Archive for the 'In Hospital' Category

Creative Hospital Discharging of the Mentally Ill

Tuesday, January 29th, 2008

This post falls under my Recollections posts of my experiences with my son DS in 2007, who has been diagnosed with schizoaffective disorder. As I began to explain in my Third Hospital Admittance post, my son was hospitalized for third time in three months last summer on August 1st, 2007.

My husband and I and DS’s two youngest siblings were in Florida at the time he was taken to the emergency room. We were returning to our home in Georgia the next day when I received a call from DS on my cell phone. He was very anxious and fearful about the delusions and hallucinations he was having. He begged me to get him out of the hospital. “Begging” is actually too mild a word. I have never had anyone ask me (over and over again) for something with such fervor and earnestness. If it was in my power to to do anything, I think it would have been very difficult for me to do nothing. The power to release him from the hospital was in the hands of a doctor, as I told him again and again. I was extremely upset by our “conversation” if you could call it that.

DS was in the hospital until August 15th. In the interim, I made and rescheduled three optometrist appointments for DS. I was told by MG at the AM personal care home that DS had broken his glasses. I asked if it was just the lenses that broke or whether the frames were also broken. She did not know. She was only telling me what another resident had told her: he saw DS break his glasses. Apparently no one knew what became of the broken glasses. I remembered DS telling me earlier that there were microphones in his eyeglass frames that “they” were using to spy on him. I knew from the strength of DS’s prescription he would be rather uncomfortable from not being able to see as well. On the telephone, he complained of bumping into walls in the hospital because he could not see. I think to him it was more evidence of how he was being affected by the illicit “drugs” (narcotics, meth) that “they” were trying to kill him with. I felt horrible about him not being able to see, so I kept on rescheduling appointments at the eye doctor’s office. I did not have a clue when he would be discharged, and I wanted his appointment to be as soon as possible. I felt bad every time I talked to the receptionist about changing the appointment.

She never asked a reason and I never gave one, and I silently thanked her for that. Through this whole experience I have learned to try to be less critical of people. I do not know what it is going on with their life and if they do not tell, it may be that it is too painful to tell. On the other hand, I remember, too, the critical librarian who ran my preschool children and I out of her quiet sanctuary the day we needed some refuge from DS, following his first hospitalization. It still hurts; I do not think I have been back to that library branch since.

Now I will tell you about the “creative hospital discharging.” DS was not happy with AM, the personal care home. He did not want to go back there when he was discharged; he wanted to come home. I reminded him that he felt no more safer at home than he felt at AM. I knew DS was still going to be too much of a handful for me and his five-year sister and three-year old brother to live with. I knew I had to stand firm. He could not come back to our house. On the 14th of August, I learned DS was being discharged. I asked JC the social worker, “How are we going to do this? DS says he refuses to go back to AM.” He said, “Don’t say anything about where you are going. Just pick him up and drive him to AM.” I did not think it would work, and I told him so. DS and I had had many conversations before that day, and DS knew where I stood on the matter.

So I show up at the mental hospital, Wellstar Behavior Health, in Austell, Georgia to pick up my son, DS. My five-year old was at kindergarten, but I had my three-year old with me, who was tired because it was his nap time. He clung to me the whole time we waited for them to bring DS out to the lobby. It seemed to be taking a very long time. When DS came out he was walking between two male staff members. This is the only time I have seen this. (On one of his previous discharges he came out with one female nurse who gushed, “we just love having DS, he is so sweet.”) I had the feeling that just before DS came through the door they were physically forcing him to move. The first thing DS says to me is “Mom, I can’t believe you are doing this.” Then he changes his tact and starts saying, “this is not my mother, I am not going with her.” DS had been saying the “you are not my mother” thing a few days before and earlier that summer. I am not certain if it was a delusion, or a way of trying to hurt me. I think he knew that he could hurt me worse by saying “I hate you, you are an idiot,” which he did, and still does on some occasions. A piece of me thinks the “you are not my mother” was a delusion he fell upon when I was not doing what he expected I would do and disturbing his reality.

Anyway, after discussing it for a while, it was obvious DS was not going with me. He was also saying things like “I would rather be homeless than go back to AM.” DS is standing there between these two guys the whole time, and one of them picks up the telephone and calls a RN nurse to come out. She came out and looked at me without a word with one of the coldest expressions I have ever seen in the healthcare profession, or to be less critical of her, maybe she had already had her fill of DS’s behavior for the day. (Why do they think people who are this unreasonable are ready to be discharged?) I surprised myself with my own strength when I said to her in a very calm voice, “He is delusional, he says I am not his mother and he would rather be homeless than go with me. He is a danger to himself.” She says, “ok,” and back through the door they all go. I carry my sleepy three-year old back out to the car for the fifty minute drive home. For a change, I think I do not shed a tear.

The next day, I am determined I will not answer the telephone if the caller identification says it is the hospital. JC calls once and leaves a voicemail that DS will be discharged that day even if it means discharging him to a homeless shelter. I start formulating a plan for how I will help DS if they discharge him to the homeless shelter. I figure I can show up in the evening when he is standing in line for his slot and give him his medication. I can give him food and some money for food. But I will not bring him home. This is a really brutal thing that is happening to DS. He has never lived away from home before that month, always dependent on us his parents. It was a waiting game all day. Later, JC calls and leaves a message that Dr. K. says DS will not be discharged to the homeless shelter, and JC will work on finding him another personal care home.) A sigh of relief for a brief reprieve.

The next morning I realize I have another voicemail from the day before. I do not know why I missed hearing the telephone ring. It was a call from MG at AM, the personal care home. (Sorry about all the acronyms.) DS had just shown up in a taxi on their doorstep in the evening and he did not have his discharge papers. It is one of the regulations; she needs the discharge papers. I call the hospital and request they fax me the papers. (The fax machine to the rescue again. I am telling you, if you have a mentally ill person in your family you need a fax machine.) I believe I call MG back first with apologies for not returning her call sooner; I am incredulous. DS appeared in a taxi? Who paid the taxi? It was prepaid. Did the hospital call you first to let you know he was coming? No.

When I visit DS, he is very subdued and despondent. I have never seen such a picture of abject misery. I see him still in my mind’s eye with his head in his hands as I ended our visit. I cry bucket loads of tears for him on my ride home. I guess for all of his talk about preferring homelessness he realizes he is better off to stay at AM because he could get up and walk out the door anytime if he wanted to. A couple of days later, when I get the courage, I ask him how he ended up in the taxi. He said they told him he was going home. I did not know, and I still do not know, whether I should be angry that they lied to him, or glad that he did not end up homeless in the street. I was so angry and confused I knew I could not discuss it with anyone at Wellstar. I am sure someone very smart could defend their actions by saying “we said he was going home and AM was his home.” I am sure they knew full well that DS would not understand it that way. I am still wondering who orchestrated the whole thing: the doctors, the nurses, the social workers, or all of them.

Well, how about you, my readers? Have you ever been lied to like that when you were in the hospital? Do you think I should be angry about the lie or glad that my son ended up where he would probably be safer? (I am not even sure what I mean by the last part of the last question: safer than being in a hospital that lies to you or safer than being homeless?)

Move to the First PCH and Third Hospital Admittance

Saturday, January 12th, 2008

This post is the next in my series of Recollections about my son, DS, who was diagnosed with schizoaffective order in the summer of 2007. My son’s second hospitalization ended on July 24th, 2007. I brought him home and we began to prepare for his move to a personal care home I had found which was located about thirty minutes away in Marietta, GA. On the night before DS moved (July 28th), he did not sleep much, I believe. He was trying to decide what to bring and cleaning, cleaning, cleaning as he was going along, of course. He has never lived away from home before, even for college, so this move was stressful for him. On the morning of the 28th, he was very agitated and upset. He was saying he wanted to go back to the hospital. That did not make any sense because he hated and feared the hospital.

black and white trianges

photo by silentvale 

When we got to the personal care home—I will abbreviate its name as AM—he was calm enough. They had told us in advance that check-in would take two hours and they were right about that. They had a plethora of paperwork for us to do. I remember DS sitting on the couch next to me, looking very drowsy through it all. They gave him a room with no roommate, though no guarantees that it would remain that way since all the rooms had two beds. His bedroom had a doorway adjoining a bathroom that passed through to another bedroom where two other men stayed.

I helped him to unpack and we had to make an inventory of every item he brought. In theory that sounds like a good idea, but in reality, over the course of the next few weeks we were bringing stuff in and taking some stuff out, and there never seemed to be a staff person available to bother with updating the inventory sheet. He wanted to bring his computer, even though there were no guarantees about being able to get it hooked up to the internet. That was an issue that MG said she would look into, but she had not yet. With the computer desk it was just too much for me to be bothered with that day. I told him we would try to get it to him in a week or two when I could get his grandfather (my dad) to help.

There was one ironic thing that happened. The home manager, MG, had brought her grandchildren with her to work that day. One grandchild was a two-year old little boy who wandered into the bedroom as we were unpacking. I could tell his presence was making DS anxious, either because to DS’s mind the child was not clean enough, or the room was not clean enough and the child was touching things in the room. One of the reasons I was putting DS in a personal care home was to get him away from his two and one-half year old brother. I gently nudged MG’s grandson out into the hall telling him, “go find grandma,” and shut the door behind him.

After the unpacking was done, DS had to submit to a visual inspection of his undressed body, performed by PL, who is the 27-year old son to MG and father of the aforementioned children. (That probably explains, too, why the children were there. Their father had to bring them along because their mother was working.) The reason for the inspection was so that any bruises, injuries, or whatever could be noted and documented in the paperwork. I began to piece together that AM was a family business. MG was the home manager, her mother was the owner and her son worked there as staff from time to time. They had at least a half dozen different staff people that worked there at one time or another that I saw, but usually when I dropped in I only saw one staff person in the home at a time.

I left instructions that DS was to go to a hospital outpatient program called OCS (Outpatient Counseling Services at Windy Hill in Marietta) and they had transportation to pick him up. They said they would be sure to wake him up early enough to be ready and they did. The program was five days a week. I was told by people at the hospital (Wellstar Behavioral Health) that it was an excellent program for people newly discharged.

It was on a Saturday when DS moved into his personal care home, AM. On Monday, his father and I, and his five-year old sister and two and one-half year old brother got in the car to make a trip to Florida to visit my husband’s mother and sister’s family. It had been a long time since we had visited them, but it was not easy for me to leave town since I was worried about DS. We had planned this trip for a long time because my husband had some work scheduled off then. We planned to return on Thursday because the five-year old had a kindergarten open house on Friday. I got a telephone call from DS about once a day. Although he had made some improvement at the time of his most recent discharge from the hospital he was reporting that there were drugs all over the chairs at OCS and there were gangs outside of AM making gang signals. He did not feel safe. These were his typical delusions that he was having at the time of his first two hospitalizations.

Wednesday night around 10 p.m. I received a telephone call from MG, the manager of AM. She said DS was on his way to the emergency room. She told me the following story. DS had also told her that he was not feeling safe. She understood what was going on and offered to drive him to the emergency room. They got in her car and were driving down the road when he began to vomit. She pulled over to the side of the road. He got out of her car and when he finished, he took off running between some houses and trees and disappeared quickly. She called the police. When they arrived she answered all their questions and asked them, “please can I go now to look for him.” She said she “felt for DS” like her own son, because she has a son the same age. While she was talking to the police they received a radio report that DS was found. Apparently he had stopped at some house to ask for assistance and they had called 911 for him. For anyone keeping count, (I am) that made DS’s fifth encounter with police or emergency personnel for the summer.

We were planning our return home on Thursday morning (August 2nd) anyway, so there was no need to change our travel plans.

Recollecting the Second Hospitalization Summer 2007

Wednesday, January 2nd, 2008

DS’s second hospitalization last year for schizoaffective disorder with psychosis lasted from July 13th through July 24th, 2007.

It began with a marathon session in the emergency room. DS’s grandfather (my dad) and I accompanied him. After we got in an examination room, a woman came in to do an evaluation. I am sorry I do not know her job title or name. She remembered DS and his grandfather from his previous emergency room visit, and after we were able to speak with her privately in the hall, she expressed her shock that he was back so soon. I now wonder how long she may have been in her job. Given our experience this year and all I have learned since, can it really be possible that it was a shock that he returned? My Dad spoke with her about our disappointment in the lack of communication we felt we had with Wellstar Behavior Health last time. She gave me the name, “Lily,” someone in a position there, and said I should speak with her if I ever feel communication is a problem again. I never did that, and I probably should have. 

It did not take too long waiting in the emergency room for arrangements to be made for the hospital transfer from Wellstar Kennestone Emergency Room to  Wellstar Behavior Health. What REALLY took so long was waiting for an available ambulance. We were there before noon, but DS was not transferred until after midnight. I wonder why mental hospitals do not have their own emergency rooms or triage area or whatever. It was not at all a pleasant experience with DS belittling or berating me constantly for causing him to be there. Finally around 10 pm, my dad, who is a very soft-spoken and gentle man, somewhat uncharacteristicly let it be known to DS that he was out of line. I was very grateful to Dad for that. I suppose it was not a necessity that we wait with DS for his transfer. They had a security person checking the room every few minutes. (Would that have been enough to prevent an “escape?”) However, he was sick and I did not want to leave him alone if it was humanly possible for me to be there. Also, I think anyone is justified in not wanting to leave a loved one alone in a hospital any more than absolutely necessary with nursing shortages and medical mistakes, etc. We had a very bad experience with my mother in this same hospital a few years ago. 

So, DS was transferred to Wellstar Behavioral Health in the wee morning hours on Saturday the 14th. On Monday morning, I believe, I received a telephone call from Dr. LT. Almost the first thing she said to me was, “it sounds like you have had a rough week.” I wondered if she knew that from talking to DS or from some reports from the emergency room. In any case, it instantly endeared me to her. (At last, a doctor with a bedside manner and who called me first!) I wondered if DS was assigned to her because of our complaint we made in the emergency room about communication.

This time DS was started on Risperdal, Depakote and Zoloft. He continued to take the Clonapezam. I did not visit DS as often in the hospital, but we talked on the telephone nearly every day. I noticed a big improvement in the delusions within 48 hours of starting the Risperdal.

During this hospital stay we (DS, his father and I) had our first ever meeting with a social worker, JC. He mainly wanted to establish where DS was going to be staying after his discharge. DS was certain he could go to live with another patient there named Mary. All the rest of us said that did not sound like a good idea. DS was very argumentative, interruptive and demanding the whole meeting. To finally reassure him that I was interested in his concerns, I took out my red memo pad and wrote down what he wanted me to about what he desired in a personal care home. That calmed DS down long enough to give JC about a minute to have his say. DS turned to me and said, “Why are you not interrupting him?” I said, “Because I want to hear what he has to say!”

little red memo book

After the meeting when JC was showing us out the security door he said, “You were really great. I do not know how you do it.” I was shocked. You mean, he does not deal with people like this every day? Well, obviously, I was feeling like I could not “do it” much more, at least not on a daily basis. That is why we were having a search for a personal care home. I must have said something that gave away my naivete at this time about how quickly I expected medicines or therapies to help DS get back to himself. JC gave us a warning to expect things to take some time. My mind has turned back to his warning again and again when I have been disappointed.

As I was saying in this post, A Place for the Young & Mentally Ill, I did have a personal care home identified by the time DS was discharged.

First Hospitalization June 2007

Tuesday, December 11th, 2007

Wellstar Hospital in Austell, GA

DS (my dear son) went into the hospital for the first time in 2007 with extreme delusions, hallucinations, paranoia, you-name-it.

DS was admitted on June 2nd and discharged on June 19th. The hospital is called Wellstar Behavioral Health and it is in a separate building behind Wellstar Cobb Hospital. Only two visitors over the age of twelve are allowed at a time during very strict visiting hours that occur twice a day for an hour and a half each spell. Patients are not allowed to have any belts, strings, shoelaces or anything sharp. Razors and things that are considered “sharps” like fingernail clips are kept in their own tiny locker that only staff can access. They must be watched while they shave. Of course, security is good, with the doors being opened for visitors by staff members with keys.

I tried to visit DS two or three times a week which was very difficult with the distance and the fact that I needed to get a babysitter for his five-year sister and two-year old brother each time. My husband was working horrid irregular long hours.

For the first week nearly every day felt like a crisis because DS would telephone me and say he was being discharged. We did not have a clue when he would be discharged. I left messages with the doctor three times to call me. He never did. (That is very typical doctor behavior I came to learn.) At the same time DS would be saying things like how filthy the place was with drugs all over everything. At times he thought the other patients were hostile towards him, organized in gangs. I did not know what kind of treatment DS was receiving other than what he told me: Zyprexa, Geodon, and eventually Abilify. Also he went to group therapy.

One time when I visited him in the first week I brought fingernail clippers that he had requested. The nurse refused to take them (to put in the sharps locker) saying, “he won’t be here that long.” Three or more days went by and I tried to bring him fingernail clippers again. She started to say the same thing, but I insisted she take them. We were met by DS in the hallway after we got in. He started saying some things to her about his latest delusions. My eyes met with the nurse’s and she seemed to say without a word, “he will be here a while longer.”

On Saturday, I got a call from DS saying he was discharged. By this time I was learning not to panic when he said that. I called the hospital to confirm the fact, and a social worker told me it was true. It was done. Come pick him up. I said, “How could this be happening? We never had a family meeting. I was told there would be a family meeting with a social worker. DS cannot come back home to live. He has a little brother and sister. He told me he hopes they have been practicing being quiet, with a threat implied.” She asks how old little brother and sister are. Silence. She says she will call the doctor. The rest of the day feels like playing chicken with the hospital. Who will flinch? I wonder if they will just put him out on the street since they discharged him. By Sunday I had learned he was undischarged. (I sympathize with whoever had to do the paperwork.) On Monday I spoke with another social worker. They were going to work on finding him a personal care home.

By the end of the week no PCH home was found. The following weekend he was having delusions about rapes occuring in the hospital. He wanted me to bring him a sleeping bag. He also said someone was stealing his weight off his body. (Interesting idea. I wish someone would steal some of mine.) I called the staff to tell them. I was actually concerned about the idea that some kinds of assaults were occurring, but the staff person I spoke with was certain nothing could have happened with all the monitoring cameras they have, etc.

The next day a social worker told me there was nothing more they could do to find a personal care home (PCH). There were no available slots, and the doctor was going to discharge DS. They promised that BH of Altrus was on the case and would continue to hunt for a PCH after DS was discharged. They had mentioned an excellent outpatient program at Windy Hill called OCS (Outpatient Counseling Services) at the Hope Program, I think. It was too far for me to drive him everyday, and since we lived in Cherokee County and not Cobb County transportation would not be provided for him to go. They made an intake appointment for him at Highland Rivers in Canton, Cherokee County, closer to home, for follow-up care two weeks away. I was worn down by then and resigned to bring him home.

He was discharged on Tuesday, June 19th 2007. I had to bring little brother and sister with me, so they brought DS out the security door with his stuff. After signing his papers and getting his prescription papers, we headed for the car. We ended up in horrible afternoon rush hour traffic in a thunderstorm. Little brother cried, or should we say, screamed, for at least 45 minutes straight. I was nervous about DS’s reaction to all the noise, but he was on his best behavior because he was just so glad to be out of the hospital, I guess. My nerves were feeling rather shot. We went home to get some dinner first before going to the drug store to fill his prescriptions. Why do hospitals always make us have to deal with filling prescriptions the very hour of discharge?

At home I wanted to get the little ones some dinner right away since it was past time. As I struggled to get things on the table and on the plates, DS was interrupting me constantly. Mostly he was demanding me to bring cleaning supplies to him. He was extremely agitated. He could not touch anything because everything was contaminated with drugs from the hospital. If he tried to clean something he would touch it and contaminate his hands. Then he had to wash his hands. He has lived in this house his whole life and was asking, “where is this or that.” The very moment the children finished eating, I took them and left the house.

We dropped off the prescription for Abilify at the drug store and went to the library. In the library I hoped to get some peace and quiet and pick up some books, too. Unfortunately the two-year old was in a mood to be rambunctious and despite my efforts to settle him down, the librarian came over and said some things that embarrassed me. We left.

We went next door to a playground, although it was raining. I could not think of where else to go and it was too soon to go home. I sat in the rain and called the social worker at the hospital. Of course, it was after hours so I got her voice mail. I said to her voice mail, “Well, here my children and I are sitting in the rain because DS has run us out of our house.” I was angry at them discharging DS too soon and dumping him on us. I regret taking my anger out on the social worker. It was the doctor I was really mad at. I never heard anything from that social worker or heard her name mentioned by any other staff at the hospital again, during other hospitalizations DS had. It makes me wonder if she found a new job.

The thunder had stopped by then (or we would not be outdoors), but the children got thoroughly soaked. They loved it. The two-year old did not even mind falling face first in a mud puddle. I sat there and sobbed out loud a little but not too much to try not to distress them.

When we went to the drug store, we could not pick up the medication because they did not have any in stock.  When we got home DS seemed a bit calmer because he had finally managed to clean most everything to his satisfaction, I suppose. The clothes washing machine was running.

This was the first hospitalization of four that DS had in 2007.

Leading up to First Hospitalization 2007

Saturday, December 8th, 2007

26 May  – 1 June 2007

 DS asks me to come to his room. He asks me if I hear the neighbors. (We live in a single family home a dozen yards from any neighbors.) At first he tells me he is hearing them, then he says he thinks they are listening to him, like on a two-way radio.

This is the first major clue to me that we are dealing with  psychosis or schizophrenia again. (Eventually, I am told schizoaffective disorder.) He says he does not want to see the doctor. This week becomes a week of ultimatums between DS and us, his parents. See the doctor or be homeless. Take your medicine or be homeless. Pain. Turmoil.

He finally agrees to take the medicine and go stay at his grandparents (my parents). Too little too late. Two days later I get a telephone call from my mother. DS is saying there is methamphetamine on the floors and countertops and all over her house. He fears he is high from the drugs because he thinks they get into his bloodstream when he touches them.

When his grandfather (my dad) gets home, DS agrees quickly to go to the emergency room because he fears he is high. I call my husband (DS’s father) at work and he agrees to go to the emergency room to meet them when he gets off work. From the emergency room at Kennestone Hospital in Cobb County, Georgia, DS is transferred to Wellstar Behavior Health behind Cobb Hospital. This is what used to be called a mental hospital, I guess. It is a separate building behind the regular hospital. Dad and hubby are told it is DS’s best option since his only insurance is Medicaid. They sit with him in the emergency room until 3:00 in the morning waiting for the transfer. They are told there is no point to following the ambulance to Wellstar Behavioral since they will not be able to visit him for quite a few hours.

He entered the mental hospital June 2nd.