Today had several noteworthy moments, which I'll discuss later when I haven't worked 10 hours.
But I evaluated a lady who just came back from gero-psych where they took away all anti-psychotics from her. I was seeing her before she left, and didn't expect to re-start her, but her overall condition was a lot worse. She certainly is not agitated anymore.
During all the time I saw her before she was very confused, but never hallucinating. Today she was hallucinating and afraid. She kept telling me she was scared.
I told the nurse this and the nurse LAUGHED and said "She always does that, it's normal for her".
So is that ok? I realize that these people have probably not had hallucinations and paranoia of their own, but it's completely scary. I remember being in a state similar to her the day after my lithium toxicity was discovered. I had been very, very sick all night, vomiting in a way that I didn't know was possible, a way that made me later struggle with realizing that the only way I'd ever really consider killing myself wasn't an option because I would never risk feeling that way again, and my doctor had me on a strict schedule of phenergan, a mild but effective anti-nausea medication. I had to keep it down every 4 hours or whatever and I had to keep down a certain amount of fluid. Unfortunately, my doctor ran phenergan through his computer for interactions and there weren't any, but buried deep in it's profile is the sentence "this drug may cause hallucinations in susceptible people". I spent a whole day hallucinating and somewhat aware it wasn't right but not sure enough and alone so that I had nobody to help me find reality. I remember it somewhat and have an email written during those hours. And I know that I would never want to live like that or have someone I love live like that for 5 minutes, much less have that be considered ok for them.
I was thinking on the way home that I don't even know how to word this in my mental health directives so that someone could understand that I need them to be certain I'm not hallucinating. In the last few weeks so much "static" has left my head in terms of not things that would be clearly psychotic, but just not supposed to be there. I never want that back. It terrifies me that I might be left like that without every med possible being tried in every way possible. I know my doctor would never let that happen, and I know when she retires she will refer me to someone just as good as she is, probably someone she trained, but if I couldn't communicate I can see someone not seeing a need to get me to the only doctor who I trust.
I've not thought about this part of aging with mental illness too much. For now my mom is my safety net. When she is gone I have no idea what will happen to me.
The scariest thought ever.