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.

Introduction | Glossary | About

semicolon: 4. Sunday

I’ve had many people ask me if when I woke up I thought “Thank God that didn’t work!”  Nope.  I felt a lot of things, but that wasn’t one of them.  Neither was there shame or regret.  I was angry it didn’t work, I was frustrated at the fact that my one good plan wasn’t very good in the end.  So now I was stuck without a way to make a quick exit following my rules.  I felt trapped.

I woke up around 8, feeling groggy.  No serious impact on my balance, I could walk just fine.  I hadn’t gotten sick or anything, and didn’t have a headache.  So I went to my actual bed and lay down to sleep.  Wasn’t hopeful I would die in my sleep.  I did feel fuzzy and detached, or not quite all there yet.

Around 9am our neighbor came into the house and when she got to the upstairs hall she called my name.  I responded and she thanked me and said she was just checking on me.  I texted her later to thank her and she made it very clear that it was no problem, and if I ever needed help, to give them a call.

I had missed texts from Therapist, who called Wife and she asked the neighbor to check on me.  She warned them that I might be dead.  That’s a request that sucks to make, for sure.  I responded to the texts and contracted for safety.  Unfortunately, Therapist’s call to Wife had been answered while she and my brother and my daughter were in the car, and it was on speaker.  So now my daughter and brother are worried.

I went back to sleep for a good while, waking up for a noon haircut.  I was still groggy and spacey, I probably shouldn’t have driven.  I drove well enough though and got my haircut.  It was hard to keep focus, but Stylist and I chatted as we always do.  Human face still worked.

My siblings, aunts and uncles all have a call on Sunday afternoon.  I was on the call like nothing had happened, nothing was wrong – or at least more than usual.  Flat and quiet.  I wish I could go back and see the call again, knowing my brother, daughter and Wife had all had that shock earlier in the day.  At some point I had called Wife and without giving any details said I was just having a normal bad day.  And I spent the rest of the day bingeing movies.

Introduction | Glossary | About

semicolon: 3. Saturday

Slept poorly, as usual.  I spent the day easily and quietly – except for the music lesson, which was quite loud, but did make me feel good for a moment.  I had hot dogs, hung out on the porch, and in the evening, I started the scotch again – it was so good!  Like drinking a peat fire.

After watching countless movies, I was nice and drunk in the low light of the porch.  It was a beautiful night, not cold, not hot. I got the pills, and took a sniff.  Medicinal.  I took out a pull and licked it.  I kept doing that for a bit, it was bitter but not bad at all.  Finally I crunched the pill.  And another one.  And then I just swallowed the other two.  

It was so easy.  No drama, didn’t feel like anything, really.  Another mundane task.  I’m guessing this is why one suicide attempt increases your risk for future attempts.  You realize it’s simple and easy, the soundtrack doesn’t swell and get dramatic, nobody rushes in and tries to revive you.  You’re alone with yourself, and everyone dies alone in one sense or another.

I had deleted my Friday note, and began a new note, scheduled to send on Monday morning.  What I wanted to be five words in the most succinct statement ever turns into paragraphs of rambling thought.  Said many of the things from the previous note, but tightened it up a bit so it would be shorter, not novella length.  Gotta edit, even if it’s your last piece of writing.

I said that I would be proud of them no matter what. And I wanted them to live their life remembering me and knowing that I’m proud of them, but don’t let me interrupt the amazing that they’re living.  I told them I loved them all, and when they smell the rain – the petrichor, my favorite smell –  think of me.  That if there is any way, I’m sending that message.  So that even when it rains they can have happiness.  I also said “Live for me.”

I was growing much more fuzzy.  Walking was more difficult, and I knew I was on my way.  I texted “I love you” to Wife and siblings, and sent “Sorry” to Therapist.  It was late enough I knew nobody would see the messages until morning.

I fell asleep on the couch on our porch.  I didn’t want them to have to look for me, and didn’t want to spoil our bed by dying in it.  I know that I wouldn’t want to sleep in a bed my partner had died in.  Much less any mess left behind.  I was a very considerate dead man.  And I slept deeply for the first time in weeks.  But not deeply enough.

Introduction | Glossary | About

semicolon: 2. Friday

Wife was going out of town to see Daughter, leaving me alone for a long weekend. I call it a weekend because it’s just like every other day of the week, but there are more people around. This depressive episode is not the first, obviously, because after all, I’m a professional depressive. The people I meet who are on their first go around frustrate me almost as much as people living their lives happily. Smiling, walking, laughing. Wife didn’t seem too concerned. Mentioned calling her for help if I needed it, and hugged me a little bit longer than usual. I talked about the movies I would watch, that I would get out of the house, that I would walk with friends at some point.

After PHP that day I ran some errands. Went to the grocery store and got food for the whole weekend. I hadn’t been seeing next week for a few days now, but I still bought the food. In my mind my calendar is always there, planning and reminding me of things coming up. But this week that went away. I didn’t see next week or any time after that. I was continuing faster and faster toward that wall.

I stopped at the liquor store and found, after some time, a single malt scotch that was “heavily peated” — it’s the flavor of peat fires, like smoke and rich ground. My favorite Irish single malt had that flavor, and I wanted something good, but not something I normally drank. If things didn’t go according to plan, I didn’t want to associate my favorite with failure. It was a bit more expensive, but I figured it would be the last one, so why not get something really nice?

Nobody stopped me, it was just an errand. Maybe if I had been wearing a Scarlet D, someone would have called me out. But they didn’t. It felt like a normal day, except I was picking up 50% of my demise. I was astounded at how mundane it all was. I wondered if everyone felt like this before a major destructive event. The fact that right up to the event, everything seemed normal and routine. I didn’t want anyone to call me out on it, and that helped my anxiety a bit.

Watched a movie, ordered some food from my favorite restaurant, and settled in for a quiet evening. Watching movies and drinking some scotch. I had a headache though, so I didn’t want to drink too much. And for some reason it felt like Saturday was a better day than Friday. By this point I had forgotten Saturday was 9/11.

Before I went to bed I wrote my first suicide note. My Therapist said it was so much harder for those left behind without a note. That without one, there was just too much unknown. I didn’t think I would die overnight, but also knew I might not be able to sleep, might get up and drink some more, might decide to take the pills. But I didn’t want to be hungover for my music lesson on Saturday afternoon. It’s funny that I’m actually thinking about my music lesson but not able to see next week?

I had never written a suicide note, and wasn’t exactly sure what to say. Essentially just goodbye, I’m removing the burden, and everyone will eventually grieve me and move on. No matter how bad it gets it can still get worse so it’s not selfish, it’s survival. That this weekend is going to happen so many more times for the rest of my life until I do it. Finally, don’t let this final act of horribleness color everything that I have taught you, everything that I’ve shown you, everything that I have loved you for.

I set the message to send on Monday morning, so I could delete it if it wasn’t needed. As I went to bed I saw a friend was still awake, online. I just dropped them a “Hey.” They called me and we talked for a long time. It wasn’t a cry for help, but I knew they had been through some of the things I had been through. We talked about depression, suicide, cookies, and the feelings we had in common. It didn’t make me feel different, but it was just nice to talk to someone for a bit. The house had been pretty lonely even after just half a day.

When it came down to it, I just couldn’t do this forever. I knew that things can get better, but things will eventually get bad again. You don’t cure depression, you manage it. Finally, I felt like I had been living with future ghosts. Every scenario I’m in, all I can think is “Is this the last time I do this? How will this be next time when I’m not there? Will I have ruined this for you by being gone? Will you remember the happy times from the days and weeks before I died? I hoped so.

Introduction | Glossary | About

semicolon: 1. Week prior to Saturday

When Saturday comes you’ll understand why it’s the anchor and “peak” low in this journal.

Things had been getting steadily worse in the previous few weeks. I went from being in a major depressive episode with little hope to a safety-last, near catatonic state with extreme depression, mounting anxiety, and no hope whatsoever. I had given up on trying, and just let the depression roll over me like waves in the middle of an ocean storm. I learned that it could always get worse, and every day it did. In the last PHP I did, I had to give up giving them estimates of intensity of depression, because I had gotten to 9 or 10 out of 10 and had nowhere to go from there. So I would just say “off the chart” or “I just really don’t know how to rate that anymore.” I had also started self harming in the form of biting. I was literally tearing myself apart.

My therapist said that my primary relationships were with depression and anxiety. She was right. I felt like I had different personas living inside my mind. The first was Depression (D). D would help me feel worse, would give answers to people in my stead, and had been around for decades. It was an old friend, and we were very close. While I didn’t like what it did to my life, I somehow didn’t want to live without it. Anxiety (A) was the second. Sometimes A was quiet, telling me something bad would happen if I talked to a stranger or called someone on the phone. It could also be quite loud, bypassing my brain and making my body shake, my mind swim, and logic was thrown out the window. A would come out and take over from D, and often I couldn’t hear D in the background because A was so loud. A was just mean and made me want to run from it, but I couldn’t. A had been after me a few times in the past, and was responsible for some of the worst days of my life, but D would always take over when A got tired. And then there was Suicide (S), who was a fairly new player in the game, but had always been in the background whispering passive suicidal ideations into my ear, making me think more and more about S.

I would occasionally cheat on D and A. Hanging out with good friends and neighbors, chatting and maybe eating pizza. I would be animated and enjoying myself. When I left those situations D and A would come at me strong. It was like a mental health hangover, and the more I drank in the happiness in life, the worse it would be the next hours or days. That always made me feel like I didn’t have any problems, because there were times when I would forget them. So obviously the times I was experiencing them was something I could just turn off, right? Nope. Also, on those social occasions I would often be drinking. Which just gave D and A more energy with which to mess with me.

Regardless, I would cheat on D and A, but I would lie for S.

There were things about S that I had never told anyone, partly out of concern for my safety, ironically. I didn’t want to say something that would bring on the guys in white coats to escort me to an asylum. But another big reason why I denied and lied for S was to keep it in my pocket. It gave me the idea that I had an exit plan, that even if the doctors didn’t know what was wrong or how to fix it, I had a solution I could call upon if it got too bad. I also lied to those who loved me, and wanted me to let them know if I wasn’t safe.

I had been somewhat open with Therapist in sharing my suicidal ideation, and in programs I would often be even more up front about how much I thought about my own death and how passive it was, or even getting close to active.

Lesson: Suicidal Ideation can be passive or active. Passive means you wish a meteor would fall from the sky and kill you. It means every little ache and pain can make you wonder if it’s a life threatening disease, and hope it is. It can also just simply mean you don’t want to exist or feel the way you do, but you have little hope for good things to come. Active suicidal ideation is planning a way to do it, attempting it, feeling unsafe, or anything else that takes it from a philosophical concept to a full bodied reality.

My safety has always been pretty good. Except for some impulsive behaviors, I thought about hurting myself plenty of times, but had only once ever done anything. One of my hobbies was to research my meds to see if overdoses would be lethal, search for other suicide methods, and track down every side effect, potential conflicts with meds, etc. that I could find. I even read “The Final Exit,” which advocates for right to die, but many people consider it to be the definitive suicide manual. I had been considering multiple plans, but as I said never implemented them. But of late I had come up with something that might fit my parameters, or rules. Being clever, a long time ago I devised some rules for my suicide, should I ever get there:

  • Had to be painless.
  • Doesn’t hurt anyone else. (e.g. even a bus driver or train driver hitting someone is traumatic for them)
  • Does not have a likelihood of failing and putting me in a worse physical situation, such as being maimed or permanently damaged.

I was determined that if I ever needed to resort to it, I would be smart enough to be able to do it successfully. The thought of the embarrassment, shame, and sadness that followed a failed attempt would not only make me feel those things, but it would put me in a deeper hole and remove the option from the future. Stuck with no escape.

I always thought I was smart enough to do it successfully. How hard can it be, killing yourself? Turns out it’s pretty freaking hard using my rules. Originally I wanted to come up with a diabolical scheme that would kill me but not have even the slightest hint of suicide. For the insurance money. But that never came to fruition, so I had to just go straightforward with self murder.

Again, pretty freaking hard. Most of the over the counter drugs aren’t dangerous enough, so it ends up having to be prescriptions. A couple months ago I had a root canal go bad and the pain from that also wanted me to kill myself. It was the worst pain I had ever felt. Dentist was sympathetic and set me up with a root canal referral and a bottle of Oxycodone. I didn’t use all of it, so we keep something like that around “just in case” for sprained ankles or really bad injuries. And there it sat, right next to the cologne I don’t wear. When you search the internet for “ways to kill yourself” all you get are suicide hotline ads and links to other depressive stuff. However, if you search for “dangers of alcohol” there are all sorts of lists of things you shouldn’t mix with drinking. Very handy. According to them, if you had a shot of beer and someone with an opioid walked by you would fall down dead in an instant.

I only had four pills. But one of those can get you loopy. Guessing four plus a crap ton of alcohol would just let me sleep, and then shut down. Ok, so in looking back it wasn’t really a foolproof plan. But it was a plan, so I was getting closer. When you take the depression quiz at the doctor’s office and you indicate that you would prefer to be dead, they ask if you have a plan. And if you have intent. Which I guess means the guts to go ahead and do it. If you simply say “No plan or intent” they smile and move on. Because passive suicidal ideation is fine, I guess. I’d been saying “no plan, no intent” for months. But now I had a plan. So I had to start lying about that. If I reveal the recipe, they’ll take away the ingredients.

Much of this information I hadn’t shared with anyone. Not Wife, not Therapist, not even anonymously online. At some point I promised both Wife and Therapist that if I ever got to that point, I would call them before I did anything. And much like the concept of the suicide hotline, I didn’t understand why I would do that. If I’ve crossed a line, the last thing I would do is to bring someone in to try and stop me. That would be counter-productive. I am sorry I lied to people who are so important to me, but I don’t feel I failed someone. I just feel like I had to do at the time what was necessary for my survival, even if survival was quitting.

The weekend before the Saturday

It was Labor Day weekend, and we were up north with family. I was incredibly depressed, and just for the fun of it (or it was a med issue?), decided not to drink that weekend, which was actually nice. Up north is a very drinky place sometimes. In front of the evening campfire, or watching a movie, or even just after having driven for many hours all hopped up on caffeine so that I could relax and get to sleep. My mother was an alcoholic who drank to be able to sleep, and that was always present on those nights. But still I drank.

But not that weekend, and honestly I didn’t miss it much. I was having trouble sleeping anyway, so it might not have helped that. And I would hopefully wake up in the morning refreshed and not dragged down by a hangover or tired from not getting a proper night’s sleep. But I would wake up with only the crushing weight of depression holding me down. Pretty much just normal for me these days.

It was meals with family and in-laws, that look I’m happy and jovial. But it’s just me wearing my Human Mask. It didn’t even really take much thought. I’ll take it off later and pay in pain for the effort of looking normal. To recover from this weekend I’ll have to take it easy for the week. Easy enough for a professional depressive. Next weekend I’ll buy some nice scotch, watch a bunch of movies, and be lazy. Except the alcohol makes the suicidal ideation kick into overdrive. The last time I was up north I tried to will myself to death. Then I thought about what it would be like to walk into the lake and drown myself. I settled on laying on my stomach in bed and trying to fall asleep with my arms blocking the arteries in my neck. Stupid, yes, but you never know. That was where I was at. Literally trying to stop breathing.

It was Saturday that I realized I would have an opportunity to make an attempt next week. To finally go to sleep and not have to wake up to the weight. Wife was going to be out of town the next weekend, and it wasn’t like something I was planning, at least not right away. It was inevitable. I would get some really nice scotch, and I would drink it freely. But I also knew when I did that it put me deeper in the hole, and tempted me to do something about it. Those were the times when the depression was scary. Actually, not scary, but more true. I would relax into it and let it have it’s way with me. And I knew that this time was going to be serious.

I got to thinking about how hard liquor makes my suicidal ideation go through the roof. Literally the first sip makes me want to find the closest bridge and jump off. The problem there is that it would potentially hurt someone else. Walking across the bridge over the highway makes me giddy nonetheless. Something having to do with alcohol. And alcohol poisoning would likely fail the first two rules. But something that would make me go to sleep? Sounds good to me.

Except this time I’d be in the worst mindset yet (because every day just gets worse, no matter how bad you think it already is) and that could lead me to do something “stupid” like kill myself. And if I had that plan and remembered to implement it in a drunken state, I would actually do it. I wouldn’t choose to do it. I would just do it. And since this was back when I thought I knew what I was doing, I figured it would work. That’s all well and good, but it occurred to me that it was going to happen regardless. I’m going to be alone, I’m going to buy scotch intending to drink in moderation, and I’m going to drink too much of it. And then I’ll have the means, the motivation, and the bravery to pull it off. Except those things were going to happen no matter what, so I was running headlong into a brick wall, and I’d hit that wall next Saturday. Nothing I can do to change it. While I’m serious about not wanting to live anymore, I don’t like not being in control of it. And that’s why I had a full blown panic attack up north on Labor Day Weekend. And couldn’t tell anyone why I was having it. I have enough random crap happening to me these days that nobody will blink an eye.

I had some Oxycodone left over from a dental issue earlier in the year. There were only four left, but I had done my research. The warnings were not to take any oxy when drinking, that even a normal dose could be dangerous. I figured four times a normal dose should do the trick. Combined with the alcohol, I would just go to sleep and never wake up again. And I had been keeping them in mind, and knew that the next time I drank heavily, my inhibitions would be gone, my safety measures would be ignored, and I would finally do it.

So it wasn’t a plan, it was a surety. Yes, I could tell someone, call someone, text someone, but I lie for Suicide, and most of me wanted it to actually happen. And the part that didn’t want me to do it wasn’t saying a peep.
So I had a week to live. I went back and forth between excitement to finally get it done, and fear because the brain often doesn’t want to be killed. So there was no guarantee.

Remainder of the week

I spent the rest of that week increasingly stressed out. I would tell the PHP group that I was bad, but I always claimed no intent. That my kids were my safety, and I didn’t want to hurt them or pass this pain on to them. In reality I was convinced that my death would put an end to the burden, the struggle, the pain for everyone. Every day that went by, it was all getting worse, and I was feeling all of it. Depression, Anxiety and Suicide were running the show, helping me not give a shit, and helping me toward that inevitability. Every day was worse, and that’s when I gave up trying to even understand how bad it was. I was simply giving in to all of it, and this just accelerated me toward that wall.

On Thursday I had a call with Therapist. I was flat in affect, my whole body shaking from the anxiety, and my sleep deficit was building and building, keeping me down. She was concerned. She had never seen me anywhere near this bad, and I agreed again to call her or text her if I felt unsafe. But I was already unsafe, and past the point of being able to ask for help. I was just waiting for the weekend. And I was skilled in making people feel like I’d be fine. Like I would finally get some sleep and feel better. That I had things in my life, my wife and kids and family, that have always prevented me from doing anything, and that sure, I was going to be fine.

Introduction | Glossary | About

semicolon: Glossary and Acronyms

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Yes, it’s not in alphabetical order. Use the search function in your browser to find what you’re looking for. Or just read them all, it’s not very long.

Introduction | Glossary | About

Roles

Inpatient : Treatment for someone who is admitted to a hospital (also see Outpatient).

Outpatient : Treatment for someone who is not admitted to a hospital. (Also see Inpatient)

Psychiatrist : MD who specializes in psychiatry. Able to write prescriptions and work with a patient on their medication management.

Psychologist : MD who specializes in the mind and its functions.  Typically cannot prescribe medication, varies by state.

Therapist : One who is professionally trained and/or skilled in the practice of a particular type of therapy.

A : Anxiety, as an internal personality

D : Depression, as an internal personality

S : Suicide, as an internal personality

Terminology

Affect : What someone feels inside that can be recognized by others.  For example: if you are looking/acting sad or have a flat tone of voice you can be recognized by someone else as you are feeling sad or depressed

Anhedonia : Describes a lack of pleasure. Often the person doesn’t feel good when they are doing the things that normally make them feel good.  Anhedonia due to depression will get better once the depression has been successfully treated.

DSM IV : A diagnostic manual published by the American Psychiatry Association that names and describes mental disorders. 

GAD-7 : Rapid screening for the presence of a clinically significant anxiety disorder, especially in outpatient settings.  ~10 questions

Involuntary status : A term used to describe someone who has been admitted into a psychiatric facility (usually a hospital) against their will or without their consent, under the authority and protection of the law.

PHQ-9 : A screening tool for the diagnosis of depression and to quantify depression symptoms and monitor severity.  ~10 questions

Recovery : When a person with a mental disorder is doing as well as they can be and is feeling mentally healthy – even if they still have a mental disorder.

Relapse : When a person with a mental disorder who has been in remission or recovery gets sick again.

Remission : When a person’s symptoms decrease and they return to their usual state after having an active phase of a disorder.

Voluntary admission : Being admitted as a patient to a mental health unit for treatment (usually in a hospital) based on a person’s agreement to be admitted.

Disorders

Dysthymic Disorder : A mood disorder. People with Dysthymic Disorder experience persistent low mood for two or more years but experience fewer depressive symptoms than in Major Depression

GAD, Generalized Anxiety Disorder : Severe, ongoing anxiety that interferes with daily activities.

MDD, Major Depressive Disorder : A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

SAD, Social Anxiety Disorder : An anxiety disorder regarding the fear of having to be in social situations. A person with Social Anxiety Disorder also avoids the situations that make them feel anxious. 

Trauma, Psychological Trauma : Damage to a person’s mind as a result of one or more events that cause overwhelming amounts of stress that exceed the person’s ability to cope or integrate the emotions involved, eventually leading to serious, long-term negative consequences.

TRD, Treatment Resistant Depression : Refers to inadequate response to multiple antidepressant trials or therapies of adequate doses and duration.  (TRDc is the clinic specializing in TRD)

Negative behaviors

Self–harm : Any injury that a person inflicts on themselves without the intent to die.

SI, Suicidal Ideation : Thoughts, images or fantasies of harming or killing oneself.  Can be passive, a thought exercise, or active, intent and a plan to commit

Substance Use Disorders : Repeated misuse of alcohol and/or drugs — often occur simultaneously in individuals with mental illness, usually to cope with overwhelming symptoms.

Suicide : The act of deliberately killing oneself.

Suicide attempt : Any non-fatal suicidal behavior, refers to intentional self-inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome.

Therapies

Antidepressant : Medication used for depression and other mood and anxiety disorders.

CBT, Cognitive Behavioral Therapy : A psycho-social intervention that aims to improve mental health. Focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.

CPAP, Continuous Positive Airway Pressure : A form of positive airway pressure ventilation in which a constant level of pressure is continuously applied to the upper respiratory tract.  It is intended to prevent upper airway collapse, as occurs in obstructive sleep apnea.  CPAP therapy is highly effective for managing obstructive sleep apnea. 

DBT, Dialectical Behavior Therapy : An evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that it can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance use. 

ECT, Electroconvulsive Therapy : Treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage mental disorders.  Not like you’ve seen in the movies.

IOP, Intensive Outpatient Programs, or day programs : Treatment programs used to address addictions, depression, eating disorders, or other dependencies that do not require detoxification or round-the-clock supervision. They enable patients to continue with their normal, day-to-day lives in a way that residential treatment programs do not. Whereas residential treatment requires that clients reside on site, clients in intensive outpatient programs live at home.

OT, Occupational Therapists : Can have many different roles. They help people to adapt to their environment and to cope with their daily life.

OT, Occupational Therapy : The use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. 

PHP, Partial Hospitalization Program : Type of treatment program that is more intensive than IOP but less than full inpatient or residential treatment.  Often like an inpatient therapy, with the difference is that patients go home at night, and it is not a safety maintained environment.  Currently often virtual

PRN : Latin abbreviation used for prescriptions. translates to: when necessary.

Psychotherapy : Treatment of mental illness by talking about problems rather than by using medication.  Treatment is tailored to each client’s needs.

TMS, Transcranial Magnetic Stimulation : Noninvasive form of brain stimulation in which a changing magnetic field is used to cause electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil, which in turn is connected to the scalp. The stimulator generates a changing electric current within the coil which induces a magnetic field; this field then causes a second inductance of inverted electric charge within the brain itself.  VNS, Vagus Nerve Stimulation Medical treatment that involves delivering electrical impulses to the Vagus nerve. It is used as an add-on treatment for certain types of treatment-resistant depression.  The device consists of a generator the size of a matchbox that is implanted under the skin below the person’s collarbone. Lead wires from the generator are tunnelled up to the patient’s neck and wrapped around the left Vagus nerve at the carotid sheath, where it delivers electrical impulses to the nerve.

semicolon: Introduction

Over the course of a week and a half in September 2021 I experienced an all time mental health low, but ended up in a different place, with a bit more perspective than I’ve had in a very long time. This is my memory, to be able to remember. Not just because I have memory issues, but because as time goes by we have different interpretations of those memories.

trigger warnings

I don’t usually offer them, but the next posts will be describing a suicide attempt, an inpatient stay, extreme anxiety, extreme depression, alcohol, med abuse, self injuring and self defeating activities. You’ve been duly warned.

Reading this may hurt, sting, or make you very unhappy. Even sad. That is not my intent. I want to share my experience so that those who are living it can understand how different therapies feel, but also so that those who haven’t felt like any of this can hopefully understand me, and what I go through.

If you do begin this, please finish it. Don’t leave it halfway, scared or angry. Hear how it ended up.

Glossary and acronyms available after the Prologue. (link Glossary and acronyms)

Introduction | Glossary | About

A short history of me

I had a severe depressive episode a few years ago. Did three PHPs, a day program, ECT and returned to work. (Now’s the time to check out that glossary) A month or two later two things happened. First, I turned a corner and started to feel alive and great again. I was optimistic, active, and my scores on the PHQ-9 were zero – my therapist and I actually had to think of something to talk about. The second was that COVID changed our world. I had a job that could be done remotely already, and we had frequent “work from home” days before COVID. So work carried on. And we got a ton of business because of COVID – don’t worry, it was helpful business, not accumulating stockpiles of hand sanitizer or something else evil. So we were a lot busier. And then we scored a partnership with a competitor, and that started a tsunami of work. We were having trouble growing the size of the team, so we all had to buckle down and hold on. And I broke. So if I refer to “the perfect year” it was most of 2020. That coincidence will come back much later on in the story. And it wasn’t really perfect.

Why “semicolon” as a title?

Project Semicolon explains that “a semicolon is used when an author could’ve chosen to end their sentence, but chose not to. The author is you and the sentence is your life”. (link: Project Semicolon) While I didn’t choose to, and the working of “the sentence [words] is your life” sounds too much like “the sentence [prison term] is your life” feels awkward to me. But it’s the sentiment that counts. The idea that the stuff before the semicolon may not be the same or around anymore, but the semicolon signals that there is just as much stuff and life ahead of the bad moment or time. Instead of a period, which ends everything.

Notes for the reader

You know how I said “short” history up there? Yeah. get a blanket, some tea, and buckle in for a bit of a read. I have done my best to edit the story, but there will be things I missed or repeated. Sorry. Please share this collection of posts or this blog anonymously with others as you feel appropriate. While this is my memory, it’s also intended to help. And the only way it can help is if people read it. I know that’s a big ask, as it’s pretty long.

Any time I mention an MD it’s almost always a Psychiatrist. Though I’ve been informed a psychiatrist isn’t an MD. Work with me. I refer to people by their role capitolized. So Wife and Therapist or even Nurse occasionally.

Enjoy. (Is that even an appropriate thing to say?)

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