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How NOT to be a trustworthy psychiatrist
First--hi, this is Jessica/Darsy/James/ssergit/that weird girl (as opposed to Gregory/Wolfy/Treellama/her husband, whom I said would post if I could not). I am doing fine. Before I address anything that's happened, I want to say, ♥.
Now, a couple of questions for you:
-Do the ends justify the means?
-If you've had a professional failure in your past, do you think you're capable to look at future, similar situations without bias?
Actually, the real question is, would you lie, manipulate, and threaten in order to save someone's life, even if it would call into question your professional ethics?
For those that want to know what happened without (most of) the tl;dr, look for the Invasion of the Stars (*****) and Cliff's Notes 1.
A littleactually, probably a lot setup for you, recap style. When I was 16, my father died. Three weeks later, my best friend's dad died, too. Naturally, this didn't go over well with either of us, and our reaction fit our age--instead of being a support, we fought and she won. The prize? All of our friends. The booby prize for me was prescription drugs and the beginning of a series of awful experiences with the psychiatric community.
Not everyone gets along, and, in addition to that, some of us have extraordinary bad luck. Finding the right person takes time, and the proverb of kissing a lot of frogs before finding your prince is applicable to all manner of situations. In the case of finding someone who was helpful for me... well, I struck out about 10 times in 7 years before I gave up.
Now, don't get me wrong. I'm mature enough (now) to realize that not all of these people were incompetent. Some needed a wider worldview--like the first person I was sent to, who knew nothing about Christianity and spent our sessions asking me questions about it. The second guy hit on me (and, though many of you know that I'm naturally attracted to the more mature male archetypes, this guy in particular was creepy and older than my father--which, considering my dad was 44 when I was born, is *really* saying something), and his way of 'helping' had more to do with things like writing backwards and trying to get in touch with my inner child. Whether he was trying to do the same, I don't know--I didn't stick around to find out. Then there was the gentleman who was so impressed by my writing that he asked me to bring new things and gushed over them each time. I kid you not. Great for the ego... not so great for the mental health.
More than once I was sent to a psychiatrist (in theory), which at the time seemed to be seeing a therapist 3 times a month(or, as I like to call it, someone who talked about seemingly nothing, and never offered any suggestions as to how I could improve my outlook or my attitude), being prescribed whatever the current 'hot new psychiatric drug' was, and seeing the actual psychiatrist once a month. When I saw him (both of them were hims), I'd be asked standard questions about my weight, attitude, and whether the drugs worked. For about ten minutes.
The final straw was a woman who was wonderful; she was really helpful and encouraging, and did what I'd been looking for FOREVER--giving me suggestions and helpful tips on how I could improve as well as take my 'hot new item' meds every day. She was still taking new patients when I was seeing her, and she ended up taking one that caused a conflict--my mother. She decided it was a bad idea to see both of us, so I got ditched out the window. She'd been seeing me for six months, and my mother for one.
I gave up on a psychiatric solution.
***** Cliff's Notes 1: I am not the world's biggest fan of the mental health profession, after getting the shaft with no lube for many years. *****
Some of you may recall the memory issues I posted about (medical tag) earlier. My primary care physician decided to start figuring them out with two options--a CT scan (negative), and a visit to a psychiatrist. It's important to note that when the PCP sent me to this man, it wasn't for depression. I have so much shit going on I never bothered to tell him it was a problem (and to be fair, the scary shit has only been going on for a month).
It was a hard decision to go to see this guy. I'd been burned so many times and had little to no faith that it wasn't going to happen again. Gregory, who is the most optimistic yet realistic person I know on this earth, begged me to give it a try. 'There are good people in that profession, don't let a few bad ones ruin it for you.'
Look for Cliff's Notes 2 and the Attack of the Tildes (~~~~~), if you're short on time.
Now, I talked to this guy three times, once for the full hour, once for a half hour, and lastly (yesterday) for twenty minutes. During the first meeting, the first half hour was for the reason I was sent to him--to discuss the odd mental stuff that had been happening, presumably to see if there was a psychiatric source in this man's opinion. Being thorough, he asked me if there was anything else. I should have shut my fucking mouth. Instead I admitted to being depressed, to having a history of it over the past ten years, and feeling worthless enough to have considered the world without me in it, albeit not actively. We scheduled a meeting for the next week.
When I got there, from the beginning of the session, he began speaking about an out-patient program for severely depressed women, that meets three times a week. It was clear that the session was intended by him to be used as a persuasive measure, to try to convince me to attend. We didn't talk about my feelings or anything that had happened, we talked about the program and I asked him questions. Specifically, whether the meet times were often (yes. BAD. I don't do well going from 0 - 60 in terms of being alone to being around a lot of other people), whether they fit into my sleep disorder (no. BAD. I'm not going to be able to a) go to a daytime group when I've got Delayed Phase, b) be able to meet three to four times a week for four hours a day when I get anxiety attacks about one doc's appt in a MONTH, c) spend prolonged periods of time around other people, because that triggers severely depressed episodes). My persuasion got nowhere, and neither did his. He asked to speak to Gregory next time, and we scheduled to meet again. He pressed me for that half hour (it was supposed to be an hour) and when it looked like it wasn't working, he ended the session.
Then comes Thursday. Gregory and I go in there thinking 'okay, he wants an outside perspective on my behavior. That's good--if I'm having trouble with memory and saying things inaccurately because of whatever that problem is, Gregory will be able to help.' We get there and it's 'send her to the hospital TODAY, for her safety' drilled into our heads. I want you all to know that while I do feel worthless, I have never, never actively sought to end my own life, I've just feared that I might. I'm terrified of pain and any kind of maiming, and just flat out don't think I could do it. Yet this man was convinced (and he convinced us) that a prolonged stay at the hospital was my only option. We left after about twenty minutes, having been lectured to and cajoled during that entire time.
I went home and sent hiatus messages to many comms at LJ.
~~~~~ Cliff's Notes 2: I spoke to the guy three times, for a total of maybe two hours. He became convinced I was going to be a danger to myself, and he convinced G and I to go to the hospital. ~~~~~
Now, you can imagine that it's one thing to go somewhere with a bureaucratic system and try to convince them of something, and it's quite another to not be very convinced of something and arrive at the same system. It turns out that at this place (which is nationally renowned for not only their patient care but for psychiatric studies), once you walk in and triage speaks to you, you cannot leave until you've been evaluated by a clinician. We arrived at 7:00 PM. I got the preliminary eval at 10:00 PM. We finally left the hospital at 4:00 AM. Those nine hours, and particularly the last four of them, are among the worst experiences in my entire life. Including losing my dad, and being sick earlier this year with the stomach flu and throwing up for four days in a row.
From the beginning, my greatest fear was simple. Ask yourself if you think you'd be able to check into a hospital, know that your every behavior would be examined to determine your treatment--and know that all of that evaluation would happen in the middle of the night. Add on top of that the knowledge that you're not good with people, and that you have a disorder where if you're awoken in the middle of the night, you will behave in a psychotic manner. Replace 'night' with 'day' and add in my sleep disorders, and you've got my fear about checking in. Then think about this: at some point, some people get so bad that they're not allowed to check themselves out. What if I got really bad emotionally--not because of the *depression* but because of the sleep disorders and the fact that I spend all my time alone and yet am going to be around people for a long time? What if I got so bad they wouldn't let me leave, and yet the reason I was bad was because I was there?!
Yet, I went there with the full intention of doing it anyway.
Look for the Infiltration of Ampersands (&&&&&) and Cliffs Notes 3 if you'd like to skip this section. If you like to read about betrayal and corruption though, give it a whirl. Good family fun. NOT.
I was sure that I could impress on them the necessity of doing an accurate eval, which would include their knowledge that I have these disorders and that waking me up/keeping me up wouldn't give them an accurate picture of what was going on, and subsequently would distort any of their findings. At first, it appeared to be working. The triage (height, bp, 'what brings you here today' section) nurse was even kind enough to put my sleep hours in the notes when she checked me in (this is exactly like an ER, but is only for psych patients). I was very careful to walk the fine line of tact between insisting that the special needs HAD to be met, and making sure they were aware of them. I didn't want to look like a prima donna, after all.
At the preliminary eval, I admit I was impressed. The main four questions...:
-Do you feel the world would be better off without you (yes)
-Have you actively attempted suicide (no.)
-Have you planned out a way to hurt yourself in any way (no)
-If there was a way you could remove yourself from the world without causing harm monetarily or emotionally to anyone you care about, would you do it? (probably)
...made me feel that they would understand the difference between wishing yourself dead and actually making it happen. The impression I got from the clinician was that I seemed pretty bad off emotionally, but wasn't a present danger to myself enough to admit me to the hospital. This was reenforced by the psychiatrist evaluation that happened an hour later as a followup, and with Gregory in the room I cried, afraid that my psychiatrist would call me on Friday and demand to know why the hell I was home, when he'd told me to go to the hospital. I felt like I was in some way letting him down, and I literally wasn't sure that I shouldn't trust his judgment enough to try to convince them to let me stay. Gregory assured me that he hadn't seen me misrepresent myself in any way, but did admit that the psychiatrist had been adamant that I be admitted.
They weren't sure, assured me that I wouldn't be in trouble and that I could come back if I felt I would harm myself, and asked me if they should call the guy (it was 1 AM) to get his opinion.
I reiterate. I should have kept my FUCKING mouth shut.
After the call, the guy came back and told Gregory that the psychiatrist wanted to talk to him in private on the phone. When G came back, he was deathly pale, near to tears, and told me I had to stay. The psychiatrist from the hospital agreed. Clearly the man they spoke to was very concerned. My first hint of a problem came when G told me one of the things that (we'll call him Jerk from now on, you'll see why) Jerk told him.
Jerk said to my husband that if he didn't convince me to stay at the hospital, he would refuse to treat me anymore.
You guys know me. I do NOT like being manipulated, and I do NOT let people try to blackmail or threaten me. Essentially what the man was saying was that if I didn't stay at the hospital, I wouldn't get any treatment from him, either. I'd be on my own.
The doc talked to me about what the circumstances would be for admittance. I reiterated my fears about the way my sleep disorders would affect my treatment. In the Patient's Rights form I'd signed hours before, it stated in various different ways that I have the right to be treated in a way that doesn't harm me, that respects my individual circumstances, and that, most importantly, is something I feel comfortable and safe about.
During this discussion, the man that I'd had evaluating me for over two and a half hours (which is longer than the cumulative time I'd spent with Jerk, and two hours longer than I'd ever spent talking with him about my depression and thoughts of worthlessness) spoke about the routine at the hospital. He admitted the fact that the evaluation team starts work at 9 AM (and it's no guarantee I'm to be seen first), which would be 2 AM for someone that normally goes to bed at 12 AM. He also said I would HAVE to speak to them (his exact words were, 'they'll wake you up'). My first fear realized. He then spoke about the exercises and group meetings that are optional throughout the day, that are encouraged but not required. I said that I'd be unable to attend any of them, and he said, 'if your little sleep problem stops you from going to a few of them, I'm sure the staff will understand.'
Stop. WHAT?!
Just... no. If I've just spent over two hours trying to explain to you that I'm NOT going to be able to be coherent and awake during the day, and how it's a DISORDER, not some whim that I can turn on and off, how am I possibly going to be able to convince a staff that's likely to have 'seen everything' and most certainly trained in some way to treat the patients similarly (as in not favor anyone or give in to special circumstances)?! What you say when you aren't trying to be deceptive is VERY telling--and this man just let slip that he didn't have any respect for the most important thing I was trying to tell him. Gregory asked him if he thought he'd be able to be fully functional and capable of communicating coherently the next day at 12 PM, and you guys should have seen the disconcerted look on his face. He went away to speak with his fellow docs.
When he came back, he had an admittance form, and sat me down with it and practically cajoled, begged, and pleaded that this was the best thing for me. G held my hand and I decided I could do it if I had to.
The first form is a consent and agreement by the patient to give 72 HOURS notice if they want to leave the hospital (ie check themselves out). I immediately expressed concern. That's a longass time, considering I would be able to decide for myself at 9 AM when the eval team woke me up the next morning (incidentally, he said he'd 'leave a note' but I'd have to explain my sleep situation to them myself). If they were going to tell me anything remotely similar to 'honey, I know you think you need special circumstances, but this is a hospital, and we need you to be awake during the day' I was going to be SO out of there. Then I asked if I could have my computer. Nope. Could I have paper and a pen? The pen is iffy, probably not. Oh, and there's no TV.
O.M.G. Sad as it is, those things keep me sane, people. Tv and writing and talking to you fine people. Take away a depressed person's ONLY things they look forward to and tell them that's going to make them better...
VERY reluctantly, I signed the form.
Next came the 'I agree that you're admitting me' thing. He kept telling me I'd have to 'play it by ear' (which I think was his way of telling me I'd have to suck up and deal). Then G asked about eating schedules. The kitchen is closed at night, big surprise. They don't make exceptions. Lovely. Chances were, although slim, that I might even be medicated so I could be awake at the correct hours. He told me this right as I was signing my name.
At that point, I took my hand away, and told him this was going to be impossible, and to rip up the form. He tried a bit of persuading and then said he'd go talk to his team.
He took the form with him.
About ten minutes later I realized that he had my signature on a form agreeing to be admitted to the hospital, even though I had protested the whole way and reluctantly signed it, finally asking that it be destroyed.
Legally, they could admit me. I signed the form. Ethically, it was a huge grey area, since they had the form with my signature, and a biased witness (my husband) was the only person to hear me say to rip it up, besides the doc himself. When that man came back, he looked me straight in the eye after I asked if they could force me to stay, and said with that look you give children when they ask 'am I *really* grounded' and he said 'kinda, yeah.'
Gregory is a very calm man. He does not, however, like to be manipulated, threatened, or forced into anything. He went to talk to the guy, and he hasn't quite told me what the conversation was, besides that the gist of it was, 'she said she wanted the form torn up, you cannot admit her against her will.'
The thing is, there is a legal protocol for hospitals and family members to forcibly admit someone to the hospital if they think they're a danger to themselves. However, after my first evaluation, they weren't considering me for admission--they only changed their mind after they spoke to Jerk on the phone. Gregory then told me more about his conversation with Jerk as we waited, terrified, wondering if they were going to come back and claim that the signature was legally binding me to stay there. Jerk had told Gregory that I would manipulate him and everyone around me to avoid staying at the hospital. He claimed that I would stop at nothing, that I would lie calmly to his face about whether I would be safe, and that on no circumstances should I be allowed to go home. He told my husband that I wouldn't be safe, and basically my blood would be on his hands (Gregory's) if I wasn't admitted to the hospital.
(Note: G and I have talked this over, and based on the VERY limited discussions I had with Jerk (and the fact that longer discussions with other qualified psychiatrists did not merit this opinion until *after* they'd spoken with Jerk), we think that he lost a patient to suicide in the past, and is determined to stop at NOTHING in his quest to prevent this from happening again. He lied, manipulated, and threatened my husband into agreeing to admit me to the hospital, essentially.)
I was furious--I'd signed a form to allow them to call him for a consult, and resolved (and have since done so) to ensure that the form would be rescinded, and that he would NOT be allowed to discover in any way what the results of his efforts were. I figure it's a pretty damn good revenge to get a call at 2 AM about a patient, try to manipulate their loved ones, and then never find out what happened. Gregory was completely disillusioned and his faith in himself was *shattered*. He'd asked me to give psychiatry one more chance, and the person he begged me to go see had turned out to be a completely unethical and unprofessional person, in his opinion, despite any baggage he might have carried to our sessions (see 'note' above).
So there I was, having been essentially told that my greatest fears about staying at that hospital had been realized, the man who'd sent me there had tried to blackmail my husband into making me stay, and I could possibly be forced to stay against my will because I'd been in the process of signing my name when I found out just how close my original fears about staying there were to the reality. The evaluation psychiatrist came back and told Gregory that basically, if he would promise to be the one liable (and not the hospital) if I killed myself, they'd let me leave. G said it was the most difficult decision he ever had to make, and if the call to Jerk hadn't been the reason the evaluation folks at the hospital had changed their mind about admitting me, he would have asked me to stay.
I would have, if he'd asked me to. I had the Patient's Rights form with me, and had underlined passages that I fully intended to use as my weapons if I was going to be forced to stay there--the most important of which states that I have the right to be treated with dignity and respect, without harsh or unnatural treatment.
If you've skipped ahead, or want an idea of what the nearly 11 hours I spent at the hospital last night was like:
&&&&& Cliffs Notes 3: 1) the psychiatrist threatened to refuse treatment to me if I didn't stay at the hospital; 2) he threatened my husband that my blood would be on his hands (G's) if I did not; 3) the evaluation people referred to my sleep disorder as essentially an inconvenience, and stated that I would likely be required to be awake during the day; 4) during the process of signing the admittance form, it was made clear to me just how little my special circumstances would actually be considered (including the fact that I wouldn't be fed equivalent meals at night), and I requested that they rip it up; 5) instead of ripping it up, the eval psychiatrist admitted that he was considering using it as a valid consent form, as it had my signature. &&&&&
Like Jack said to Rose in Titanic--'I'm not an idiot. I know the way the world works...' I know that hospitals can't make exception for every special case. However, I believe that if that special case will directly affect the evaluation and subsequent treatment of a patient, it MUST be considered, and the Patient's Rights form I signed when I got there (which had four typos, btw, lol) states that multiple times.
I also don't want to blindly condemn people for doing what they believed was necessary to save someone's life. However, I firmly believe that the man I saw first came to the severest conclusion about my danger to myself because he may have lost a patient to suicide in the past. His determination to blackmail and guilt Gregory into convincing me to stay at the hospital (including attempting to destroy any trust G has in anything I say--'she will say or do anything to avoid being admitted'--even though I was quite reasonable in my concerns about staying at the hospital... it's disturbing. The hospital's evaluation psychiatrist's crisis of conscience about forcing me to stay there because I signed the form--the same form that I hadn't completely finished signing (I had to initial the back) and demanded he rip up (which he never did)... is disturbing.
Yet, I come away with this DETERMINED to find a psychiatrist who won't be dishonest or morally ambiguous/unethecal in his or her treatment. Why? Because Gregory went to bed in tears believing he betrayed me. He begged me to see the Jerk in the first place, and solely from that man's limited exposure to me, took me to the hospital. He was speechless for ten minutes after realizing what lengths Jerk went to, to try to get me admitted. You do NOT tell the husband that his wife's blood is on his hands if she makes the decision not to stay at a psychiatric hospital. If she's that bad, you call a code, and have her forcibly admitted. I firmly believe that man didn't think G would actually tell me what their phone conversation was about.
'Nobody puts Baby in the corner.' NOBODY makes my husband, a man I've never seen question his faith in ANYTHING, believe that he has lost faith. I will find someone to prove that he was right in the first place (not all psychiatrists are bad/are not a good fit for me), if I have to go through three football fields of shit to do it (Shawshank Redemption AND Dirty Dancing references in one paragraph++).
I'm going to post this, call my PCP, and go to bed--I've every intention of thanking you guys in the comments when I get up. However I have one last word for the wonderful people on my friends list. I haven't cried since I got home. I had one of the shittiest days in my life, and was treated pretty poorly by people with whom I had put a lot of trust but I haven't cried--because when I got home, I had 35 emails telling me what a wonderful person I was, how you were standing by me and thought I was brave, how I was in your prayers... and those virtual hugs mean more to me than all my TL;DR could ever say.
Thank you. ♥
Now, a couple of questions for you:
-Do the ends justify the means?
-If you've had a professional failure in your past, do you think you're capable to look at future, similar situations without bias?
Actually, the real question is, would you lie, manipulate, and threaten in order to save someone's life, even if it would call into question your professional ethics?
For those that want to know what happened without (most of) the tl;dr, look for the Invasion of the Stars (*****) and Cliff's Notes 1.
A little
Not everyone gets along, and, in addition to that, some of us have extraordinary bad luck. Finding the right person takes time, and the proverb of kissing a lot of frogs before finding your prince is applicable to all manner of situations. In the case of finding someone who was helpful for me... well, I struck out about 10 times in 7 years before I gave up.
Now, don't get me wrong. I'm mature enough (now) to realize that not all of these people were incompetent. Some needed a wider worldview--like the first person I was sent to, who knew nothing about Christianity and spent our sessions asking me questions about it. The second guy hit on me (and, though many of you know that I'm naturally attracted to the more mature male archetypes, this guy in particular was creepy and older than my father--which, considering my dad was 44 when I was born, is *really* saying something), and his way of 'helping' had more to do with things like writing backwards and trying to get in touch with my inner child. Whether he was trying to do the same, I don't know--I didn't stick around to find out. Then there was the gentleman who was so impressed by my writing that he asked me to bring new things and gushed over them each time. I kid you not. Great for the ego... not so great for the mental health.
More than once I was sent to a psychiatrist (in theory), which at the time seemed to be seeing a therapist 3 times a month(or, as I like to call it, someone who talked about seemingly nothing, and never offered any suggestions as to how I could improve my outlook or my attitude), being prescribed whatever the current 'hot new psychiatric drug' was, and seeing the actual psychiatrist once a month. When I saw him (both of them were hims), I'd be asked standard questions about my weight, attitude, and whether the drugs worked. For about ten minutes.
The final straw was a woman who was wonderful; she was really helpful and encouraging, and did what I'd been looking for FOREVER--giving me suggestions and helpful tips on how I could improve as well as take my 'hot new item' meds every day. She was still taking new patients when I was seeing her, and she ended up taking one that caused a conflict--my mother. She decided it was a bad idea to see both of us, so I got ditched out the window. She'd been seeing me for six months, and my mother for one.
I gave up on a psychiatric solution.
***** Cliff's Notes 1: I am not the world's biggest fan of the mental health profession, after getting the shaft with no lube for many years. *****
Some of you may recall the memory issues I posted about (medical tag) earlier. My primary care physician decided to start figuring them out with two options--a CT scan (negative), and a visit to a psychiatrist. It's important to note that when the PCP sent me to this man, it wasn't for depression. I have so much shit going on I never bothered to tell him it was a problem (and to be fair, the scary shit has only been going on for a month).
It was a hard decision to go to see this guy. I'd been burned so many times and had little to no faith that it wasn't going to happen again. Gregory, who is the most optimistic yet realistic person I know on this earth, begged me to give it a try. 'There are good people in that profession, don't let a few bad ones ruin it for you.'
Look for Cliff's Notes 2 and the Attack of the Tildes (~~~~~), if you're short on time.
Now, I talked to this guy three times, once for the full hour, once for a half hour, and lastly (yesterday) for twenty minutes. During the first meeting, the first half hour was for the reason I was sent to him--to discuss the odd mental stuff that had been happening, presumably to see if there was a psychiatric source in this man's opinion. Being thorough, he asked me if there was anything else. I should have shut my fucking mouth. Instead I admitted to being depressed, to having a history of it over the past ten years, and feeling worthless enough to have considered the world without me in it, albeit not actively. We scheduled a meeting for the next week.
When I got there, from the beginning of the session, he began speaking about an out-patient program for severely depressed women, that meets three times a week. It was clear that the session was intended by him to be used as a persuasive measure, to try to convince me to attend. We didn't talk about my feelings or anything that had happened, we talked about the program and I asked him questions. Specifically, whether the meet times were often (yes. BAD. I don't do well going from 0 - 60 in terms of being alone to being around a lot of other people), whether they fit into my sleep disorder (no. BAD. I'm not going to be able to a) go to a daytime group when I've got Delayed Phase, b) be able to meet three to four times a week for four hours a day when I get anxiety attacks about one doc's appt in a MONTH, c) spend prolonged periods of time around other people, because that triggers severely depressed episodes). My persuasion got nowhere, and neither did his. He asked to speak to Gregory next time, and we scheduled to meet again. He pressed me for that half hour (it was supposed to be an hour) and when it looked like it wasn't working, he ended the session.
Then comes Thursday. Gregory and I go in there thinking 'okay, he wants an outside perspective on my behavior. That's good--if I'm having trouble with memory and saying things inaccurately because of whatever that problem is, Gregory will be able to help.' We get there and it's 'send her to the hospital TODAY, for her safety' drilled into our heads. I want you all to know that while I do feel worthless, I have never, never actively sought to end my own life, I've just feared that I might. I'm terrified of pain and any kind of maiming, and just flat out don't think I could do it. Yet this man was convinced (and he convinced us) that a prolonged stay at the hospital was my only option. We left after about twenty minutes, having been lectured to and cajoled during that entire time.
I went home and sent hiatus messages to many comms at LJ.
~~~~~ Cliff's Notes 2: I spoke to the guy three times, for a total of maybe two hours. He became convinced I was going to be a danger to myself, and he convinced G and I to go to the hospital. ~~~~~
Now, you can imagine that it's one thing to go somewhere with a bureaucratic system and try to convince them of something, and it's quite another to not be very convinced of something and arrive at the same system. It turns out that at this place (which is nationally renowned for not only their patient care but for psychiatric studies), once you walk in and triage speaks to you, you cannot leave until you've been evaluated by a clinician. We arrived at 7:00 PM. I got the preliminary eval at 10:00 PM. We finally left the hospital at 4:00 AM. Those nine hours, and particularly the last four of them, are among the worst experiences in my entire life. Including losing my dad, and being sick earlier this year with the stomach flu and throwing up for four days in a row.
From the beginning, my greatest fear was simple. Ask yourself if you think you'd be able to check into a hospital, know that your every behavior would be examined to determine your treatment--and know that all of that evaluation would happen in the middle of the night. Add on top of that the knowledge that you're not good with people, and that you have a disorder where if you're awoken in the middle of the night, you will behave in a psychotic manner. Replace 'night' with 'day' and add in my sleep disorders, and you've got my fear about checking in. Then think about this: at some point, some people get so bad that they're not allowed to check themselves out. What if I got really bad emotionally--not because of the *depression* but because of the sleep disorders and the fact that I spend all my time alone and yet am going to be around people for a long time? What if I got so bad they wouldn't let me leave, and yet the reason I was bad was because I was there?!
Yet, I went there with the full intention of doing it anyway.
Look for the Infiltration of Ampersands (&&&&&) and Cliffs Notes 3 if you'd like to skip this section. If you like to read about betrayal and corruption though, give it a whirl. Good family fun. NOT.
I was sure that I could impress on them the necessity of doing an accurate eval, which would include their knowledge that I have these disorders and that waking me up/keeping me up wouldn't give them an accurate picture of what was going on, and subsequently would distort any of their findings. At first, it appeared to be working. The triage (height, bp, 'what brings you here today' section) nurse was even kind enough to put my sleep hours in the notes when she checked me in (this is exactly like an ER, but is only for psych patients). I was very careful to walk the fine line of tact between insisting that the special needs HAD to be met, and making sure they were aware of them. I didn't want to look like a prima donna, after all.
At the preliminary eval, I admit I was impressed. The main four questions...:
-Do you feel the world would be better off without you (yes)
-Have you actively attempted suicide (no.)
-Have you planned out a way to hurt yourself in any way (no)
-If there was a way you could remove yourself from the world without causing harm monetarily or emotionally to anyone you care about, would you do it? (probably)
...made me feel that they would understand the difference between wishing yourself dead and actually making it happen. The impression I got from the clinician was that I seemed pretty bad off emotionally, but wasn't a present danger to myself enough to admit me to the hospital. This was reenforced by the psychiatrist evaluation that happened an hour later as a followup, and with Gregory in the room I cried, afraid that my psychiatrist would call me on Friday and demand to know why the hell I was home, when he'd told me to go to the hospital. I felt like I was in some way letting him down, and I literally wasn't sure that I shouldn't trust his judgment enough to try to convince them to let me stay. Gregory assured me that he hadn't seen me misrepresent myself in any way, but did admit that the psychiatrist had been adamant that I be admitted.
They weren't sure, assured me that I wouldn't be in trouble and that I could come back if I felt I would harm myself, and asked me if they should call the guy (it was 1 AM) to get his opinion.
I reiterate. I should have kept my FUCKING mouth shut.
After the call, the guy came back and told Gregory that the psychiatrist wanted to talk to him in private on the phone. When G came back, he was deathly pale, near to tears, and told me I had to stay. The psychiatrist from the hospital agreed. Clearly the man they spoke to was very concerned. My first hint of a problem came when G told me one of the things that (we'll call him Jerk from now on, you'll see why) Jerk told him.
Jerk said to my husband that if he didn't convince me to stay at the hospital, he would refuse to treat me anymore.
You guys know me. I do NOT like being manipulated, and I do NOT let people try to blackmail or threaten me. Essentially what the man was saying was that if I didn't stay at the hospital, I wouldn't get any treatment from him, either. I'd be on my own.
The doc talked to me about what the circumstances would be for admittance. I reiterated my fears about the way my sleep disorders would affect my treatment. In the Patient's Rights form I'd signed hours before, it stated in various different ways that I have the right to be treated in a way that doesn't harm me, that respects my individual circumstances, and that, most importantly, is something I feel comfortable and safe about.
During this discussion, the man that I'd had evaluating me for over two and a half hours (which is longer than the cumulative time I'd spent with Jerk, and two hours longer than I'd ever spent talking with him about my depression and thoughts of worthlessness) spoke about the routine at the hospital. He admitted the fact that the evaluation team starts work at 9 AM (and it's no guarantee I'm to be seen first), which would be 2 AM for someone that normally goes to bed at 12 AM. He also said I would HAVE to speak to them (his exact words were, 'they'll wake you up'). My first fear realized. He then spoke about the exercises and group meetings that are optional throughout the day, that are encouraged but not required. I said that I'd be unable to attend any of them, and he said, 'if your little sleep problem stops you from going to a few of them, I'm sure the staff will understand.'
Stop. WHAT?!
Just... no. If I've just spent over two hours trying to explain to you that I'm NOT going to be able to be coherent and awake during the day, and how it's a DISORDER, not some whim that I can turn on and off, how am I possibly going to be able to convince a staff that's likely to have 'seen everything' and most certainly trained in some way to treat the patients similarly (as in not favor anyone or give in to special circumstances)?! What you say when you aren't trying to be deceptive is VERY telling--and this man just let slip that he didn't have any respect for the most important thing I was trying to tell him. Gregory asked him if he thought he'd be able to be fully functional and capable of communicating coherently the next day at 12 PM, and you guys should have seen the disconcerted look on his face. He went away to speak with his fellow docs.
When he came back, he had an admittance form, and sat me down with it and practically cajoled, begged, and pleaded that this was the best thing for me. G held my hand and I decided I could do it if I had to.
The first form is a consent and agreement by the patient to give 72 HOURS notice if they want to leave the hospital (ie check themselves out). I immediately expressed concern. That's a longass time, considering I would be able to decide for myself at 9 AM when the eval team woke me up the next morning (incidentally, he said he'd 'leave a note' but I'd have to explain my sleep situation to them myself). If they were going to tell me anything remotely similar to 'honey, I know you think you need special circumstances, but this is a hospital, and we need you to be awake during the day' I was going to be SO out of there. Then I asked if I could have my computer. Nope. Could I have paper and a pen? The pen is iffy, probably not. Oh, and there's no TV.
O.M.G. Sad as it is, those things keep me sane, people. Tv and writing and talking to you fine people. Take away a depressed person's ONLY things they look forward to and tell them that's going to make them better...
VERY reluctantly, I signed the form.
Next came the 'I agree that you're admitting me' thing. He kept telling me I'd have to 'play it by ear' (which I think was his way of telling me I'd have to suck up and deal). Then G asked about eating schedules. The kitchen is closed at night, big surprise. They don't make exceptions. Lovely. Chances were, although slim, that I might even be medicated so I could be awake at the correct hours. He told me this right as I was signing my name.
At that point, I took my hand away, and told him this was going to be impossible, and to rip up the form. He tried a bit of persuading and then said he'd go talk to his team.
He took the form with him.
About ten minutes later I realized that he had my signature on a form agreeing to be admitted to the hospital, even though I had protested the whole way and reluctantly signed it, finally asking that it be destroyed.
Legally, they could admit me. I signed the form. Ethically, it was a huge grey area, since they had the form with my signature, and a biased witness (my husband) was the only person to hear me say to rip it up, besides the doc himself. When that man came back, he looked me straight in the eye after I asked if they could force me to stay, and said with that look you give children when they ask 'am I *really* grounded' and he said 'kinda, yeah.'
Gregory is a very calm man. He does not, however, like to be manipulated, threatened, or forced into anything. He went to talk to the guy, and he hasn't quite told me what the conversation was, besides that the gist of it was, 'she said she wanted the form torn up, you cannot admit her against her will.'
The thing is, there is a legal protocol for hospitals and family members to forcibly admit someone to the hospital if they think they're a danger to themselves. However, after my first evaluation, they weren't considering me for admission--they only changed their mind after they spoke to Jerk on the phone. Gregory then told me more about his conversation with Jerk as we waited, terrified, wondering if they were going to come back and claim that the signature was legally binding me to stay there. Jerk had told Gregory that I would manipulate him and everyone around me to avoid staying at the hospital. He claimed that I would stop at nothing, that I would lie calmly to his face about whether I would be safe, and that on no circumstances should I be allowed to go home. He told my husband that I wouldn't be safe, and basically my blood would be on his hands (Gregory's) if I wasn't admitted to the hospital.
(Note: G and I have talked this over, and based on the VERY limited discussions I had with Jerk (and the fact that longer discussions with other qualified psychiatrists did not merit this opinion until *after* they'd spoken with Jerk), we think that he lost a patient to suicide in the past, and is determined to stop at NOTHING in his quest to prevent this from happening again. He lied, manipulated, and threatened my husband into agreeing to admit me to the hospital, essentially.)
I was furious--I'd signed a form to allow them to call him for a consult, and resolved (and have since done so) to ensure that the form would be rescinded, and that he would NOT be allowed to discover in any way what the results of his efforts were. I figure it's a pretty damn good revenge to get a call at 2 AM about a patient, try to manipulate their loved ones, and then never find out what happened. Gregory was completely disillusioned and his faith in himself was *shattered*. He'd asked me to give psychiatry one more chance, and the person he begged me to go see had turned out to be a completely unethical and unprofessional person, in his opinion, despite any baggage he might have carried to our sessions (see 'note' above).
So there I was, having been essentially told that my greatest fears about staying at that hospital had been realized, the man who'd sent me there had tried to blackmail my husband into making me stay, and I could possibly be forced to stay against my will because I'd been in the process of signing my name when I found out just how close my original fears about staying there were to the reality. The evaluation psychiatrist came back and told Gregory that basically, if he would promise to be the one liable (and not the hospital) if I killed myself, they'd let me leave. G said it was the most difficult decision he ever had to make, and if the call to Jerk hadn't been the reason the evaluation folks at the hospital had changed their mind about admitting me, he would have asked me to stay.
I would have, if he'd asked me to. I had the Patient's Rights form with me, and had underlined passages that I fully intended to use as my weapons if I was going to be forced to stay there--the most important of which states that I have the right to be treated with dignity and respect, without harsh or unnatural treatment.
If you've skipped ahead, or want an idea of what the nearly 11 hours I spent at the hospital last night was like:
&&&&& Cliffs Notes 3: 1) the psychiatrist threatened to refuse treatment to me if I didn't stay at the hospital; 2) he threatened my husband that my blood would be on his hands (G's) if I did not; 3) the evaluation people referred to my sleep disorder as essentially an inconvenience, and stated that I would likely be required to be awake during the day; 4) during the process of signing the admittance form, it was made clear to me just how little my special circumstances would actually be considered (including the fact that I wouldn't be fed equivalent meals at night), and I requested that they rip it up; 5) instead of ripping it up, the eval psychiatrist admitted that he was considering using it as a valid consent form, as it had my signature. &&&&&
Like Jack said to Rose in Titanic--'I'm not an idiot. I know the way the world works...' I know that hospitals can't make exception for every special case. However, I believe that if that special case will directly affect the evaluation and subsequent treatment of a patient, it MUST be considered, and the Patient's Rights form I signed when I got there (which had four typos, btw, lol) states that multiple times.
I also don't want to blindly condemn people for doing what they believed was necessary to save someone's life. However, I firmly believe that the man I saw first came to the severest conclusion about my danger to myself because he may have lost a patient to suicide in the past. His determination to blackmail and guilt Gregory into convincing me to stay at the hospital (including attempting to destroy any trust G has in anything I say--'she will say or do anything to avoid being admitted'--even though I was quite reasonable in my concerns about staying at the hospital... it's disturbing. The hospital's evaluation psychiatrist's crisis of conscience about forcing me to stay there because I signed the form--the same form that I hadn't completely finished signing (I had to initial the back) and demanded he rip up (which he never did)... is disturbing.
Yet, I come away with this DETERMINED to find a psychiatrist who won't be dishonest or morally ambiguous/unethecal in his or her treatment. Why? Because Gregory went to bed in tears believing he betrayed me. He begged me to see the Jerk in the first place, and solely from that man's limited exposure to me, took me to the hospital. He was speechless for ten minutes after realizing what lengths Jerk went to, to try to get me admitted. You do NOT tell the husband that his wife's blood is on his hands if she makes the decision not to stay at a psychiatric hospital. If she's that bad, you call a code, and have her forcibly admitted. I firmly believe that man didn't think G would actually tell me what their phone conversation was about.
'Nobody puts Baby in the corner.' NOBODY makes my husband, a man I've never seen question his faith in ANYTHING, believe that he has lost faith. I will find someone to prove that he was right in the first place (not all psychiatrists are bad/are not a good fit for me), if I have to go through three football fields of shit to do it (Shawshank Redemption AND Dirty Dancing references in one paragraph++).
I'm going to post this, call my PCP, and go to bed--I've every intention of thanking you guys in the comments when I get up. However I have one last word for the wonderful people on my friends list. I haven't cried since I got home. I had one of the shittiest days in my life, and was treated pretty poorly by people with whom I had put a lot of trust but I haven't cried--because when I got home, I had 35 emails telling me what a wonderful person I was, how you were standing by me and thought I was brave, how I was in your prayers... and those virtual hugs mean more to me than all my TL;DR could ever say.
Thank you. ♥
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~CT