23: The Hold Continues

November 13, 2011

Gabriela and I both felt that her anti-epileptic drugs (AED’s) needed to be changed, and so had the doctor at Henry Mayo.  But no one at Huntington agreed. That didn’t change my feeling that Gabriela’s psychotic break was completely attributable to her medications, and I knew that Gabriela would agree with me; we had had many conversations over the last year with each other and with Dr. Wreck on this topic.

All of that aside, stopping these types of medications abruptly is well-known to be very dangerous. Each drug should be started slowly, and when they are discontinued they should be taken away just as slowly.

On Sunday, just like the day before, I was in the hallway of Ward 400, sitting while Gabriela stood. This time she let me hold her hand.

Gabriela had taken most of her medications in the morning but had refused the blood pressure and anti-psychotic meds. I asked the CA why she was being given blood pressure medication.  He explained that because Gabriela wasn’t sitting or lying down, her blood pressure was high.

Gabriela had some expression to her face today, not like the last few days when she showed no emotion at all.

She was wearing a clean pair of pants that naturally made me comment on the improvement in her appearance.  The CA indicated that Gabriela had urinated in her pants earlier, so the change was required.

Later during that visit Gabriela started to get so weak that the staff insisted that she sit. While we sat, Gabriela wouldn’t let her feet rest on the floor. Her leg muscles quivered from the strain of holding her feet off of the ground, so I got a pillow from her bedroom for her to rest her feet on. She looped her arm through mine as we sat and I chatted. She responded mostly with the little flickers of smiles, and sometimes spoke oneword responses.

I asked Gabriela why she had not taken her AED’s the night before.

She whispered in my face. “Test.  Her breath could have wilted flowers. She never looked at me directly; she either focused up or down, but never made eye contact. She continued in a whisper, “I’m clearer.

Oh, my God! Gabriela was conducting her own test! She knew it was the AED’s. At this point Gabriela appeared so incredibly strong to me, even though she was barely functional. She was fighting to show the doctors it was the medication.

Dr. Wilson was the psychiatrist on-call that weekend. He was tall, had a full but not fat build, wore rectangular horned rim glasses, and had a booming voice. He showed little interest in the patients, and the patients reciprocated with indifference to him.

Dr. Wilson was, unfortunately, the doctor we met with in the conference room that day. Dr. Wilson sat on one side of the table and I on the other. Gabriela chose not to sit but stood beside me.

Dr. Wilson spoke first.

“Gabriela, tell me why I should not continue your hold?” He asked looking up at her and squinting quizzically.

She tried to form words but failed and gave no second attempt.

He looked back down at her file and said, “Well, I’m going to continue your hold for an additional 14 days.”

Gabriela finally mustered a response. She stood, arms folded, looking past the doctor.

“No,” she said with slight hesitation.

Dr. Wilson looked up squinting as he waited for her to finish … there was no more.

“Well,” he said dryly, “as I said, I am continuing your hold for an additional 14 days.”

He continued matter-of-factly, “If you want to argue it you may, but let me make this perfectly clear: I have 30 years’ experience. Who do you think they are going to listen to, me or you? You don’t take your medications, you don’t eat, drink, bathe, sleep, or speak.… I think they will go with me.”

He paused. “Let me give you some advice.” He searched Gabriela’s file for her name. “Gabriela. If you want to talk about leaving, look directly at my nose when you talk and explain what your plan is. I won’t let you out without a plan.”

He leaned forward and placed his elbows on the table and cradled his chin on his interlocked fingers and waited.

Gabriela stood shifting her weight from one foot to the other, then back again. Taking one hand out to gesture with, she looked in the direction of the doctor and began to speak.

Dr. Wilson interrupted before she got her first word out, putting his index finger to the tip of his nose. “Look at my nose.

It was obvious that Gabriela was giving this her best shot. “I will go home.

Dr. Wilson leaned back in his chair again, touched the tip of his nose and tauntingly said, “Over here. Hey, over here. Look at my nose. So your plan is you’re going to go home.

He smiled at her. “Well, Mom, what do you say?”

He kept his eyes on Gabriela who had turned and looked at me hopefully.

I wanted so badly to support Gabriela against this doctor and agree to take her home. But I knew that I wouldn’t be able to help her alone.  As gently as I could speak, I said, “You need to stay here sweetie, I can’t help you.”

Closing Gabriela’s file, Dr. Wilson ended the meeting with, “So it looks like you have no plan?” The hold was continued for 14 more days.

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