I heard Malcolm Gladwell on Rachel Maddow’s show the other day talking about decoding institutions. The journey that I’m on now vis-a-vis my mother’s mental illness is one of not simply decoding institutions, but of decoding a system that involves multiple institutions.
My bipolar mother is not, in the strictest sense, a “danger to herself or others,” so she is not currently in the hospital. However, she is manic, and she isn’t taking care of herself very well. She hasn’t been taking her medication (not regularly; most likely not at all). She’s still ‘cleaning’ her apartment. I don’t know what, if anything, she has been eating. Without medication, she is probably sleeping very little.
My brother called me at 2:30 a.m. on Sunday morning to say that mom had gone to the emergency room via ambulance, but then had been discharged and sent home via ambulance company van (cheaper than full-on ambulance). The ambulance driver called my brother because my mom didn’t have a key to get back into her apartment.
I just repeated the events as they were presented to me. So what actually happened? My mom managed to call 911 and apparently requested that she be taken to the Tuality Hospital in Forest Grove (which is not the closest hospital, but it is the one that has the geriatric-psychiatric unit). She was so sleepy in the emergency room that they could barely get information out of her. She said that she needed to sleep, but couldn’t sleep at home.
They asked her if she felt safe at home. Oh yes, she said. (My question: So why aren’t you sleeping at home?) She said she’s been taking her medications (even brought them with her!). She said that I stole a ring from her but that, upon reflection, there is one more place that she may have put it. She asked for hot chocolate and something to eat. They fed her mushroom soup (she’s decided to become a vegetarian—since this manic episode started, that is). She said she wanted to talk to her psychiatrist (at midnight on a Saturday night?).
Actually, the emergency department staff were talking to the psychiatrist that treated my mom when she was an in-patient about another patient, so they did mention that my mom was in the emergency department. But the upshot of the whole deal is that my mom passed muster (not a danger to self or others) and was sent home. (By the way, all the beds in the geriatric-psychiatric unit were full anyway.)
So she got back to her apartment and didn’t have a key to get in. The ambulance-van driver called my brother, who lives locally but does not have a key. The apartment building manager is on vacation at the moment. After an hour of trying to figure out what to do, the driver looked in the handbag my mom had with her. Sure enough, there were keys in the bottom of the bag.
It is now Monday morning. I called my mom.
Me: Hi Mom, it’s Kelly.
I hear the phone sliding back into its holder. Click.
Since I’m a thousand miles away (literally), my main option at this point is to (once again) call the police and ask them to do a welfare check. That’s how this system works.
Previously in this series:
#7 Uncertainty
#3 Disappointed
West Coast Grrlie Blather 
Wow. And how are you doing?
Okay. So her insurance doesn’t cover hospitalization unless she’s a danger to herself or others. The hospital is full. Perhaps the workers are overwhelmed. The “experts” send her home.
The question then arises, is there no one who can tell you and your brother how to cope with this? Is there no social worker, case worker, anyone? Are you supposed to be an expert simply because you’re her offspring? Can you learn what to do online?
How can you do this work without skills? Why does the hospital turn you all away without giving you some coping tools? I don’t understand this. When you leave any other hospital unhealed, the nurse gives you instructions for how to care for your wound.
Ah, Kelly, I’m so sorry. Perhaps you just have to step back. But I’m guessing you don’t see that as one of your options.
You might want to go over and join Godammit I’m Mad’s Crazy Mothers club: http://www.godammit.com/2008/11/24/the-crazy-mothers-club
Sorry, that’s all I got.
I’m sorry too. There must be something you can do…try Jewish Family Services, even if you’re not a jew.
My mom spent her last years like this. She scared me when she called me in the middle of the night, hissing about things she believed I took from her or should give to her.
One day, I came home to find a package on my doorstep. It contained every baby picture or relic of my childhood, including the little hand-print in clay. On one of my baby pictures, she scrawled “devil from hell.”
Aaaah! It is so hard. Is there anyone she trusts or might trust…a clergy person or someone like that? Anything to get her back on her meds, I guess.
I wish I could help! But listen: I understand. xoxo
Kelly I am the mom to two bipolar children. Life with this disorder is never dull. I don’t have any magic words of wisdom for you. Your mom is an adult. She has the option to refuse treatment. Our medical system is such that many people are lost in the system. It seems to be particularly bad with mental disorders. You may be able to apply for medical durable power of attorney. This will give you more leverage to demand treatment for your mom. Unfortunately, unless the person is witnessed threatening harm to themselves or others there is no way to force a hospitalization. We don’t treat any other disorder like we do mental disorders. If you present to the ER with mild chest pain you will fast tracked into a room and the testing begins. Perhaps we should just send those people home until the pain increases or more symptoms are apparent. Or perhaps we should turn away all the “clinic” visits – kids with a fever, someone with gastroenteritis (you can just stay home and vomit), the guy with the back pain…. There is a gaping chasm with regard to equality of treatment and the standards by which the treatment is provided. I guess if you are unstable but not suicidal or homicidal it is ok to derail your life and let chaos reign. As a nurse I know this and as a parent I get to experience the frustration.
Mania is tough to deal with. Imagine being unable to shut off the noise and thoughts in your brain. This interrupts the little sleep that is to be had during a manic episode. Sleep deprivation fuels the fire of mania. As the episode progresses the level of agitation and irritability increases. I know in one of my boys this means rages, defiance, irritability, screaming…. the list goes on. My other son presents with aggression. He attacks his brothers and becomes so annoying that he must be separated from the rest of the family. Life can get really complicated with the mood swings. The depression is an added bonus.
I could go on and on. Feel free to email me. I will gladly commiserate with you and you can vent on me if you need to. I feel your pain and know it can get awfully lonely dealing with this disorder. Hugs!