rogers would have handled that ten minute talk. Would it hurt to show even an ounce of compassion?
Treatment? I was naive enough to think that inpatient psychiatric hospitalization would include some type of treatment. Perhaps a psychological evaluation? Individual or group-based psychotherapy? Oh, Chelsea. That would be far too logical. When I asked someone about whether I had access to therapy or an evaluation or anything of the like, they seem perplexed and explained that psychologists don't work on the psychiatric units. It was as if I should have known that. Of course they don't! Who does work on the psychiatric units, you ask? Psychiatry, pharmacology, physical therapy, occupational therapy, and recreational therapy. And what sort of treatment do these fine teams offer? Fear not, because there was some top-notch intervention happening. For example:
- Recreational therapy consisting of playing "Apples to Apples" for an hour. Not some kind of modified "therapeutic" version. Just Apples to Apples.
- Occupational therapy consisting of playing a "Know Your Senses" game wherein we identified our five senses and answered questions like, "What smells make you happy?"
- Recreational therapy consisting of a golden retriever therapy dog visiting the ward for an hour.
Okay, so the dog I actually liked. It made me smile. The rest of it? As Neil told me when I called him and reported on the lack of actual intervention available in the hospital, "Try not to scream 'BULLSHIT' out loud." So I bit my tongue. I attended all the not required, but strongly encouraged groups. I played along with the social norms and followed their unspoken rules, the primary one being, "We don't talk about anything going on in our lives, or what brought us here, or what we'll do when we get out." I was quiet and compliant and plastered on a smile whenever the nurses were nearby because the whole goal of everyone there was to get out. And obviously one has to seem okay to be released from the psych ward.
You might be wondering about the psychiatric and pharmacologic care available, and let me tell you - I was too. I wondered about it on Wednesday when I was admitted, on Thursday when no one mentioned anything about medication, and on Friday when it became clear that no one was going to start me on any medication and the weekend was approaching. My friends and family and therapist and psychiatrist wondered, too. I have enough hospital experience under my belt to know that nothing happens in hospitals on the weekend. So Friday afternoon, I asked to speak to a psychiatrist and they sent a med student in to talk to me. She was nice enough. She wanted me to tell her everything again because, well, really god only knows why because she was there in morning rounds two days prior when I gave the fourth story-telling hour. She asked me what I do for fun and told me I should go to a knitting group and then masterfully pulled from the Dr. Who tote on her lap a sock she was knitting. I got the impression she had orchestrated the entire conversation to climax with her revealing her half-completed sock and me having an epiphany. KNITTING! THAT'S WHAT'S BEEN MISSING FROM MY LIFE! But you can't go around the psych ward suggesting that someone is orchestrating conversations - seems a touch paranoid, no? So I let it slide and smiled and nodded and pretended that I have the time and money for a new hobby right now, and can we please talk about medication? And you know what she did?
Wait for it, because this is good.
She asked me what I thought I should take. Now, I'm not normally a cocky person at all, but as my brother said when I was explaining life in the psych ward to him, was I going to need to stand up and shout, "Hey! Is there anyone here who is smarter than me who can help me?" I mean, okay, I'm in the same field. I have some training. But I'm not a medical doctor. I don't know everything about psychiatric medications. Luckily, I have good friends who do, and I called my friend and she basically told me what to ask for. So I asked for Pristiq, an SNRI, and knitting med student said UNC doesn't have Pristiq, but they do have an older SNRI, Effexor. So I said let's do it. And she said okay. Was there any discussion of possible side effects, mechanism of action, et cetera? Of course there wasn't! (I did later learn from talking to other patients that you can ask the nurses to give you an information sheet about any medications you take, but this is inside information that no one is advertising. You have to make friends with frequent flyers to get the inside scoop on navigating the psych ward.)
But anyway, success, right? I got my 37.5 mg dose of Effexor and I was on my way. They gave me said dose at 4 PM on Friday and mentioned that it might interfere with sleep. So I took the Vistaril (basically Benadryl) that I had prn that night and I slept fitfully, but okay. The next morning, the weekend psychiatric resident asked me how I'd slept and I said, "fitfully" and he immediately added Trazodone (an old-school antidepressant that, when taken in lower doses, can help one sleep) prn to my medication list. I tried to explain that maybe the sleep issue was just because I took the Effexor so late in the day, and that I didn't really think it was wise to start taking Trazodone when we were trying to assess the effects of Effexor, but you know, that's none of my business or anything. I just didn't take the Trazodone. On Sunday, I asked whether they were planning to increase the dosage, because if there's one thing inpatient psychiatric hospitalization is good for, it's supposed to be the ability to quickly titrate medication dosages given the controlled and monitored environment. They said, "Sure!" It was as though they were waiting for the word from me to, you know, do their job. So Sunday they put me on 75 mg.
The weekend was long. According to the schedule posted by the two telephones the patients shared, we were supposed to have various groups over the weekend. Mindfulness, spirituality, other programming and whatnot. Turns out that those things were on the schedule, but that didn't mean they actually happened. I was in the "sun room" waiting for the spirituality group to start and tolerating awful stand-up comedy blaring from the TV and this guy entered the ward and mentioned that he was the chaplain, so I thought we'd be having a group. But he just sat in the Sun Room with us for an hour and then left. I guess the honor of being in his presence was spiritual enough?
The good news about the weekend was that visiting hours were much, much longer. And I had visitors all the time. Jonathan and I played scrabble, I checked out my colored pencils from the nursing station and colored mandalas, I read a lot, I checked out a ball-point pen and journaled a bit. I discovered that patients had access to an acoustic guitar and my friend came and taught me chords. That was what I missed most while I was in the hospital - music. I wasn't allowed anything with strings or cords, so headphones and earbuds and the like were a no-go. I had a little mp3 player, but no way to hear the music. Of course TV was totally fine, and the TVs were continually on. One day I mentioned to my nurse how much I loved music, and she said, "Well why didn't you listen to music before?" She was suggesting that I should have tried that prior to my hospitalization, and then obviously I wouldn't have been depressed and suicidal. Obviously. Anyway, I also got my own room after that first night, and they took me off the high-level suicide watch, so I had bit more freedom. Still no drawstring in my hoodie (oh yeah, they let you wear normal clothes on the ward), no cords, having to check out all toiletries and check them back in, plastic cutlery, and one single heaven-sent cup of coffee per day, but some freedom nonetheless.
I survived the weekend. It was pretty quiet. A wave of patients were discharged on Friday, so there were a handful of us old hats hanging around. The ward holds about 20 patients. A few more trickled in over the weekend. Monday morning there were four or five of us crossing our fingers and hoping to hear the only word that mattered: discharge. We did our song and dance for the psychiatrists and med students and all of us got the green-light to go. Jonathan came and got me and we went out to lunch and then he took me to see Neil, and we talked about the absurdity of the hospital, and he reminded me that one of the highest-risk times for suicide is immediately following hospital discharge. So we talked about safety and life and self-care, and Jonathan took me home. A couple days later, I met with my psychiatrist and regaled her with all the stories. She kept my medication the same, and we set up the next appointment, and on life went.
And on and on it goes. The psych ward adventure cost us about $75 out of pocket, as we've already met our high deductible so we're only paying 10% at this point. That was a relief. I'm still baffled by the whole thing, and disheartened to see the sausage factory that is crisis mental health care in America up close and personal. I've slowly told people what happened, and where I was, and how I am now (sometimes okay, sometimes not, but that scary hopeless dark place usually keeps its distance). Now, of course, I'm telling anyone who reads it. And I do this not without a great deal of thought about the implications of this choice. I wrote with abandon about the births of my children, primarily because it's helpful for me to write, and partially to promote the view that birth is normal and by sharing our stories we help each other. And as we come to the end of Mental Health Month, and we talk so much about erasing the stigma of mental illness, here I am holding my shame out for you to see. Because when I do that, it's no longer shameful. It's my story. It's a part of my life, and I learned from it, and it doesn't make me any less of a person or a mother or a wife or a friend or a therapist.
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| - Stephen Fry - |
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