November 16, 2011
Wednesday I had a mid-afternoon appointment with Dr. Duncan and Abby, the social worker. During the meeting I found, to my surprise, that Dr. Duncan had canceled the Riese petition that had been started, to which I had chalked up all the improvements I’d noticed in Gabriela the previous evening.
Dr. Duncan explained that early Tuesday morning Gabriela had become belligerent with one of the nurses, and that she had tried to hit him. As a result, the nurse had given her an injection of Haldol, a strong anti-psychotic; then Gabriela was put into the quiet room for a few hours.
I listened, stunned. I began to imagine Gabriela, who was in the worst mental condition of any of the current residents on ward 400, being asked to comply with a request that she might have perceived as threatening.
Maybe she had become violent. After all, while she was at Henry Mayo she’d scoped the place out for its weakest entrances and exits; then she’d set off the fire alarm several times, trying to break out during the commotion. She had thrown herself through a window at Huntington in an effort to escape, and again set off fire alarms. She had tried desperately to convince me to have her taken to the ER where she felt we could make a clean get away.
The movie playing in my head went like this: Gabriela, such a little bit of a thing but looking like a complete wild woman, flailing alone against the staff. Ultimately, she is subdued by three hulking bouncer types. Then Nurse Ratchet injects her with a vicious thrust of a hypodermic needle. The scene ends with Gabriela falling limp in their grasp and being carried off to the quiet room. I faded back into the current conversation.
Dr. Duncan was in the midst of explaining what had caused the improvement in Gabriela’s condition. He told me the reason she was now eating and drinking and had gotten some sleep was thanks to the heavy dose of anti-psychotic medication; this had been enough to give her a little “snap.” She was starting the process of coming back!
Dr. Duncan and Abby were both on the same page regarding protocol. Gabriela needed to be moved up on Seroquel rather quickly, 25 mg at first to make sure there would be no negative reaction. As soon as that hurdle was cleared, the dosages would be increased.
I asked what progress had been made in determining the linkage between her AED’s and her current psychosis.
I watched Dr. Duncan as his face twisted and he bobbed back and forth uncomfortably in his chair, searching for the best way to say it. “We don’t believe that there is a relationship between Gabriela’s behavioral issues and her medications,” he said at last.
He continued, “Bobbie, it is known that visual hallucinations are an indication that the psychosis is organic.”
I listened in disbelief. Should I offer that I surely remember having visual hallucinations after taking LSD?
“Well then,” I asked him respectfully, “what is your initial diagnosis?”
He cleared his throat and fumbled around searching for words, dipping his head forward much like a chicken clucking around the yard. “It’s close,” he said.
He clenched his teeth, then continued, “It’s either bipolar I with psychotic features, or schizo-affective disorder. They are very similar and it’s too early to know for sure which it is.”
I stopped breathing. I had never heard of “schizo-affective,” but it sounded damn close to schizophrenia. I didn’t ask a single question; it was all I could do not to run hysterically from the building and never, ever return. The only thing that kept me seated was knowing I was the only person who could help Gabriela get through this.
There had been nothing in my life that could’ve prepared me for hearing a diagnosis of “schizo” -anything being applied to Gabriela.
I refused to take it in, to digest this diagnosis at all. I left it on my plate, untouched.
Our meeting ended, and what really made it surreal for me was that it was all handled so matter-of-factly by both Abby and the Doctor.