Therapist Homework

My therapist and I have decided that she will give me a writing prompt once a week, and we’ll use that as a starting point on certain topics. I may share some of them here. This prompt was:

When a public figure dies, it can sometimes feel like a personal loss to us. Describe your experience(s) with this and your thoughts on why it happens

When I was in high school and struggling for the first time with my own definition of who I was, Eric introduced me to Spalding Gray’s work.  Eric was my friend who was the best read and most cultured, he himself a playwright with some young success.  He would throw gasoline on the fuel of our pretentious media consumption.  When we found a movie that was obscure, strange, incomprehensible, or made a heavy impression on us, we would likely call it an “Eric movie.”

Being the 1980’s we were newly in love with Jonathan Demme’s work.  Jonathan’s latest movie was Swimming To Cambodia, a Spalding Gray monologue. The idea of a movie simply about a man on a stage talking was not initially interesting.  He would sit at a desk and talk about a bit part he had in a major motion picture.  That’s all.  That is when I learned what a monologist was.  And that was when I learned that one line in a movie can be spun into 90 minutes of story.  I didn’t know it at the time, but that’s what I wanted to do.

I have since read all of Spalding’s books, seen all of his filmed monologues, and spent hours reading about him on the web.  He had a history of not being normal.  And that’s what he would use to create his works.  Telling stories of youthful indiscretions or the trials and tribulations of the entertainment industry, he would make these bizarre stories feel familiar.  At least to me.  I have always wanted to be a New Yorker, and I suppose more than that I always wanted to be a New Yorker just like Spalding Gray.  

He had issues.  Dealing with depression throughout his life, as well as a horrible accident in 2001 that began his ultimate decline.  He was a passenger in a car that got hit by a small truck, in Ireland.  His injuries were severe, and the recovery took months and months.  At the time I was a young father dealing with a child we had no idea how to help.  This was also the beginning of my formal depression treatment.  

I was so far away from my younger self, the one who wanted to live in New York.  I was completely disconnected from art.  Reading wasn’t an option in my busy life, and movies and TV were for decompressing with the wife.  For a long time I forgot about Spalding Gray.

When he died in 2004 I read it online in the news.  I read that he had committed suicide and that only bolstered my connection to him.  By 2004 my depression was starting to gain steam after years of simply being an annoyance.  By then I had two children, both very young.  Everyone tells me I was a great dad, but most of my childrens lives growing up are a gray cloud to me now.  I can look at pictures and remember, but if I try to think of the year 2004 it’s just a hazy mess.

Spalding Gray was a neurotic genius.  Much of his content was autobiographical in a way that made him very vulnerable.  And told the stories of his own problems in the mental health arena.  Many of them were parts of his personality and didn’t require treatment, per se.  But others were depression, anxiety, or OCD related.  Very entertaining, but in retrospect very telling and sad.

He died when he jumped off the Staten Island Ferry.  He had many attempts before that, but this one was a bit different.  No note, no forewarning, just sudden and sad.  I thought about him out there in the dark and cold weather of mid January.  When I think about it I feel so alone and cold and insignificant in the shape of the universe.  And it jars me to think that he could have felt the very same way in those final moments.

While he was missing, before they had discovered his body, everyone had to go about their daily work.  There was a family birthday.  Friends came and went, visiting and consoling his wife.  Telling her this was just like him, and he’d be back before they knew it – likely with a very long and interesting tale to tell.  An article talked about the eerie normalcy of the house during that time, and it reminds me of my concept of “future ghosts.”  Those things that happen even though you or others feel like the world has ended.  Even in grief, the car needs filling up or the bills must be paid.  Or the memories that feel like they take place in a different life.  During the before.

On January 11, 2004, Gray was declared missing. The night before his disappearance, he had taken his children to see Tim Burton’s film Big Fish. It ends with the line, “A man tells a story over and over so many times he becomes the story. In that way, he is immortal.” Gray’s widow, Kathie Russo, said after he disappeared, “You know, Spalding cried after he saw that movie. I just think it gave him permission. I think it gave him permission to die.”[2]

Big Fish is one of my favorite movies, and the meaning is not lost on me.  When I tell my own stories that seem incredible, or don’t match what the external “me” represents, I enjoy the communication but worry people won’t believe them or that one day they will be gone, I will be gone.  For Spalding it may have been an upsetting release, that permission to die.  For me it makes me cry for a different reason.  It’s the final telling of the stories, but the guests who attend at the end of the movie validate them.  They make you understand that your own story can be told so many times, and it can be interpreted in many ways.  It can seem either so boring or so incredible as to be unbelievable.

I am sad that we won’t have any new Spalding Gray books or monologues.  And that it reminds me so much of myself.  But it also inspires me to keep telling my story and keep writing.  That we all have unique gifts, and we can all use our stories to help, amuse, entertain or even just relate.  Recently I have been given an opportunity to try and tell my stories in their own unique way, and that excites me.  I suppose I will even live through some new stories in the meantime.

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Thank you.

semicolon: Prologue

The plan was:

  • A PHP, remote from that same hospital  (on the intake call before starting I was answering the nurse’s questions before she finished asking them, I was so familiar with the system)
  • Structure my days before the PHP starts, so I don’t just sleep and watch movies
  • Follow that with a day program (fewer hours/ fewer days per week)
  • Continue with the TRD clinic
  • Ketamine treatments
  • Continue to apply for the VNS
  • Work with my regular therapist on identity, grief, and suicidality.  Because the referral never called me back.  And my therapist knows me really well.
  • Continue with my MD, who will get suggestions from my extended care team
  • Work on finding couples therapy for communication
  • Live “the good life” with self discipline and compassion

I have described things in the past tense, especially from “before” but it isn’t really the past tense.  It’s all still there.  But there is a glimmer of hope, challenges to come, and a future I can think of. 

I’ll take it.

Introduction | Glossary | About

semicolon: 11. Home

I spent a lot of the weekend with calls with my siblings, my children off at school, my extended family, and the guys in my support group.  Two of them came over on Sunday to visit, which was nice.  I enjoyed quite a bit of porch time, which happily had not been spoiled by the fact that I had attempted suicide there one week before.  Which again felt like months before.  I had been hoping for sweater weather, but instead it was sweat weather.

While I had a brighter outlook, and it would continue to get brighter in the weeks to come, I had some limitations.  I still had the tremor in my limbs.  But now I also had vertigo.   It was the sensation of standing on the deck of a boat on the ocean.  Sometimes calm seas, other times a storm raging.  I had to keep the adage “three for the boat” in mind pretty much all the time.  That’s the idea that you keep your feet on the ground, and use at least one hand for steadying.  I also got exhausted quickly – say one point I was showering and washing my hair and thinking “Man this is a lot of work, my arms are so tired!”  So any effort pretty much ran my battery down.  And I was still working off my sleep deficit.

Those new side effects (likely from the trazadone that I’m still not willing to give up because it helps me sleep so well) would have thrown me into a deeper pit of despair even just a week ago.  But now I had my new knowledge, meds, outlook and optimism, and finally a passionate desire not to spend more time in the hospital.  So I would weather the storm and hope the side effects lessened over time.  They didn’t, but that’s a completely different story.

So I’m still good, and bad.  I have a better outlook and can work on getting a normal sleep pattern and life.  But I still had some depression and anxiety.  I still had my side effects, but I was excited about writing and beginning a new career.  I am a higher risk for suicide, having attempted once.  But I felt like I wouldn’t lie for S anymore.  

I described it to my therapist today, a few weeks on.  I feel like I’m a bright(er) shining light in a metal cage, standing in a room just littered and piled high with depression.  The shining is my new attitude and optimism.  The cage are my physical limitations, but I can see through the bars, it’s not a wall.  (Also, I can write in the cage!)  And with the depression all over the place I have to be very careful where I step, and I have to shovel it all out of the room as fast or slow as I can.

Introduction | Glossary | About

semicolon: 10. Friday

Actually slept.  They had to wake me up.  I’m still insanely tired, but it’s just sleep deficit tired, and I know I can sleep it off over the next weeks.  Not so tired it hurts, like Thursday morning.  I want to go home to my own bed and wear belts again.  Oddly enough, that sounded almost like optimism and an ability to see that I have future days coming.

Girl and Old Man are both leaving today, and as the day wears on we hear of more.  Steve-O, Singer, and maybe Mama.  We also found out that Gangster was moved somewhere else last evening.  No more conversation pit outside my door every night!  Don’t know if he went home or somewhere else in the hospital.  As a result, the hallways last night felt very calm, though I didn’t quite understand why.  What this meant was that half of the unit would be leaving.  And considering that Mumbles stays in his room except for mealtimes, and I felt like Tank was going to be moving out or to another (maybe more secure?) unit, that left very few of the current crowd.  So no matter what, the shape of the room will be very different come Sunday morning, with quite a few new patients likely coming in Friday night and Saturday given the downsizing of the unit today.

Breakfast was jovial.  I still wasn’t really eating, but I ate more than usual.  I told bad jokes and the “fun group” looked a bit confused.  Apparently I was pretty darn flat up until today so they had no advanced warning about my horrible dad jokes.  I was also feeling my shoulders relaxing, dropping a bit more often.  I was in too bright a mood to feel the depression, the anxiety was less than a five, but dropping to maybe a two occasionally. I felt a bit like I could breathe again.

My suicidal ideation was crippled by yesterday’s learning session with the MD.  Knowing the biology of it just really took it’s teeth out.  Everyone was just brighter all around, except Spectrum who looked sad and jealous of everyone leaving.  She was a long hauler, and I felt bad about how happy people were about leaving.  But she must be somewhat used to it by now.  She just worked on her GDE/GED in the TV area.

Morning check-in was almost fun.  The usual passers passed, like Tank and Mumbles.  But even those not going home seemed to feed off the energy of the day.  The shift supervisor was nice, and the programming for the day was going to be very light and very fun.  The morning group was making cast iron skillet banana bread.  Everyone said it was a sign that this was going to be a good day.  And so far, it absolutely was!

After check-in I was hanging out in the TV area just writing in my journal, and I saw my case manager come in.  I caught up to her and we had a chat.  After my good night’s sleep, the discussions with the MD the previous day, and my concerns about just “hanging out” for the weekend, I had a new attitude and perspective.  She was very supportive, and said she would dig into the paperwork and MD’s discharge info, a PHP for after I get out, all sorts of useful things!

Morning group was fun.  I had a bit of confidence that I could go home that day, and the mood of so many people in the unit was one of optimism.  So how do you make skillet banana bread in a locked unit built to prevent you from hurting yourself?  Carefully, that’s how.  We were supervised by the OT therapist.  She had us in two groups.  My group did the first part while the other group mashed the bananas, then they combined our bowl with theirs and put it in the skillet and oven.  I was really happy to be doing something productive other than crosswords and sudoku.  We cleaned up the area and worked on creative arts while it cooked.  

I did a paint by sticker.  Little was across from me and apparently set up a free service of making magnetic bracelets.  She must have done half a dozen in twenty minutes.  As she finished one, someone else would ask if she could do one for them.  They were really nice.  While she worked away she would sing along to the music the therapist had brought in.  She not only had a beautiful voice,  but knew the words to most of the songs.  It was just a fairly calm time with a glint of delight.  

Later that morning I saw Little with her minder, and she said “Want to see something I do sometimes for fun?”  She proceeded to sit down on the base of her rolling IV stand, legs crossed – she fit perfectly, being so little.  She then pushed herself around by her hands, getting up speed and coasting along.  Kinda like those little scooters we had back in gym class.  Everyone thought it was hilarious.  Another sign of the good day.

Steve-O is doing laps.  I once asked him if he did the whole 17 laps, but he said he always lost count, so he just did it for a period of time and called it good.  Timing things is hard in the unit.  There are a few clocks in the public spaces, but given the fact that time feels “different” in such an intense yet boring environment, it’s often hard to tell how long you’ve been doing something.

I also realized Mumbles wasn’t dangerous – that the minders were for Gangster.  Tank is the last scary one.  And for some reason, only having one person on the unit that seems unpredictable and dangerous is easier than multiple folks like that.  Also, the fact that I’d be a senior member of the unit if so many people left, that it felt like it would have been easier just to watch the new people flow in.

Around noon, MD and her whole team, including my case manager, talked to me in my room.  My case manager had given the MD a heads up on my progress over the last night and my improved mood.  Had a good discussion with the MD, although she had one of her students give the backstory summary.  Poor student was so nervous, but she did just fine.  I have dealt with more than a few medical professionals who were just out of school, new at a job, or even just nervous.  I work hard to be very patient with them and thank them and tell them they’re doing a good job.  I love the looks of relief on their faces.  MD was clear that there is a good deal of work yet to do, and that it wasn’t going to be necessarily smooth sailing.  It’s likely to be two steps forward, one step back.  But keep an eye on the net gains and keep hope alive.  

And then the MD cleared me to go home.    She told me about a podcast she had done a few years back (link: The Mind Deconstructed) and I told her about this blog. She may even be reading this. (Hi! Thank you so much!)

My case manager was getting my logistics together – PHP, appointments, meds, etc.  It would likely be closer to dinner time.  Just as simple as all that.  My assigned nurse would work on the paperwork, too.  Of course there was a shift change, and when I realized the morning team was gone, I checked in with them.  I asked my new assigned nurse how it was going and she said it was all on track for a late afternoon discharge.  They didn’t have many details, but it looked like all I had to do was wait on my meds.  They were giving me some Trazodone to take home.  To be honest that seemed weird.  Handing a whole bottle of tranquilizers to someone who had attempted suicide with pills.  Apparently it takes a great deal of the med to overdose, and it has to be combined with another danger factor.  I didn’t look that up to make a plan, just to fill in the blanks in this piece.  It was strange to be doing that kind of research and not get the “If you need help..” banners all over the search results.

During the many hours I had to kill, I packed my stuff, which wasn’t more than some clothes, book, journal, and art.  I stacked it neatly on the bed and then only had a few hours – minus two minutes – to kill.  Back to the book, I guess.  I checked one last time late in the afternoon to see that paperwork was good to go, but the nurse said apparently the discharge paper hadn’t been signed yet.  I finally knew what would have been worse than not getting the discharge thumbs-up on Friday.  It was packing and anticipating getting out, then getting the rug pulled out from under me.  That would be far worse.

In the last hour they managed to pull it off, my meds had arrived, and we just had to wait until five, when my wife would pick me up.  Since the latest nurse was also gone, they had some trouble finding my personal items.  They checked everywhere.  Eventually they found them right where the nurse had said they would be.  Those shift changes are a killer.

They took me into the admissions/discharge room with the lockers, and gave me the remainder of my things.  The first thing I did was put on the belt.  I thought I might have lost some weight, and the jeans were not as hip hugging as they had been all week.  They gave me my “secured” items, which were my wallet and contents.  It was a sealed envelope with a marking to show it hadn’t been opened after it was filled on Monday.  My CPAP was in the room and I packed it up, as they had just sort of piled it all up in the case.  I turned on my phone and just put it in my pocket.  My week without technology was pretty peaceful from a certain point of view, and I wasn’t ready to be shackled by my phone.  I intended to use it much less, to read books more, craft more, and all of the other elements of The Good Life.

Unfortunately, when I did check my messages, all of my texts had the exact same friday afternoon timestamp, and would not open.  At all.  And I tried all.  I’m pretty bummed to have missed messages my family members may have sent me, or just missed messages at all.  Fresh start, though, so I guess it’s okay.

Finally the moment had arrived.  I was the fifth patient leaving that day, and it couldn’t have been soon enough.  One of the nurses led me through two layers of locked doors, past the entrance to one of the other five mental health wards, through a third door that I’m sure is locked at night, into a waiting area.  This is when I found out I had been on the third floor.  I knew it wasn’t the first floor, but time and space, including height, were a little wacky.  As the elevator doors closed I noticed a bulleting board for information, and photos of all the doctors.  I guess this is where visitors wait while they’re searching them and waiting for a minder to lead them in.

Going down we stopped on the second floor.  It was identical to the third, doctors and all.  I had assumed the doctors worked in more than one unit, but they must be in all five.  I did hear a nurse saying that they had a shift in one of the geriatric unit, and that meant it was going to be boring.  Apparently the old folks just sit and watch the fish tank, and there is rarely any interesting patient behavior.

On the first floor was another labyrinth of hallways, and the exit that had actually gotten me into the building.  I guess the ambulance doesn’t get a special entrance for a mental health unit transfer to a mental health unit.  I was so disoriented on the ambulance ride five days before that I had no idea where that entrance was located.  And here again, it took a couple turns and streets before I knew where I was.  I thought I knew all the interesting roads in the city, but this was a loop or two tucked back above the river, and I never knew it was there.

Wife was very happy to see me, very excited.  It was hot out.  I felt like I had been in the hospital for five weeks, not five days.  And apparently the world had continued on without me, as we ran smack into rush hour traffic almost immediately.  When I got home, I had a long, hot shower.  And then had another one.  I wanted to wash the smell off me – both the smell of my body and that unidentifiable mental health unit antiseptic smell.

We had a simple dinner, and a typical evening.  A bit of time on the porch, a bit of time watching TV, and then off to bed at a reasonable hour.  Part of the good life plan was going to bed and actually going to sleep.  It was nice to be back in my own bed.  I slept well.

Introduction | Glossary | About

semicolon: 9. Thursday

I woke up tired to a painful level.  Desperate.  I shuffled down the hall, already shaking.  Vitals were taken and unsurprisingly my blood pressure was high.  Anxiety on full blast with a backup of absolutely wanting to die.  My nurse, however, was really nice and we had a good long check in, being honest as I can, doing a good job so far, I think.  She asked questions and said things that were clearly assessing me but also saying things to show support and sympathy at the same time.  It didn’t help much, but it was nice for someone to really listen to me.  I admitted to some passive self harm thoughts and to both active and passive suicidal ideation.  No plan, no intent, and I felt safe here, but maybe not out of the hospital.  Especially with the high anxiety levels.

I can’t quite remember the morning.  Just that I was sitting in the TV area, full body shaking and feeling like I wasn’t getting better, I was getting worse.   I knew I had to just make it day by day, or hour by hour, or even minute by minute.  I saw the MD making rounds but they weren’t anywhere near my room yet.  

I do remember that we had an OT group with creativity, and I drew an image I had been thinking about since the art of the previous day.  I had imagined a darkly colored face smeared downward.  The morning OT didn’t have access to colored chalk drawing sticks, so I used oil crayons.  Wasn’t exactly what I had in mind, but maybe someday it’ll be worth a ton after I accidentally become a famous artist.

My hands were black with oil crayon, and I went and got another piece of paper.  Nice, super textured, heavy weighted paper.  I had no idea what to draw.  So I used the oil on my fingers to just put fingerprints randomly across the paper.  I was still bummed they didn’t have colored chalk, but they did have black charcoal sticks.  And I loved the effect on the opening credits of the show/series “The Pacific.”  The way the charcoal stick drew on the canvas but exploded bits of charcoal as it went, making a properly beautiful mess.  So I drew lines from fingerprint to fingerprint.  Which led to more doodles, which led to more.  I drew some patterns and such, but it wasn’t until I started drawing long curving lines that I saw the hair.  And the eyes.  And everything.  Honestly this image scares me, because it’s so pained and mangled.  As a result one of my favorites.

When I’m arting I often have an idea in mind.  It may change as I screw it up, but I’m usually working in a fairly determined manner.  So here I was with two drawings that I loved, and it was 20 minutes into the session.  I didn’t want to just keep making art, I felt I was done.  But I didn’t want to leave, either.  So I thought I might make something “happier” or more upbeat.  Grabbed the horribly messy oil crayons again and just started with a shape.  Filled it in.  Another shape.  Filled it in.  And so on.  There may have been an eye in there somewhere, but I was mostly killing time.  And of course that’s when cool things happen.  I just thought it was random brightly colored shapes.  But I guess my mind was guiding my crayons like middle school girls trying to raise spirits on a ouija board.  It wasn’t until I got home and was showing Wife my art when she said, “Oh, yeah, it’s a sailboat.  I can see that.”  Except I hadn’t told her what anything was.  It was pretty cool.  Wind in the upper left, looking down on the boat and cockpit.  You can find enough other parts of a sailboat to actually see it if you try hard enough.  Back to the theme of the magic eye puzzles and “Oh, it’s a boat!” from Mallrats, the movie.  Yes, it’s an old-people comedy from the 90’s and surely somehow even more offensive today than it was trying to be back in the day.

So I guess I did find a way to distract myself. 

Near the end of the OT group, my MD found me and asked if we could talk in my room.

That discussion put me on a whole new level of understanding, a new direction.  She explained the Vagus nerve response, or the mammalian deep dive response.  When I think of this, I think of a sea otter.  It needs to dive deep to find food sometimes.  But when you’ve been underwater, diving deep, the first thing that happens is that you are running out of air.  You also cross into a much colder level of the water – and that is a very quick change.  These things often give us the impulse to panic.  But that sea otter needs to dive deep, so in order for that to happen, the Vagus nerve is looking for a sudden body temperature change, and the feeling of running out of air.  This points me to one of the reasons for a Vagus Nerve Stimulator.  It kicks the Vagus nerve every few minutes, so you’re essentially shutting down panic constantly, making sure it doesn’t happen.  The VNS is also for TRD patients and it somehow helps with depression, which is what I’m headed for.

We can stimulate the Vagus nerve manually but doing a 4-8 breathing, meaning breathe in for four seconds, breathe out for eight seconds.  You can’t do it for long because eventually you’re going to run out of air.  The second, and most important part is the temperature change.  The best way to do it is to place your face in a bowl of ice water for as long as you can, but probably not more than 30 seconds.  An alternative is to place something ice cold directly under your eyes.  You can also put something cold on the back of your neck.

I had learned all of these things independently, but nobody had ever explained how they connected and why they work.  Or if they did, I couldn’t remember it.  It made sense now, and would have back then as well, so I would think I would have remembered that.  I like science.

She also focused on my personal grief.  Since losing my career and having my memory downgraded/changed, I needed to get a new identity.  My career went back a long way, and one of the things it stood for was “I may have dropped out of college twice, but look at what I have accomplished.”  Losing my previous identity in some ways was something I was going to have to understand and grieve.  Also, losing that identity removed the support it provided.  So this could place me back to my teen years, and by extension my younger years.  Back to my childhood, which my therapist describes as “trauma through neglect.”  So yeah, she packed my baggage, it’s up to me to carry it and work with my therapist to unpack it.  So I need to build a new identity almost from scratch

In the short term, we needed to tackle the top of this pyramid.  And that’s to keep me alive, stabilize me.  The second layer is getting the right therapy going, addressing these identity and grief issues.  And the third layer is quality of life – not just pulling me back from D, A and S, but getting me to a point where I am truly enjoying my life and continuing to grow. 

Once I’m stabilized and can go home, there are three major points to work on.  First, the biological.  Switching my meds so I actually sleep, and doing TRD clinic outpatient.  Working with my psychiatrist on meds, and continuing down the road the TRD clinic is taking me. That would be the ketamine, Vagus Nerve Stimulator, and whatever else they may have planned.

The second focus is Psychological.  Learning and relearning distress tolerance skills and blocking the suicidal thinking.  She simplified what suicidal thoughts were.  I wasn’t in the clearest mind, but what I understood is that when in a (depression or anxiety) crisis, the brain wants to help reduce the stress.  One of the things it does is offer different types of methods that will help us immediately.  In the case of suicidal ideation, it offers that thought as a way of understanding there is a quick and simple way to fix the situation.  It’s not your laziness or depressed mood or wanting to quit, it’s the brain saying “here’s one idea out of many..”  Initially, it offers just a tiny bit.  But as time goes by you build up a tolerance, so it offers more of these thoughts with increased intensity.  Eventually you go from “I wish I was never born” to “the impulsive idea of seeing a way to kill yourself and considering it” to actual planning and seeking opportunities to act these thoughts out.  It just keeps getting worse, as you continue in a crisis.

So it’s not my personality’s fault.  And just understanding that science took a lot of the power away from S, my internal personality.  By understanding why you’re thinking these thoughts, it makes the brain give up offering them just a tiny bit.  So the more often you recognize those thoughts for what they are – a brain reaction – the less often they come, and with less intensity.  That alone changed the way I thought about hopelessness and suicidal thoughts.  Combined with understanding the causes of the worsening of my depression – childhood trauma, life changes in career and local family footprint – made me understand a few things.  First, it’s not me looking for an easy way out because I’m weak. Second, I can science up my own reaction to those thoughts.  Third, it feels like someone has really identified the things that I need to work on, by myself and with professionals.  And finally, there is a plan of attack, a logical way of addressing my issues – not just throwing dart boards at a wall and deciding to try ECT or TMS or a new drug without any specific mechanism that it is likely to correct.  

It’s all about balance between science and therapy.  Understanding the physical aspects, but also what emotion aspects set them off.  Those are distress tolerance skills.

In the drawing above (that she made conveniently in my journal) you can see the biological, psychological, and social elements to work on.  Some connect to others, but for the three actions, there are understandings of what’s missing, and what needs to be reduced.

This is where it all changed.  Not in a religious transformation type of change, but more like they slowed me to a stop and gently pushed me in a different direction.  It’s up to me to do all of the pushing to get up to speed, though.  And she stressed that it’ll be two steps forward, one step back, but keep an eye on the net progress.  There will be bad days, but eventually they will come less often.  One of the factors that made me buy this idea was that it wasn’t going to be “do this and it’ll be perfect” – which usually leads to a single failure and thus a lack of faith in the system.  It’s a realistic plan going forward and I’m a human, so people will understand if it’s not perfect.

I asked about when I might go home, still thinking I was going to be stuck here forever.  Understanding was half the equation, I still needed sleep and support and something to keep me off the bottom of the mood pool.

What she said surprised me.  They like to have a typical three day plan.  Day one they get to understand you and the crisis you’re in – and how.  Day two is coming up with and presenting a plan to the patient.  And day three is seeing if you can attempt some of the interventions, and get to a place where you can be assuredly safe.  This was day two.

Given my depressed mood and anxiety, along with the sleep deficit, I wasn’t too hopeful.  Friday would be my third day, and I still didn’t feel much different.  I had to let the learnings of today simmer a bit.  And I had a bit of optimism but not a ton of hope yet.  So the fact that day three was a friday, I was expecting to be able to consider talking about my release after the weekend.  And I really didn’t look forward to three or four more nights in the unit.  

Back to the grind of the day, I was a bit late for lunch.  When the nurse took the cover off she was surprised, and asked if this was all I ordered.  It was the Caesar chicken day.  Just a single, sad little piece of chicken, though it tasted pretty good.  I couldn’t eat anyway between the exhaustion, trying to process the things the MD just told me, and the growing stress that Wife was coming to visit that night.

The group in the afternoon was about values.  Specifically values and goals.  The therapist was young and new and nervous and read awkwardly from her guide paper.  But she was nice enough and eventually chilled out a bit.  It was just her, Singer, and me.  Thank goodness there wasn’t just one of us.

The point was that values and goals aren’t the same thing.  Sounds obvious, but in a previous program we always talked about value-life-actions.  At check-in we might talk about what value-life-actions we did the night before, or at check-out they would ask us to name one as a goal.  It was always hard to understand what a value-life-action was, because they were always usually tasks or things to do.  But with this group it all just clicked.  It’s a simple concept, but in short your Values are how you want to live your life generally speaking.  Goals may have something to do with your values, but they’re not the same.  Achieving those goals could help strengthen or weaken your values.  The why of the goal, as opposed to the literal goal of the goal.  I know it seems like a simple concept, but it’s key in your recovery because you often have to re-identify values and how you want to live your life.  For me especially, since I needed to work on my identity, who I was, what I believed in, and what I wanted to guide me in life.

We also talked about control.  We discussed understanding your situation and handling it responsibly and easily.  The mantra the therapist offered was “Observe, Describe, Participate.”  You observe what’s happening, describe it in a way that makes sense (or doesn’t) with your values and goals, and then you choose to participate or not participate.  Singer offered up the phrase her mother used to say, “catch it, check it, change it” which is ultimately the same thing.  Notice it, check that it matches your deal, and change it if it doesn’t.

The ever-so-familiar bus metaphor came up.  Stick with me, this actually applies to some of the things I was having to mull over.  It’s simple.  You’re the bus driver.  The passengers are things you feel:  You like vanilla.  You are scared of dogs.  You feel shame for something.  You hate homework.  Anxiety.  Depression.

Rather than drive the bus on the route you are supposed to, we often let the passengers tell us how and where to drive.  There’s a dog in a yard in the next block, so let’s go around the long way to avoid it.  You can choose between vanilla or chocolate, so “You like vanilla” tells you to go for the vanilla.  Eventually you become so familiar with how the passengers are going to derail you, that you actually do their thing before they even ask for it.  Sometimes we don’t want those passengers to control us as much, so maybe we push them to the back of our brain/bus.  They’re still there, there are just a bunch of passengers in front of them.  During my “perfect year” I had pushed Anxiety and Depression back into the very last seats on the bus, and ignored anything they said.  But they were still there, waiting.  Waiting for an opportunity, or just waiting for all the other passengers to get tired and sit down for a bit or get off the bus.  So it was an apparently perfect year, but the whole time I was working my butt off to keep ignoring depression and anxiety.

And the final advice on the bus metaphor was that when you try to control the passengers, you lose control.  Not exactly sure what the right thing to do is, but if I recall correctly, it was keeping the passengers in their seats, kicking the rude passengers off the bus, and driving your route.

During quiet time I tried to nap but didn’t get any sleep.  It was so long since I had REM sleep, I had forgotten that I wasn’t dreaming.  And I was buzzing about getting to leave some day.  Tried to level set my expectations fairly loose though.  But now that I had an ember of hope, and my mind was blowing on it and dropping dryer lint on it, it was starting to burn a bit brighter.  So while I was excited about the prospect of my own bed and to get away from the as yet unidentified industrial cleaning product smell, I needed to be ready to spend the weekend here.  And if I wasn’t, I was really going to have to finally take a shower.

As my outlook brightened with further internal discussions and debates, I started to think about what’s next, not “how can I make next not happen?”  I called Sister, as Wife said she had wanted to talk to me as soon as she could.  We’ve always been close, and she used to give me pep talks in high school when she would come back from wherever catholic school cheerleaders go on weekends.  Don’t worry, nothing too horrible, but “kegger” is a major player in those stories.  We would talk and when I was having problems she would dump endless cliches on me, which actually helped quite often.  She said I sounded better than she’s heard in many years, and that gave her some hope as well.  I didn’t know how I sounded, but I listened to myself for the rest of the call and realized I was brightening up.

Before seeing the MD, possibly even the day before, I wrote Wife a letter.  I was taking responsibility for my actions, admitting that I had to earn her trust in my safety, and what I intended to do to better my situation.  I talked about “the good life” – don’t worry, I’m getting there.  After talking to the MD I re-read the letter and it was actually in line with what the MD said.  Nothing earth shattering, but good logic steps with the right perspective and understanding that nothing is perfect.

The “good life” was not a radical change in beliefs or how I live my life.  It wasn’t the “perfect” life, or even the “new” life.  It was simply a guide to having a good life.  The irony that it sounded like “the good place”(a show about where you go when you die, is it heaven or hell?) was not lost on me.  It was something like this:

The good life

  • Sleep discipline – lights out at 11pm
  • No screens in bed, dead trees books ok
  • 2+ meals a day
  • 1 hour of creativity every day – play instrument, write, craft, whatever
  • 1 hour vocational/career effort daily – when able
  • Walk every day
  • Minimize Alcohol.  Not quitting, stopping and then moderation
  • It won’t be perfect immediately
  • There will be setbacks but it’s all doable
  • Keep scienceing it.  Learn the logic of therapies and treatments.
  • Don’t rush it, but don’t lose sight & hope
  • Need another PHP for structure and continuance of goals.

That’s it.  (That’s it?  That’s an awful lot of bullet points for “it”)  And I am still trying to follow that guide a month later.  It felt realistic.  I began by understanding that if I break a rule or one doesn’t work out, that doesn’t destroy the effort before or after.

I was getting used to the danger people like Gangster and Tank.  But I was working hard not to be near them or between their minders, and it was a nervous task to do that.  Dinner was some random horrible thing, I think it might have been chicken tenders and the bread with cheese glued to the top.  As people throughout the day found out they may be getting out of the unit Friday or Monday, the mood lightened.  Dinner was good conversations, often funny, and often not just the table I was at with the fun folks, but everybody in the dining area.  Except Mumbles, he just kinda rapped about whether or not he wanted a condiment through the dinner hour – but it sounded like happier rap, if that makes sense.

The Thursday night movie was Frozen 2.  I had seen it only once and thought I could hang out for that while I waited for Wife to visit.  The TV was turning the picture bluish purple – even the commercials.  So it wasn’t just the dark mood of the movie.  I was getting more and more anxious about the visit.  It was a complicated feeling: excited to see her, scared of what she might say, worried someone on the unit would have a proper end of day meltdown, and so on.

I used the day’s learnings to calm myself.  Ice directly on my face, 4-8 breathing, and focusing on calm.  And it worked.  I still think it was because I knew what it was doing now, not just doing a placating therapist trick to get my mind off anxiety.  Cold as it was, it really showed me that what the MD had said actually had merit!

Wife visited, she was very quiet but it was good to see her.  I gave her the letter, all four pages.  Yeah, obviously I can’t shut up in speaking, writing, or blogging.  I couldn’t read her, and I’m usually fairly okay at figuring out what she’s feeling.  The dark side of me was worried she had come to say she wanted a divorce, that she couldn’t keep supporting me like this.  She just said she was tired, no dire news or anything.  I talked about the MD’s discussion from the morning, explained the unit as much as I could from there, and we chit-chatted a bit.  I felt relief when she left, not because I didn’t want to see her, but I was so worried about how she was feeling.  It didn’t make me feel too much better, but I was relieved that she was at least okay.  She also brought my CPAP machine, which hopefully would help me sleep.  They immediately locked it away, because, you know, ligature risk.  Wires and tubes and such.

Got back to the TV area to watch the end of the movie.  Two people are leaving for sure tomorrow – both of whom are in the fun group and we’ll all miss their energy.  We also got a new person last night, so that might balance the numbers.  I’m told weekends are both boring and rife with new patients.  There was one new person, New.  

I was still extremely tired, so I tried to go to bed early.  Unfortunately, my overnight minder doesn’t start doing that until 10:30, so I had to wait.  And wait.  And wait.  But I had a nice big dose of trazadone on board, a new sleep med.  And now that I had my own CPAP machine with a properly fitted mask, along with the final cherry on top of the sundae – earplugs!  Don’t know why I hadn’t thought of that earlier in the week.

And I slept.  Leg-en-dary sleep.  Slept so deep and well that I had tons of dreams.  I didn’t realize how long it had been since I had a dream.  Sleep deprivation will do that to you.  My dreams are always fun dreams.  Like letting the subconscious version of me out into the world, or my memories of places, just to have fun.  Apparently it’s common for veterans to have dreams in which they’re back in boot camp or where they attended training or were stationed.  I routinely have dreams about showing up per orders at my first training school.  But as me now, middle aged and out of shape.  Someone else was in my barracks room, I had just my street clothes on, no uniforms, hair out of regulations, and with absolutely no shits to give.  I would stand around saying “Hey, you wanted me back, so none of that is my problem.  You want me to look like a Marine, then great, hand me some uniforms.”  It would eventually devolve into wandering around the base, maybe doing weird things.  Like inflating the Post Exchange and watching it float away like a balloon, or seeing out of context friends and wondering how they got there, and why?  It was just a military version of a college campus, but without any of the fun parts.  Dreams like that.

So that night I dreamed that Wife and I visited Army Friend and Army Friend’s Wife in the pacific northwest.  Hanging around with them at their house, with their pet – a brown version of Sonic the Hedgehog. Because that’s normal, right?  We also went out to dinner and for a night on the town.  But instead of having a cocktail, I had milk.  I’m not drinking right now, but milk?  I would have much preferred a ginger ale or a Shirley Temple if they didn’t call it a Shirley Temple.  Pretty sure we broke into the house of the first CTO I worked for and avoided all the security lasers and just ran around.  Snuck out successfully later.  See?  They’re fun dreams where I can simply goof around.  Never ever scary, which is good.  But also never, uh, sexy, which I guess is a bummer.  Funny.

Introduction | Glossary | About

semicolon: 8. Wednesday

Awakened early from a poor sleep and was told breakfast was ready.  Getting dressed meant putting on my personal socks and the grippy socks over them.. I was chilly and didn’t mind the layers.  It also would hopefully help the fact that a middle aged guy was walking on hard floors without the usual orthopedic inserts in his shoes.  Used the bathroom and headed down toward the nurses station.  When I got there I got the usual “who are you?” and they took my vitals.  I didn’t have my sweater or a sweatshirt, and they offered one because I looked so cold.  The truth of the matter is that I was so anxious I was shivering and shaking.  Also likely looked like a deer in headlights, the new guy in prison.

My blood pressure was quite high, but not enough to be worried about.  It was, after all, probably the most stressful morning I’ve ever had.  That includes Marine Corps boot camp.  I learned early on that this was comparable to boot camp.  If you understood and played the game, nobody would mess with you and you wouldn’t get a minder.  Although this experience had much less panicked running around.  One of the standard items I had been given was a notebook, and they showed me where I could get a safety pen.  Just like boot camp, I wanted to remember as much of this as I could, so I journaled as well as I could.  The shaking didn’t help, but none of my notes were indecipherable when I came back to them.  It was so nice to be writing, getting thoughts out.  I’m an introvert who is comforted by telling stories or making detailed observations.  It also seemed like a pacifier to help with my social media, texting, and email withdrawal.  Though that wasn’t much of a problem.

I was one of the last to have breakfast, but they placed me with Old Man, and that felt a little comforting.  He excused calm.  Because I hadn’t had an opportunity the night before to fill out a menu, I got what I would call a generic breakfast.  I was beyond being able to eat, so I drank the milk and juice, and the coffee.  I prayed it was decaf.  I didn’t need a caffeine buzz today.  I was not likely to be gaining weight this week.  One of the meds I was on was an appetite suppressant, and I had been losing weight quite nicely, without exercise.  Might not be a healthy loss but I’ll take it.  And after I’m out and strong enough, I intend to bring back my usual 3-6 mile walk every day.  As it happened, that was foolish optimism.

After breakfast we had the unit meeting.  It consisted of a quick check-in, might even have been just a word to describe how you were feeling,  Also your name since turnover was so high, and we were presented with the topics for today’s groups.  I skipped the early one, so I had a couple hours to fill the time, which seemed daunting given the level of anxiety I was experiencing.  At the end of check in, Singer sang Amazing Grace acapella.  It got stuck in my head and I told her so later that morning, thanking her for getting it stuck in my head.  She was one of the first patients I talked to.  I had until 11:15 for my first group, and no clock in my room, so I kept having to walk down to the nurses station to check the time.  I hadn’t come up with the white noise machine timers yet.

Around ten in the morning I was visited by a medical resident and a student to prepare for talking to the MD later that day.  I told my story again, and I am really good at it by this point.  The resident responded with “Wow.  You’ve been through a lot.”  Summary:  Major depressive disorder, generalized anxiety disorder, treatment resistant depression, therapies include multiple PHP, day programs, a full round of ECT, a full round of TMS, groups focusing on CBT or DBT and occupational therapy.  Had memory and cognition issues from the ECT.  Also multiple psychologists through the years as well as multiple psychiatrists.  Many different drugs, some given up and some still layered on my typical regimen.  A suicide attempt after years of passive and active suicidal ideation.  Childhood trauma in the form of neglect, losing my job, which was really ending my career, and having two kids in college.  So I was now an empty nester with Wife.  So yeah, I guess I have been through a lot.  I considered myself a professional depressive at that point.  The resident said I would for sure have a CPAP that night, likely a hospital provided one, but Wife could bring my personalized one from home.  Mentioned the minder overnight thing, which I will explain later.  I ended up hopeful that I wouldn’t be here forever.  Which was a big deal for me.

Around 11 I talked to my case manager.  I didn’t think I really needed one, but whatever.  It was really just an introduction and a little bit about logistics.  Her primary role would be helping me with post-release programs and appointments.  She ended up being very thorough and ahead of me by a couple steps most of the time.  I would ask her about something in general and she would already have my back history explaining why I was asking, but always had a plan and had already begun the effort, like setting up a PHP after release.  She had my sister’s name, so she was one of the few people whose names I would remember.

At eleven thirty I had my first group.  It was an OT that consisted of a dice game.  You would roll two dice and look up that combination on a sheet.  And then you answered the corresponding question.  They were things like “My triggers are..” and “When I’m feeling anxious, the best distress tolerance that works for me is..” and “my earliest memory is..”  On the back side of the sheet were more softball questions, like “My favorite food is..” or “My favorite season is..”  It was fun, and I forgot myself a few times, which was a relief.  I also got to know some of the other patients much better, and they got to know me.

Lunch was okay, but I don’t remember what it was.  I do remember it was still too much food.  I sat with Steve-O and Mumbles. Had a good conversation with Steve-O and got to hear more clearly some of the things mumbles was saying.  Some were statements about himself and how he was feeling, repeated and evolving as he said them.  My full body shake was much quieter, but I was still running at an extremely high stress level.  I felt I had to put on my Human Face during the group, and that’s always exhausting.  It also makes me feel like maybe I shouldn’t be there, but I noticed everyone else does it sometimes, and I should just enjoy the moments where D and A aren’t pestering me.

At some point in the day Singer turned and said something sharply to a place where there were no people.  I think she has hallucinations.  Wasn’t actually creepy or anything, just fascinating.  Most of the patients were fascinating in many ways.  Their experiences, their problems, their attitudes all made me feel more connected to them with my own situation.

Talked to my assigned nurse, answered some questionnaires, filled out some forms, and was finally able to see about getting things from my locker.  She gave me my book “The Social History of {my instrument}, Volume 1.”  Thick and boring to most, but not me.  She also gave me the clothes I brought with me in my backpack, except the pajama pants.  And finally she let me have my slippers and sneakers, which didn’t have shoelaces.  I immediately put my shoes on, they felt so much better than none.  I also put on my sweater right away, and that made me feel more comfortable and myself.  Asked the nurse my list of questions, mostly logistical and about rules.  As soon as we were done I went to my room and changed into jeans, a t-shirt and my sweater.

I finally got to speak with the unit psychiatrist, and she was very nice.  She really seemed to understand what was happening to me. This was the day to get to know me, and her questions were quite on point.  She essentially boiled it down to minimize my drug load, maybe tweak them.  Also, we would need to address the grief of my career, children not being home, etc.  Finally, something about my identity and needing to figure out who I am again.  One thing bothered me.  I have always wanted my depression and anxiety to be special or unique.  And if it’s not, I think they can’t understand what I’m going through.  This MD had seen so many different cases and patients, It was hard to appear as some new and interesting case.  She did mention the “You’ve been through a lot!” quote and that was nice.  To finally be recognized for all that I have experienced, and how hard it was.

I was also starting to question my usual psychiatrist and the hospital she worked at.  It was where my kids were born, my ECT, TMS, PHP and day programs had been.  It was our home hospital.  But I was concerned that here was a doctor who had identified some specific issues and talked about meds like she knew what to do.  My normal psychiatrist hadn’t come up with some of those things, and she knows about me as well as anyone could.  I eventually dropped that thought when I considered the fact that this MD was actually a professor and specialized in stabilization at the inpatient units.

I was assured that I would see the MD every weekday that I’m in the unit.  She got me thinking, though.

I was thinking about depression and anxiety being my primary relationships.  Could it be because everything I used to identify myself is gone?  So if I work on my identity, that will help.  That also sent me down a path to reflect on who I really was.  So I wrote down all of the things that used to identify me, and everything else, plus new interpretations of the deficits.  So who am I?

  • booksmart clever
  • funny
  • great memory Able to let go of missing thoughts
  • accomplished accomplished in my past, likely will be again
  • programmer/technologist speaker and writer, a creator
  • husband
  • father
  • brother
  • son Love and loved by wife’s family
  • a bit overweight thinner and healthier
  • wiser?
  • stable working on it

I also had a hard time understanding how I was feeling.  Overwhelmed, for sure.  But I’ve had so many strong emotions, mostly bad, so it’s hard to remember what normal is.  Is depression as an 8 out of 10 normal for me now?  So what does worse feel like?  I kinda don’t know how I feel anymore.  So I guess I have to once again figure out what feels.  At the time I wrote the things I was experiencing right then:  tired, stressed, in problem solving mode, anxious, depressed, and hopeless.  And the hopelessness feeds on the effort and self discipline that future work will require.

The staff member who does CPAP equipment check-outs came, fit me for a mask, and the pressure seemed a bit stronger than usual, but I like it like that.  Again I was confronted by the thought that maybe it’ll cause an aneurism or something and I’ll die in my sleep.  I longingly hoped for that scenario.

Was about to anonymously describe the other patients on the unit but remembered Girl, interrupted and how that blew up in her face.I did eventually take very cryptic notes about some of my co-patients, and then expanded that when I got home.  You can read those in the “Inpatient / People” section.

The afternoon group was OT, creative arts.  I made a sticker by number of a woodpecker.  It was simple and maybe childish but it did help me get my mind off myself for a brief time.  I was interrupted by a call from the pharmacy confirming my meds.  Which is always a hassle given the total number of meds, and the fact that of the eleven pills I take, some of them are of different doses, so you have to walk people through the med list and explain how things work.  I am surely getting better at that.

Dinner was mixed.  It was chicken tenders and plain white rice.  And peaches, which I hadn’t ordered but ate anyway.  The chicken tenders were really good, but the rice was bland.  Ate everything though, which was good for me.  Socialized a bit at dinner and I’d been slowly getting to know some of the other patients in a friend-like way.

I called Wife, and she was very relieved I was getting the help I needed.  Her demeanor was much more calm and level.  She said she would come visit me Thursday night and every night after that.  I thought “why bother?  But, ok..” which is indicative of the isolation I felt most of the time.  I looked forward to her visit immediately, and that helped me get through the horrible and brilliant next day.  She and my aunt were going to tag team on the weekends, as there were two visiting times.

At some point during the day I folded and organized my clothes on the shelves.  It made me feel a tiny bit like this was my space.  Wall locker ready for inspection!  I still hadn’t showered and knew I was going to have to sooner or later.  I was still wondering when I would get out of the hospital, vertically or horizontally, I didn’t care which.  I was hoping I’d be out by the end of next week, but didn’t want to get my hopes up.

Our evening group was art therapy.  We were given two outlines of a profile and were supposed to color one that showed how we felt when we were anxious, and one that showed how we felt when we weren’t anxious or depressed at all.  I let my creative juices guide me and ended up with one that looked like chaos, and another that looked like the profile was blue skies with clouds, and outside the profile was sunlight and warmth.  I liked how they turned out, and when we had to go around to show and explain our completed work, people seemed impressed.  Showed a couple people after group and they were impressed as well.  So not only did I get some feelings out, but I got the boost that comes with recognition of a job well done.

I had used colored artists’ chalk for the two drawings, and spent quite a bit of time afterward thinking about what I could do next.  It’s not therapy if there isn’t some art and/or coloring!

When I explained my drawings, they were pretty straightforward.  After my explanation and the response from the occupational therapist, I said out loud the line about “it’s not therapy without art.”  I then mentioned that when I was in my first day program we made a ton of art and I would bring it home and my wife would just stash it away.  I had been going through ECT at the time, and it erased much of those memories and had made it hard to think since.  After my ECT and day program had finished she started putting one of those creations on our refrigerator door every week or so.  I would see it and be amazed, as I thought it was really good, and that it somehow captured how I felt at times.  I asked who the artist was and she said it was me.  So that was a fun little perk after the program.  When I finished telling the story and looked up, all I could see were shocked faces and wide eyes.  Some of these kids might be more messed up than me, but I had time and experience on my side.  At some point, I had to explain what ECT was to a few friends who had asked what it was..

I went to my room near lights out, and the CPAP was brought to me.  Every moment I was in the room with the CPAP machine, I had to have a round the clock minder.  Just so I wouldn’t use the cord for shock or as a ligature, etc.  It did seem to me that it had a number of good uses for suicide.  Except for the minder sitting in a chair in my doorway.

I started the machine and had a loud air leak, and the mask had a tiny leak that sounded like a whistle.  Not awesome.  I managed to stop the big air leak by tying a sock around that part, but it meant that I had to be very careful when I moved.  The whistling persisted no matter how much I adjusted the mask.  I’ve had a number of different masks and sizes, but it just wouldn’t seal.

Unfortunately everyone who took a shift as my minder seemed to have a cough.  Every time I came close to falling asleep, a loud cough would whack me awake.  Also, since my neighbor needed 2 full time minders, they were always chatting – and sometimes my minder would join the conversation.  Still not awesome.

Midnight brought some commotion on the unit.  Tank was yelling and I could tell it was both in and out of his room at times.  Since I had a minder, my door was open and I could hear everything quite well.  He was yelling something about taking him to the emergency room, over and over.  Not sure what was wrong with him.  Eventually I heard the thump I was expecting, and the yelling turned into “I’m not resisting!” although for a while it was “stop resisting!” so he was a bit confused.  And we all know that saying you’re blurry resisting often means you are, and always means you’ve lost the battle.  Eventually he stopped yelling.  I don’t know if they sedated him or talked him down.  But it finally got quiet.  

And yet I still didn’t sleep.  Eventually I was totally over the coughing, whistling, and leaking.  So I took the mask off and my minder came in.  I told him to take the CPAP and asked what time it was.  Three thirty.  So I could still get four hours of sleep without someone staring at me and coughing, the door closed and no extra noises beyond the white noise machine.

Nope.  Brain wouldn’t turn off.  I got a few bits of sleep but not any long stretches, and certainly no deep REM sleep.  Essentially I didn’t sleep at all Wednesday night.  And that wasn’t good.

Introduction | Glossary | About

semicolon: 7. Inpatient

Physical Layout

Horrible map. Give me a break. I didn’t draw it in a nice studio.

A virtual tour of the unit:  A long hallway with patient rooms on both sides.  17 laps down and back equals one mile.  You would occasionally see someone doing it, or even a handful of folks on a walk together.  There were plenty of phones with short cords scattered in the hall and other areas.  One was near the end, by my room, and it became my favorite.  The cords were short so as not to provide a ligature danger.  They were so short you really only had one position you could be in, and that was sitting on the chair close to the phone.  Forget standing up, even if you were short.

My end of the hallway had a locked storage area.  The doors to the rooms had blinds in them between panes of (I assume) unbreakable glass.  You could open and close the blinds from outside the door.  Since they checked on everyone every fifteen minutes, at night they would flip them open and closed as quickly as possible.  So every fifteen minutes there would be a “snap!” and light would flood the room.  And then another snap of the blinds closing.

At the end of the hallway with the (locked) door into the unit, there were actually two locked doors to get out.  The first directly faced another Mental Health unit, and to the right outside the locked door was a lounge type area and elevators.  Pretty sure that was where visitors waited when the staff was getting someone to brief and search them for contraband, and open the door.  There was a bulletin board with the pictures and ranks of the doctors for the unit.  As I was leaving later that week I discovered we were on the third floor.

Ok, back to the unit.  At the door end of the hall was the admission and discharge room, which had a bathroom and lockers until you left.  Personal goods were stored in the lockers, and you could only access them if you had a really good reason.  And you would be escorted, and they would get the things out of the locker for you, and inspect it before handing it over.  

Opposite the admission room was the dining area.  Four round tables and the heaviest chairs you can imagine.  They must have been filled with sand or something.  They were plastic and you would grab one like you were going to slide it, and being plastic it’ll give little resistance, right?  Nope.  As I was checking out my case manager tried to move one and was fooled by the weight — and she’s done this countless times.  

The food ranged from ok to not great.  Institutional food, of course.  The chicken tenders were good, almost spicy.  There was a breadstick with cheese on it that was nice.  But the milk tasted funny, the juice was bland, and sometimes the meal options were.. confusing?  I ordered “Caesar Chicken” for lunch, somehow thinking it might be a salad.  But if not, something more substantial than what I got.  Which was one piece of chicken, lonely on the plate, which tasted a bit like caesar chicken.  I tried to find an image from a search for “single piece of chicken on a plate” and got nothing like what I needed.  After all, who would take a picture that sad?  Beyond the quality and clarity of orders, what you got was more in the “spirit” of the menu.  You wanted a cookie?  Might end up with asparagus instead.  Wanted a peach cup?  Sure, we’ll give you a breadstick.  Sometimes they were right, but sometimes they were absolutely nothing you ordered.  I guess you can do that to people in a locked ward, since they’re not going to come down and complain to you.

Like this, except gray chicken. And no silverware, just sporks. Also didn’t have a watermark of the place I stole the image from.

Beyond the dining area was the group room.  The wall between group and dining was a large unbreakable glass wall with a locked door in it.  It had plenty of storage cabinets (locked of course) containing craft and other occupational therapy (OT) items.  When attending anything in that room you were required to wear a mask.  We often did art there as a daytime OT group, or in the evening for “creative hour.”  They did have quite the collection of craft products!  When someone came to visit, they would unlock the group room and lock you in there.  And watch from the outside to make sure nothing untoward happens.  The view was similar to my rooms, but overlooked either staff or non-locked patient outdoor area.  Big fence, but some nice lawn furniture.  And (city) clean, fresh, natural air!  Sadly only seen.

The next area down the hallway was what I thought of as the living room.  Moderately comfortable chairs, a rocking chair built like the dining area chairs, and a TV.  This is where we had the morning check-in with all of the patients and most of the staff.  The leader of the check-in was the “boss” of the day, and they were as varied as they could be.  One was strict and sharp, another was casual and funny, yet another was scared for her life because it was her first time leading a check-in.  The TV was on when there were no group sessions, meals, or (night) lights out.  The content on the TV was as moderate as you can get.  No content with possible triggers, which ruled out violence.  No shows with heavy vulgar language, which ruled out some movies.  No content with the rest of the triggers, like alcohol, suicidal ideation/depiction, no sexual content.  So what you’re left with is The Learning Channel and shows like ghost hunters and “Survive in the desert/snow/jungle” and so on.  So glad Trading Spaces isn’t still popular.  The TV quality was slowly degrading while I was there.  It went from watchable, to heavily purpled, and by the time I left the image was jagged/shaking.  It was a large screen TV (but not too large) housed in a metal box with holes for the sound to get out, and an unbreakable window of plastic to see through.  There was another one in the group room for presentations.

The separator between the dining area and the living room was half blocked by the wall the TV was on, and the other half was a counter bridging the two areas.  There was always (decaf) coffee there, and often crosswords or sudoku puzzles, both copies out of the newspaper, so some of them were hard to make out.  There was usually a newspaper, games, and sometimes snacks.

In the corner of the living room was the window for taking meds.  You would be called to the window or your assigned nurse would lead you there.  It was hard to hear through the speaking port, but raising your voice did the trick.  All day long people were getting regularly scheduled meds and PRN meds (the kinda you take when you need it, like for migraines, anxiety reducers and so on. Saved you a trip to the glossary. You’re welcome) and because it was in the living room / tv area watching a show included people being loud enough to be heard, or arguing with the pharmacist nurse.  If you’ve seen One Flew Over The Cuckoo’s Nest it was similar to that med window, but rarely was there a line.  

The heart of the unit was the nurses station, right off the living room, in the crook of the L, so to speak.  There was a big screen TV (not in a metal cage) that displayed the list of patients by first name, and their corresponding assigned nurse, MD, and case manager.  If you needed anything, this is where you started.  There was always someone there, and if they couldn’t help you they could find your nurse.  Because, you know, it was a small space.  Just look around and you can usually find them.

Not my hand

The nurse’s station was where you would find a menu every morning with your name in big letters.  You filled out the menu requests for tomorrow, and dropped it into a bin with the other patient’s orders.  You could also get headphones there, which were safety legal headphones that according to one of my nurses was “really bad” but the patients on the autism spectrum used them from time to time for calming.  I never tried them.  You could also find a crossword, but I’m guessing it’s weekly, as it was always the same one.  And for doing crosswords or sudoku or writing in a supplied journal, you could get pointless (literally) pencils or naked pens.  The pencils were useless, and write about as well as you can write with a lead made of soft plastic.  The pens however, if you can find one in the supply box, actually work well enough and are comfortable to write with. Essentially a soft flexible plastic tube over a pen cartridge.  I saved one to take home but when I got home I couldn’t find it.  Really bummed, it was my favorite souvenir!


There was a private shower across from the nurses station, and they timed it.  But at least you had enough privacy.  I didn’t use it, to be honest, but if I had stayed one more night I would have.  They also had a laundry machine/dryer that you could use.  Both laundry and shower you had to sign up for at a certain time but I never saw a long waiting list.

The is *exactly* what my room looked like. Ok, except for the desk and chair. I just had a heavy block of table.

My room was a single due to COVID, but would normally be a double.  Which would be an even worse nightmare.  A bathroom immediately to the right inside the door.  The bathroom didn’t have its own door, but instead there was a large yoga pad like piece of plastic attached at one side with a strip of nylon belt for a hinge, and on the opening side there was a strip of fabric with a magnet, so you could close it for just a little bit of privacy,  The “door” pad was covered with a picture of the ocean, beaches and tropical trees.  Pretty much the opposite of your context in the unit.  You could not bring in your own toiletries, but whatever you needed, they had a low price version.  The toothpaste was ok.  The sink (and all the sinks on the unit) was a ligature preventative sink  It had just the spout and if your hands were under it, it would pour cold water.  After a few seconds it warmed up enough to be called warm, but never hot.  When I got home I held my hands under the faucet a few times, thinking the water would just turn on.  The toilet was normal-ish, but any area that would have plumbing or pipes, or the tank, was walled off with metal.  There was a button to flush it.

There were a few built-in shelves on the left, and in the main space was the bed.  Along the windows was the air (conditioned or heated depending on the season) “shelf” where you could put stuff, or more commonly someone would sit on it while you sat on your bed for a check-in or MD interview, what have you.

I asked if the doors needed to stay open at any time, and was told I could always have it closed if I wanted, but the 15 minute checks would be flipping the shade.  So it’s not like you could lock yourself in there and close the shade, since it was controlled from the outside.  And there was no lock, of course.

There was no clock in the room, and no way to get one.  That was very frustrating, especially during “quiet hour” not being able to tell how much of the hour had passed.  There was a white noise machine in the room, probably someone had needed it in the past and they hadn’t removed it.  None of the other patients had one.  But it had a snooze timer on it.  You could set it to fifteen, thirty, or sixty minutes and it would turn itself off.  So all I had to do was set it to the amount of time I had before an event, and when it turned off I knew it was about time.  Took me a day and a half to think of that though.

The first night I did not have a CPAP machine.  The second night I had a hospital supplied one, and the third night I had my own.

Poor sketch of my room’s view

The view out the window was of trees immediately in front of the window, but only on the right side.  On the left I could see the bridge over the river for the university.  It’s the same bridge that a famous poet used when he jumped to his death.  My first year attending there was an article about a student who jumped off, killing himself.  And a friend from my youth jumped off it last year.  I had been watching his memorial group on social media, and he was in my thoughts very often.  But I thought it interesting that the only thing I could see well was a bridge I associated with death.

I was very happy to have views of trees.  Science and Nature are my religion, and it was nice to have something that was spiritual to me so close.  However, even though I was extremely familiar with the river and the roads around it, I couldn’t figure out exactly where our building was located until I looked it up later.

The time I spent in my room was either with MD’s discussing my case, or sitting on my bed reading or writing.  I was trying to maximize my time here, not just watch tv and mope.  Even at my lowest I knew this was an opportunity to learn about myself.  The room was comfortable enough, but it had an unfamiliar, peculiar antiseptic/scented smell that if I ever smell it again, I will instantly see that room in my mind.  That smell was one of the reasons I really wanted to go home, in the end.

Nurses

There were two types of nurses, for the most part.  The first were the care nurses, who could do all the medical things a nurse can do.  Talk about meds, check in with you in the morning to see how you’re doing, or even just answer simple questions about your case.  The other kind of “nurse” wasn’t able to answer questions, and would guide you to a care nurse.  They tended to be either scrappy looking or big and strong, and I thought of them as orderlies.  Like the ones in movies that they call when someone is acting out, and need to be subdued.  They are very clearly security.  

Some patients would get “nurse” minders, but they were really like bodyguards.  Not for them, but from them.  You could get a minder if you had a medical device that had ligature risks, like an IV you need to roll with.  Or if you have a history or risk of violence, or even if you’re just being ornery at times.  Some people would even get two minders, and they would follow so closely, like at an arm’s length.  If they went to the counter to read the newspaper, the minder would literally be right next to them, with the other minder covering any major exit points.  It was both scary and fascinating.  Any of the staff could be a minder, but there was always at least one orderly type very close.  It was such a subtle difference between different staff that it would be very easy not to even notice.  And one of my favorite “nurses” turned out to be an orderly type.  That was quite a surprise when I figured it out!

It’s understandable, though unnerving.  As the day wears on people get tired and cranky.  The environment doesn’t help, either.  It’s just that some of them have a bit of psychosis, too.  So when they get cranky they become dangers to themselves or other patients.  Happily, I never got a minder (that I knew of) as I was well behaved, even more respectful and polite than most of the patients..

Clothing

Try to imagine this but without shoes or a smile
Again, no smile

From almost the first moment you get to the Emergency Room, you are given the mahogany scrubs, with no pockets, belt or drawstring or elastic.  Until you come up with a method for keeping them up, you are always holding them with one hand.  Methods included rolling the top of the pants up, usually with a folded over bit of the top of the pants to “peg” them.  Or tucking the top into your underwear – the scrub top was long enough that nobody would see that.  Or even just not caring, and using a hand to keep them up.  The scrub tops were long-ish, since the scrubs you’re given are big enough to be baggy on you.  I actually liked the color, except for the sweatshirts.  If you were cold the staff could give you a sweatshirt, which was “safety green.”  They were warm, but clashed with the mahogany, being neon colored.  

I realize now that I should have smuggled a scrubs shirt out, as another souvenir.  They had plenty of them, I liked the color, and it was actually somewhat comfortable.  Also, I felt like for the amount we were paying we should be able to take home souvenirs.  Nobody has shared that number with me yet.  But it doesn’t seem like inpatient anything or ambulance rides are cheap.

See? Grippy! Kept them.

When you start inpatient you are given the scrubs, and the grippy socks.  They’re the kind of ankle sock that have rubber patterns on them so you won’t slide around on the linoleum floors.  Thus the term “grippy sock jail” due to the socks, and the spartan locked area you lived in.

For those patients who were admitted without much notice, they didn’t have much in the way of street clothes, so they just stuck to scrubs.  If you did have street clothes you wanted to wear, the staff would take you to the locked lockers and take things out for you with a good inspection to make sure they were safe.  As a result, I did not get my pajama pants with the drawstring.  But I did get shoes!

Schedule

The schedule looks something like this:

8:00-8:30 Breakfast
9:30 Ward meeting/checkin
10:00-11:00Group
11:15-12:15Group
12:30Lunch
1:15-2:15Group
3:00-4:00Afternoon quiet time / shift change
5:30Dinner
6:00-8:00art therapy or other activities
10:00Lights out

The group sessions were varied but interesting for the most part.  Usually well attended, but not mandatory.  The fact that the TV goes off during the group sessions surely shows that they are encouraging everyone to go.  The different types of sessions that I saw were Occupational Therapy – art with an explicit type of art or subject.  Creative Time, which was mostly just art.  They opened the cabinets and let people choose what they wanted to do.  It was really well stocked and included colored pencils, pens, oil crayons and chalk, even sticker by numbers books for an easy project.  Education was a typical “this is what mindfulness” is or distress tolerance and so on.  Dancy Therapy looked like they put music on and lead a dance session.  It looked exhausting to me and I skipped it.

MDs

There were a few different types of doctors.  The first were the residents, who would usually do the heavy lifting before the MD came in.  Asking about history, clarifying your story, talking about meds you’re on and so forth.  There were regular MDs that seemed competent, but some patients were complaining that their MD didn’t help at all, really.  And then there were the Professor MDs.  They usually had students of varying levels following them around.  And because they were professors, they were extremely good at communicating and breaking things down to simple concepts for patients.  Luckily, mine was the latter.  Sometimes they had a gaggle of students, other times they would fly solo.  More on that later.

Because it was a teaching hospital, you would occasionally see students hanging around.  You could tell the older students from the younger by the varying looks of fear on their faces.  I guess I can’t blame them.  They are locked in prison with people who are in mental crisis, and anything can happen.  Not often, but sometimes.

What I missed

First of all, everything.  When my doctors had offered inpatient treatment to me in the past, they talked about it being “time to take a break” or “a way of having some time to rest” – which made me think it would be a bit more gentle.  But it was grippy sock jail indeed.

I missed my musical instrument, especially since I was reading about the history of my specific model.  I missed shoes and warmth and hugs.  I got my shoes eventually, but still felt chilly a lot of the time, even with my issued sweatshirt or personal sweater. I missed fresh air, as none of the windows opened and they no longer let patients out into the backyard gardens.  I missed KFC, having seen a commercial on TV and had been having institutional chicken strips.  Hard not to compare.  I missed streaming services that don’t have commercials.  I missed our pets, as they really give me a lot of happiness and comfort.  But most of all I missed having something to keep my pants on.  And I missed time and days.  With no clocks it was easy to let go of the concept of time, and as most days were identical, you had to work hard to remember what day of the week it was.  As time was hard to judge, you come away with the feeling that you were there for weeks instead of days.

People

Obviously anonymous, but I’ll be mentioning some of them later, or just want to share the diversity of patient types.  These were not names we used with each other, just descriptives I can use to reference them.  I did refer to Mumbles by that term, and by the time I left many people were using it.  I might feel bad about it, but the people who adopted the term left the same day I did, so it’s unlikely still used.  Also, these patients were of many different ethnic and economic communities, which made me feel comfortable, as we live in a fairly diverse part of town.  The suburbs would not have felt like my tribe.

Mumbles was a young man, likely the youngest age that gets you into our ward, not the adolescent ward.  He did not make eye contact, and was always muttering what sounded almost like a rap, but it was more like thoughts being expressed.  LIke, every thought.  I initially thought he had two minders, as they were always outside his door when he was in his room, which was all the time except for meals.  Turns out the minders were for gangster, who lived across the hall from him.  I would occasionally hear Mumbles muttering at night, as he was just next door to me.  He was actually responsive, but not very willing.  At check-in we would all have a daily question to answer, and he heard enough to say “pass” every time.

Mama was the only person on the ward older than me.  She had a hoarse voice, I think she smoked in the real world.  She would make jokes comparing the ward to jail, and I really think she spent enough time in both to know as much as she did.  She was what I would consider an “experienced” patient, having been in inpatient before a couple times at least.  She arrived halfway through my stay and didn’t skip a beat.  Knew enough to be able to navigate the system.  She was also one of the people playing cards almost constantly when there were no groups or meals.

Old man – probably not that old, likely not as old as me.  But he was like a ward dad, and very nice.  He was tall, had a huge smile, and was always willing to share his experience to help someone out.  Was usually in the card game.  We talked for a bit about our experiences in the military.  He was army but that’s okay, he seemed nice enough.

Tank was in the unit on a legal hold, meaning he had to wait until it timed out and he was considered safe.  The people not on a legal hold could technically request to leave AMA as long as they were safe, but we all just waited until the MD cleared us.  He was a young man with a foot cast, and walked with a limp because of it.  Always seemed to be angry, and occasionally had a minder.  He never shared (“pass”) in check ins, never went to groups, and seemed to just be waiting on the hold expiration.  He would occasionally be surly, but I didn’t feel like he was dangerous.    Pretty much the only pastime he had was watching TV.  He had a favorite chair, and if someone (at one time me) sat there he would say he was sitting there.  In my case I just moved because I didn’t want to agitate him, but when Singer took the spot he just stopped, stared for a second, and then found another seat.  I think he knew she was not going to take his shit, and might even be able to take him in a fight, despite the fact that she was half as big as he was.  While watching TV he would get up every few minutes and go down the hall.  I wondered if he had something going on that made him have to go to the bathroom.  It turned out he was just going to one of the phones, and usually didn’t get through to whomever he was trying to reach.  At one point he was complaining about those ads on the TV and why were they the same ads over and over?  He was talking about commercials, had no idea what they were.  Funny, a bit.

Singer was a slight woman, very kind and spiritual and caring.  She also had a ton of tattoos, some that looked like prison tattoos.  She was funny and outgoing and very gracious, sharing her sudoku book or food at meal times.  She was wiry and tough, despite the fact that she was a full head shorter than me.  When she left she sought out every patient she had even the remotest pleasant interaction with, and was very sincere in wishing each one luck.  I call her singer because she would occasionally sing a song at check-in or during creative time.  Some of them were classics, some of them were her own creations.  It was always beautiful and inspiring.

Girl was  the Emma Roberts character (from the movie It’s Kind of a Funny Story) of the ward, albeit chubbier, with colored hair growing out, and visible self harm scars.  She was someone I would guess might be working on or having completed a GED.  Turns out she had her Masters in something mental health related.  She was very smart, very outgoing, and usually very pleasant.  She was going to rehab (with Old Man) after the inpatient stay, and her boyfriend had just finished rehab and was in a sober house.  I thought it was cool they were both cleaning up at roughly the same time.  She was usually in the card game.  She was almost half my age, but we got along well.  She was one of the first people to talk to me, and was always ready with a nice word for anyone who looked glum.  That’s a lot of nice words.

Spectrum was a young girl who was on the autism spectrum.  Not the smartest in the ward, but as nice as she could be.  She would be sitting in the living room area and just yell “HEY NURSE!” until a nurse came.  Usually for something simple and mundane, not really worth yelling for a nurse about.  But that was just her way.  She was working on her “GDE” and would often need help with assignments.  I’ve always maintained that getting a GED is both easier and harder than getting a high school diploma.  Some of her practice sheets were ridiculously simple, while others were really hard.  Who goes around knowing the year the state was founded?  I rely on internet searches for that kind of detail.  She had been “in the building” for over six months, moving from unit to unit, but also spending time in different kinds of places in the system.

Steve-O started the day after me.  He looked enough like the celebrity that I had to consider a while if that might really be him.  He wasn’t.  He lived in the town I grew up in and sells insurance.  He did not make a sales pitch while in the unit.  He was a nice guy, often did laps in the halls, and after leaving the unit was going to stay at his brothers in a far suburb because it would be a good peaceful place to recuperate.  No idea why he was in, but he was one of those folks who obviously wasn’t planning the stay.  He had little kids at home and knew that would be a stressful enough environment that he should just go back there.  Was usually in the card game.  He was probably the closest to being a peer of mine.

Little came into the ward during the day, and she looked terrified.  Turns out that was just her resting face, and she was another very experienced patient on the unit.  She had a nasogastric feeding tube, which she had on almost constantly.  When we had meals she would only have beverages and maybe a light snack.  I have no idea why she had it, but she talked like she had it since she was very young.  She was quiet, experienced, and had a 24×7 minder due to the tubes and charging cable on the device.  Very nice, looked  very young but had recently gotten an EMT certification.

New the last new patient before I left.  She was an older woman with an accent I couldn’t place.  Possibly german.  She paid attention to everything going on around her, like an inexperienced patient like me.  She seemed to know what she was doing, however.  She always wore a mask and hadn’t gotten to the point where she could sit down and socialize yet.

OT – a bright, cute blonde young woman who ran many of the group sessions and all of the OT sessions.  Very helpful, very sweet.  The epitome of a healthcare care worker.  Seemed to genuinely love helping people, seemed like the girl next door.  But she could also be very gently clear and direct if someone was acting up.  Probably the person we saw most regularly as there were one or more OT sessions per day.

Gangster – This was the young man that had two minders around the clock.  At night they would be in chairs outside his room, close to mine.  At least one of the minders was the biggest “assistant” in the unit at the time.  Gangster never talked about going home, and I’m not sure how long he had been there, but it seemed like he was probably there for a while, and didn’t sound like he was getting out soon.  Talked like a young man who thought he was toughest around, as well as overtly and awkwardly hitting on the prettier staff on the unit.  With the way he was doing it, I doubted it worked in the real world, much less for people who had read his file.  He didn’t act out the whole time I was there, but you always felt like he was about to.

There were other patients and many staff, but these listed were the ones I interacted with or watched the most.

Introduction | Glossary | About

semicolon: 6. Tuesday

In the morning they took my “ship” facemask and gave me a black one without straps.  I was allowed to take it off when I was sitting in my chair/area.

I like boats

It’s hard to remember exactly the events of the day, as I was rocking a severe sleep deficit and it was a long, boring day.  I do know that I would rather spend the day in the EmPATH unit than in a regular ER room.

Safety mask, no strings.

There weren’t too many people in the EmPATH unit, which was nice.  Maybe a bit more than a dozen of all ages and races.  Some of them got prescriptions and went home, and I wish I had looked closely at everyone in case I ran into them while inpatient.  There were no external windows – I was missing nature already.  There was a group check-in in the morning and it was very light.  Had a lunch meal, ordered through “room service” via phone with a short cord.  They literally called it room service.  You got a menu and just told them what you wanted.

My nurse and I talked about my file/story.  Seemed amazed at the amount I’d been through.  There were a few others who did the same thing that week.  I guess I could be proud that my history has shocked more than a few people when they read it.  Those people are mental health professionals who have seen just about everything.

I met with a psychiatrist, nice man, very quiet.  He said we should try adding lamictal, an SNRI.  Don’t know that it made my chart, had one, once in EmPATH.  Just layering on more meds, as usual.  He hinted at ECT since that might have worked for me last time.  And he agreed that inpatient is the next right thing.  He said he was going to try for a bed at the hospital by the river, near the university, or coincidentally the hospital I was born at, in another city.  Not too far, but a hassle if Wife wanted to visit.

I was still feeling every feeling.  Tried crossword puzzles but it was hard to concentrate, and the marker they gave me was almost totally dried out.  Read and reread musical instrument book, but I kept having to go over the same paragraphs over and over. But it helped keep my mind off my situation.

I spent the rest of the day waiting for a room.  The Social worker was working on it and said she would call Wife with info as it developed.

I went to sleep around eight in the evening, only to be awakened at ten.  My nurse told me I got a bed at the hospital by the river, and transportation was on its way.  I had no idea how they were going to get me there.  Uber?  Limousine?  Ambulance?  Airlifted?  Ok, maybe reaching a bit on the airlifted idea.

I called Wife twice that day.  On the second call she angrily went into things like wanting a commitment from me to get better and want to live, etc.  Couldn’t speak to any of those points as I still didn’t want to commit to live.  It was not what I needed to hear at that moment, and went into zone out mode, hard.  The nurse waited with me.  He was a large man, both wide and tall.  He spoke so softly it was very hard to hear him.  But we got to talking, and he gave me a bit of a pep talk, as he had also been a longtime AA sponsor.  I appreciated it and told him so when transportation arrived.  I wish I knew how to send him a message about my changes.

I packed up all my stuff, which was just a book.  Transportation were EMTs with an ambulance and stretcher.  The male EMT helped me into the stretcher, where I was strapped down for safety.  Like, “you’re not going anywhere” strapped down.  I noticed when he walked it was almost military.  When he did a subtle about face and then marched over to the stretcher, I knew he had to have military training.  I asked him if he was in the reserves and his eyes went wide and he was very surprised.  He was indeed in the Army reserves.  We talked a bit about that and finally the female EMT finished all the necessary paperwork.  A receipt for a patient.  Ambulance trips are not cheap!

They rolled me out to the rig and had trouble getting the stretcher in.  It was a little funny.  The female EMT rode in the back with me and we headed out.  I couldn’t see much of the journey, but I distinctly remember when we passed under a bridge close to home.  Might have had a twinge of homesickness.  I remember being very pleasant and chatty with the EMT.  Human face back in action.

We arrived at the hospital late at night, but there seemed to be a lot of people there.  I couldn’t tell who was on staff and who were patients.  They took me into an admission room and made me change into a paper hospital gown.  It had full coverage, no chilly tushy.  They had me open my mouth, they checked my hair, and they had me do one jumping jack.  All looking for smuggled goods.

As seen littered in parking lots everywhere

Got back into my beautiful scrubs and they took the “strapless” mask and gave me a generic hospital mask, light blue.  Pretty much everything I had went to storage.  Even the book.  I was led to a single occupancy room (Due to COVID) at the far end of the hall, where three people were sitting in chairs chatting.  I was told someone would come explain things for me.

So I sat in the bright room for a good while.  Turns out it was two hours.  Felt like ten hours.  No clocks in the rooms.  Nobody came, so I thought I might go find someone to ask at least what time we wake up.  Went to the nurses station and found out it was one in the morning.  There had been a shift change and I got lost in the shuffle.  A nurse took me on a short tour – short because it wasn’t a large unit.  I was blurry eyed and exhausted.  They offered me something to help me sleep, but I turned it down.  I have no idea why.  Probably the anxiety, which was through the roof.

When I finally got to bed I just took off my socks and climbed in.  The bed was really quite comfortable, but this was my second night without my CPAP, and I slept poorly.  Again.

Introduction | Glossary | About

semicolon: 5. Monday

Monday I had a virtual PHP call from 9 to 3.  Wife was coming home at 3, so I was just going to explain everything when I saw her.  I called the folks at the PHP and explained what happened, and they said I should go to the ER immediately.  I talked them into letting me go Tuesday morning, and was safe as I’d be in the PHP all day and then Wife would be home with me.  At no point did I even consider lying about it.  But I guess I could have fairly easily.  It wasn’t a program I was very settled in, so I didn’t know how much I trusted them.

Wife came home, and I explained what happened.  She said she had guessed that from the text to Therapist and the things I had talked about on Sunday.  I told Wife I had a call with Therapist at four, and she  said we should go to the ER right after.  We both attended my call with Therapist, who agreed that now was better than the morning.  I had sent a message to my doctor at the Treatment Resistant Depression Clinic, and he suggested a hospital just a few minutes south of me, because it had a new EmPATH unit.  This information ended up being crucial to my recovery.

Wife and Therapist were both pretty upset, mad even.  They both reminded me I was to call them if I ever felt unsafe, and the fact that I didn’t broke a lot of their trust.  I felt bad about that, and knew I’d be working to regain that trust for a long time.  Therapist kept cool, but I could tell by body language alone that they were trying to be professional and calm.

I packed a bag with my knowledge of what kinds of things weren’t safe.  No hoodie with strings, no pajama pants with a string “belt” and no electronics, etc.  Packed some toiletries but they weren’t allowed either.  Wife took me south to that particular emergency room

When I checked in, the person in front of us was asking how much longer their wait would be.  They were told four to five hours.  Good thing I brought a book.  The book was volume 1 of a social history of the instrument I play.  Crazy detailed and I had to read every paragraph a couple times.  So I knew it would be a good long read.

They had a plastic window in front of the front desk. So when it was my turn in line, I had say I had a suicide attempt and was still suicidal and didn’t feel safe.  Don’t know how many people heard it, but it was crowded enough that I felt a bit conspicuous.  I was told to wait and someone would come get me.  Rather than four or five hours, someone was out to get me in about ten minutes. Apparently if you’re on their property and say you’re not safe, their liability makes things move faster.  I would not recommend this as a tactic for anyone who doesn’t want to go to grippy sock jail, er, Inpatient Mental Health ward.

Rendering of recently remodeled ER

They took me back to a room where they took my vitals, then to a proper ER room.  The doctor came in and by that point I was so anxious I had full body shivers of anxiety and my eyes were as wide as they could be.  I was scared.  So they gave me some Ativan when they set up my IV.  That helped immensely.  They took a prodigious amount of blood for tests, and gave me a deep sinus COVID test that felt like they were sticking it far enough in to poke my brain.  Waited 90 minutes for tests to come back.  That was about the normal time.  Everything was negative – and that was my first COVID test.

They had me change into mahogany scrubs, and all of my stuff went into a locked storage closet in the room.  Shoes, phone, belt, clothes, etc.  All I had were the scrubs and my book.  When the tests came back they said they were taking me to EmPATH.

Lesson:  EMergency Psychiatric Assessment, Treatment, and Healing (EmPATH) units are where people in crisis receive expert treatment tailored to their needs in a calming environment – instead of a loud, potentially chaotic emergency department (ED).  The concept is new but needed.  In an EmPATH unit, arriving mental health patients go through medical screening before entering a safe, therapeutic, living room-style area with rapid access to the support they need to stabilize their situation. This includes specialized care from psychiatrists, mental health nurses, therapists, and other trained mental health professionals who will work with each patient to identify needs, administer medications, and begin appropriate treatment and healing.  Some patients get meds or a therapy plan and go home from that unit, others go to inpatient.

This is not like they have on TV

After a faux wheelchair ride down a labyrinth of hallways – or maybe the Ativan was making me confused, we went into another small room, where the nurse removed my IV and told Wife that this is as far as she can go.  We hugged a long and tight hug, and she left.  I didn’t have that panicky feeling when you are about to go do something scary with strangers.  I blame Ativan again.

I know it’s petty, but I’ve had a lot of wheelchair rides, but they have all been in the new, modern style – four small wheels.  Just once I would like to get pushed around on a classic wheelchair!

EmPATH unit, my chair was around the corner to the right. More chairs behind the person taking the picture.

I was then taken directly into the EmPATH unit.  It looked like a sick bay from the recent Star Trek shows.  An asymmetrical room in an L shape, nurses station in the middle corner so they could see everyone.  All the chairs were like barcaloungers, but when you go back on them, they go completely flat so you can sleep there.   I was given a pillow and a blanket, and set up in a chair at the end of the short part of the L.  I was given a tour on the way to the chair, snack section, bathrooms, quiet rooms, etc.  By then it was ten or eleven PM and I was super tired.  I curled up in the chair and went to sleep fairly quickly.  Again, not a good night’s sleep.  In a chair.

Poorly drawn map of EmPATH

Aside:  As a “safe” environment, there were very few ways you could hurt yourself.  When you’re in an environment designed to thwart self harm, it’s hard to not treat it like an escape room and look for ways to get past their defenses.  I thought of taking the staples out of all of the magazines and building something that I could stick in a power outlet, but I had a feeling these were not normal outlets.  I spent the next two days with those thoughts in the back of my mind.

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