Thursday, August 7, 2014

I met someone in the ER today

I met someone in the ER today. Not face to face. In fact, I made a point not to look at him when he was discharged. I didn’t meet him, but I peed right next to him. I could not feel or move my legs when I came in so they brought a potty into the room for me, and I held onto the bed rail and peed right next to the thin curtain that divides the room.

I didn’t have to look at him. I felt I already knew him just by listening to him in his mania. Despite the disjunctures I recognized the mechanisms he uses to slip through. I recognized how easy companionship comes when you have people’s attention. But that companionship – when you are in denial, and narcissistic – is not friendship. He is young. But not too young to know he can’t rely on these thin tricks much longer. Your mania is no longer amusing to the people around you. You are exhausting, and you are exhausted.

There are so many threads cut, waving in the breeze, tantalizing. Each frayed connection seems minor, but becomes sharp over time, until you are left stranded on the other side of where you were quite sure you were meant to be. “Where am I?” he asked, “But how did I get here today?”,and “What the fuck’s going on?”.

I wondered why every time I was brought to the ER this year, there was a Bipolar or schizophrenic next to me – invariably a confused person with multiple indications who did not wholly understand why they were there. I speculated the ER’s were full of them these days. Then I realized: Oh wait, I’m bipolar! They put us together in one area so they can watch us. Duh. I did disclose this information to them after all (most reluctantly), and it's in the system by now. In my mania, I am unaware of my mania. But they are not. While the tech was testing my standing HR, I burst out laughing. I asked the tech why they put the Bipolars together in one area. He looked surprised that I asked. I asked if it was because we are unpredictable. He gave me a diplomatic answer involving a need for observation. I imagined there was probably a marshall nearby with a weapon, assigned to appear instantly in case of an episode. I tried to behave as normally as possible, or how I imagine normal people to act in such a situation. I tried to behave well. I resisted engaging in conversation with my roommate, because we were both manic, and we might have had a jolly good time.

They made him pee into a pan just on the other side of the thin curtain dividing the room. He then yelled over to the the tech: “Hey, how old do you feel?” The tech responded with a dull “thirty-five”. I thought the question was brilliant, and laughed and said that I feel like a hundred and five, even though I am only fifty. He laughed and said he felt like he was “a thousand” though he sounded 22. He sounded 22 in spite of the vomiting, the drinking, and the smoking. He joked with one of the nurses about the state he was in when he was admitted previously. He described how he was crying so hard that it made him vomit, and how he’s had these episodes since he was 5. His lack of inhibition about his psyche and body was endearing. I momentarily imagined he and I having hot sex together, right on the ER bed, right in earshot of the tech who sat facing us in the hallway.

Once I was topped off, and they removed my IV, and gave me my discharge papers, I walked out – past the gurney where my roommate now sat, waiting, for 3 policemen and 3 techs to transport him back to the County Hospital, where they will decide whether he will be discharged, or whether he will continue to be treated for the episode during which he was arrested. They will decide. I walked past him a free person. It is difficult for me to walk; he is able bodied. But I am free, and he is not. But for the grace of god I would be imprisoned too. A high-functioning Bipolar instead carries their prison with them wherever they tread. It becomes heavy over time – perhaps so much so that you want someone else to take over guard duty. Like when you are crying to the point of retching, helpless to stop. It feels like spasms, but it drags your emotions along with it, so that you are stuck between the emotion your heart elicits, and the physical response that consumes you. Back and forth, until you are drained and can’t feel anything at all anymore. You stop responding and you stop caring. Someone needs to guard the thin curtains that divide the room.

Good experience in the ER today

I had a very good experience in the ER today. I asked to be taken to the research hospital and this time they were able to accommodate me. I began seizuring this morning when my arrhythmia kicked in. I wasn’t able to correct it. I have been using D-Earth throughout the day and night to keep my electrolytes up. But this morning I took more than the usual amount and started seizuring anyway. At that point I wondered if I was hyperkalemic, so I had to get my potassium level measured right away, as the symptoms of too-little potassium and too-much potassium are identical: an imbalance in either direction will trigger an arrhythmia, then seizures, cell death, organ failure, and finally cardiac arrest.

My QT phase was not prolonged when they measured it – the arrhythmia subsided after about 35", before ECG hooked up in ambulance. As I was extremely dizzy and unable to move my limbs, we proceeded to the ER. While there, I was surprised they had the tech measure my standing and sitting heart rate, in addition to prone. I had told them I was orthostatic intolerant, but I didn’t expect them to know what I was talking about. It was a good thing they measured it: 40 pts. increase upon sitting (from prone position), and 40 pts. increase again while standing (from sitting up). The maximum difference (80 pts) is double what Dr. Ahern measured when I was on the tilt table in December 2012 (though I imagine the tilt table would exhibit less variation under the same conditions). It could be the orthostatic intolerance episodes are triggering Long QT, as standing has now become a significant physical stressor. Normally OI would trigger tachycardia. They administered saline without my having to ask them (even before they confirmed orthostatic intolerance), and gave me a liquid oral solution of electrolytes after finding my potassium low. They did not complain at all when I refused the potassium pills, since potassium gluconate triggers diarrhea. (Potassium was low at 3.6 surprisingly, after a full tablespoon of D-earth between 4 and 7 am this morning.) Discharge instructions: No more caffeine ;-( Also I got a reference sent to an arrhythmia center, where I am supposed to report asap. However, the physician did not know whether they accept medi-CAL, and the state has not yet processed my application for insurance (submitted in December). So I am likely a long way away from the arrhythmia center.

The hospital did everything perfectly, actually, and quickly. I was impressed. They also did a great job when I was there in January with vomiting/dehydration. The experience I had today was a far cry from the one I had at S.M. Hospital, where they refused to administer fluids, electrolytes, and 02 as requested, which would have stopped the seizures. Instead they sent me home 3x while seizuring, and sure enough I came back 3x with the same problem. I think it is safe to say: go to the good hospital, even if you have to wait. But at the same time I can see now how it happened. The first time I went to S.M., I insisted I had a neurologic problem, because I was experiencing headache, neck pain, and upper body pain in addition to the seizures. But these symptoms eventually subsided* while the arrhythmia, hypokalemia, and seizures persist. They did a CATscan unnecessarily, which probably annoyed them – but it was a great relief to me to get a normal CATscan because I have migraines and vertigo, and should have had one long ago based on my diagnosis.

My Bipolar diagnosis also makes me suspect to healthcare professionals, as most of them assume that all your problems are “in your head”. In fact, mental health patients typically have multiple medical conditions, and they are less likely to get diagnosed and treated for their non-psychologic medical conditions compared to other patients. (I don't know whether this statistic takes into account the general problem of lack of access to health insurance by mental health patients, or if they surveyed only those with insurance)

At the same time most healthcare professionals probably don’t realize that just going to the ER will trigger a hypo manic or manic episode in a Bipolar patient because of the excitement and because of the attention. The attention also triggers narcissism in patients who are delusional. It is easy to misunderstand this response. It makes it seem like the patient is there to get attention. In the ER today they were smart enough to use this talkativeness to gain information without becoming annoyed by it (no small feat). Social situations trigger manic episodes in Bipolar and Schizophrenic patients. And there is a more crowded, intimate, physical, and pointed social interaction than in the ER?

*     *     *

I asked my son about how I was treated at the corporate hospital. He accompanied me there the second time. He informed me that they were annoyed with me because I was “hysterical, swearing and screaming at everyone” I came in contact with, and berating the staff loudly the moment they left me. I have some memory of these interactions. I remember suffocating and jerking from seizure, and I remember abject terror. I was afraid to fall asleep for 2 weeks after that, and the lack of sleep triggered a manic phase. I considered jumping off the bridge in between hospital visits, because I was so afraid of suffocating to death in the ER. It feels like the seizures in April (9-12 hours/day over two weeks) caused brain damage. It feels like entire chunks of my existence are missing.

* I suspect that the headache, neck pain, upper body pain, abdominal swelling and pain, as well as diarrhea, anal itching and bleeding were caused by parasites, possibly blastocytis. The D-earth has cleared these symptoms up to a great degree. I suspect any lingering symptoms in this department are being caused by IBS (associated with Dysautonomia).