It was mid-summer, about two weeks after we admitted our younger son to a therapeutic boarding school, when my daughter, older son and I visited her psychiatrist to increase a daily anti-anxiety medication and ask for a renewal on an emergency anti-anxiety medication so strong that it’s normally prescribed only for adults. After lunching at a favorite restaurant and wandering around book and toy stores I realized that my daughter was showing signs of increased agitation and resistance to reality (flapping, dancing, voicing sounds not words, singing directly to non-existent people, and repeating the same question phrase multiple times). In short, it was a fairly typical day in our life, except for being down a kid.
By the time we left the second store, I was working on escape routes. Trundle-rushing the kids back to the car, I opted not to hit the public restroom figuring that there was no way I could simultaneously wipe and corral my increasingly unpredictable child. Instead, I formed a plan to get to the pharmacy ASAP in hopes that a dose of the emergency meds would head off this manic episode, just as it had helped the fourteen other times we used the medication in the past two months. Apparently, 14 is the maximum number of these pills we can have at any one time. Because, you know, there’s a fine line between “psychiatric emergency” and “every fucking day of her quickly crumbling life.”
Once in the car, she started in earnest. After showing physical frustration and vocalizing, her next step towards complete mania is usually paranoia. Like the gentle slide into quicksand, I was accused of loving my son more, of buying him gifts because I wanted her to run away, of only liking him, of letting him always call the family shots, of throwing away her other brother, and a host of other slings and arrows. It was not the first time I wished she was back in a five-point harness carseat. She was rocking so hard the car shook. As I drove, one eye on the road and the other in the fisheye mirror, I watched her unravel and tried to calculate possible vectors for shoes, hats, canes, and any other necessary object I had foolishly left floating around the car. Half way to the pharmacy, as I played the scene forward, I imagined myself home alone with this child and unable to lock her in a safe space because she’s already torn down those barriers (physically, not emotionally, those are still fully and frightfully intact) and redirected us to the nearest emergency room.
Now my body was shaking, heart beating so fast my legs did the Humpty Dance. In my mind, I begged her not to notice that we were no longer heading home. Out loud I had rerouted my conversation from placating to abject mollifying, agreeing with anything she said no matter how preposterous and apologizing for all the implied sins I had committed as a mother, a woman, a person, a flea. Mea culpa, my child, please forgive me for our family trip to Germany, I should have thought that through.
As we turned off the last major street towards the hospital I dialed 911. The nature of my emergency? “I’m traveling south towards the hospital with my son and daughter. My daughter is in a rage and has a history of 5150. Is there anyone who can meet me at the emergency room to help me get her in?” Well, no, that only happens in disaster movies and some seriously dated TV shows. My life, all evidence to the contrary, is neither. They did stay on the line with me long enough to hear my daughter’s continued raging. It’s seriously funny how often I want folks to know that I’m not the one who’s crazy … while simultaneously despising that word like some hate “moist.”
At the hospital I pulled to the curb, told my son to stay put, and began the task of dragging my daughter into the ER. Oddly enough, she did not want to go. Her wrists locked in my hands, I pulled the two of us towards the building and the awaiting oasis of help. The “swoosh” of the automatic doors sounded comforting enough, like the sound of the hold-back gates at Magic Mountain, but the interior left a little to be desired. By which I mean that, other than other patients, the entire ER was devoid of human life. No white coats, no blue scrubs, no ID tags of any kind. So, I did what any sane mom would do in an increasingly dangerous situation and yelled. “HELP! My daughter has a history of 5150 and I need help NOW!”
There are a few key words that can help smooth over pesky situations. “Allergy” is one when dealing with waitstaff and the ingredients of menu items. “Medical” helps when you’re convincing the roller coaster staff to let your albino child wear their sunhat. “Rash” will usually get you to the front of the Urgent Care queue. “5150,” the California code for involuntary psychiatric hold, is the go-to phrase when you’re alone in an ER holding a person with the sudden strength of Zeus and the intellectual abilities of an increasingly intoxicated Bacchus. (It’s a frightening situation, and one that does not require the parallel use of Greek and/or Roman god names, thankyouverymuch.) It was amazing how quickly official folks came out of the woodwork. Like I’d yelled, “Free beer!” at a fraternity. Even the other would-be patients took notice and backed away. Well, that could have been because my daughter was by then making sounds like a screaming banshee and I was struggling to keep her from harming me and those around us. Did I mention she’s ten? Dainty thing. A sweet Inner Mongolian flower.
After saying the magic phrase and summoning those with the power to help, the triage portion of our stay went fairly smoothly. During the nurse’s kind questioning and under the gaze of three of her closest friends I was able to rearrange my daughter on my lap so that we sat in traditional safety hold fashion: My left hand on her right arm and my right on her left arm and crossed like a straight jacket, my legs twining around hers, my feet on hers so that the likelihood of kicking was reduced. Believe it or not, this was a fairly effective hold until she grew tall enough to hit at my teeth with her head. Oh, did I not mention that we’ve played out this scenario, in increasing intensity, for the past five years? Que era era.
A hospital ID bracelet was strapped on my daughter and she promptly ripped it off. You go, girl! Then we crab walked our way, a symbiotic two-headed creature out of Mummenschanz, to the room somewhat dedicated to emotionally disturbed patients. In addition to the requisite hospital bed, monitors, and single-use products this room featured a glass front and barely movable sliding door. Through the glass front, for the entirety of our five-hour stay, sat a series of men named Michael who were periodically called upon to forcibly keep my daughter in the room, this task made somewhat easier by both the immobility of the door and the comic methods my daughter employed for escape.
Not long after we arrived, but after a few rounds of mom-on-daughter UFC action, a nurse from the behavioral health unit came to do an assessment. This is when I first heard my daughter’s specific plans for ending her life.
(Let me stop here a moment and say: Finding humor in the raw absurdity of my life is the only way I survive. That having been said, suicide is no joke. When I was in high school, interviewing to become a peer counselor, I was told that a person who once tries to commit suicide is more likely to eventually die by their own hand. It’s easy to dismiss suicide, and the epidemic of it, as a “permanent solution to a temporary problem.” But, that grossly underestimates the prevalence and perseverance of mental illness and psychosis and grossly overestimates the mind’s ability to heal itself. Though all three of my kids have told me, at various times, that they didn’t want to be alive anymore this was the first time any of them mentioned specific plans. Another tip from the high school clinic: Ask about specific plans; the more coherent the plan the more likely it is to be carried out. So, when my daughter came up with more than one way to kill herself, we all took serious notice. Over time her father and I have also come to some kind of acceptance that this may be the way that she leaves this life. To know us is to know that we understand suicide is a distinct possibility for at least one of our children, have accepted the fact of this possibility, and will make decisions for our children accordingly. End of conversation.)
During the interview, the nurse and I made the decision that it was time for hospitalization, to help my child through a time when she was clearly a danger to herself and others. Though, the logic behind placing a small group of suicidal and/or violent children, all under the age of 12, together in one place somewhat escapes me it was at least known territory (her first hospitalization came six months before).
The time between the decision to hospitalize and the actual hospitalization varies greatly depending on: If a facility has an opening, if that opening is appropriate for a pediatric patient, and if your child qualifies for their program. Once all that is ironed out, you sign a piece of paper stating that your child is a “gravely disabled minor” and they are officially on a 72-hour safety hold. Easy peasy!
Then you wait for an ambulance. In our area, the closest pediatric facility is 50 miles from home. Considering that I barely made it two miles with a raging disabled minor in the car, no one expected me to do 50. No worries, this gave her enough time to try out a variety show of escape attempts. First she rushed the door, only to be stopped by a Michael. She tried that numerous times. Then came the costuming. The room was filled with rubber gloves, sheets, gowns both paper and fabric, masks of all variety, and a pillow. Rubber gloves were employed to make it easier for her to escape anonymously. No fingerprints! A gown clearly indicated that she was a doctor, so two were put on. Perhaps, she thought, if she could hide her face Michael wouldn’t notice. Masks, blankets, paper sheets … she was a veritable mummy. At each attempt, a Michael would stand firm at the door reminding her that her mother was in charge. Right, because when I’m in charge the first thing I choose is for my baby to have a psychotic meltdown requiring handing her over to complete strangers for an unknown amount of time (though usually one week). So much for being the decision maker.
The last attempt was perhaps the most creative. I had been holding her, off and on, in my lap (off when she was contrite, on when she was manic) for a few hours. She figured that the Michaels knew who was in front and back, so she pulled a blanket over our heads and reversed our positions, coming out from behind me towards the door. The fact that the blanket went with her, revealing me completely (ta da!), somehow escaped her.
My son? He came to the room some time in the first half hour, brought in by a very kind nurse. He and I texted each other for another hour while my mom drove to the hospital to take him home. “Sorry” appeared most often. “I’m scared” only once. Brave, brave boy.
Near the end of our stay, my husband arrived. It was then, five hours after leaving the mall, that I finally was able to go to the bathroom and do what nature intended … followed by wiping in privacy.
Not much later the ambulance arrived. They strapped our girl into a stretcher, bolted her in place in the back, and drove 50 miles to her home for the next nine nights. We left the parking lot at the exact same time and followed the ambulance for about five blocks until we turned off towards an In N Out to buy dinner for what was left of the family. Yes, there were milkshakes.
A recent study reported that folks who can find humor in even the darkest situations live about three years longer than average. This is great news for us as we’ll need to work into our 70s to pay all the hospital, ambulance, therapy, and prescription bills. Plus, there’s replacing the doors broken down in the name of mania, fuel and other transportation costs associated with visiting our daughter in the hospital and taking her to the innumerable follow-up visits with providers, and support for my now-insatiable Peet’s habit.
What cannot be cost-balanced is the emotional toll it takes on the rest of our house. My daughter has been hospitalized four times in the past 10 months, and every day is waiting for it to happen again. I joke that I suffer from Pre-TS, present traumatic stress. Unfortunately, some in our house are challenged with actual PTS and these lives are in balance every time we make the decision to say that our daughter is, in fact, a danger to others.
Mental health care in the US is woefully lacking, especially so for pediatric sufferers. I churn through the options every day, knowing that we’re doing the absolute best anyone can for our kids and saddened by how short these efforts fall in addressing their needs.
Folks ask, “What can I do?” My only response now is, “Believe me.”
Believe me ... this ain't no joke.