A call for help (chapter 7)

August 21, 2010

The next morning I am full of dread. Acid churns in my stomach and I wander restlessly from room to room, unable to do anything for more than a minute, as I wait for my daily call from Dr. S.

When he does call, he introduces me to the notion of dissociation. I am not quite sure what it means at the time, but I grasp that it has to do with how Scott, who had been making such good progress, slipped back into psychosis and denying the reality of the world when confronted with the bad news of not returning to college.

Dr. S. actually questions out loud whether Scott might remain in this dissociative state we have pushed him into, but then reassures himself that the medication will give him the scaffolding to hold on to reality. Great. I love it when a doc has a dialog with himself that results in scaring the pants off you.

I am alone in the house. Chuck had to go to work to keep his business up and running and my older son Justin was over at a friend’s house. Scott’s hospitalization was very hard on Justin, and he dealt with it by not really dealing with it. The movie ‘Shutter Island’ was fresh on everyone’s mind that summer, and Justin said that the grounds and buildings of the New York Presbyterian hospital remind him exactly of Shutter Island.

I decide to go for a hike in the woods. We can do that just by walking off the back of our property. I always take my hiking buddy, our gorgeous loving German Short Haired Pointer with me when I go. He is of course blissfully unaware of everything that is unfolding but is always on hand for a hug and is happy to lay with his head on my lap for hours at a time, if only I would let him. 

Our house abuts 100 acres of woods so we have lots of good trails. The hike is aerobic since it goes up and down hills and soon I have my heart beating fast. My goal is to try to create some endorphins through exercise. I believe I succeeded. I resolve to put aside the soul-consuming fear that Scott would disintegrate permanently into a dissociative state. I also resolve to call upon the spirits of passed family members for help.

Oh boy -  this is the part where she has a complete meltdown, you are thinking now. 

Call it the edge of insanity, call it enlightenment, call it desperation, or call it an exercise high, but in my mind I reach out to my Nana who had passed away at the age of 101 and my father who died 9 years earlier and had been a great pal of Scott’s.  I ask their spirits for help, to come to the aid of his wandering mind and to bring him back to his senses. I was not sure where Scott’s mind went when it wandered away but I thought maybe they might have better luck getting the two them reunited. With this call for help, I feel reasonably functional and somewhat optimistic.

No sooner am I back at the house on that beautiful August day that a bird flies into one of our windowed walls. It makes a loud thumping sound, and I worry that it injured itself. The other part of my brain thinks: Nana or Pappa, acknowledging my call. I walk over to the window to ensure there isn’t an injured bird on the ground. Not seeing one, I turn and start to walk towards the stairs to get changed and ready for visiting hours. As I am turning, another bird hits a different window with a second loud thump.  Second spirit, reporting for duty, I think.

Yes, I suppose I truly am nuts at that point, but in my heart I am really glad to have them onboard.  

(continue reading) 

The Haven (chapter 6)

August 12^th – August 20^th  , 2010

Scott’s windows faced the tennis courts. From the moment he got there, he was completely fixated on going outside and playing tennis with his father.

Of course he couldn't go outside because he was not yet cleared for it. The Haven has a system of levels and based on this level patients are accorded certain privileges. For the first few days - I don’t remember exactly how many - Scott is watched 24 hours a day. We can imagine that this corresponds to level 0. Gradually, as they get “promoted” to the next level, they are allowed to do things such as go outside in a group with supervision, and I think by the time they get to level 5, they can go outside with family members and no medical staff required.

His fixations are hard to deal with since they are irrationally important in his mind, and lack of resolution leads to frustration, which quickly escalates to a violent mood. He never struck us, nor anybody else in the hospital, but he would huff and puff,  get in your face and says things like “do you know how much I can hurt you”.  He is big and can be intimidating, even when you know what a gentle warm person he is outside of his manic episodes. 

Thus his fixations became very important to us. We longed for him to get cleared to go outside.

Every day there is tremendous angst, for Chuck, my sisters and for me, around what level Scott would be at and when he might get cleared to the next level. The hardest times are the weekends. On weekends the patients need to just sit tight. We often say that they are just "parked" on weekends. Their regular doctor is not there and no level changes take place.

These two weeks are a real mixed bag and a complete emotional roller-coaster. By now my older sister J. has arrived from California and for a short while Chuck and I benefit from having both my sisters with us to bolster us and help us keep our chins above water.  

Much of the specific details of those days escapes me now.  I believe there are the memories that we can’t delete no matter how hard we try and there are those that the mind mercifully dulls slowly with the passage of time. As I recall it was a beautiful August. The sun was warm and the breeze gentle. In the mornings, we would sit outside on the back patio, under a blue sky, drinking coffee and waiting for it to be time for visiting hours. I couldn’t drink caffeine because of my anxiety, but I guess I drank decaf or had tea. 

It was such a comfort to have my sisters with us. They introduced some structure and normalcy for Chuck and me. And maybe they were a distraction. Perhaps I did not allow myself to fall apart quite so completely as I would have otherwise because they were there. Perhaps Chuck and I did not resort to tearing each other apart in our pain because they were there. Either way, we were a team. All of us together. A small group, where nobody managed to keep it together all the time, but usually at least one person was functional and able to provide support to the others. 

I am not sure what we did during those mornings, but I expect it involved research. On the drugs Scott was being prescribed. On bipolar. We started to learn about the different types of bipolar, and what we might expect for Scott going forward. We were such rookies that it was news to us that there are two types of bipolar: type 1 and type 2. 

We have since learned that type 1 leans towards the manic side, always involves hospitalization, and usually comes with a psychotic break. But at the time, when we were so new to bipolar, we scoured the pamphlets from the hospital and the internet, trying to figure out which type he had, and in the absence of confirmation, which type we wished he had. At times we researched what questions to ask, and at times, I at least, practiced escapism, retreating to my garden to pull weeds, or sweep the front steps. Anything to support the illusion that I had some control over some aspects of my life. But all these activities were just preludes to the main event of the day, which was the drive down to the hospital for the start of visiting hours.

Life on the psychiatric ward has a rhythm. A very slow one. Since the group of ‘clients’ was quite small when Scott first arrived, they became a fairly close knit group – or at least as close as one might expect given that each was dealing with his/her own psychiatric issues, and they were thrown into daily close proximity but knew in their hearts they would never see each other again once they left that floor. It’s probably not dissimilar from the bonds between people in a lifeboat.

Chuck, my sisters and I are there every day from the start of visiting hours until the end. The Haven has generous visiting hours, so we are there something like 5 or 6 hours every day. On weekends it is more like 8 hours. We know all the mental health workers by first name, even though they are on rotating schedules, we know the patients, and we even know the patients’ families. Unlike the other ward we had seen at the same hospital, the patients here have their families visit with great regularity.

The familiarity of the daily pattern is somewhat comforting. It is particularly comforting to the patients, but even to the family members – whose nerves are worn down and who are exhausted from their daily trek to the psychiatric hospital carrying the stress of having a loved one here. 

There are often daily traumas, sometimes with your loved one, sometimes with somebody else on the floor, but each of us knows what it feels like, whether it is our turn to be sitting in the hallway crying or somebody else’s turn. We avert our eyes if we don’t know the family member well enough to offer comfort, but sometimes there is no comfort to give. Only the passage of time can bring slow healing to the pain that happens here. 

Other moments are surprisingly, and very fleetingly, happy. I recall a raucous game of Pictionary in the lounge, with one of the mental health workers leading the game, involving many of the patients and family members. There are also rare peaceful times, watching a movie in the lounge on the big-screen TV after dinner, a sleepy medicated Scott laying on the sofa with his head on my lap. Other patients close to Scott’s age whose family members had already started the long drive home, having pulled up chairs, cracking jokes or putting up a running commentary on the movie. Good days and bad days.

We optimistically hope for a unidirectional recovery. My grounding belief – the one that allows me to get out of bed every day, get dressed, put food in my mouth - is that every day Scott will get just a little bit better. And he does have good days but he also has bad days. On the bad days, he slips back into his manic world and becomes irritable, irrational and obsessive. Unfortunately for my grounding belief and me, his trajectory is not unidirectional. Even though we boost each other in our little support team of my sisters, Chuck and I with the catch phrase “good days and bad days”, the bad days are very difficult, and there are evenings where we walk off the ward, out of the building into the summer night air and feel a crushing weight that stuns us all into a heavy silence. On one such drive home, K. tries to make a joke out of the fact that even the cheer-leading squad has punked out. 

It costs everyone to remain calm and upbeat in the face of Scott’s setbacks into irrational, manic behavior. And he is doggedly persistent about it. He wants to get off the floor. He wants to go outside. He wants to play tennis. He wants to know his discharge date. He wants to make plans to get back to college. And therein lies the rub. 

Every day that he is on the ward brings us closer to August 27^th - the day he is supposed to be traveling back to campus at Middlebury College – and the pressure gets ratcheted up. Everyone but Scott knows that it is not possible for him to go back to school on the 27^th. I am still operating in something of an unrealistic bubble, and part of me wonders if maybe he can go back to college, but just get there two or three weeks after the start date. 

I want very much to not break his dream and somehow make it possible for him to go back to school. We speak with Scott’s doctor and social worker about this, and we explain that we are punting every time the issue comes up. Maybe we should just tell him he is going to be a ‘little late’ returning to school … maybe we should wait until he is discharged to break him the bad news. His medical team gives us the excellent advice to confront the issue while he is still in the hospital. Since he will take it poorly, they have the capacity to deal with the consequences and they can keep him safe. Chuck and I agree to have the sit-down and break Scott the news.

It is probably somewhere around the 20^th of August when we have the meeting. By now my sisters have had to return to their lives and their jobs, so it is just Chuck and I with Scott’s social worker and the wonderful Dr. S. who sit down in the room. Thinking back on it now, I contrast it with the meeting on the men’s ward with Scott’s previous doctor. This room is large and airy, with art on the walls and big windows facing out onto the grounds. There are many seats in the room and we only take up a subset of them. 

But I do not notice any of this at the time. My heart is in my throat and I am sweating. The cost of these emotions is even higher because of the need to appear outwardly calm and upbeat for Scott.  I fear breaking this news to him. I know how painful it will be, and I feel that his losing the semester at Middlebury is the worse possible outcome from his being diagnosed as bipolar. I guess that just goes to show that the mind helps us by compartmentalizing facts. Somehow I thought my greatest burden was the pain he would be caused by the fact he would miss a semester or two and not return in the fall to be with his friends and teammates. Clearly, part of my brain must have missed the part about him having a life-long illness.

I don’t remember how it came out: who said what first, but I guess we all took turns giving him the message. Scott’s agitation immediately skyrocketed and he started what I think of as his ‘huffing-and-puffing behavior’. There was real panic in his voice, and the panic was taking refuge in fury. He also loudly proclaimed that if we did not let him return to school he was going to kill himself. I observed that the more Scott got agitated, the more Dr. S. lowered his voice, lowered his gaze and did everything to not confront or inflame Scott. I followed suit and kept my voice low and calming. We were all hoping we could get through this meeting and get past this issue. 

But the situation deteriorated, and soon Scott was getting visibly distressed and regressing into psychotic behavior. He started talking to himself, mumbling about how the events leading up to his hospitalization could not possibly all have been coincidences … they just couldn’t all be coincidences. By coincidences he meant all the ‘signs’ he had seen that showed he was indeed a CIA agent, people were indeed trying to kill him, he was indeed under constant observation, and all the other events his manic mind lined up into his version of reality. Dr. S. saw this regression and suggested gently that we had discussed this subject enough for today. 

For me, with my optimistic belief that progress would be sustained and unidirectional, this setback for Scott was devastating. He stormed out the room and refused to speak with us any further or even to have us on the floor. I was so emotionally fragile myself, that his proclamation of his intent to kill himself was terrifying. My hands were shaking and a weight on my chest was compressing my heart was making it hard to breathe. I recall that after the meeting had disintegrated, I stepped just inside the dining room where I was alone and leaned my forehead against the wall. I seemed to lack the strength even to hold my head on my shoulders. The social worker found me this way and asked if I was alright. “Am just trying to breathe” I replied. I should have known that of all places, a psych ward is the safest place for a person who wants to end his life. It was at this point that I found out that the windows on the floor don’t open and wont break, although I should have probably already guessed that.

Chuck and I didn’t leave the hospital grounds, even though we had been banished from the floor by Scott. I recall sitting in the car, which we had moved to a parking spot where it faced the exit for his ward. From this position we could see people going in and out of the building, but could not be seen from his room. I guess he was right when he thought there were cars parked outside the building with occupants who were watching him.

We had agreed with his doctor that Scott would stay on the ward today and not be allowed outside for that afternoon’s activities, given his threats to escape and to kill himself. I don’t exactly recall why we were sitting in the car watching the building. Maybe we just couldn’t bring ourselves to leave, or maybe we thought he would change his mind and call to ask us to visit during visiting hours. It was a 90-minute drive round-trip to the house, so presumably it made sense to stay put for a while. 

At some point we called the nurses’ station to inquire how he was doing. I guess we wanted to know if he had resorted to punching the walls again or if they had to give him extreme tranquilizers. I was thrown into a complete state of terror during a moment of confusion when they weren’t quite sure where he was. Finally the answer came back that Scott was not on the ward. This didn’t make sense to me since the doctor had agreed to keep him inside. My voice rising in pitch and panic, I think I snapped at the nurse when seeking clarification. Clearly she didn’t deserve this and probably had no idea where my emotional turmoil was coming from, but it did seem to me that given how much we were paying per day, plus what the insurance was paying, they should have managed to not to temporarily ‘lose’ a patient who was suicidal that morning. Eventually it emerged that Scott had gotten much calmer since the meeting earlier in the day and they had cleared him to go with the other patients for that day’s escorted activity, which was a swim in the pool.

It’s funny (or just plain sad) the things that one resorts to when stress has put you in a state of mind that is not exactly completely stable. Again I am fuzzy on all the details but I do remember lurking around behind a building on the hospital grounds, peeking out from behind the hedges in order to get a glimpse of Scott walking back with the group from the pool. I wanted to see him but felt that he couldn’t see me watching him since he had told us to leave. I also really didn’t want to feed his paranoia by having him see that we were ‘spying’ on him, but I had this desperate need to try to see if he was going to break away from the group, or if I could tell from his body posture whether he was terribly despondent. 

Of course I couldn’t see him well enough to detect his emotional state and he didn’t burst away from the group and make a mad dash for the woods or a road while I watched. I went back to the car where Chuck was waiting, and after a while we called the nurses’ desk again to confirm that he was indeed back on the ward and there were no further plans to leave the building that day. At that point, Chuck and I undertook the long sad drive back to our house. 

(continue reading) 

The Diagnosis (chapter 5)

Wednesday, August 11th  2010

For the first few days we have no diagnosis for Scott. The morning after he was transferred to the Haven he was seen by his medical team. I don’t recall exactly who was on the team, but I know there was at least his doctor, his social worker, a nurse and probably some other mental health workers. 

Perhaps that’s another reason one pays a premium at the Haven – just the concept of having a ‘medical team’ is somewhat reassuring. Contrast this with what happened in the Men's Ward where we had to fight to get just 10 minute's of the doctor's time. Scott’s doctor, whom we will refer to merely as Dr. S., was a lifesaver and real blessing. My husband Chuck and I were still completely overwhelmed and terrified by the situation, but we were moving towards firmer ground and Dr. S. helped to get us there. He spoke with us daily, in a manner that was straightforward and open. He didn’t sugar-coat anything, but his directness, calm demeanor and matter-of-fact presentation helped to make things a little less scary. 

He explained how Scott was still in a paranoid delusional state and still believed that the cars parked outside the hospital were there to watch him. He further explained that in this state, he couldn’t just tell Scott that he was having a psychotic break because it would all just get folded into his paranoid view of the world. Instead he said that he would wait and as the medication started to provide some scaffolding for Scott’s jumbled mental condition, it would eventually crack the door open just enough for Dr. S. to get his foot in.

Far from making a snap decision like the incompetent and unthinking doctor at the ER, the  team at the Haven are monitoring Scott and his reaction to the medications he is being given.

Scott was immediately placed on very high doses of Lithium and Zyprexa. Still he remained very manic and volatile, and so he was also given Thorazine to help calm him at times when the bull started to rage. This usually happened at night, when sleep evaded him and he would get agitated. I recall Dr. S. telling us that if any of us were taking the medication that Scott was on, we would lay down and sleep for a week. But Scott was like a run-away freight train at that point all the lassos that Dr. S. threw up around him were unable to slow him down.

When Scott is manic he gets fixated on sports, usually football. At the Haven, he only wanted to wear athletic clothes with sneakers, and he liked to set the treadmill at an angle of 15 and run on it. In the middle of a conversation or sometimes during a meal, he would drop to the floor and start doing push-ups. This thing with push-ups he had been doing for some time. 

We were so naïve we missed all the warning signs. If we had known anything at all about mania, we would have been tipped off when during a July 4^th weekend party at a friend’s house, he got up at 6 a.m. after only a few hours sleep and decided to jump in the pool and swim laps at great speed. He tried waking all of his friends but they were hung over and told him to go away; saying he must be crazy. He told us all this upon his return from the weekend away, in his ebullient verbose way of that summer, but we merely shrugged and marveled at his high energy.

Yet his high energy eventually degraded to erratic behavior. When the psychosis came, it seemed to us that it came quickly, but in reality he had been able to ‘cover’ it for some time. It was only after he was hospitalized that we started to discover some of the things he had been doing. For example, we discovered in his wastebasket a check for $200 that he had thrown out, but fortunately had not ripped up as he had most of the other things he was getting rid of. We found a hardcover book that he had attempted to burn in the outdoor fire pit (not sure what his thinking process was but the book was the Diary of Anne Frank). He had been practicing self-defense with golf clubs and garden tools, knocking the head off a hoe as he smashed it against a rock. It eventually came out that he thought his father and I were with the CIA and were plotting to have him killed. Therefore he had to cut his ties with his past and be prepared for the attack when it came. My heart hurt to think of him in this dark place. 

And so we waited for a diagnosis. Dr. S. seemed to feel that Scott’s symptoms pointed to a mood disorder, especially once he found out that Chuck’s father suffers from Bipolar Type II, but it seemed that he was still reluctant to rule out schizophrenia. Bipolar has a strong family tie, and if one member of the family has it, it is much more likely that others will too. It is also more common in males.

Dr. S. would eventually settle on a diagnosis of Bipolar Type 1, the more severe of the multiple types. These days they talk about a schizo-affective spectrum and don't rush to label an illness with a tidy label. But the waiting to know what he had and therefore what we could expect as a prognosis was hard, and it was hard to have Scott be so different from his usual self … so ‘crazy’.

Most of us have an inherent fear of madness. This fear stems from our old lizard brains, and is often irrational. We fear snakes and things that move in the dark, or the spider that drops from the ceiling into our hair. We fear people who, in less enlightened times, were labeled ‘lunatics’. We fear the institutions where they were housed. The term ‘lunatic asylum’ conjures up Hollywood-conveyed images of terrifying spaces overflowing with people who have left the boundaries of what we understand to be our fellow humans. We are all tainted by these images. When a person you love abruptly becomes somebody else, somebody unrecognizable, unpredictable and irrational – and you know that the things you say and do are now being interpreted by him through some distorted lens, it is as if the ground beneath your feet has cracked and you have been swallowed into a dark chasm. We lose our foundation and we lose our way. Our minds were gripped by fear,  our thoughts darting about like insects trapped in jar. Chuck and I feared this madness that had claimed our sweet son. We feared it deep down inside our old brains, where a knot of terror sat like a malignant tumor.

Yet we had an unspoken pact to never expose these feelings inside the walls of the hospital. When we pressed that buzzer to request entrance to the Haven, whatever turmoil or anguish we had been engulfed in up to that second, we covered up with a smile and an outwardly calm demeanor. Scott was so volatile, that our primary goal in those long days at the hospital was to keep him calm and to distract him if he looked like he was headed towards an agitated state. Because he had so much energy, it was hard to be indoors with him, but it would be many days before he was cleared to spend an hour or two outside in the courtyard under the supervision of mental health workers. Fortunately they have a ping-pong table at the Haven, and we spent hours and hours playing ping-pong. Both Scott and his father are quite good, and Scott’s greatest glee was to challenge his father to a game in hopes of beating him. Sometimes he would win, but not always.

As the days passed slowly by, Scott started to forge bonds with the other patients. While we had been motivated to move him to the Haven so that he would be with other people his age, it turned out that the patients who had the greatest influence on him were adults. There were two people in particular who played an important role in his path to healing. One was a recovering alcoholic whom I gather had been on a bender and checked himself into the Haven. He was in his mid-forties and I believe he was a successful businessman who may have been involved in commodities. Group sessions took place in the morning before visiting hours, and we came to find that Scott was wholly impressed with what this gentleman had to say, and respected his input. The other patient was a doctor. I do not know why she was in the Haven but she read a lot and was doing research on her condition. When Scott went into crisis in his second week at the Haven, these two would play a pivotal role in helping him at a time when neither his doctor nor his family could reach him.

(continue reading) 

 

The Men's Ward - New York Presbyterian Psychiatric Hospital (chapter 3)

Monday, August 9th  5:00 pm 

Driving back home from the hospital I can’t speak. I am working so hard to hold on, to keep from completely disintegrating at the thought of having checked our son into that psychiatric ward, that I wonder how I will get through the next hour, and the hour after that, and the one after. I had called my sisters from the ER last night after receiving the first doctor’s pronouncement of schizophrenia, and they had offered immediately to come and help. No, I told them … there’s nothing you could do, I will keep you posted. But today, I realize that I am completely dysfunctional at the moment, and it is not fair to rest everything on my husband’s shoulders. I text an SOS to my sisters. Literally. Very quickly I get a text back telling me help is on the way… details to follow. I put away my phone and focus on breathing. 

_____________________________________________________________________________

 

Later that day we arrive back at the men’s ward with Scott’s belongings. I don’t remember packing them, nor driving back to the hospital. I remember ... collapsing on the couch in our living room, literally prostrate with the pain of what was happening to Scott. I remember, my husband trying to comfort me, telling me that he promised me our son would be ok, and my telling him not to make promises he could not keep. I remember, hearing my husband, who had gone down to the basement to try to keep the sound of his sobs from me. 

Scott is out cold. A tray of food sits on the table in his room. There is some round flat breaded something, which I expect is meat of some type. There are also round carrots, the frozen kind. It crosses my mind that I think they are called “carrot coins”. I can hardly imagine a less appealing looking dinner. A kind nurse is on duty. She smiles at us and we sit together in white plastic chairs in the hallway outside Scott’s room. 

She tells us that he tried to leave after we did and did not react well to finding the doors locked. He punched the walls and became angry. He is not a small guy, and his fury when he is manic can be intimidating. Apparently they gave him some serious tranquilizers since he is now completely comatose. He did not stir when we touched his shoulder or called his name. She reassures us that sleep is the best thing for him now. It is how the brain heals itself she says.  We tell her about our experience at the ER. Amazingly, she scoffs at the ER doc’s diagnosis. I am only a nurse she says, but I can tell you he is not schizophrenic. This is most likely a drug induced psychosis, or mania from bipolar.

Unbelievable! I am so relieved tears fill my eyes. I may have actually taken her hand to thank her for sharing this insight with us. I walk out of the ward to make a phone call since cell phones are not allowed on the floor. I call my younger sister, who lives in Washington DC and is already en-route to New York. “The nurse says she doesn’t think it is schizophrenia,” I say joyfully into the phone. “It’s most likely bipolar”. My sister pauses, not quite sure how to take the information. When did a diagnosis of bipolar become joyful news she must have wondered. We share details on her ETA and that she should just let herself into the house since we will be asleep before her arrival estimate of midnight. That night, we sleep the sleep of the dead. In all honesty, for me it is an Ambien-induced slumber. My goal was to sleep instantly and not have time to think. 

(continue reading) 

 

The Psychiatric Hospital (chapter 2)

Monday, August 9th 2010 - 9:00 am

We have decided to take Scott to New York Presbyterian Hospital. They participate in our insurance plan, are in White Plains which is only a 45-minute drive from our house, and these things seem like important considerations at the time. 

Returning home from the ER the night before around midnight we are dazed and tired, and decide it is best if we set Scott up to sleep on the sofa in our office. In this way, he would have to walk through our bedroom to leave. We want to make sure he does not drive away, and also we could not deal with getting rid of all the knives and sharp tools in the kitchen. 

Lying down to try to sleep, I face what feels like the worst night of my life. In the morning we will be taking our beautiful child - our handsome, smart, loving, funny, varsity-athlete, straight-A student – to the psychiatric ward. He is no longer the Scott we know and love. He is a manic, volatile, unrecognizable person from whom we have been told to protect ourselves and whom cannot be trusted not to hurt himself.  The pain is so acute and so vast that I cannot find the edges to grasp on to. It hurts to breathe and it hurts to be conscious. 

Amazingly, I eventually sleep. I know this because in the morning, Scott is no longer on the sofa in the den. In his mania, he slept almost not at all, and at some point went to his room. Fortunately he did not try to leave. He agrees to go to the hospital with us. With treat him with kid gloves because his reactions and responses are so alien that we are not quite sure whom we are dealing with, or what to expect. Apparently he is still under the impression that he is going to the hospital so that he can hook-up with a nurse. In his imaginary world where we are all actors to bring about what he desires - he feels he is playing a part, where we all pretend that he needs to go to the hospital because he is not well, but in reality, it is part of an elaborate scheme so he can get laid by a nurse.

We have called, and NY Presbyterian is expecting us. We were given instructions on how to find Admitting.  Still, it has not occurred to us to pack any clothes or toiletries for Scott. Like automatons, we get numbly in the car with him. We try to keep our voices calm and neutral. The hospital will be nice. I think they have beautiful grounds. They may even have a swimming pool … 

He does not notice, but we do, that the doors lock once you walk into Admitting. The process is very long and tedious. He is seen by many people, examined, interviewed both with us and without us. A woman has him fill in the paperwork for a voluntary admission.  She instructs him to write on the form: “I need help” and he complies. 

A doctor eventually shows up. We have been there for several hours already. He comes through one of the locked doors wearing a suit and is brusque, seemingly irritated to have to be interviewing Scott. His pager goes off several times during the short time we are in the room with him and each time he consults it. We feel like an afterthought. Our world is crumbling around us, and he can barely take the time to make eye contact with us. I am silently hoping that this man will not be Scott’s doctor once he is admitted. Scott asks if there is a swimming pool. The doctor is dismissive and tells him curtly that he has bigger things to worry about than the pool. He does not look up as he says this, but continues writing something on yet another form. A little empathy, compassion or even patience would have gone a long way that morning. But we are not to find any from the staff here. 

Sometime later a person comes to escort us to the ward. Since Scott is 18, he will be placed on the adult males’ ward. We are buzzed through various doors and eventually enter the ward. Linoleum floors, fluorescent lights, white plastic chairs, and a TV that is on at the end of the hallway greet us. Doors open to small rooms with twin beds. Some rooms have two occupants and I am happy to see that Scott has been assigned a room that is a single. The men seem to be passing the time by hanging out and walking back and forth in the corridor. They are all much older than our son. Most of them seem to have had hard lives and are not in a good place. Some have headphones, others are talking to themselves. Clearly this is a psych ward and the people are not here because they are doing well but still I am taken aback. So many men, some in hospital pajamas, some in sweats, shuffling up and down the hallway. Scott  will be under continuous observation initially, which is standard, since he is still deemed a risk. 

At this point we realize that he has no clothes or any personal items, so we decide to drive back to the house to gather these things. It’s not that we really thought he was not going to be admitted after he was examined at the hospital, it’s just that we were incapable of thinking further than what was necessary to put one foot in front of the other.  Our doctor had gently told us this morning on the phone that we needed to tell the hospital that we were looking for an evaluation and an admission. Yet in our automaton state we were operating mechanically and not really thinking about anything.

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In the beginning ... the cataclysm (chapter 1)

August 8, 2010 – 11:00 a.m.

The handsome young man visible on the screen in the control room of the Military Police’s headquarters at West Point appears quite normal at first glance, but there is something very wrong with his grin and his posture given the circumstances. 

With his feet on the table and his chair rocking backwards, one has to look more closely to notice the handcuffs, the smirk or the occasional chuckle at some inside joke that only he is aware of. 

The Sergeant Major, an impressive man of imposing size and height, glances at the screen and turns away angrily, not realizing that my world is crumbling as I take in my son, aged 19, who is so far gone and out of character that he is clearly suffering from what I think of as a “nervous breakdown”. 

I had listened patiently, if fearfully, to the description of what had landed Scott here in handcuffs. I wanted desperately to just limit the repercussions, get him ‘off the hook’ and take him home. Then we could deal with whatever was going on with him. 

“Here’s one thing you should know,” the Sergeant Major had told us forcefully when he came out to speak with us in the lobby upon our arrival. “Your son was almost killed today. My men broke with protocol when they did not press the button that brings up the barrier capable of stopping a speeding truck. The barrier comes up in an instant and he would have crashed into it at 70 miles per hour: being killed on the spot.” Unlike the other officers who are in uniform, the sergeant major is dressed in sweats and had apparently been called in from the gym on his morning off upon being informed of the incident.

We make understanding, sympathetic noises. Thank goodness they used their common sense … I don’t know what has gotten into him … this is not like him at all … he hasn’t been himself recently. Our murmured reassurances continue, but we just want him to let us get to Scott; to take us back to where he is being held and to get him sprung with the least amount of damages possible. 

We simply have no idea that we have stepped through the looking glass and are entering a world so foreign and terrifying to us that we will be completely unprepared to deal with it.  

As my husband speaks reassuringly with the Sergeant Major and the others at MP Headquarters, I alternatively listen to their conversation, glance over at the holding room where they have Scott locked up, and walk outside to wipe away my tears. We are waiting for the New York State police to arrive, who will take custody of Scott. My older son is here too and he has been texting with a dear friend, who is also a wise attorney, to whom we had turned when we first found out the reason Scott had not returned from picking up a friend at West Point. ‘Admit to nothing he counsels’. Good advice. But there is nothing for us to admit to. We know nothing, and understand even less.

                                          ________

It will be months before Scott will be well enough to share with us what he thought was happening that day: a training exercise for the CIA. Driving the 15 minutes from our house to West Point, literally at 100 miles per hour, he believed he was part of some type of operation. Since he thought that all the other cars on the road were part of the training exercise and employed by the CIA, he knew that they would watch out for him and were timing his speed. Approaching the control point at the gated entry to West Point, rather than taking the path that requires cars to stop and hand over ID cards while the car’s trunk and underside are inspected for bombs, Scott took the lane that was open and is reserved for Army security personnel. He floored it and my BMW, which he had taken when he asked if he could give a friend at West Point a ride over to our house, responded accordingly. As he blew by the entry checkpoint, the MPs hit the alarm and quickly scrambled to pursue. When he pulled up in front of his friend’s house, the cars that had been in pursuit stopped as well, and his friend opened the door to find Scott being placed into handcuffs and under arrest. All part and parcel of the exercise he thought …

Same day – 7:00 p.m.
 

We are in the Emergency Room of the local hospital. It is Sunday and there are only a few other patients, but I hardly notice them. It is hard to ignore the man on the other side of the curtain from us, who appears to be a drunk and is quarreling very loudly with a family member over what has landed him here tonight, but my awareness of him fades in and out. My heart is beating so rapidly that my breath is shallow and a sharp pain somewhere in my chest seems to be causing my vision to malfunction. 

“Yes, he is hearing voices. Looks like schizophrenia.” The ER doctor tells us matter-of-factually. Scott has been taken for a cat scan of the brain and the doctor has stepped into our curtained hell after speaking with Scott privately, to share his medical conclusion with us. He walks back out. 

My husband and I are left staring at each other, at a loss for words, trying to grasp what we have just been told. I type schizophrenia into Google on my phone – but at first I can’t spell it. Google helps me and I scan the results, looking for something that will tell me he can have a normal life, even as a schizophrenic. What I find is less than reassuring. We wait for Scott to be returned and when he is, we try to act calm and normal. 

By the time the New York State police officer had arrived at MP Headquarters, we had had enough time with the Sergeant Major for him to understand that this was not a case of a kid acting like a punk. Scott was not drunk and was not on drugs. He had seen the doctor two days ago and clearly needed to be seen again. We promised him we would be in touch with our doctor as soon as we got Scott home. We shared the fact that we believed he had been abusing 5-hour energy drinks for many days. “Legal crack” is how the sergeant major referred to the drinks. Of course we also thought that he had been taking psychedelic drugs, but this we did not share. His behavior was too odd to explain otherwise.

We had needed to rush home two days ago from what had been a planned weekend getaway in the Adirondacks. Scott’s behavior on the phone had been so bizarre that I found myself wondering if he had a brain tumor. We asked his older brother to drive him to the doctor’s office, while we made the four-hour trek back to the house.

Once home, chatting with Scott, trying to keep him calm and dig a little deeper as to what was going on, he told me how incredibly good he was getting at Lacrosse. His brother had coaxed him into a game of catch as a means of distraction while waiting for us to return. He added that his coach would be very proud of him, which was out of character for Scott who is normally his own greatest critic, but nowhere near as odd as when he mentioned that he thought he was getting help from the “spirit of the house”. Who is the spirit of the house I asked. “Whomever is controlling the weather” he replied calmly. 

At that point I asked him if he was taking hallucinogenic drugs, and he replied that he would really like to know the answer to that question. He thought maybe somebody had been giving him some without his being aware. The doctor had taken blood and urine samples that morning but we would not have the results until Monday. We believed that all we had to do was keep an eye on him over the weekend, while we waited for the blood work to come back. If we kept him home and stayed with him, all would be fine. When he asked on Sunday if he could go pick up his friend at West Point so they could hang out together back at the house, this seemed like a safe thing to agree to as West Point is only a short drive from our home.

But these thoughts are far from my mind as we sit, frozen in uncomprehending fear at what is unfolding before us, in our curtained space of the ER on Sunday night. A call to our pediatrician after the debacle at West Point had landed us here. At first I get his service and when they ask if it is an emergency, I hesitate but then say yes. When I get the doctor on the phone and explain of Scott’s arrest and his charging the entry gate, he tells me in his calm and gentle manner that he agrees it qualifies as an emergency. Scott needs an emergency psychiatric evaluation he says. He recommends a couple of hospitals: Four Winds and New York Presbyterian. 

Since it is Sunday I can’t through to the latter, and the former tells me to take Scott to our local emergency room. We comply. It seems simpler than dealing with a psychiatric hospital anyway. We’ve been to the ER many times with Scott already for sports related injuries: X-rays, dislocated fingers, stitches … a trip to the ER with him seems almost familiar, and given how bizarre and scary life feels at the moment, familiar is good. However, it was a decision that turned out to be a big mistake on our part. 

                                          _______________

I lose track of the number of people who have asked Scott if he knows who the president is. The triage nurse, the ER nurse, the first doctor, possibly the attendant who came to wheel him away for the CAT scan. Scott thinks it is a lark and by the second or third time, he replies jokingly that he is not sure, but it might be Richard Nixon. At first alarmed, they eventually realize he is not serious. 

Once the doctor makes his pronouncement about Scott and the schizophrenia, they post a security guard outside our curtained enclosure, and refuse Scott the right to go to the bathroom. He might hurt himself, they say. What is he supposed to do, hang himself with toilet paper? He has to go so they roll in a potty and he has to squat. So much for preserving patient dignity. 

The security man standing guard is aged and looks like he would have a coronary if he had to break into a sprint. Given Scott’s six-foot frame, 180 pounds and speed on the field, he seems like a very unlikely person to provide security of any type. But during the long hours where we wait interminably for the next step in the process to happen I am surprised when I see the guard casually walk up to man who has entered the ER and quietly ask him for something. The man produces a large switchblade. Catching the guard’s eye, I smile tiredly, and he tells me he can spot them right away. Good for him, I think. I certainly had not noticed anything.

Time ticks slowly by. We are not sure what we are waiting for. But we wait. Scott has been medicated with tranquilizers so for the most part he rests fairly quietly. However, he is pretty amped up for somebody with that much medication in him. 

His ER nurse is sweet and well intentioned. She is also very pretty. She has a name like Mindy or Candy. I see an article on the wall that mentions her and her “high-energy competency in the pressure cooker setting of the ER”. I’m glad that they apparently have good nurses at this hospital, since so far I have been completely underwhelmed by the doctor in every way. 

As it turns out, Scott thinks that this trip to the ER is a ploy that we (or somebody) cooked up so that he could get laid by a nurse. God knows what type of things he has said to her when she escorted him off for an interview ‘in private’. Since Scott is over 18, they keep taking him away from us to question him. This makes us very uncomfortable since clearly Scott is not is his right mind, and we are not feeling very reassured by the medical staff and their decision-making.

At some point I speak with the nurse to ask her about her assessment of his condition. She looks sadly at me and concurs with the doctor’s evaluation. She sees that I am having a hard time processing this diagnosis, so she shares with me that her brother was diagnosed years ago as a schizophrenic, and it is good that we are finding out now about Scott. Now he is in a safe place she tells me. Looking desperately for straws to grasp onto, I ask her how her brother is doing now. I want to hear that he is doing fine. I want to hear that with medication he is living a happy and normal life; that he is married, has kids and a job that he loves. She shakes her head and glances downward. He’s no longer with us, she says with the tone of a person who often deals with fatal outcomes. He killed himself. Well, now I feel so much better. I am so glad she decided to share this life event with me. I walk away quietly.

We were told some time ago that we would need to wait for a ‘team’ from another hospital to come and do an evaluation of Scott. The ER doctor is a medical doctor and in spite of his pronouncement of schizophrenia, the hospital needs a psychiatrist to make an assessment. Apparently the hospital doesn’t have a psychiatrist on call. I find this hard to believe. Their procedure under these circumstances is to call for a traveling ‘team’ (they keep using this word, so we assume there is more than one person – how many people does it take?) from Westchester Medical Center. It is about a 45-minute drive, so we wait, and we wait. 

Hours go by. The wonderful, pronouncement-making, brusque ER doc has gone off-duty and is replaced by somebody else. The other doctor does not poke his head into our little enclosure. We see him sitting in the middle area in front of a computer, but he ignores us. We wait. 

Eventually I decide to call our pediatrician. It is by now 11 p.m. and we want his input on what is going on. We are a ship afloat without a rudder and it should have occurred to us to call him much sooner. He calls the ER doc on duty and speaks with him. He then calls us back to tell us that he is coming in and will be there soon. God bless him for leaving his comfortable home at this late hour of the night to deal with a crazy kid and his overwrought family in the ER. He gets there shortly and comes in to chat with our son. Scott appears overjoyed to see his doctor. He is grinning ear to ear. We are pleased to see him this happy since his mood has been volatile and we are trying to keep him calm. We don’t realize that his mood is completely out of line for the circumstances and tips off the pediatrician that something is seriously amiss.

Our pediatrician pulls us aside and fills us in that the ‘team’ was not dispatched. There was some problem getting them mobilized, and the ER is preparing to transport Scott down to the county hospital where he will be ‘housed’ overnight. Because he has been deemed a risk, he will be handcuffed during transport. As we try to process this information, he tells us that he has taken the responsibility for discharging Scott to our care, thus overruling the orders of the ER doc, with the promise that we would bring him to a psychiatric hospital first thing in the morning. He has his back turned to the central control area where the doc on duty sits, and tells us lightheartedly that the ER doc is offended, and most likely has his nose bent out of shape. 

Given that our pediatrician is on staff at this hospital and will no doubt have to work again with this doctor, it is wonderful and amazing that he cares enough to have taken these steps to make our lives and Scott’s experience slightly better.

Hallelujah! We feel reprieved, as if an angel has touched down and been embodied in this wonderful man, who has been our pediatrician for all of Scott’s almost 19 years, and for my older son’s 22 years. 

He speaks with us out of earshot of Scott, and cautions us to take the situation very seriously. We must remove all things that he could use to harm either himself or us. Kitchen knives, scissors, pills … Even these words of gloom do not dampen our relief at getting away from this ER and being able to take Scott home.

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