Grace is in the hospital again. I left her wee, crying face there at 10:40 last night. For the record, that was the longest intake in the history of intakes! Four hours! I could hardly form words near the end.
Grace’s latest decline started Tuesday afternoon when she told her dad that she wanted to hurt herself. As usual, it came out of the blue, but, this time, she reported the urge rather than following through. She stabbed herself last September and told me afterwards, then I whisked her away to our home away from home–the Behavioral Health ER. Tuesday evening, her dad distracted her until the urge passed and she seemed stable. Yesterday, Grace’s school called me in the afternoon. I was at my 14 year-old’s therapist’s office. Grace had tried to harm herself during class; they didn’t feel comfortable sending her home on the bus unsupervised. My husband picked her up while I waited at the therapist’s office…and called Dr. Klerpachik. STAT.
Her meds are clearly not working. Can I get an ‘amen’?
Of course, I had to play “Make Your Way Through The Labyrinth to Reach The Goblin King” in order to even speak to a breathing human being upon calling Dr. K’s facility, but I did leave a message on the nurse’s line. ::dramatic music ensues:: And, Tammy the Nurse called me back.
My 14 year-old and I were sitting at my local Caribou when my cell phone rang. She wanted to debrief after her therapy session, and I was waiting on Grace’s antipsychotic medication refill from the pharmacy. Apparently, in the middle of our managing Grace from Monday evening to yesterday morning, I overlooked that she had run out of her Abilify–her very important antipsychotic meds. That’s a very bad thing. She did, however, have a refill! That’s a very good thing. Dr K., however, had recently increased her daily dose so she ran out of her medication sooner than the insurance company would have liked, and they were refusing to pay for a refill. We were in a bind. The pharmacy had faxed Dr. K to request her new dosage in order to fax the insurance company, but it was nearing the end of his facility’s office hours (Who stops doing business at 3:30 PM?). Anyway, I was feeling flustered and worried when Tammy the Nurse
Nurse Ratched called.
“This is Tammy, one of the nurses. So, tell me what’s going on with Grace.”
I explained Grace’s self-harming behavior and insisted that I needed to speak with Dr. K.
“Well, I don’t know that he’s even here. If it’s that serious, then take her to the ER.”
“Well, Tammy, the ER is going to bounce her. I’ve done this before. If a child isn’t ideating at the exact moment that they are in the ER, they are released. That’s how it works.”
She took a tone, “Well, you say she has ideation now. So, if it’s that serious, then you need to take her. The doctor may have left, and he’s not on call. I’m not paging him.”
“I see. I so appreciate your willingness to help, Tammy. By the way, where do pharmacy faxes go in your facility? Grace has run out of Abilify. She has a refill, but our insurance is new. We are running into some problems due to a dosage change.”
“Is she completely out?”
She started laughing at me.
“Wow. Wow. You really need to get on the ball. We need more than a few hours to take care of that.” (No, they don’t)
“Oh, well, I guess I lost track of calling in that refill in the midst of managing my schizophrenic daughter’s self-harming ideation, Tammy! Thank you so much for your compassion. I’ll wait for Dr. Klerpachik to call me back…if you can please pass on the message to him assuming he’s still in the building since you’re not going to actually page him?”
She was silent. I said ‘good-bye’. (I know. I could and probably should have handled that conversation better. I’m going for full-disclosure here.)
Everyone in the mental health community always says to take your mentally ill kid to the ER if they are threatening to harm themselves. Here’s the reality on that little chestnut: Insurance companies don’t like to pay for much. Unless your kid is actively foaming at the mouth, threatening to kill or harm themselves at the exact moment that a clinician sees them, they will be released into the care of the caregiver. There is usually little to no room in a facility for a person who might do something as opposed to someone who is actively doing something.
This is what happened to Grace last September. She had stabbed herself with a fork in the wrist repeatedly. I called the Behavioral Health ER and described her actions. They told me to bring her in which I did. The psychiatrist on duty took a look at her and decided that she was okay because she wasn’t actively ideating at the exact moment that he saw her. She was subsequently released, and three days later she experienced a full psychotic break. What many practitioners don’t seem to understand is that psychosis isn’t always a constant nor is suicidal or self-harming ideation. It comes in waves. The urge to self-harm is strong for a time, and then it passes. A few hours later it surges again. This can last for days unless there is a proper intervention. This is the problem with these drive-thru ER visits. A doc takes a look at a child, questions them, “Do you wanna hurt yourself right now?” The kid shrugs and says, “Not right now.” The kid is released. Two hours later the child is turning their no.2 pencil into a shiv. Nurse Ratched clearly didn’t get it.
Do you know who got it? Dr. Klerpachik. He got the message and called me twenty minutes later! As soon as I picked up the phone, his voice was on the other end asking for information. I brought him up to speed quickly, and he replied, “I’ve admitted her. I did it when I got the message. There’s a bed waiting for her. She’s clearly suffering, and I don’t like it. We’re gonna figure this out. Someone is gonna call you soon.” God bless his funky, cotton socks! I love him. I want to kiss him and buy him lots and lots of Star Wars fan fiction!
So, Grace is at the hospital for the fourth time in six months. She’s a frequent flyer. That’s what we’re calling her. I think that’s the nature of the…brain in this case.
Oddly, I’m not too stressed. Oh, I was. Yesterday, as I sat in Caribou, enduring Nurse Ratched’s insensitive laughter, I thought I might cry or implode. Listening to that nurse tell me to “get on the ball”, her tone dripping with self-righteousness, I wanted to roll around on the floor and scream. How dare she accuse me or judge me! Does she want to trade places with me? Could she do what I do? Does she want to take care of Grace AND an autistic child AND a 14 year-old girl on the bipolar spectrum AND a very normal 16 year-old, too? Does she want to do that AND try to have a life? Does she?
So, in my blind fury, I’m embarrassed to say that I texted a friend: “The nurse from Grace’s clinic defines ‘bitch'”, but, damn that autocorrect, this is what was sent instead:
“The nurse from Grace’s clinic defines ‘Butch’.”
I read and reread what I’d sent. I started talking to myself aloud in front of my daughter. “What? No! That’s wrong! That is NOT what I wrote! She’s not butch at all! She’s a…well, I suppose she could be butch. I haven’t actually seen her. She did sound sort of masculine on the phone..”
“Mom?” my daughter’s voice rising up, interrupting my loud ruminations.
“What does ‘butch’ mean?”
And that’s when I lost it. I just started laughing. Very, very loudly. The absurdity of it all. The idea that I even bothered to text someone about Nurse Ratched. I don’t like calling other women bad names. I call myself a ‘bitch’ from time to time, but, really, I don’t like to call other women that. I was hurt and frustrated and scared for Grace. It’s better to just identity what I’m really feeling rather than transfer my stuff onto a complete stranger even if said stranger was, let’s face it, insensitive and rude. She did, however, do her job. She passed the message to Dr. K, and Grace is now where she should be.
In the end, it was a long day, but it wasn’t a bad one. I’m starting to get the hang of this.