Thursday, August 4, 2011

Hell Week: Hazing via Head Shrinking Hospital Administrative Imbeciles

Let’s just say that I am teetering on the twin edges of Fuck-It devastation and Bleak depression, the incurable smallpox varieties. I am trying to keep my stitches from unraveling, keep the hem from dragging along the floor, keep my dress on, buttoned, panties up. Because really, what I long to do, in extreme maudlin, exaggerated, hyperbolic fashion, is rend all fabric from my body, run stark naked into the nearest, deep body of water, and take a deliberate, long, head first dive.

I apologize in advance. But this has been a shitty, shitty week, and it’s not even over. Last week, I was barely hanging on, but managed to stay afloat, buoyed by my perspicacious, compassionate psychiatrist, the doctor who has served as astute manager of mood as well as empathetic therapist this past year, not to mention the careful administer of the electrical voltage to my brain circuitry. Literally, the only psychiatrist capable (and credentialed) to do all this, to understand and treat ALL of me (the Bipolar Disorder, the Eating Disorder, the Alcoholism, the Self-harm), ALL at Once, in the entire northwest Pennsylvania area. *This is an important detail that you need to have at the ready in a mere few paragraphs.

So. My psychiatrist saw the warning signs, the rapid depressive descent I was taking over the past few weeks and decided an immediate course of ECT would be effective and we would start on Monday.

“Okay,” I said. “I can hang on until then. Hope that things will get better even against my natural pessimistic inclination.”

“And no cutting? Because you know the consequences.”

“Yes,” I sighed. “I lose you as my doctor.”

“And no trying to kill yourself between now and then? And if you seriously consider it, you will call me regardless of time?”

I shrugged. “I don’t want to be a bother.”

His pointed stare.

“Okay, okay. Regardless of time.”

“And you will eat something. Protein. I need something to work with in order for ECT to work. Yogurt, granola, some fruit? And no throwing it up?”

I nodded.

“Say it,” he said.

“Okay,” I said. “I can do that for you.”

“You matter, and not just to me. You matter to a lot of people. Your family, for one. Your kids. You decided to bring your kids into the world. You’re responsible to them—you have to stay alive for them. For them, not for me.”

And then he was gone for the rest of the week at a conference and I was left to hold on to that hope and promise he offered once again. ECT worked before, last Fall, when I fell and fell and fell. Surely it could work again.

All last week, even though I struggled every day with urges to cut, with darker urges towards the implacable Furies, I held onto my doctor’s words. His words, his instructions are the first that I’ve really ever listened to, or respected, or truly acted on from a mental health professional. In part, because he calls me on my b.s., sees through my irony and defensive self-deprecation, pokes and prods and sometimes shoves in all the right (wrong) places. Generally, when he tells me to do something—not cut, eat an apple, call or email and tell him I’m still alive—I do. So I held on all last week—to my kids, to my husband, to my friends, to AA, by my fingertips.

On Sunday, a strange, late afternoon phone call from the hospital: screw-up with insurance, ECT delayed. I immediately sent my doctor a desperate text. He was equally confused as everything was in place and ready to go before he left for the conference.

“Don’t worry,” he said. “Be ready to come up in the morning. I’ll figure it out.”

7a.m., he calls. “You’re good to go.” Miracle worker.

When I get up to the hospital, with husband and kids in tow, we have a quick, but direct conversation. It would be best to admit me as inpatient as he believes I should probably receive 3 treatments, rather than 2 this week, and with the possibility of Christopher and the kids gone from home for a few days, he would feel better with me under observation, i.e., SAFE. The plan: Go home, come back up on Tuesday afternoon, check-in, stay the rest of the week.

Really. Once he said those words—SAFE here, under (his) observation, I felt relief, felt the struggle leave my body, felt like I didn’t have to be vigilant for myself for a few days—could cede the constant, anxious watchfulness over to his more capable hands. Just give up the 24 hour guard duty for a few days and close my eyes, try to turn off the thoughts, the voice of IT, yield, surrender, be literally under his trusted watch.

Tuesday: I arrive at the ER to check-in as instructed. Anxious, chewing my nails, trying to breathe. But still, absolutely certain I am doing the right and necessary thing.

“Dr. B. sent me here to check myself inpatient for ECT.”

Administrator: “Dr. B. doesn’t work here.”

“Of course, he does. He told me this yesterday. I had ECT yesterday and he decided I should do this today.”

Administrator: “No, Dr. B. doesn’t work here anymore.”

The long story short? Dr. B. came back from his conference to the “shock-and-awe” campaign of the hospital administration. Immediate termination. He was hired last summer as Head of Psychiatry to create a new vision plan for the hospital and psychiatric resident program. Apparently, the vision required re-vision, which meant pissing off the old (provincial) guard, likely getting his (better, smarter, more efficient) way most of the time, and expecting change to happened yesterday.

I can’t really imagine what this means to him, but I know that he is a conscientious, empathetic, responsible doctor, so this is not how he would have wanted to leave his many patients.

In my own selfish, narrow world?

ECT has been suspended. No one else is licensed in the hospital. No one else is licensed between here and Cleveland or Pittsburgh, cities 2 hours away.

I have not been given a contingency plan by the hospital, no substitute. They made no plan for what would happen when they couldn’t offer someone like me who had started ECT the rest of her ECT treatment. An analogy? Like starting a medication and then abruptly withdrawing it without regard to side effects, withdrawal symptoms. Not to mention, medications cannot substitute for ECT as I am medication resistant. Tried them all—the anti-depressants, the neuroleptics, the anti-psychotics, the anti-anxieties. Nothing else gets me out of the hole as effectively and quickly as the current of electricity resetting neuro-pathways. Not immediate bliss, not innocent happiness, but it provides respite, a refuge from the Furies, restful shelter from the helter skelter.

Now? Nothing. Not even a phone call from the next-in-line doctor in-charge as to what has been put into emergency placement for me. Of course, this next-in-line doctor is still in training, isn’t fully credentialed anyway, so I don’t expect real, complex help there. Nor do I expect a doctor to work with my nutritionist like Dr. B. did on a weekly basis.

Oh, there’s that issue, too. Dr. B. ordered a bone density scan and blood tests to check up on some nutritional issues he was concerned about. No one seems to know where those results are; no one seems to have the time or professional courtesy to pass them on to me so that I can pass them on to my nutritionist and perhaps gain other clinical advice.

But really, what is most devastating, and I mean truly sobbing-off-and-on-all-day devastating is the fact that I have lost the one doctor I have trusted with my life for the first time in my life. Despite however terrible, shameful, humiliating, terrifying, or self-condemning my thoughts or actions have been over the past year, I told him everything BECAUSE he listened to it all, did not humiliate or shame me, but offered clear, concise instructions as to what I could do to improve my stability, to extend the periods of a quieter mind, to change deeply entrenched and seemingly unchangeable thought patterns, to learn to choose higher cognitive functioning (“You’re smarter than that!”) over impulsive, lizard brain (“You don’t need to cut your arm over and over anymore! Just talk to me. “), to begin to imagine that I might be able to make peace with all that plagues me and find, miraculously, a cure: mind, body, and spirit pulled together; medication, ECT, therapy, balance, forgiveness, love, self-smarts, and a clinical, clear understanding of my own particular brain chemistry—its triggers, its basement of horrors, its strange proclivities and obsessions, its passions and joys, its despairs and its necessities.

And now he is gone. And I am left, bereft. I don’t know how I can do it all again: find another doctor somewhere within 150 miles that can tackle all of IT, a doctor that I can fully trust, a doctor who has his integrity and confidence, his professional brilliance and humane empathy.