Gabriela

November 30, 2011

Gabriela and I discussed the after care facilities on my list of what I thought were the best options.  We were both on the same page regarding exactly what her needs were, and she understood that I was having a very difficult time finding a suitable place.

Most of the inpatient facilities offered shorter term programs that ranged from three weeks to three months,  and Gabriela and I both knew it was going to take longer than that for her recovery.

Tranquility had risen quickly to the top of my list, but Gabriela was leaning toward some out of state facilities that she had heard about while she was at Huntington. I explained that if she checked into a place far from home, and found that for some reason she wanted to leave, there would be nowhere for her to go. This was a real concern for me because her admittance would be voluntary, so she could leave any time she wanted.

I did tell her that the man who ran Tranquility was helping me find a place for her at another facility because they had no openings for the next few months.

One afternoon, I called Bridges to Recovery.  The cost of a bed there was $45,000 for a one-month program.  They had only six beds, but each day was full of an assortment of therapies. I thought it might be a good first step for Gabriela, and would buy me more time to find a more permanent place. If I could get my primary insurance company to approve them as a “preferred provider,” then the cost would be fully paid for.

The director of Bridges was a nice enough man, who seemed willing to work with me as I coordinated the conversation between Bridges and my insurance company. Everything seemed to be working out.

Gabriela had looked over the information I’d brought her about Bridges, and liked what she saw. Abbey knew Bridges by reputation and liked them. Dr. Duncan liked them, also, and Claire and I liked them. Another plus was that at the end of the first month, if Gabriela wasn’t ready to leave, it might be possible to extend her stay.

I was really just looking for a place that could help Gabriela while we waited for an opening at Tranquility. Everyone felt that Bridges would work well for the first month or so, then Gabriela would transfer to Tranquility for the long stay.

Each day I worked with the director of Bridges to make sure everything was in place. Bridges was a very well-known and very posh facility; Claire and I both joked that we wanted to go there just for a break.  Gabriela was very excited to start on her road to recovery there.

We knew Dr. Duncan was keeping Gabriela at Huntington just long enough for Bridges to be ready to receive her.  As we came down to the wire, Abbey pulled some strings to get the authorization for Bridges from the insurance company, which came just the day before Gabriela was to be discharged. Excellent!

The following day I had to pick Gabriela up from Huntington, and drive her to Bridges.  I sat in the waiting area of Huntington that next afternoon, knowing all I needed was to get that last confirmation from the director of Bridges that everything was a go.

My cellphone rang. It was him. “Bobbie, good news! We have heard from your insurance company and everything is taken care of.”

A sigh of relief from me. “Thank god,” I thought.

He continued. “We have decided to give you a $25,000 scholarship toward the tuition, so when you bring your daughter over today, just bring a cashier’s check for $20,000 made payable to Bridges to Recovery.”

I felt a jolt! This couldn’t be happening so close to her release. There were no other options! I had crossed every “T” and dotted every “I.”

“I told you I have no more money!” I desperately reminded the hollow businessman on the other end of the phone. “There is no way that I can come up with $20,000 in two and a half hours! Insurance has already authorized this. They will be paying!”

The voice on the other side of the line said, “Yes, they have authorized your daughter’s treatment, so they will reimburse you.”

Completely defeated, I sighed into the phone without an ounce of energy left in me. “I have nowhere to take my daughter, nowhere to get help for her now!”

He quickly chimed in, “We will send you some information on a place called Paramount Health. It accepts your insurance, and we will give them your number so they can call you.”

I sat in the waiting area and tears poured. Here I was just minutes before Gabriela would be let out, and now I had no plan.

As I sat in the waiting area the evening nurses arrived, the one that I wasn’t particularly friendly with. She’d called me from her cell phone very late a few nights earlier and said ominously, “Call your daughter on the hall phone.” Then hung up.

When I’d called as she had instructed, it was nearly 11PM.  Gabriela answered, she was having a difficult night. She was panicked, paranoid, and frightened. She wanted me to come to the hospital, and then in the middle of our conversation one of the client assistants walked over and just hung up the phone. I was worried, because Gabriela had been crying and was out of sorts enough that the nurse had called me. I called back, but there was no answer, so I called the nurses’ station.  The nurse that had called me from her cell answered.  I asked, “What’s going on?”

She acted as if she hadn’t called me earlier, and answered, “Everything is fine. Your daughter is just a little sad.”

I was completely confused. “What the heck is going on over there?” I paused. “I would like to drive over and see Gabriela.”

She responded that visiting hours were over. I asked her, “Call your head nurse and see if you can get permission for me to come in, then call me on my cell. I will be on my way.”

I received no phone call as I drove. When I arrived, the gates were locked and it was about midnight, so I was told to leave. I asked if they would tell Gabriela that I had come.

This is the nurse that now stopped and sat next to me. She asked what had happened.  I explained that I had really let Gabriela down: that the place I’d thought had been completely set up, and which Gabriela was to go to in just a few hours, had just pulled the rug out from under me completely. And I had no backup plan.

Now, Gabriela would be going home with me, and I wasn’t ready for that. And neither was she. The nurse put her arm around me and confided that she has a son who suffers from a mental illness. And that we, as parents, do the best that we can, and it’s not always easy and we aren’t always perfect. “Life is tough enough as a parent. But add to that the twist of an adult child with a mental illness, and our job has just become 100 times more difficult; and any support system out there for us or our children has become 100 times more rare. We do the best we can and you have tried harder than any mom I have watched. You have done well. Your daughter will be fine. It’ll be okay.”

She and I sat and talked until I didn’t look like I’d been hit in the face with a frying pan. Until I wasn’t crying, and my voice could hold a steady tone. Then we walked to Ward 400 together. I wasn’t ready to tell Gabriela, but I knew I didn’t have any choice.

November 15 to 16, 2011

As soon as I arrived home that evening, I searched online for Tranquility Psychiatric Center and read their entire website; along with the reviews I found.  It definitely sounded like a place that would be perfect for Gabriela.

I waited impatiently for 9AM the next day to call Tranquility.  When I called I was put through to the director’s voicemail, where I left a short message regarding my interest in their program. By the end of the day I had received a call back from the director, Harry Sline, and we discussed Gabriela’s current diagnosis and needs. Then Harry explained their program and the cost and the fact that, sadly, there were no openings for the next four months.

Generally this would have ended the call, but Harry could tell that I was worried, tired, and frustrated with the lack of good quality, accessible, and affordable mental health facilities. He offered, “Bobbie, don’t worry, I will help you find a place for your daughter. You call these places …” and he listed off three facilities and the contact names for each. “Tell them that I sent you. If none of those work for you call me back and I will give you three more.”

Incredibly, I hung up on him! I was crying so hard I couldn’t even manage a thank you to end the conversation. There were so few people in this process that had offered help that it left me speechless when it finally happened.

I had a few other facilities which, along with Tranquility, made my short list of top choices.  I printed out information on each, then called them individually and collected cost, insurance, entrance requirements and so on. I included in the group a partial hospitalization program that was in our town.

I wrote up a brief outline of the information I had gathered on each facility and made two copies, one for Gabriela, the other for Abbey and Dr. Duncan.  Gabriela wanted to be fully in charge of the selection process for the facility she would be heading to and I wholeheartedly agreed.

During the hours and hours I spent on the Internet each day looking for facilities or help for Gabriela I had stumbled across a quote. Gabriela loves quotes and this was one she needed to have. I printed it out and tucked it into a writing journal that I planned to take to her the next evening.

At dinner I gave Gabriela the journal and told her, “I put a quote in it for you.”

She opened the book and read it:

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, sensitivity, and an understanding of life that fills them with compassion, gentleness and a deep loving concern. Beautiful people do not just happen.” — Elizabeth Kuber-Ross

She folded up the quote, placed it back inside the journal, then leaned over and gave me a huge hug, saying, “I love the quote! Thank you!”

November 25, 2011

On the Friday evening after Thanksgiving, I was drinking coffee while Gabriela ate dinner. Then Cody arrived. He appeared to be unhappy about something. He muttered a greeting to Gabriela as he pulled up a chair and positioned it so his back would be toward me.

He leaned back uncomfortably in his chair, and sat without saying a word.

Gabriela tried to engage him in conversation, but all she could get out of him were single–word responses. Cody didn’t make eye contact with Gabriela, and completely ignored anything I said. He was present but made it clear he didn’t want to be there at all.

About five minutes into Cody’s visit, Gabriela leaned toward him and whispered, “Dad, if it’s okay I think I would like you to leave a little early tonight. I need to talk privately with Mom. Okay?”

Cody’s response was a slight nod of his head.

Cody sat silently. I couldn’t figure out what had happened that had made him so angry, but it was clear that it had something to do with me.

Gabriela’s tolerance for her father’s behavior lasted only a few more minutes before she leaned in toward him and whispered, “Why don’t you leave now?”

Cody got up and left without a word.

Neither Gabriela or I needed to talk about what had just happened. We were both so accustomed to this type of behavior from Cody. We knew that something had set him off, and that it was probably something small, but he felt the need to punish me with his silence and it didn’t matter that he was subjecting Gabriela to it, as well.

Shortly after Cody left, I received a text message from him: “Keep her on your insurance.”

I responded: “Yes, I think that’s better because we would never know when you would just cancel her coverage like you did last time.”

Cody’s last response was “I’m done.”

That was it, the proof of the pudding.

This could have been a blow to Gabriela, but she hadn’t had any relationship to speak of with her father since she was about eight.  He knew nothing about her, nor had he taken the time to get to know her.

I did find out from Claire that evening the probable reason for Cody’s anger. Claire had said one evening as we drove to visit Gabriela that she was shocked Cody had told both of us he wanted a divorce in the same way.  I didn’t say anything, but the look on my face must have been puzzling, so Claire clarified: “He called you from the platform and told you he wanted a divorce. Right?”

“No,” I responded, and told Claire the story of how I had asked for a divorce on Independence Day. She was mad as hell and had brought it up with him just two nights before.

This was the last visit from Cody while Gabriela was in the hospital, and he never even called to find out how she was doing for the rest of her stay. It would be an understatement to say that fatherhood didn’t come naturally to Cody.

Of all the patients on ward 400 with Gabriela at Huntingdon Hospital, Zack had become one of my favorites and Gabriela’s sidekick. The two of them got along great, were about the same age, and were both bright, well-spoken young adults.

Zack had a different set of problems from Gabriela; he was a “dual-diagnosis” but his situation was a little more complicated than that. A few years ago, when he had been a sophomore in college (he was now about 24), his mom told me he had been living the life of an average 20 year old. Then one day she got a phone call.

Zack had been in an accident and had been thrown from a car. As a result of the accident, Zack had frontal lobe brain damage and had been kept in an induced coma for nearly three months. After the coma and during his recovery, Zack had had to relearn how to talk and walk, along with many other basic life skills. It had been a long road to recovery for Zack, as well as for his mom and dad.

Zack, like many young people his age, had also enjoyed drug use, and during his recovery he met some pre-accident “friends” from college who encouraged and supplied him with drugs. These friends continued to do this despite warnings from Zack’s mom that it was important that Zack stay away from drugs completely. According to Zack’s mom, these friends supplied him with drugs every day for nearly a month, until finally Zack suffered a psychotic break much like Gabriela’s. So he really was, as he had assured me during Gabriela’s first days at Huntington, “just like that”.

Because Zack’s parents had conservatorship over Zack, they were keeping him at Huntington Hospital to get him “clean.” Zack needed to be off drugs for at least 30 days, as a prerequisite for getting into a rehab program for people who suffered from traumatic brain injury, psychosis, and drug abuse.

His parents were divorced, but one or the other was there to visit Zack almost every day.  And if they weren’t there, Gabriela and I included him as though he were a part of our family.

My first introduction to Zack, of course, had been when he’d told me, “she’s in there.”

After Gabriela had taken her first shower, Zack and his dad were in the day room. They sat across the dinner table from us and Zack’s dad greeted Gabriela with overwhelming enthusiasm: “Wow!” he exclaimed, “What a difference!” He leaned toward Gabriela, “No really.  I have greeted you every day since you arrived, for what—” He looked to Zack for confirmation, “a week?” Zack nodded. “This is an amazing change! Welcome, nice to meet you.”  Gabriela smiled shyly, “Nice to meet you, too.”

Zack’s psychosis made him get stuck on ideas and he would wander around the ward lamenting, “I’m gonna die.” As previously noted, he spoke in a very deep, surfer dude, California way: “I’m gonna die, soon. Dude, I can totally feel it, I’m gonna die.”

One day I said, “Zack, how old are you?”

He responded, “24.”

“Look, I’m more than twice your age.”

Zack’s mouth fell slightly open as he listened, sleepy eyed.

I continued “Statistically I will die much sooner than you and I’m not quite ready to go.”

“Dude, you really think so?” He asked sounding somewhat relieved.

“Yep,” I assured him.

Zack walked away, considering the possibility that his death may not be so imminent.

Another interesting character was a longer term patient, Roger. He was almost 6′ but thin as a pole; he couldn’t have weighed 145 pounds. Roger had a full beard and long, straight, sandy blonde-gray hair. He spoke with a notable twang; I later found was from Oklahoma.

Roger was confused, disoriented, and angry when he first arrived. He didn’t know where he was or why he was being held. He had arrived after Gabriela’s first week, during the time she had started her recovery but was still hearing voices.

His first week, Roger disrupted the ward by never remembering which room was his, despite the large sign the staff had posted on the door jamb with his name on it. Roger was known to have gone into everyone’s room at one point or another, sometimes climbing into their bed even if they were already in it!

One of those first nights, after Roger showered for bed, he walked from his room and stood naked in the doorway of Gabriela’s room.  Which freaked her out. The staff swore they would keep an especially sharp eye on him so that Gabriela would be safe.

The following day, while I was visiting her, Gabriela had gone to her room to retrieve something, and returned shaking — Roger had left his clean folded clothes on the foot of her bed. That was it for Gabriela. After that she avoided him completely, and wherever Roger was, she wasn’t.

Much to her relief, Roger was briefly off Gabriela’s ward when he was transferred to ward 200 (the geriatric ward). But that didn’t last, because he was disruptive there, as well.

By Thanksgiving, Roger was making progress. I watched him sit quietly by himself and eat. He must have eaten his weight in Thanksgiving dinner, and when he was done, he quietly adjourned to his room for the rest of the day.

After Roger’s behavior during the first week he was on the ward, it took Gabriela quite some time to warm up to him. But eventually, as he improved, Gabriela gave me small snippets of information about Roger; he hadn’t shared his full story with anyone else as far as I knew.

Although no one knew what for, Roger had spent time in prison and he taught Gabriela and Zack a card game called “Spot” that he had learned while incarcerated.

In all the time on the ward Roger had only had one visitor. When he visited the two of them sat together at the very end of the hallway on the floor and talked. He never had another guest again which made me sad to think that he was navigating life completely alone.

One weekend afternoon when almost everyone was in the day room lazing around, watching TV, playing cards, or just visiting, Roger walked into the room. He saw Dr. Wilson through the window between the day room and the nurse’s station. Dr. Wilson was seated at the computer, leaning back with his arms folded behind his head talking to one of the nurses, his back to the day room. Roger stood in the middle of the room and faced the window.

He announced loudly, “Let’s see how long it takes the bastard to notice this!”

Roger held out both hands, middle fingers fully extended, flipping off Dr. Wilson like he was holding pistols. “Wanna take bets?” he chuckled, then the room erupted in a combination of laughter and bets.…

“Five minutes!” shouted one patient. “Three minutes,” from another.

“Bet he never notices!”

It was a “Cuckoo’s Nest” moment. I couldn’t hide my amusement. Roger held his position, like a gun fighter from the old west, for nearly five minutes before the client assistant noticed his pose and gave him a quick quiet room threat.

Larry was the longest term patient; he had been on Ward 400 for 11 months. Larry was schizophrenic and had a conservator who was not at all interested in his care. He was in a court fight to regain his rights to self-determination.

He was very upbeat, but almost never interacted with the other patients. He watched TV intently, or spent time in his room; that was it.

Because the phone for patients was next to Larry’s TV seat, he had answered the phone quite a few times when I called to speak with Gabriela. Each time he answered he would yell into the phone, “I don’t speaka English … I speaka Chinese, Japanese, Russian, Italian”….whatever the language de jour was. Then he would hang up the phone.

When I first walked into a psych ward, I tried not to make eye contact with any of the patients. For some reason I thought mental illness might be contagious, and I also felt that if I didn’t acknowledge mental illness then there would be no way that my daughter would have it.

I know how ridiculous that sounds, but this was all so new to me.  What I came to know was that the people on a psych ward are just people.  Zack was a mathematical engineering major; Roger was an engineer; Larry was a harmless guy that in the sixties we would have referred to as odd.

The people on a psych ward are a slice of society. There are people from every facet of life:  the rich, the poor, the educated, the uneducated, the married, the single, the young and the old. We all run the risk of experiencing mental illness.