Oops, I Did It Again

About a year and a half ago I detailed my first car accident in Life Experiences That No One Needs.  I didn’t need it the first time, and I definitely didn’t need it again.

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To start at the beginning, I went to work at the hospital at 7 am Tuesday.  Around 9:30 the phone rang with a call from an outside line.  I never answer these calls, as they’re never for me, but I was sitting at the desk and happened to glance up at the phone and see that the number was my mom’s cell phone.  I got excited, thinking she’d gotten the call that a kidney was available for her.  The actual purpose of her call was much less exciting.  She said that she had fallen and thought her wrist was broken.  She asked me to come get her and take her to the ER.

I got off the phone and rushed to the back room where a coworker was filling in for the crew lead who is on vacation.  I frantically told her I needed to leave and why, and she told me to drive carefully.  I did, and the 10 minute drive to home felt like it took hours.  I brought mom to the ER, waited around with her for what felt like more hours, and she learned that her wrist was just sprained.  She got a wrist splint and was released.

Mom had been planning to get a blood test redone that day and asked if it was okay if she did that before I took her home.  At this point I’d missed so much of work I figured it didn’t matter, and went with her to the outpatient lab.  I finally got her home and headed back toward work.

A couple of miles from work, I was going around a curve when the car slid on the wet road and went into the other lane.  As I tried to correct it, the car slid the other way, into the grass, and turned sideways and the back of the driver’s side slammed into an electric pole, breaking it in half.  I sat there, stunned, and a moment later someone pulled into the driveway of the nearby church and came running over.

I was shaking too hard to dial my phone, so she called 911 for me and waited until the police arrived.  I had some minor pain in my left knee and left upper arm, but my bigger concern was that I hyperventilated so badly that my entire torso and both arms went numb.

A county sheriff’s deputy asked me to explain what happened and took my driver’s license and insurance card.  The paramedics let me get out of the car on my own and walk to the ambulance, where they just had me sit on the bench seat and buckled me in.  A different deputy brought my license and insurance card back before we took off, and gave me the report # on her business card.  She said that the road doesn’t slope correctly on that curve and there are a lot of accidents there.  After some time to calm down, I wondered if I could file a claim against the state department of transportation due to that fact.

The ambulance took me back to the hospital, so it was kind of like getting a very expensive taxi to work.  I had to put on the sexy hospital gown and the doctor said he didn’t think anything was broken but recommended getting the x-rays anyway for peace of mind.  So I got a couple of x-rays of my knee and a couple of my upper arm, and then the x-ray technician wanted one of my elbow too.

It didn’t take long for me to be released and I headed back to work, where my supervisor asked if I was cleared for duty.  I think she might have asked if I was okay first, but that’s not what stuck in my mind.  I finished out the day and a coworker gave me a ride home.

I didn’t call mom and tell her what happened.  I thought I would wait and say it when I got home, but then I realized I was too scared to tell  her face-to-face so I texted her.  She said, “Seriously?”  As if I would joke about such a thing.

I didn’t freak out too badly until I got home and she reminded me that I needed to report the accident to my insurance.  I did so and had to answer a million questions asked by some foreign lady at a call center, and one of the questions I didn’t know the answer to so I had to call back later with that information.  Then I asked mom a question and she said I should have asked them, so she called them back and I ended up having to talk to someone again because she couldn’t answer his questions.

Juggling our schedules to share a car was a nightmare last year, and finding a new car was even more of a nightmare.  This time will be worse, because the budget is much tighter.  I don’t know how I’m going to survive this.  I was supposed to be working on that driving anxiety hierarchy and can’t make progress on that as long as I’m sharing mom’s car, if I can even get over the increased post-accident anxiety.

Then I had to drive mom to a concert she was singing in.  It was in a city I don’t normally drive in, and it was after dark.  I got almost there before I completely freaked out and had to pull over at a gas station.  She drove the last couple of miles with me having to buckle her seatbelt, start the car, and put it in gear.

The next day I had an appointment with Brent.  My notes already said that I wanted to increase my BuSpar dose, and with this turn of events I felt even more strongly about that.  He agreed to increase it to 15 mg 3x a day, but still prescribed it as PRN and told me not to take it if I don’t need it (but then turned around and reassured me that I should take it if needed and not try to suffer through the anxiety).  He was not willing to make two changes at once and I was still bringing up the idea of Lamictal, so he agreed that when I see him again in a month we will start it then and eliminate the Latuda, if I still want to at that point.

Brent has a bunch of questions he has to ask every time and one of them is “Do you have any thoughts of hurting yourself right now?”  He literally means “right now” – if it was the day before he’s not concerned.  I always say no.  I said no, and then said, “Wait, that’s a lie.”  Last night around the time I was talking to the insurance company I started planning to buy a couple of bottles of Benadryl.  Surely if 40 pills screwed me up as bad as they did, 200 would do the trick.  I didn’t get a chance to buy them because mom was with me, but I was still considering it even when sitting in the waiting room before my appointment.

I kind of spaced out and Brent asked me a question that I swear sounded like something about coffee.  I have a bad habit of not asking people to repeat themselves and just giving a vague answer and hoping it’s right.  So I said, “No.”  The question was whether I would call if I needed help.  Oops.  I didn’t understand the next question either and this time did ask him to repeat it.  He wanted to know if I needed to be in inpatient.  He said he had no grounds for making me go there.  Really?  I just admitted to current suicidal ideation and there are NO grounds?  I would have expected at least tiny ones.

I said I’d avoided going for a year and now was aiming to get through all of 2015.  He asked again if I’d call for help (this time I said yes) and he repeatedly assured me that if I called he’d squeeze me in, even the same day.

Later in the day, I also had an appointment with Sadie.  We focused primarily on the obstacles this development would present for working on my driving anxiety.  At this point mom and I are sharing a car, which means I can only take it for necessities, such as work and therapy.  That rules out doing any of the steps on my hierarchy, given that even when I had my own car mom told me not to do them because they were “too dangerous”.

Sadie said it was crystal clear why I had anxiety.  At another point she said she’d like a session with my mom to tell her to stop sabotaging what we’re working on.

I had committed to doing the first four steps during the week between appointments, and I did complete those, plus three more.  I practiced making left turns onto and off of the US highway, and Tuesday night I drove someplace new locally by dropping off my car keys at the towing company.  Sadie was excited that I managed 1/3 of the list in a week, but I still need more practice at the left turns, and all the other steps on the list are harder and more time-consuming.

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The Cost of an Overdose

As it turns out, overdosing is mighty expensive. It has been 28 days since I overdosed, and the bills have poured in to my insurance company. Here is a breakdown of all the charges, with original cost and insurance-approved cost in parentheses:

AMBULANCE
* ALS1-EMERGENCY ($1,100 -> $400.06)
* GROUND MILEAGE ($112 -> $50.12)
* AMBULANCE O2 LIFE SUSTAINING ($35 -> $0)

EMERGENCY ROOM DOCTOR
* EMERGENCY SERVICES ($506 -> $332.16)
* ELECTROCARDIOGRAM REPORT ($25 -> $17.78)

ICU DOCTOR
* INPATIENT PHYSICIAN SERVICE ($501 -> $233.99)

COUNTY HOSPITAL
* MISCELLANEOUS SERVICES ($42.15 -> $34.14)
* MISCELLANEOUS SERVICES ($58.72 -> $47.56)
* MISCELLANEOUS SERVICES ($8.60 -> $6.97)
* MISCELLANEOUS SERVICES ($47.10 -> $38.15)
* MISCELLANEOUS SERVICES ($67.40 -> $54.59)
* COMPREHEN METABOLIC PANEL ($322.40 -> $261.14)
* ASSAY BLOOD ETHANOL ($105.00 -> $85.05)
* ASSAY URINE ACETAMINOPHEN ($159.60 -> $129.28)
* THERAPEUTIC DRUG ASSAY ($97 -> $78.57)
* DRUG SCRN 1+ CLASS NONCHROMO ($250 -> $202.50)
* AUTOMAT HEMOGRAM-COMPLET DIF ($77.50 -> $62.78)
* AUTOMATED, WITHOUT MICRO ($48.60 -> $39.37)
* CRITICAL CARE FIRST 30-74 MN ($693.20 -> $561.49)
* NONINVAS EAR/PULSE OXIM;SING ($88 -> $71.28)
* ELECTROCARDIOGRAM, TRACING ($207.90 -> $168.40)
* INPATIENT PHYSICIAN SERVICE ($584.70 -> $473.61)
* MEDICAL SERVICES ($75.40 -> $61.07)
* ELECTROCARDIOGRAM REPORT ($26.70 -> $21.63)

ON-CALL THERAPIST
* MEDICAL SERVICES ($82.50 -> $58)

MENTAL HEALTH CENTER INPATIENT UNIT
* MISCELLANEOUS SERVICES ($2,000 -> $1,050)
* MISCELLANEOUS SERVICES ($56.33 -> $0)

PSYCHIATRIC APRN
* INPATIENT PHYSICIAN SERVICE ($85 -> $85)
* INPATIENT PHYSICIAN SERVICE ($75 -> $65)

The grand total was $7,537.80, of which my insurance approved $4,689.69. Fortunately for me, I had already reached my maximum coinsurance for the year and did not have to pay a cent of this. Unfortunately for the purposes of this post, I cannot give an idea of what the out-of-pocket cost would have been.

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The real cost of an overdose isn’t monetary though. It’s the risk of having permanently damaged internal organs. It’s the awkward silence when you try to explain what you were thinking, or possibly not thinking. It’s the knowledge that everyone is looking at you distrustfully, wondering how long until you try it again. It’s the awful realization that you could very well be dead, and after coming that close you understand that you never wanted that to happen. It’s the fact that once you’ve overdosed, it continues sounding like a legitimate solution, no matter how mild your depression may be.

Keeping the Stories Straight

At the beginning of Thanksgiving week, I got up in the middle of the night, stumbled around my living room, and went crashing to the floor.  I couldn’t get up.  I screamed for my mother, who leaped out of bed and came to help.  Then, of course, I refused her help.  I managed to pull myself into a dining room chair, but was shaking too hard to drink the glass of water she brought for me.

After some interrogation she asked if I had taken a bunch of pills.  I denied it.  Then she asked again and I confirmed it.  In total, I had taken somewhere between 40 and 50 Benadryl.  When mom realized she couldn’t get me to the hospital on her own, she called 911.

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Many hours of my life are a blur.  I thought I remembered the presence of “Deputy Wayne” from Celebrating February 14th.  This made no sense, so I assumed I hallucinated.  I remembered ambulance lights and being helped outside to get in it.  I remembered a bedpan.  That’s about all until I woke up hours later in the ICU.

Things were not much clearer in the ICU.  From that portion of the day, I remember repeatedly getting out of bed.  I remember trying to yank out my IV needle.  I remember a really sweet nurse who offered to order my meals for me so I wouldn’t have to make scary phone calls.  I remember the on-call therapist dropping by to determine whether I should be admitted to inpatient, but I don’t remember the slightest thing about what I said to her.  I remember mom visiting and telling me that Deputy Wayne really had been there, but I had to ask her about it all again the next day because I wasn’t sure I hadn’t also hallucinated the conversation in which she confirmed his presence.

I told many different stories about the overdose – some of them during the time when I was not coherent enough to know what I was saying, and others during the course of the following week when everyone wanted an explanation for what I’d done.  Some of the stories:

“I did it for attention.”
“I don’t know why I did it.”
“I wasn’t trying to kill myself.”
“I wanted to hurt myself.”
“I took a few for sleep and it impaired my judgment so I took more.”
“I overdosed on Benadryl.”  (no reason given)
“I tried to kill myself.”

In the beginning, “I don’t know why I did it” was pretty close to the truth.  This was what I told my psych APRN when he came to see me the next morning in inpatient.  He tasked me with figuring out the reason(s) I did it so we could prevent it from happening again.

I told most of my friends that it was an accident.  That I took them for sleep and took a few more when they weren’t helping, and took a lot more when my judgment became impaired.  The truth in that was that I did only take a few at first and my judgment really was impaired by the time I took the rest.

I told one close friend that I wanted to hurt myself, but wasn’t trying to kill myself.  I did want to hurt myself.  I had wanted to hurt myself for days.  I didn’t plan to kill myself, although suicidal thoughts had been stuck in my head just as long.

With a few people, I didn’t give them a reason and let them make their own assumptions about what happened.  With one particular person, I needed to impress upon him the severity of the situation, so I said I tried to kill myself.  This is sort of true too…I did try, even if it wasn’t entirely intentional.

It took me a while to figure out exactly what happened and why and how to explain it, so here’s the truth:

I had been having suicidal and self-injurious thoughts for days.  The kind of thoughts for which I’m expected to call the local mental health center’s emergency hotline.  The kind of thoughts I didn’t think were that much of an emergency and surely I could handle them myself.  The afternoon of the overdose, a friend confided in me that she had been suicidal the night before, for the first time in her life.  She said the only reason she didn’t do it is because she had a “painless and tidy” method in mind but lacked the tools needed to execute it.  I don’t blame her for my thoughts, but it did spark something in me.  The idea that I really could do it; that nothing was stopping me.

I didn’t really plan on dying.  I didn’t make any sort of preparations.  I just knew that I had once taken 10 Benadryl with no lasting effects so maybe this time I could try 15.  I was clearly a chicken about it, because I only took 5 at a time, giving myself the chance to back out.  5 pills every half hour, until I reached 15.  Then 20.  At 20 I still felt fine, if somewhat groggy.  I dumped another huge pile in my hand, tossed them in my mouth, and swallowed.  I knew when I took all those at once that it could kill me, but it’s true that my judgment had been impaired.  I didn’t have the capacity to make a decision about whether I wanted to die.

I was terrified going into inpatient this time.  I was convinced I would be permanently committed.  In reality, they only held me 2 nights.  I got 5 nights once for lying about having suicidal thoughts, but when I overdosed I only got 2 nights?  This was baffling.  I can only imagine that they were trying to get me home for Thanksgiving.  I didn’t argue on being released, not wanting to ruin Thanksgiving, but I was still very depressed the next few days and would have benefited from a longer stay.  I’m still working on learning to put my own needs first.

Life Experiences That No One Needs

Your 21-year-old car has looked a little better in its time, but it’s still running great as you coast toward a green light on the US highway that cuts through your small Midwestern town.  An oncoming car sits waiting and waiting in the turn lane, waiting through the huge gap between you and the car ahead.  As you reach the intersection, the driver abruptly turns left.  There’s a split second that lasts an hour, in which you hold your breath, choking on fear as you slam on the brakes, already knowing that the laws of physics make impact inevitable.  The noise as the two cars crush together is familiar from years of Hollywood’s most thrilling action films, but now you are inside the noise, not separated from it by a widescreen and a projection system, and it echoes in your ears long after the sound waves have dissipated.

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The air bag explodes with a cloud of suffocating powder, filling the close confines of the car.  You choke, gasping for air, and somehow find the presence of mind to inch your car out of the intersection and into the driveway of the nearby high school, hoping the cloudy air and your watery eyes don’t cause you to hit anything else along the way.  You roll down the window, desperate for oxygen, and in between gulps of fresh air you fumble for your cellphone, feeling like Homer Simpson when you think, “What’s the number for 911?”  As you remember the number, you forget how to operate your phone, and as you remember that your fingers forget how to move without shaking uncontrollably.

You have just managed to dial for help when you’re interrupted by a voice at your window, spilling out of the lips of a man in a blindingly fluorescent yellow vest.  You wish he would go away, and let you finish doing the responsible thing.  You try to focus on the voice on the other end of the phone, asking for the location of your emergency, and when you name the intersection the voice asks you what city you are in.  The rest of the call is a blur, and after you hang up you are surrounded on all sides by witnesses reassuring you that the accident was totally the other driver’s fault and that they are staying to give a statement.

It seems like mere seconds between the end of your phone call and the beginning of sirens, and it may very well be seconds given how tiny this town is.  The fluorescent yellow vest belongs to a man who has identified himself as a volunteer firefighter who happened to witness the accident.  He keeps telling you not to move, and you are incapable of listening, trying to reach for the window handle on the passenger side, reach for the hood release when the official firefighters show up.

You won’t realize until days later that you never give a thought to the condition of the other driver, as you sit there filling with panic and trying to focus on the paramedic’s instructions, asking you what hurts and whether you can squeeze his fingers.  In the back of your mind, you’re convinced that you’re okay, but you know what happened a few weeks ago when you thought the same thing after taking a tumble on an icy sidewalk.  You know that even if your body isn’t hurt, your fragile emotional state is well on its way there, so you agree to go to the hospital.

This is when things take a turn for the embarrassing.  Out comes the neck brace, which does its job of immobilizing you – perhaps too well, as your chin no longer functions when you try to answer an onslaught of questions.  Out comes the backboard and you are surrounded by dozens of disembodied hands trying to pull you onto it and out of the driver’s seat as gently as possible, which is, as it turns out, not that gently.

You lie on the backboard on the stretcher, face to the sky, being pelted by raindrops in Mother Nature’s sick game of Chinese water torture.  You reach blindly, unable to open your eyes in this weather, for the wallet tucked into your lunch sack, and successfully present your driver’s license and insurance card to the person you have to assume is a police officer.  You seem to lie here in the rain forever, the sky crying tears you are still too shocked to muster, before finally being loaded into an ambulance.

After a series of steps to secure you in place, and the removal of a glaring light that still prevents your eyes from opening, the ambulance takes off, blaring its sirens as you think, “This is not an emergency!”  It is a small town though, low on excitement, and clearly the paramedics will take any opportunity to show off their siren.  You jostle and bump along, then head up a steep hill which gives you the bizarre sensation of lying down and standing at the same time.  You are thankful that your injuries are minor, as this carnival ride would have you shouting in pain otherwise.

Somehow, amid all the noise of the siren and jostling of the stretcher, you are expected to answer a series of questions, to which you can barely remember the answers.  You hesitate when asked for the name of your family doctor before finally remembering that you’ve seen your new nurse practitioner a whopping two times and she does have a name and it’s right on the tip of your tongue…  You are asked to name any medications you currently take, and hesitate again when one of them leads to a blank expression and a “What’s that one for?”  “Bipolar disorder,” you mumble.

Eventually the ride comes to an end.  It seems to have taken an awfully long time in spite of the aforementioned smallness of the town.  You are rolled out of the ambulance and into the ER, seemingly inches away from the lights zipping by overhead.  You barely notice when the combined 200 lbs of your body and the backboard is transferred from the stretcher to a hospital bed.  Someone comes to get your health insurance card and ask you a million more questions, and by now you’re so overwhelmed that you’re not going to remember anything that was said.  Except that after again asking for a list of medications, your medical history is repeated back to you as “high blood pressure, depression, anxiety, and bipolar disorder”.  Clearly someone is not up-to-date on what “bipolar disorder” means, seeing as how depression is one of the poles.

A woman offers to call your mother for you, if you can’t get a cellphone signal.  You barely get a signal, and your mother doesn’t answer, so as you are leaving a voicemail the woman has to remind you to let your mother know that you’re okay.  You do, but if you were totally okay then you wouldn’t be at the hospital, would you?

Your mother arrives in no time, and that’s when you start to cry.  You feel awful about the car and are terrified of the process of dealing with insurance companies and hunting for something new to drive.  A sweet young nurse practitioner comes in to inspect your knees and chest, and she orders x-rays of your chest and right knee.  You go off to play the most contorted game of Twister in order to have the x-rays taken.

At some point, a police officer arrives to return your driver’s license and insurance card, which is now smeary from the rain.  You think about how you’ll need to get it replaced, before remembering it’s for a car that you will no longer have.  The officer takes your statement and thankfully remarks that it matches the one given by a witness, so the insurance companies should determine that the other driver was at fault.

The results on your x-rays come back and everything looks fine, so you end up leaving with an ACE bandage on your knee and a naproxen prescription in your hand, but not before grudgingly accepting a tetanus booster.  You know you’ll spend days feeling like a bullet ripped through your triceps, but given that you work in a filthy warehouse and are exceedingly accident prone, perhaps the shot is not such a bad idea.