Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Sunday, January 17, 2010

Hospital Trauma: Item 4983

I've probably posted about this before. If nothing else I am sure I did somewhere in the daily notes I posted. But this is continuing to haunt me and I have to talk to Dr. Mind about it, to try to take away the anger and anxiety that comes from it.

Every morning they started the day with a group. The group generally included a few announcements, like such-and-such doctor was going to be late today and the afternoon whatever group had been changed to something far less useful for Just Me. Then they'd go around and we'd all talk about how we slept, how yesterday went and how we felt this morning. Inevitably the'd remind someone that depression often feels worst in the morning. They'd also ask specific questions about something that might be happening for one of us if we didn't bring it up.

On the 3rd day I knew I was probably starting the patch. I wasn't certain because it depended on whether the pharmacy could get it before the doctor's sample stash ran out. I found out that I was indeed starting it when the art therapy student running the group asked how I felt about this. After determining that she meant I was, I said what was true, that I was glad to be starting, but also very nervous because no medication has a very high chance of working for me and I didn't know if I could handle it if this didn't, given that going off it would mean having few good choices, and would also mean another hospitalization. She kept lecturing me on having a positive attitude. At that point I felt so bad that I didn't need the lecture and I was much less shy than usual. I got pretty mad at her and finally told her that she could tell me how positive to be after she had taken more than 40 medications, most without any success, for the treatment of one condition, in a matter of less than 10 years. She continued to insist I was being negative and that this would affect the outcome and that there was no relevance statistically to how this med would work.

She was wrong. Once you are treatment resistent you stay that way, and you continue to be much less likely to respond to anything. I also continue to believe that I have a right to approach meds cautiously, because if I start every med with that wonderful certainty that it will work and it fails, just like so many before it, I wind up crushed. It is not negative to be realisitic. It is not negative to protect yourself.

Looking back, the truth is that I went into this as optomistically as possible. I took a huge leap of faith to give up on a med that had worked for me for so long. True, I knew it was reaching a point where it wouldn't work well much longer and where the side effects had become worse that was reasonable to tolerate (and damaging to my body), but I did decide to go ahead and give up what was at least more or less working and move on to something we could only hope would help. Statistically I was a good candidate. Dr. Brain had always thought so, and this drug had been in back-up position for several years. I knew that. By the time I started it in the hospital those things may have been less in the front of my mind, but basically I went into this on day one knowing that I was taking a huge risk, that I had little choice, that it was hopefuly is that this could work but that nobody would know until it had time to help (6 weeks, by the way), and that it would devastate me if I let myself think think that this would work wonderfully and it didn't. By the time I wasted 2 days of my life in the hospital with no med change on day one, and the med being taken away on day 2, and the rapid decrease in dose I had done in the 5 days prior to admission hitting hard, all I really knew was that something had to happen and that this had the best chance of helping, even though it wasn't necessarily a good chance. I also knew and reminded myself many times in the first few days that other meds with less of a chance of doing anything had changed my life (Seroquel, which even Dr. Brain had expressed doubt would help, and which was the first antipsychotic I even tolerated enough to take more than a couple months, after being on 3 or 4 others, one on 2 or 3 occasions just to be sure the bad reaction was that drug). But I was not putting all my eggs into one basket. That student tried to demand I did, and I still am bothered by it.

I know that she just didn't know. She probably had never even looked at my history and if she had it wouldn't have been detailed. The hospital never took a detailed history and Dr. Brain's history in the hospital chart won't go back through everything as she's only been there 4 years and would have no reason to have filled in everything before that. She also was about 22 years old and left in charge of a group of psych patients, quite possibly for the first time. I did a horrible job the first time I led group in the psych unit at my clinical. Not because I did something to a patient like she did, but because the thing I had planned didn't work and I didn't know what to do so I kept on trying, even though I should have just started throwing a ball around and shut up. Even if she had been more experienced, my situation is rare, and also the degree to which I understand my situation is rare, because I am a healthcare professional. I was encouraged not to talk about what I did for a living (stupid since the nurse in the group was encouraged to talk about it, and because it wasn't like I had a lot of energy to filter what I was saying to keep the staff comfortable). So her annoying statements might really have been just directed at the wrong patient and would have been appropriate in a different situation. Nearly certainly they would have been appropriate had I not been through so much trying to get any med to work, ever, in the past.

That happened the morning I lost control totally in the afternoon. I have no doubt that it was linked. When I did lose control totally I couldn't have named a single reason, other than it started when I heard someone who had been there a day less than I had but who had gotten started on meds immediately tell someone on the phone that he already felt a little better. Since I'd been there longer and only felt worse I just couldn't handle hearing that, and then things just snowballed.

This won't happen again. The things that happened that day make up a huge part of my terror of hospitalization, which Dr. Brain dose admit will happen if I need any change to my antidepressant and quite possibly with other changes thanks to interactions. When asked she also admitted that further hospitalizations will be more like 2 to 2 1/2 weeks long because of how long it takes to get MAOIs out of the blood and start another med. And she was firm that it will be in the same place; she is very adament that the general psych unit is not right for me. I understand why, and I know that I have to get past my fear.

I did talk to her about various things to have in place next time and I have a list of orders she'll write before I go in, things like a shot of something if I get out of control, orders to allow my sensory stuff without arguing with the staff, that my PM meds cannot be given early and then staff expect me to act just like I was fine when I needed to sleep; etc. Hopefully she'll be able to work out for me to have phone appts with Dr. Mind as well, something that desperately would have helped this time.

But nothing can protect me from students. And that scares me.

1 comment:

Emilija said...

I never took students or therapists too seriously in the hospital- especially the OT's! I was a very bad patient. If I couldn't get out of going to a group, I just didn't take it very seriously. Low expectations, I guess, that anyone could understand my situation. And when I wasn't drugged up, I sometimes couldn't help opening my mouth and telling people they were on the wrong med or the wrong dose or needed something changed, and probably needed a new doctor! Oh, I really got in trouble for telling people the potential side effects of medications. I'm not a good group person when I'm depressed, and ever worse when I am manic.

I knew I was there to keep me safe and to adjust my meds, and that was all I expected from the place. Occasionally in some places I actually had a good nurse, but usually the only "therapy" I got, if any, was from fellow patients, if I found anyone I connected with.