Bree

Every time I have a stay in the inpatient unit there are one or two people I really connect with and we exchange contact information to stay in touch.  In my most recent stay, one of these was an 18-year-old girl I’ll call Bree.  Bree was depressed and suicidal and had a tendency toward self-harm.  She had been there for two weeks, and spent the past week sleeping in the “quiet room” so she could be monitored more closely.  I shouldn’t be impressed by this, but she fought the staff and it took four of them to hold her down – she had a real fire in her, despite the depression.

Nearly another week later, on Thursday, Bree was released despite telling the staff that she wasn’t ready to go.  She immediately began messaging me on Facebook to talk about how scared she was to be at home because she was still suicidal and didn’t understand why they sent her home.  I talked with her nearly continuously all evening, and again the next evening.  On Friday night she attempted suicide while talking with me.  She had taken an unknown quantity of an unknown combination of pills, and the moment she said she had taken them I called for help.  I didn’t know her address, but I called the inpatient unit and asked them to call 911.  13 minutes later she stopped responding, after sending a final message of “I’m started to feel funny.”

I have to assume that the inpatient staff took me seriously and that help arrived.  I have to assume that she was taken to the hospital and her physical symptoms were managed and she was readmitted to the inpatient unit.  I have to assume these things because the only way I’ll ever know that she’s okay is if she messages me again, which could be weeks or even months from now.

I know that I did everything I could, yet I still feel like I failed her.  Like when she refused a ride to go back to inpatient, I should have offered to come sit with her.  Or when I woke up Friday morning, I should have messaged her immediately instead of waiting until she decided she wanted to talk.  I feel like there was something I said, or something I didn’t say, that would have made a difference in her decision.  I know this is unreasonable.  I know she was in pain she thought she couldn’t bear anymore, and nothing I said in a Facebook chat was going to magically fix that.  It doesn’t prevent me from thinking about her non-stop, unable to concentrate on anything else.

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Oversharing in Therapy

Back when I was manic last year, I talked a lot to everyone about everything.  My mouth just wouldn’t stop moving in front of coworkers.  My fingers wouldn’t stop typing in e-mails to new friends who soon knew more than my old friends knew about me.  After I started treatment, this behavior persisted for quite some time.  I got used to being open with everyone whether they’d earned that openness or not, and I’m still learning to build up relationships before dumping my personal issues on people.  I must say, as a blogger this is hard because the whole concept of blogging involves sharing personal information with people I don’t even know.

I recently met a whole group of new people and I was doing a great job at keeping secrets and getting to know them on a superficial level first.  There was one person in the group who did the exact opposite.  On every one of our dinner outings she spoke in great detail about the loss of her job and a tragic death in the family.  Her audience was slightly different each time, so I think I was the only one to hear this story over and over.  It reached a point where it seemed like she couldn’t possibly be benefiting from telling this story again – like it was just keeping the wounds fresh.

I spoke about this to my therapist last week and she asked if this gave me some perspective on what oversharing felt like from the other side.  I know why she asked this, and I know that she was absolutely not saying “See how it feels for me?”, but I got to wondering if it is possible to overshare in therapy.  Intellectually I think it’s not.  The whole purpose of going to a therapist is to have someone who must listen to whatever you need to discuss.  Emotionally I’m feeling something quite different.

I’ve always had a rule that I’m honest with my therapist.  I don’t lie to her and I don’t leave out anything that seems important, because it would be a waste of my time to talk to her if I did.  That doesn’t mean I’m open with her though.  I’ve been seeing her for a year and have yet to show any real emotion in front of her.  I still go in and joke around and laugh even when the content of the conversation is serious.  There was only one time the facade started to crack, and all that happened then is that I had to look away while saying that something was difficult for me.

There are things on my mind all the time that I feel like I can’t discuss in depth with her.  I feel like she doesn’t want to hear them, like she’s steering me away from focusing on my thoughts and back to the DBT skills.  Always the DBT.  For example, when I came to her office for the first time after my overdose last year, I felt like she didn’t want me to discuss what had happened.  I am still stuck on that event, especially on how much it bothers me that I can barely remember that day, and on how scared I was that they let me leave inpatient so soon afterward.  But now it’s been 6 months and the time to bring it up has long passed.

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.

niagara-river

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.

benadryl

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.