FROM THE CUCKOO’S NEST

220px-Chestnut-breasted_Malkoha2First, let me say that the term “cuckoo’s nest” is a bit of an odd one, as, to my knowledge, cuckoo’s don’t build nests—they lay their eggs in other nests for other birds to raise (how smart is THAT?). But I am in the cuckoo’s nest, nonetheless. The one Ken Kesey made famous. The proverbial cuckoo’s nest.

I use this term fondly and with no derision. It was a struggle for me to get in here, and I’m proud to have made it into these mythical halls.

Yes, really and truly. I am writing you from an anonymous inpatient psychiatric ward in an anonymous city. And I’m writing you because too many people won’t speak of such things, and such things simply must be spoken of in polite company. Mental illness is a topic too depressing to be oft discussed, and to make this worse, I am a chronically depressed person writing to you about a depressing subject, but someone has to do it. Mental illness is far too marginalized in this country, and we all ought to be speaking about it more openly. Perhaps, then, we might start caring for the mentally ill with greater clarity and kindness.

I checked myself into this facility by way of the hospital emergency room. It seems to be the most direct—and perhaps one of the only—routes left to safe care for the mentally ill since the Reagan years. I showed up at the emergency room desk on Monday morning. I was checked into the cuckoo’s nest at 9:30 that night after an exhausting day I’ll elaborate on more later.

What put me over this edge? The psychiatrist in residence here—I’ll call him Bob because he looks like a Bob to me and because I’m embarrassed to say don’t remember his name, although I meet with him each morning. Anyhow, Bob explained to me that treatment-resistant depression, which is what I have, combines poorly with stress. Which I have had in spades. Sunday night, at a time when most of the stresses had rather suddenly been removed from my plate, I started feeling shaky. By Monday morning, I was in deep trouble. If asked if I were a danger to myself or others, I would have had to reply, “Any minute now…”

Bob likened my situation to a person with a backpack, trooping up a mountain. Someone keeps adding rocks, one or two at a time, to the backpack. At a certain point, you stagger. Then, with that last rock, you fall. Then Bob changed metaphors and shifted over the image of a turtle on its back. I liked that turtle image—squat, fat, and flailing helplessly. I liked it better than the hiker in the backpack, so I’ve stuck with that turtle. It feels just about right.

Bob said often when we are holding up a huge load and it suddenly falls away, we often collapse, because—for the first time—we can. I believe many people push themselves beyond their health limits. I know I do. This time, I pushed myself beyond my mental health limit. The weight came off, and I fell over.

There are a lot of things I want to say about this little side-journey in my life, but I can’t say it all in one night. If you are interested in the view from the cuckoo’s nest, I invite you to follow the next few blog posts. If this stuff depresses you and you’d rather have some lighter reading, I fully understand and I encourage you to push the “delete” button now.

The first thing I want to say is that I can now tell you from the inside what I have always suspected from the outside: The mental health treatment system in this country is appalling. I say this unequivocally. Access to care for the mentally ill is abysmal. It is demeaning, it is exhausting, and it is near comical in a twisted sort of way. Please note that I am saying nothing of the sort concerning the people who are delivering mental health care. So far, from my experience, everyone—from doctors to nurses, social workers, security guards, and janitors—has been kind and gentle. Well, maybe one guy is a bit of a jerk, but really, everyone else has been splendid.

I’ve been battling depression for 25 years now. This is the first time I’ve ended up in an institution, and this is how I came to be here: There was nowhere else for me to go. My previous doctor, a psychiatric technician under the oversight of a psychiatrist, had left her practice. I had felt that my anti-depressants were failing me for weeks. And I’d been calling around to other psychiatrists in my area, looking for someone who would take on a new Medicare patient. No one wants Medicare patients. At least, psychiatrists don’t want them.

And all the time I was calling around and searching, my depression was sinking its teeth deeper into me. In desperation, I called the number of an inpatient treatment center. They could only see me if I came in through the door of the emergency room. They hinted that it could take many hours before they would determine if I qualified for inpatient care. So, I had Carter drop me off at the emergency room with a small stack of magazines. He went off for sandwiches.

When you walk up to the emergency room counter and say, “I think I may be a danger to myself or others,” they get you into a room really fast. Like, warp-speed fast. Then, they leave you there. It is a locked room, bare, no windows, and nothing you can hurt yourself with. It was a long time before I saw anyone, and the day was interspersed with fairly brief visits by a variety of folks, followed by hours of alone time. Everyone asked, over and over, “Have you been thinking of hurting yourself?”

This was a dilemma. If I said “no,” I’d be essentially cutting myself off from the only source of help I felt I could get quickly. If I said “yes,” I was honestly not sure if such a thing was something I was prepared to tackle outright in the next few hours, so would I be lying? So I said “I will be shortly.” And by the time they asked me for the sixth time, I said, “Yup, you betcha.” Whatever it takes, I thought. I’m not enduring this marathon ER blitz for nothing.

I asked questions of the people who came in to talk to me, and they told me very little. I’m someone who needs information to feel safe and secure, and there was little of that forthcoming. I did not know what I was committing myself to, nor really for how long. I just knew that if I got checked in, I would be able to see a psychiatrist and get my medications reviewed and revised. And that I would be safe and secure and tucked away from a world and a life that had suddenly, overnight, become far too big to handle. At that point, nothing else much mattered to me, so I breathed a small sigh of relief when a nice nurse came in and said to me at 9pm, “An ambulance will take you to the facility. They are coming now.” When I asked if I should have my husband bring me some things—clothes, medications, anything—the nurse told me to ask about all of that after I got to the center.

So, off I went in the ambulance, thankfully, and with no sirens blazing.

No one should have to go through such a gauntlet for help. Most especially, people who are struggling to keep their minds together. At a time when I was least able to string two sentences together, I had to make a complex plan to get the help I needed, and then I needed to endure hours of frustration before I had any idea if I’d qualify for any help at all. Since coming here, I find myself surrounded by mentally ill comrades far, far more fragile and far more desperate than myself, people who are forced to cycle in and out of these places because there is nowhere else for them to go. My heart aches for these people. This is nuts.

So, I am writing you from my private, dorm-like room here on the upper floors of wherever it is I am. I am allowed plastic forks and spoons, but no knives, except at meals, so go figure. I may have my computer, but no container of dental floss, but I can tear off a length for my use providing it does not seem suspiciously long. I have had my medications altered by Bob, and we are hoping they work. The rest of my focus while I am here is to find a source of continued medical help when I leave. Where will I find a Medicare Friendly Psychiatrist? Does such a person exist? We’ll see…

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