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Where else can you get a really good look at a train wreck of emotional dysfunction
and not be right in the middle of the thing?

Monday, August 3, 2015

Aegrescit Medendo

And the sickest joke was the price of the medicine
Are you laughing at me now?
May I please laugh along with you?
{Lloyd Cole & the Commotions, "Lost Weekend"}

Last Tuesday I finally broke down and went into a hospital, and it was (unsurprisingly) a nightmare.  I couldn't bear my severe depression any longer, so I checked into a mental health treatment center after getting off of work.  The intake counselor said that they wanted to admit me, and I told them that would be all right.  I was so emotionally exhausted that I honestly didn't know what to do.  I figured they would keep me a night or two, and then help me figure out some outpatient care that would match my needs while still allowing me to hold down my job, which I have no choice but to continue with full-time.

It took them six hours to process me.  I went in a little before 8 p.m. and didn't get to the ward until 2 a.m.  I hadn't eaten since 3 p.m. Tuesday afternoon, but by then it was too late for me to get anything.  The next morning I met with a nurse practitioner who was filling in for the psychiatrist assigned to my case.  I told her all of the medications I take daily, including the three psychotropic drugs, and gave her consent to verify them with my regular pharmacy.  However, come 9 p.m. when they were dispensing medications, she hadn't put any orders in for me, and it was too late for anyone to do anything.  So I ended up missing an entire dose, which is probably the single worst thing I could do in regards to my mood.

To be brutally honest, the place was closer to a prison than a hospital, and I needed treatment and counseling, not incarceration.  I wasn't there for detox or for suicide watch, both of which necessitate a secure environment focused primarily on passing a crisis period, and medical treatment—especially psychological treatment—is not one-size-fits-all.  The place was so boring and profoundly unstimulating, and no one took the time to orient me or explain how anything was done.  There was one TV that was occasionally turned to a local channel.  There were no puzzles or other solitary pastimes, and the two books I saw on the floor were some romance novel and the "L" volume of a set of encyclopedias from 1959.  I went to a couple of group therapy sessions, but that just made me sadder.  While all of my fellow patients were incredibly decent, their problems were so much more profound than mine and heart-wrenching, making me feel like a spoiled brat.

By Thursday morning, I had been in the same clothes, including socks and underwear, for 48 hours and hadn't been given any hygiene products, like a toothbrush.  I'd had enough and told the nurses that I wanted to leave and wrote out a letter explaining why.  They told me I would have to go through a review process, and I was wondering if I was going to have to involve one of the attorneys I work for.  First I met with the head nurse, who was wonderful.  She apologized and didn't try to make excuses for the fact that I wasn't given any orientation.  She got me clean clothes and a toothbrush & toothpaste and got me set up with a shower while my original clothes were washed.  She suggested I consider staying a couple of more days because, if I left against medical advice, I couldn't participate in one of their outpatient programs.

Later that day, I had my second opinion on my desire to leave, which was odd since I never had a first opinion.  I only met with the nurse practitioner briefly the day before, and we never discussed my release.  The psychologist doing the second opinion was also wonderful, and he and I discussed my situation.  He asked if I would consider staying until Friday or Saturday, as 72 hours is considered a minimum standard for inpatient care.  I didn't really want to stay there since it wasn't a therapeutic environment, but I said I would consider it since I was trying to meet him halfway and would prefer not to leave against medical advice.  I explained that I wanted to get back to work on Monday and have a day to transition on Sunday.  He said he understood my need for assurances, and I thought we'd come to an understanding.

Then I finally met the horrible human being that was the psychiatrist assigned to me.  Keep in mind that I'd never met the woman, so all she had to go on were notes in my chart.  She didn't bother taking me somewhere private to meet with me like everyone else had.  Instead she talked to me from behind the glass of the nursing station.  My first note of apprehension came when I sat down and she was yelling on the phone at someone about some (unrelated) situation.  Basically she undermined everything that the psychologist and I had just agreed upon.  She told me I could speak to her tomorrow about my release, though implying that it wasn't going to happen then, and said that she wouldn't even be there Saturday to authorize my discharge.  (The healthcare providers are contracted by, not employees of, the facility.)  I'd had my limit, so I told her, fine, I would leave immediately.  The psychologist signed off on the fact that I wasn't a danger to myself or others (meaning they had no legal grounds to hold me), and I finally got out of there late Thursday afternoon.

When I got home, I contacted my employer about coming back to work on Friday morning, as I felt jumping back into a routine would be best for me.  In an effort not to focus solely on the negative, I have to say that the people I work for and work with couldn't have been kinder or more supportive.  Friday at work went off without a hitch, and I spent Friday evening with a couple of dear friends and their delightful children.  Unfortunately, the weekend sort of deteriorated from there.  I had all these plans of things to accomplish on Saturday, but got very little of them done.  And on Sunday, I couldn't get myself out of bed before 3:30 in the afternoon and was a very dreary dinner guest at my parents' home that night.

On top of everything else, now I'm concerned about the potential fallout for technically leaving the hospital against medical advice.  My health insurance may decided that they don't have to cover my stay for that reason, which means that the hospital will try to bill me personally for their astronomical fees.  I won't pay it, even if I could (which I can't), because I tried to work with them about my care and my release.  The psychiatrist was the one who wanted to dictate to me based on a five minute (and one-sided) conversation instead of taking into account my needs and my situation.  In this entry I've only touched on all the negligent malpractice perpetrated in my short stay and their substandard care.  What worries me is that the unpaid bills may end up trashing my credit for the next several years, and that will cause even more problems for me down the road.
The Tyranny of Filthy, Filthy Hope
Alex: My mood is like a prison.  Or a straightjacket.  I can never escape it.
{Michael St. John, Constricted, a book which I'll never have the energy to write}

So here I am, back to wrestling with my mood: same old start, same old end.  It seems everybody I talk to is still trying to tell me "if you do this" or "if you do that," you'll feel better.  I just have one thing to say...fuck you!  Because I've done all of that shit and never felt better, and I don't need people transferring upon me their pet dope or specific agenda when they hear me but never listen.  For ten months (as of today as a matter of fact), I have abstained from any drug stronger than caffeine, exercised regularly, eaten well, practiced good sleep hygiene, followed a routine and generally taken care of myself, my apartment and my job.  And still my mood is a struggle every day.
I honestly don't know what to do with myself.  I'm so loathe to pick myself up again and to keep trying as I've done a million times before.  My whole life is built on fantasy and false hope without a single foundation of personal fulfillment.  But even having this conversation in my head just makes me think of all the people and animals who know nothing but a life of misery and suffering, so why the hell should I—with all my 1% privilege—feel entitled to anything more?  My depression keeps screaming at me that I'm worthless, that life is worthless and that the only good thing about it is that it mercifully doesn't last forever.