Car Accident

New experiences for Isaac last night. We were in a car accident and I was taken to the hospital by ambulance. The EMT at the scene told me that the officers would "take care of my dog" and I said, "No, he's a service dog, he will come with me" and I was prepared to argue. I would have refused to be transported if they refused to take my service dog with me. But as soon as I said that, the EMT said, "Oh, that's good" and they were happy to bring him with me. There was plenty of room in the ambulance and the EMT told me they had transported other service dogs before. Isaac jumped up in the ambulance with no problem and I told him to lay down and he did.

Isaac has been in the ER before so that was no big deal for him. They took me to get a CT scan and the nurse asked me if my service dog had to go with me. I said "He can't stay here by himself" because of course I was not going to leave him unattended in the ER. She said an aide would take care of him for me while I was gone if that was OK with me and assured me I would not be gone long. I would not have asked staff to watch him but it was their idea. I agreed and the aide said he would take Isaac outside to go potty if that was OK with me. I said it was. He mentioned that there wasn't much grass outside (this was a hospital in a city area) and I told him Isaac would pee on concrete or other surfaces and told him to just show Isaac where to go and tell him to go potty and he would. When they were bringing me back from the CT scan, Isaac was lying on the floor by the nursing desk with three employees gathered around petting him.

I was really glad Isaac is perfectly fine being handled by other people and is not stressed by being separated from me. He seems OK after the accident, but I might take him to the vet today or tomorrow just to get checked out just to be sure. An EMT looked him over for me at the scene of the accident and then a friend checked him over carefully for me at the hospital later. It was a while before I could check for myself because I had a cervical collar on and stuff for a while. I am OK now, just really sore, and Isaac and I are at home.

The hospital and the EMTs were really great and I was relieved not to have to argue about taking Isaac in the ambulance with me.

Documentation

Today I had to go to the ER. I've never had any problems at my local hospital before, not in the ER or the lab or the x-ray department or visiting patients. But today the triage nurse asked me "Is that a certified service dog?"

I said "He is a service dog but there is no certification."

She looked like she didn't believe me and asked "Do you have documentation?"

I said "I do" and pulled out a rather tattered copy of the ADA Business Brief (note to self: put a new one in my purse) and showed here where it says businesses can ask if a dog is a service dog and what the dog is trained to do but that they cannot ask for ID or documentation.

Best service dog documentation I can carry.

I am going to contact whomever is in charge of the ER and make sure they educate their employees.  But I was not feeling well enough to deal with it today.

Access Dispute Resolved

Remember my recent access dispute at a health care facility? I called and spoke with a patient advocate last Monday afternoon and I spoke with her again this morning. In just four business days, this is what she, and the company, did.

They (meaning people in charge) investigated to confirm that the Dept of Justice does not consider a Post Anesthesia Care Unit to be a "sterile area" and that, if visitors are permitted in the unit, then service dogs must be permitted too. They also made sure they understood exactly what areas can legally exclude service dogs and she mentioned them to me on the phone - things like burn units, bone marrow transplant units, etc.

The advocate also looked into the hospital's own policy regarding service dogs and found that their policy, as well as the ADA, were violated. As you might expect, hospital policy includes complying with any and all federal laws and not violating the civil rights of patients or visitors.

Now comes the really amazing part. In just four business days, a mandatory meeting/training session was scheduled for all employees of four different departments, including same day surgery and the PACU. The advocate told me one employee was absent the day of the meeting, so she was educated in a private meeting this morning. All employees were educated about the ADA and hospital policy. Some expressed concern that the PACU was a sterile area and they were told in no uncertain terms that the hospital and the Dept of Justice agree it is not and that, if visitors can just walk in wearing street clothes, so can a service dog.

The advocate told me a couple employees asked "What if it's not a real service dog?"

And they were told "That is not your call to make." They were informed of the two questions the ADA allows them to ask and told that if the handler answers those questions, the dog is allowed. They were also educated about when someone can be asked to remove a service dog, if the dog is disruptive or not housebroken.

Employees were also reminded (because apparently they are supposed to already know this) that if a patient or visitor is concerned that their rights are being violated, there is a patient advocate available 24/7 who should be called right away.

This information is also going to printed in a newsletter that all staff receive.

I am more than pleased. How amazing is it that this was done in less than one week?

The Biggest Access Dispute So Far

Last week I had an access dispute, by far the most upsetting I've had since getting my SD. I thought I'd share what happened, how I handled it, what's been done to date to deal with it, and I will provide updates as I get them.

This was in a health care setting. I was informed I could not visit a friend in a particular unit and had to wait until they were moved to a private room "because the service dog is not allowed in there."

Me: What? Why not? The Americans with Disabilities Act says if visitors are allowed, I can take my service dog.

Employee: That's what I thought but I am being told we don't allow dogs in there.

Me: But why?

Employee: It's a sterile area.

Me: Oh. So visitors have to change into scrubs and wear masks and gloves and stuff?

Employee: Well, no.

Me: They can wear street clothes?

Employee: Yes.

Me: Then that's not a sterile area. But I'll tell you what. Let's call the ADA Info Line at the Department of Justice and ask them. Here, I have them on speed dial.

Employee: Well, there are other patients in there.

Me: So?

Employee: The doctor doesn't want the dog in there.

Me: My friend's doctor doesn't? May I speak to him, please? He can call the ADA Info Line. They will be happy to explain the federal law to him.

Employee: Well, not that doctor specifically. It's all the doctors. It's just their policy.

Me: Well, the doctors cannot have a policy that violates the federal law. Who can I speak to about this?

Employee: Well, it's the head nurse that is saying service dogs aren't allowed.

Me: May I speak to her? Or how about her supervisor? You are violating my civil rights and you cannot do that.

Employee: Well, I can check again in an hour or so.

Me: No, that's not acceptable. I want to speak to someone right now.

Employee: Let me go check.

So the employee comes back and says I can visit "just for a few minutes."

I ask who I would speak to in order to prevent this from happening again because "discriminating against visitors with disabilities is not OK." I am told I should speak to the patient advocate. I ask for contact information and she says she'll get it for me but she never does. 

I really feel like she did not give it to me on purpose, not that it was just an oversight, but that she did not want me to complain.  Dude, that does not work with me.  I can find that information.

On my way into the unit to visit my friend, a nurse calls out, "Hey! That dog can't come back here!"

I say, "Someone already checked on it and said he could. The Department of Justice also says he can," and continue on my way.

So yesterday I get online and look up a phone number for the patient advocate at this facility. And no, it was not that hard to find.  I call and speak to someone who sounds appropriately concerned.

She says she will need to check because she knows there are certain areas where they can deny access to a SD, like an OR. I say yes, sterile areas, like an OR or a burn unit, where visitors would have to wear special clothing. But on this unit, visitors wore street clothes. I tell her the Dept of Justice says that's not a sterile area and they can't deny access and encourage her to call the ADA Info Line and ask for herself. She thanks me for clearing that up for her, says I answered her question about that.

She tells me she needs to talk to a bunch of people. The employee that denied me access and gave me the run around when I asked who I could speak to about it. The head nurse of the unit my friend was on. The facility's regulatory compliance person. She says that clearly their staff needs to be retrained on the ADA. She asks if she can call me back later in the week to let me know what progress she's made.

What made this access dispute the most upsetting?  Well, it had already been a long, stressful day.  Other employees had been semi-rude or unhelpful - for instance, one refused to give me directions to the cafeteria because it was apparently to hard to explain how to get there. But also, it's not like I could choose to go visit my friend at another health care facility.  They were a patient at this facility.  It's not like if a fast food place denies access and you can just go down the street to another fast food place.

That's a Well-Trained Dog!

I had to go to the ER today for a cut that I thought needed stitches (ended up with just steri-strips instead). Isaac was lying on the floor beside the gurney when the doctor came in.

The ER doctor said hello to Isaac and held out his hand for Isaac to sniff him. Isaac just looked at him.

The doctor said "Are you shy?" and of course Isaac did not respond.

So then the doctor said to me "Is he a little leery of strangers?"

I said "No, he's just not supposed to say hi unless I tell him he can." And then I told Isaac "You can say hi" and Isaac jumped up, tail wagging, and sniffed the doctor good.

The doctor was like "Oh, that's a well-trained dog!"

I'm like, well, yeah, he's a service dog. It always makes me wonder what kind of service dogs they are used to seeing.

X-Rays

Today I had to go get my knee x-rayed. I was planning to put Isaac in a downstay behind the little divider thing where they x-ray tech stands but there was another x-ray tech that volunteered to hold the leash for me in an adjoining room. They left the connecting door open so I could hear what was going on in there.

They had to take several x-rays and partway through I heard Isaac's tags jingle and heard the tech tell him, "They will be done in a minute."

I called out, "Isaac, stay" and didn't hear anything else. 

As soon as I was done, I called him and he came trotting, but not running, into the room where I was. 

Then when I started to walk out of the room, Isaac turned back to the tech that had watched him for me and said goodbye by nuzzling her hand for a second. It was cute. 

And he behaved very well. 

And no one asked me why I had a service dog.

Can You Take a Service Dog to the Hospital with You?

I have a service dog, a yellow lab named Isaac, who is trained to help me with my post-traumatic stress disorder and the herniated disk in my back. Due to my disabilities, I’ve had to spend a fair amount of time in hospitals, both as an inpatient and as an outpatient. When I was preparing to get my service dog, I started researching whether or not I would be able to take him to the hospital with me.

Under the Americans with Disabilities Act, people that rely on service dogs are allowed to take their dogs to most health care facilities, including doctors’ offices and hospitals, as long as the presence of the dog doesn’t cause a “fundamental alteration in the provision of goods or services.” What that means in practice, and in plain English, is that you cannot take a service dog into an area where the presence of the dog would compromise the quality of care given to you or to other patients.

One easy way to think about it with regards to a hospital is to consider in which areas of the hospital people have to wear special clothing. In an operating room or a burn care unit, for instance, staff members all have to wear gowns and gloves and masks and shoe covers and hair covers. However, you cannot dress up a dog like that. The presence of a service dog could cause serious problems and there is really no way around it, no “reasonable accommodation” that could be made in order to allow the dog’s presence.

Plus, if you are having surgery, you are not going to be able to manage your dog and your dog is not likely to be able to do any tasks that help you with anything. Most likely, you’ll be unconscious but even if you are having surgery under local or regional anesthesia and are awake, you’re not going to need your dog to pick up things for you or open doors for you or alert you to sounds or whatever it is your dog usually does for you.

You should, however, be able to take your service dog to the emergency room, to the lab, to the cafeteria, to the gift shop, and to visit patients on most units of the hospital. If you are going to the emergency room because you are sick, though, you might want to bring along a friend that can help with your dog. If you end up being there a long time, your dog may need to go outside and you might not be able to take it for a walk right then. If you have to get x-rays or certain other tests, it may not be safe for your dog to be in the room with you, and hospital staff is not responsible for caring for your dog.

If you need to be admitted to the hospital for some reason, in most cases you should be able to take your service dog with you if you want to, but you should think about it carefully. If you are sick enough to require hospitalization, you are probably too sick to take your dog for walks and to take care of your dog in other ways. You could arrange for a friend or family member to come in several times a day to take your dog for walks, or you could hire a dog walker to do that. Still, your dog is probably going to get bored and unhappy doing nothing but sitting beside your hospital bed for several days. Most people that rely on service dogs choose to leave their dog with a friend or family member when they need to be hospitalized. A family member or friend could bring your dog to visit you while you are in the hospital, however.

Since receiving my service dog, I’ve only been hospitalized once. I elected to have a friend care for my dog during that time because I felt it would be too difficult for me to care for the dog while I was in the hospital. I felt it was important to consider what was best for my dog and spending five days cooped up in a hospital room wouldn’t have been best for him.

And if you're wondering if your service dog is allowed in an ambulance with you, in most cases the answer is yes.  You can read more about that here.

Trip to the ER

Last night I went to the ER.  I didn't intend to.  I intended to go to Urgent  Care.  My local hospital has both an ER and an Urgent Care and I didn't consider my condition life-threatening or emergent, so I drove over there intending to be seen in Urgent Care.  However, they informed me I needed to be seen in Emergency instead.

I was feeling dizzy.  I've been feeling dizzy a lot lately and haven't posted much about it because, well, I figure people get bored hearing me complain about not feeling well, and I just didn't feel like talking about it.  I have seen my primary care doctor twice for it, though, and we still don't know what's causing it.  He is supposed to be referring me to an ENT but I haven't heard from him yet.

Anyway.  I was super dizzy and repeatedly felt like I was close to passing out.  I felt vaguely nauseous and, I don't know, just not right.  Something was wrong, I just didn't know what.

So I went to the hospital, intending to be seen in Urgent Care and ended up in the ER instead.

Isaac went with me, of course.  They wanted to take me from the registration desk back to an ER bed by wheelchair since I was dizzy.  They didn't want me to faint or fall or anything.  Isaac had never walked beside me before while I was in a wheelchair.  It never occurred to me to train him to do that, because it's not something he's ever needed to do before.  He handled it just fine, though.  He kept looking at me like he was not quite sure what he was supposed to do, and I was a little bit worried he'd get too close to the chair and get his toes run over, but I told him to heel and he did great.  It might not seem like a hard thing for a dog to do, but heeling with a wheelchair is different than heeling beside someone that is walking.

They took me back right away.  I didn't have to sit in the waiting room at all.

They seemed pretty concerned and got me hooked up to a heart monitor right away and then did an EKG.  My heart appeared to be just fine.  Although at one point the EKG tech said something like, "Oh, that's not good," and I thought, "Crap, there is something wrong with my heart."  Turns out she was talking about the  machine.  A cord was not working right.

I took a towel for Isaac to lie on.  He was snoozing away on the floor on one side of the gurney and at one point I had two nurses and the EKG tech on the other side of the bed, all doing things to me.  Or trying to.  I kept saying, "If you need to get on the other side of the bed, I can tell Isaac to move."  They kept saying, "Oh, no, we don't want to bother the puppy!  He's fine.  We're fine."

At one point I invited Isaac up on the bed with me.  He thought it was too high and too small and he did not want up there.  He preferred his towel on the floor.

The staff was all really good about Isaac.  No one distracted him, no one questioned my right to have him there.  One of the nurses asked me about what Isaac did for me, and when I told her some of the things he does, she said something like, "It's just amazing what they can do" and that was it.  The doctor didn't ask what Isaac did for me.  I'm honestly not even sure he realized Isaac was there.

It was overall a really good ER experience, and I'm glad because I have avoided the ER since my bad experience nearly three years ago.  I really like my local hospital.  I felt like they treated me with a lot of respect.  Of course, I wasn't there for anything mental health-related. 

You know how in the ER, you can often kind of hear what's going on with other patients?  Emergency rooms are not always the most private of places.  Well, a little while after I got there, a young woman was brought in by ambulance.  I couldn't see her but I could hear her some.  I could hear nurses talking to her some.  She was in a lot of pain, I think abdominal pain, and was crying and moaning some.  I'm not sure how old she was, not a teenager, but a young woman, I think.

Anyway, I overheard them asking her about her medical history and stuff, and heard that she was on the spectrum.  They were referring to it as Asperger's, although that diagnosis no longer exists, technically.  All forms of autism are now referred to as autistic spectrum disorder, or ASD.  Anyway, even though she had autism, they were treating her the way I image they'd treat someone without a neurological disability.  They were talking to her like an adult, like she was capable of answering questions about her medical condition (and it seemed that she was indeed capable of doing so).  Her boyfriend was there at first and later I think a family member was there, but the ER staff all talked to her, not to the other person.  That may seem obvious or common, but it's really not.  It is common for medical people to ignore a person with a disability and talk to their companion instead, like the disabled person is not capable of peaking for his- or herself.

Back to me.  They did some blood work, and it was all normal except my blood sugar was a teeny bit low.  So I got some orange juice and graham crackers.  My blood pressure was low, so they gave me some IV fluids.  After a full bag of fluids, my blood pressure was even lower than it had been when I arrived there!  So they gave me more fluids.

They also wanted to do a urinalysis.  I didn't think I had a UTI, there was no reason to think I did, but whatever.  They wanted me to pee in a cup so I peed in the cup.  And guess what?  I have a UTI.  Apparently a pretty bad one.  I have no idea how I could have a really bad UIT and not know it.  I have no pain, am not peeing any more than usual, have no fever, my pee seems normal to me... I don't know.  But it was bad enough that they wanted to give me some IV antibiotics while I was there.  And they sent me home with a script.

I don't think the UTI is causing my dizziness, though.  So that has not been resolved.  At least I found out I have a UTI, though.  At least I'm being treated for it.  I just don't get how I didn't know I had one.

Got a Mammogram Today

Today I had to get a mammogram and I took Isaac with me. The radiology tech remembered Isaac from when I was there having a stomach x-ray done about six weeks ago. She didn't remember me but she remembered Isaac. It's funny, but that is often the case.

Isaac was really good. I put him in a down stay behind the console where the tech would be while actually taking the x-ray. She had to take a total of four different x-rays and had to leave the console to reposition me, then return to the console, for each one. I asked her not to talk to Isaac or even look at him when she did so, because I figured he would take any attention whatsoever as an invitation to get up and socialize. He stayed right where I told him to under all the x-rays were done and I called him over to me.

The radiology tech reminded me that I'd let her pet Isaac last time we were there.  I took that as a hint that she'd like to pet him again.  I told her she could pet him when we were all finished, and Isaac was quite pleased to be told to "go say hi" to her.

To the Emergency Room Physician that Assaulted Me

I am writing this letter because I hope it will help me heal.  I don’t really expect you to care about how your actions have affected me.  If you were the type of person that cared about things like that, you would not have assaulted me in the first place.  I used to be a social worker and I worked in a batterers’ intervention program, so I know, personally and professionally, how unlikely it is for abusers to actually change their behavior.  I wish you would at least take a moment to think about how much damage your abusive behavior has caused, I wish you would change, but I don’t expect you to.

You saw me in the emergency room a little over a year ago.  It was November 23, 2012.  I came to the ER because I’d cut myself on both forearms with an exacto knife.  I suffer from major depression and PTSD, which I explained to ER staff.

I had about 50 cuts on each forearm.  My arms were swollen and sore.  Here is a picture for you, in case you’ve forgotten how they looked.  This was taken the next day.

You put seven staples in my arms, with no anesthetic, no pain meds of any kind.  I asked for lidocaine before you started, complained of pain during the procedure, and requested pain medication repeatedly afterward, only to be ignored by you and by other staff people.  I didn’t try to refuse treatment because, while I understand I should have had the right to do so, I was afraid that right would not have been respected.  None of my other rights were being respected, after all.

The nurse had previously threatened to have me put in restraints when I said I didn’t want to put on a hospital gown.  There was no reason to put on a gown, you could have easily treated my arms with me fully dressed.  Threatening to put someone in restraints when they have a history of being tied down and raped is unbelievably horrible, but that’s what the nurse threatened to do to me, just because I wanted to keep my clothes on.  So I figured if I tried to refuse to allow you to staple my arms with no pain medication, I’d find myself in restraints while you did it anyway.  

I knew how emotionally upsetting being restrained would be.  “Upsetting” really doesn’t describe how it would feel.  It would remind me of what my father did to me when I was a child.  I would probably have a flashback.  I would be terrified.  And I figured no one in the ER would help me if that happened, since they weren’t helping me so far.  So I felt I had no choice but to allow you to staple my arms.

That’s not really consent, though.  If you threaten to hurt someone if they don’t comply, and so they comply, that isn’t consent.  You stapled my arms without my consent.  It hurt.  It was an assault.  You assaulted me right there in the emergency room and no one did anything about it.

Do you have any idea how that has affected me?  I bet you don’t.  But I’m going to tell you.

See, being assaulted can affect someone for a very long time.  It’s been more than two years since you assaulted me and I still have nightmares about it frequently.  Before you assaulted me, I was having nightmares about my father abusing me as a child a few times a month.  After you assaulted me, I began having nightmares much more often.  Sometimes the nightmares are about being in a hospital and sometimes they are about my father assaulting me, but I have them several times a week now instead of several times a month.

I have flashbacks, too.  I have flashbacks of you stapling my arms, only it goes on and on, and I can’t make it stop.  It’s terrifying and it feels like it’s happening now.  My arms hurt, even though I can see there are no wounds on them now.

Since you assaulted me, I have found it very difficult to seek any type of medical care.  I don’t trust doctors anymore.  Oh, I realize there are many good doctors out there, many compassionate, caring physicians.  I know most are not assholes like you.  But after being assaulted by a doctor, I find myself afraid that it might happen again.  So I don’t always get medical care now, even when I need it, because I am so afraid.  That’s your fault.  Before you assaulted me, I was never afraid of seeking medical care.

About six months after you assaulted me, I accidentally cut my finger while chopping an onion.  I am pretty sure it needed a couple stitches.  It bled for 15 hours.  I was too scared to go to the ER, though.  I was afraid they would refuse to give me anything for pain when they stitched the cut and I was afraid they would think I cut myself on purpose and insist on admitting me to a crappy psych ward involuntarily.  So I just bandaged it up tightly and stayed home.

When I had a mammogram that found something abnormal in one breast, I delayed having it biopsied for a while because I was afraid of going to the hospital.  I was afraid I’d be in a lot of pain after the surgery and that they wouldn’t give me pain medication.

I don’t know if I’ll ever feel safe going to an emergency room again.  I hate to allow you to have so much power over me, but the truth is, you are in a position of power and you should use that power wisely and carefully.  You should take care not to do harm.  You certainly shouldn’t be assaulting patients that come to you for care.

Girl, Interrupted

Last night I watched "Girl, Interrupted."  I've seen it before.  I'm not sure what made me want to see it again.  If you haven't seen it, you should.

Whoopie Goldberg plays a wonderful nurse is a psychiatric hospital and at one point she tells a patient she needs to get things out, put it down somehow, put it away from her, where she can't keep curling up with it.  That makes so much sense to me.  She also tells a patient, in a very dark moment, "Don't drop anchor here."  And I get that, too.

The movie takes place in the 60's and psych wards in the 60's were very different than they are now.  People stayed in the hospital for a long, long time.  Partly that was due to less effective medications, I think, and partly because we didn't have managed care then and people could actually afford long-term treatment.  I definitely don't think spending months upon months in psych wards is helpful, at least not for most people, and I'm all in favor of community-based care.  I wish there was more, and better, care available in most communities, but I'm all in favor of community-based care.

Twenty years ago, well, more like 25 years ago (gosh, I feel old now), psych wards were not like they were in the 60's, not like in this movie, but they were different than they are now.  Back when I first started being admitted to psych wards, a typical length of stay was about two weeks, maybe three.  These days, it's unusual if they keep you more than a week.

They had more treatment in the psych wards back then and more activities.  The last time I was in the hospital, in 2013, they had two or three groups a day and they were stupid groups.  It was the same the time before that, in a different hospital, in 2006.  But they used to have four or five or six groups or activities a day, group therapy, art therapy, some sort of fitness, relaxation training or meditation, arts and crafts, movies, bingo (OK, I didn't say it was all exciting).  One hospital had a plant therapy group once a week.  You got to plant things.  You got to decorate the pot and take home a plant.  Ceramics, yoga, music therapy.  One hospital had this thing one day a month where the patients cooked lunch.  We made Chinese food when I was there.

There is a scene in the movie where the patients are taken on an outing for ice cream.  I've been on a couple of those patient outings.  One for ice cream, even.  And one to play miniature golf. 

There was a feeling of safety there for me.  Which seems a bit odd, considering how terrified I am of the very idea of going to a hospital now.  In fact, last night I had a nightmare about being admitted to a psych ward.  Watching that movie probably triggered it.  But there was a time when it felt safe.  And I can certainly see how it would have felt that way in the 60's, when people were going to war and dying.

A Year after the Hospital

I've made it through Thanksgiving.  I was a little worried about how I would do since last Thanksgiving ended up so bad for me.  Last year, I ended up in the hospital.

Tonight I was reading the posts I wrote about my experience in the hospital last year.  Actually, the posts about it were written in March; I wasn't able to talk much about it until four months after the fact.  I was too traumatized to talk much about it for a while.

I was reading the post in which I explained how I left the hospital in significantly worse shape than I was in when I was admitted.  I was still in worse shape in March, four months later.

I am better now, a full year later, than I was in March.  But you know, I am still worse now, a whole year later, than I was when I was admitted.

Honestly.  Seriously.  The damage done in that hospital in just five days was that severe.

Prior to that hospitalization, I was having nightmares three or four times a month.  Four months after the hospitalization, I was having nightmares four or five times a week.  Now, a whole year later, I still have them at least three times a week.  Often, the nightmares are about being hospitalized, although some are about my childhood or other things.

I am sleeping better now than I was in March.  I've always had a lot of trouble sleeping, but that is probably back to how it was before the hospitalization.

I have flashbacks to the ER doc putting staples in my arms without any pain meds.  I don't have them as often now as I did back in March, but I still have them occasionally.  I hadn't had any flashbacks of the childhood abuse in a long time prior to the hospitalization.

I'm a lot less anxious than I was in March, but still have more anxiety and have to take more medication for it than I did before the hospitalization.  I take a medication for Vistaril as needed for anxiety and used to take 25 mg when I needed it, which was usually a couple times a week.  That was before the hospitalization.  After the hospitalization, I was taking Vistaril two or three times a day, usually.  Now I'm down to taking it four or five times a week, usually, but I'm also on a higher dose.  I now have to take 50 mg, twice the amount I used to take.

My pain is significantly worse.  I don't know how much of that can be attributed to the hospitalization, but I think the increase in stress and anxiety has made the pain worse.  Also, before the hospitalization, I was receiving treatment for my back pain from a specialist at the Cleveland Clinic and I was taking Vicodin as needed for the pain.  Since the hospitalization, I've had a very difficult time seeking medical care for anything.  I haven't seen the specialist since then and I ran out of Vicodin about a month after the hospitalization and am now on Tramadol, which does not seem to work as well.

I also have "phantom pains," what some people refer to as "body memories," where I feel like my arms are being staples or like the staples are still there, even though those wounds have long since healed.  I don't have those pains as often now as I did back in March, but I still have them.

I am more comfortable seeking some types of medical care now than I was back in March, but I had no problem seeking care when I needed it before the hospitalization.  Over the past few months, I've been able to see my primary care physician for a urinary tract infection and for strep throat.  I even went to the dentist, which is something that's always been difficult for me.

However, when I cut my finger about six months ago while chopping an onion, I did not feel safe going to the emergency room even though I was sure I needed a couple stitches.  My finger bled for 15 hours.  I am not exaggerating when I say I would have preferred to bleed to death in my bed than go to the ER.  I still feel that way now.  And prior to that horrible experience in the ER a year ago, I would not have hesitating to go get stitches if I accidentally cut my finger while chopping veggies.

Despite my increased pain, I do not feel comfortable seeking help for that.  I am afraid no one will believe me that I am in a lot of pain.  I feel too vulnerable to go see anyone about it.

I haven't been in therapy since a couple months after the hospitalization.  I did go back to therapy for a little while afterwards, but it didn't really feel safe.  I think it would only be safe to go if I was very, very careful about what I said and if I avoided some topics completely.  And I don't see the point of that.  Why bother going to therapy if you can't talk freely about things?  It would be too stressful, trying to make sure I didn't say the wrong things.  It would be too dangerous.

I did finally go back to see my psychiatrist and now see him every three months.  I am very guarded about what I tell him, though.  This is going to make me sound really paranoid, but I'll admit it anyway.  I have not given him my new address.  I never told him that I moved.  If I am in his office and he starts talking about hospitalizing me for any reason, I plan to get the hell out of there fast.  He wouldn't be able to send police or anyone to get me because he doesn't have my address.

That sounds really paranoid, doesn't it?  I don't think I was ever paranoid like this before the hospitalization.  But you know, just because you're paranoid, that doesn't mean they aren't out to get you.  I have a story about that.   Maybe I'll tell it another day.

Anyway.  While I am able to get some kinds of medical care now, I still have a lot of trouble with that, and I never had that issue before the hospitalization.

I also don't trust people as much.  Not that I was ever a person that trusted easily.  But a friend was with me in that emergency room, someone I trusted to take care of me, and he sat right there and did nothing while that doctor put staples in my arms with no pain medication.   Our friendship has not been the same since and I don't think it ever will be.  We are still friends, but I don't trust him much.  Not with things that really matter.

But I don't trust other people much, either.  I don't trust anyone to be there for me, to help me, to do things for me if I really need something.  I don't trust anyone to take care of me or protect me.  There weren't many people I trusted to do that before, but now there is no one.

So things are slowly getting better, but I am still worse now than I was before that hospitalization.  Worse, a whole year later.

Hospitalization (Part VI)

Read the first five parts of this story here:

Hospitalization (Part I)
Hospitalization (Part II)
Hospitalization (Part III)
Hospitalization (Part IV)
Hospitalization (Part V)

The entire time I was in the hospital, I was extremely anxious.  Not just anxious, but fearful.  I did not feel safe. 

On top of that, I was unable to see my therapist (I missed a scheduled appointment; when I saw her following my release, she was unhappy that hospital staff had not even bothered to call her to let her know I'd been hospitalized, as she says they typically do at other hospitals), I did not have my service dog (maybe I'll write about why I did not even ask to be permitted to have him on the unit another time), I had difficulty keeping in touch with friends since I had no internet access and no place to make private phone calls, and I found it difficult to sleep due to all the noise at night since I was not permitted to shut my bedroom door.  My condition worsened significantly while I was in the hospital.

Let me say that again.  My condition worsened significantly while I was in the hospital.

I think that's the thing I'm the most angry about.

Consider this:

Before I was hospitalized, I was having three or four nightmares a month.  Now, four months after my hospitalization, I have nightmares four or five times a week.

Before my hospitalization, it had been a few years since I'd woken up at night screaming.  In the four months since my hospitalization, though, that's happened a number of times.

I've always had a lot of trouble sleeping, but that's gotten even worse since my hospitalization.  Last night, for instance, I fell asleep around 11:00 pm and woke up at 1:30 am, unable to go back to sleep.  I was up until about 4:30 am, when I finally went back to sleep and slept until 6:00 am.  And that's a typical night for me these days.  Four hours of broken sleep.  Actually, I consider last night a good night, because there were no nightmares.

 I had pretty severe anxiety before my hospitalization.  Severe enough that I was prescribed medication for it and had a service dog trained to assist me with it.  But since the hospitalization, the anxiety has been much worse.  I probably use at least twice as much medication for it as I used to.

And I have some issues now that I never had prior to that hospitalization.

I am now afraid of seeking medical care.  Initially I thought I would just never go to the ER again.  But now, four months later, no health care providers feel safe to me.  I've been completely out of pain medication for my back for a while now and the back specialist will not call in any more refills for me, and I'm afraid to go in to see him, so I've just been doing without.  I suffered with a sinus infection for six weeks before I got up the nerve to go see my primary care provider and ask for antibiotics.  I was terrified of seeing my psychiatrist, even though I've always liked him and trusted him in the past, and ended up deciding to go off my antidepressants rather than go back to see him again.

When I was discharged from the hospital, I still had staples in my arms.  I was instructed I should see my primary care provider a few days after discharge to have them removed.  I removed them myself at home instead.  I actually told the nurse at the hospital that I planned to do that, that I was afraid of seeking medical care.  She said, "Please don't do that," but didn't do anything to address the fear.  Removing them was easy.  You just use clean wire cutters to clip them in the middle, then use tweezers to pull each side gently out.

I've considered what I will do if I ever cut myself and need sutures again in the future.  I don't think that's all that likely, since it's only happened twice ever, but it's possible.  Or what if I just trip and fall and cut myself accidentally?  That happened once, too.  Well, I discussed this with a friend of mine and he pointed out that one can actually buy a suture kit and find tutorials online to learn how to suture.  I'm sure this sounds extreme and nutty to many people, but I thought about it, and then started googling.

I ended up buying a surgical stapler from Amazon.com.  It was cheap, too.  I figured it would but a lot easier to staple a wound than to suture it, especially if it was on my arm and I had to do it one-handed.  It even came with a surgical staple remover, so there's no need for the wire cutters.

I've decided I'm into DIY medicine from now on.

But seriously, I think the fear of seeking medical care is a really serious problem.  And I don't know how to deal with it, especially since I'm also afraid of seeing my therapist now, too.  Initially after the hospitalization, I was able to see her.  But after I decided not to go back to my psychiatrist and to stop taking my antidepressants, I figured she would disapprove of that and then I was afraid to go back to see her.  I don't think therapy was going to be very helpful for me, anyway, because I don't feel I can be honest with health care providers about how I'm doing if I'm not doing very well.  If I have to pretend everything's OK, then what's the point of going to therapy?  How's it going to help?

Hospitalization (Part V)

The morning after I was involuntarily admitted to the hospital, I got to meet with the psychiatrist that had admitted me the night before without seeing or speaking to me.  He spent about ten whole minutes with me.  Mike was at the hospital with me when the doctor arrived and I wanted him to stay while I talked to the doctor, but the doctor absolutely refused to allow him to stay.  He said that after he talked with me privately first, then he would allow Mike to come in and he would speak with both of us together.  That's not what happened, though.  After spending ten minutes with me, he left, without inviting Mike to come back in. 

All patients, in psychiatric units and other hospital units, are supposed to have the right to have family members or friends involved in their care if they wish, but I was denied that right.  Since having a strong support  network is especially beneficial to people with conditions like depression, it seems like it would be even more important to include people of the patient's choosing in the treatment process in instances of mental illness, but apparently that is not how things are done at this particular hospital.

The doctor told me that state law required him to admit me for three days since I could be considered a danger to myself.  I told him I thought the law said he could admit me for three days, not that he was required to.  He then agreed that it was not a requirement.  That may seem like a small thing, but it bothered me because I felt like he was assuming I was too stupid to understand what the law really said and was trying to mislead me about it.

I tried to explain why I felt that I would be better off at home than in the hospital but he wasn't listening.  He said he believed I would hurt myself as soon as I was discharged, since I had a history of self-injury, and that he didn't think anything they did in the hospital would change that.  I said in that case, then why should I stay for three days?  If I'm going to hurt myself anyway, what different does it make if I do that in three days or in two days or in just one day?

He said the difference was that if he kept me for the three days allowed by law, he could not be sued when I went home and hurt myself again.

I said, "Let me make sure I'm understanding you correctly.  You are not keeping me in the hospital because you think it will benefit me.  You are keeping me here so you do not get sued."

He said, "Yes, that's right."  Seriously.  That's what he said.  I have no witness to that since he would not allow Mike to stay in the room while he spoke with me, but he said that.

It turned out, by the way, that the law allows patients to be involuntarily admitted for up to three business days.  Don't ask me why it matters if it's a weekday or a weekend, but that's how the law is written.  Since I was admitted on Friday evening, that means I ended up being held there for five days.

I also told the psychiatrist how the emergency room physician had denied me any pain medication but he did not seem concerned about that.

Later that day, I finally got to see the real patient rights advocate, although I found him less than helpful.  He told me all he could do for me was to write a note in my chart to let my doctor know that I was unhappy with the way I had been treated in the ER.  Well, I'd already told my doctor that, but he didn't care.  I told the patient rights advocate that I didn't understand the point of his role, if that was all he could do.  He then advised me that I could file a formal grievance with the hospital if I wanted.  He said I would have to ask a nurse for a form to do that, he could not give me the form, and he could not tell me anything else or answer any questions about how that process worked.  I don't get why his job even exists, since he apparently does nothing whatsoever.  Maybe the hospital just thinks it sounds good to say they have patient rights advocates available?

Hospitalization (Part IV)

If you've never been in a psychiatric unit, it's not the same as being on any other unit in a hospital.  There are typically no televisions or telephones in the patient rooms.  There is a patient lounge where patients can watch television and there is a phone available on the unit for patients, but it's not very private.  Visiting hours are much more limited than on most other hospital units, with visitors usually only being allowed in the evenings during the week but also in the afternoon on weekends and holidays.  There are usually laundry facilities available for patients to wash their clothes; patients usually wear street clothes on the unit.

Psychiatric units limit the kinds of belongings patients can have in their rooms, for safety reasons.  I've been visiting psychiatric units for more than 20 years now, and it seems to me that over the years, they've gotten stricter about what things they allow.  For instance, there was a time when patients were usually allowed to have portable tape players with headphones.  They usually don't allow those anymore, though.  I don't know if they think patients might hang themselves with those little cords that connect the headphones to the CD player or what.

There is not a lot of privacy on a psychiatric unit, although there really is not a lot of privacy in any hospital setting, really.  But on a psychiatric unit, they check on patients all the time.  Like every 15 minutes or something.

At my local hospital, they have a rule on the psychiatric unit that patients are not allowed to shut their bedroom doors.  At night, the lights in the hallway are bright and the night shift nurses talk and laugh loudly much of the night.  It's very hard to sleep.

The only door patients are allowed to close there is their bathroom door.  There is no lock on the bathroom door, though, of course.  One day while I there, I was in the bathroom, doing the personal things people do in bathrooms, you know, and the housekeeper walked right in without knocking.  After that, I felt unsafe in the bathroom.

I know hospital food is usually not very good, and no one really expects it to be good, but the food I got during this hospitalization was horrible.  I am a vegetarian, and they actually had a separate vegetarian menu.  However, they apparently have very few vegetarian options.  I had soggy grilled cheese sandwiches and cheese pizza almost every day.  Since I had gastric bypass surgery, I try to eat a diet higher in protein and lower in carbs, but they just didn't have any better options for me.  I had a friend bring in some protein bars for me so that I could supplement my diet.

They provided no real treatment for me while I was in the hospital.  They did give me medication, but it was the same medication I'd been taking at home for quite some time.  They didn't change anything.  In addition to my antidepressants, I take a number of vitamin supplements, and I had to have a friend bring those to me from home.  The hospital didn't have the right kinds of vitamins.

My local hospital offers no individual therapy; most inpatient psych units don't, although a few do.  While I was there, they did offer a couple of group sessions each day, except for Sunday, when there were none.  There was one group session where they discussed communication skills and how to be assertive, which is something I used to teach when I was a social worker.  There was one group session where they talked about ways to be healthier, like eating well, exercising, and getting enough sleep.  There was one group session in which we played a board game that was meant to help us identify and develop our leisure skills.  In another session, we played a board game that was meant to improve our self-esteem.  Improving my self-esteem probably would be good for me, but I didn't think the board game really did much for my self-esteem.  Plus, being in a situation in which I had no choices, no privacy, and was not listened to was damaging my self-esteem, much more so than any board game could improve it.

A couple times, someone asked me if I was feeling suicidal.  I wasn't; I wasn't feeling suicidal when I cut myself, either.  No one seemed to get that distinction, though.  No one ever asked if I was feeling like hurting myself or cutting myself the entire time I was in the hospital, not once.  I wouldn't have admitted it if I was, because I wanted to get out of there.  But they didn't even ask.  No one tried to help me come up with better coping skills or anything like that.  They never really addressed the issues that brought me to the hospital in the first place.

Hospitalization (Part III)

Before I was taken to the psychiatric unit, I asked to speak to a patient rights advocate.  I felt I was not receiving the quality of care I should have been getting, since I was being denied pain medication.  I was informed that the hospital's policy was that a patient rights advocate would contact a patient on request withing 24 hours of the request.  I also asked several times to speak to the social worker I'd talked to earlier but was told she was not available.  I asked to speak to someone in charge of the ER and was told by the nurse that she'd see if the person in charge was available, but I guess that person was not available because I never saw anyone in charge.

After about eight hours in the ER, I was finally take up to the psychiatric unit, where I was happy to find there was no patient in the other bed in my room.  At least I had a room to myself.

I was on the unit almost three hours before I finally got some pain medication.  I kept asking for it, over and over again, and was told that it had finally been ordered for me but that it often took a few hours for the pharmacy to send medication upstairs.  No one seemed very concerned about my pain.

About the time my pain meds finally got to the floor, the nurse told me that the patient rights advocate was there to speak with me.  However, the man correct her and said he was not a patient rights advocate, he was a chaplain.  I asked why a chaplain had been sent to see me but no one seemed to know.  The nurse seemed confused to hear that a chaplain and a patient rights advocate are not the same thing.  I certainly had not asked to speak to a chaplain.  I am not Christian and would not expect to find a pagan chaplain working in my local hospital.

The chaplain asked if he could talk to me anyway, even though I hadn't asked to see him.  I agreed to speak to him because I was upset that no one was listening to me and thought perhaps he could do... something.  I don't know what I thought he might be able to do for me but I guess I thought he could get in touch with the patient rights advocate or talk to someone in charge about what was happening.   He never told me he could do those things, I was just hoping.  That's not what he did, though.

He asked me what happened that caused me to cut myself.  I didn't feel like trying to explain everything so I just said something like, "I've had depression for years and years.  A lot of bad stuff happened to me when I was a child."  He told me that had a lot of bad stuff happen to him when he was a child, too, and that he used to suffer from depression, as well. 

Can you guess what's coming?  He got over his depression.  He was cured.  Now he is filled with joy, and all because he found God.  He prayed and he forgave the people that hurt him, and that's all it took to cure his depression.  He was sure it would work for me, too.  All I needed to do was to pray and forgive the people that hurt me, and then I wouldn't be depressed anymore and would not need to be hospitalized ever again.

Hospitalization (Part II)

So I talked with the social worker in the ER and she informed me that my psychiatrist was out of town so she could not call him to discuss whether or not I needed to be admitted.  She would have to talk with the psychiatrist on call, who had never met me.  I had a bad feeling about that.  I explained to her all the reasons why I thought it would actually be better for me not to be admitted: I had an appointment in three days with my therapist, and I would not get any therapist in the hospital; many of my coping skills, like taking walks, taking hot baths, and listening to music would not be available to me in the hospital; I had just received my service dog a week before and being away from him would be stressful for me; and so on.  She acted like she understood all that and said she'd talk to the doctor on call about.

I also told her that my psychiatrist and I had previously agreed that my local hospital did not do a very good job of providing inpatient psychiatric care.  He has privileges there and sees patients there because it's the hospital nearest his office, so the most convenient for him and most of his patients.  But he told me that if he or a member of his family needed inpatient psychiatric care, he would not go there.  He told me where he would go and agreed with me that I should seek inpatient care elsewhere if needed.  The social worker said that if the doctor on call felt I needed to be admitted, she would see what she could do about arranging for me to be transferred elsewhere.

Well, I don't know what she actually told the doctor on call, but a couple hours later, the ER physician (not the psychiatrist on call, this was a medical doctor) came in and informed me I was going to be admitted.  I was upset.  I asked what about being transferred to another hospital and he said he didn't know anything about that, but that the psychiatrist on call, without ever actually speaking to me himself, had declared I was a danger to myself and was to be admitted for a 72 hour hold.  I asked to speak to the social worker to find out why I was not being allowed to go to another hospital but was told she was not available and that maybe I could speak to her later.  I never was able to speak to her later, though.

Now, I was in the ER for about eight hours altogether.  It was very cold.  I had to ask repeatedly for a blanket before someone finally got me one.  Then the nurse came in to clean my wounds and she washed them, getting the blanket wet.  So then I had a wet, cold blanket.  It took a very long time to get another. 

After I'd been there for several hours, I asked for something to eat.  I can't eat that much at one time, since I had gastric bypass surgery, and it had been a long time since I'd eaten.  I was told I could have some saltines or some graham crackers.  Now, I have reactive hypoglycemia, and if I eat starchy carbs without any protein, it often makes my blood sugar drop very low and I feel like crap.  Mind you, when I say my blood sugar drops very low, I mean it has been as low as 37 in the past when I've tested it.  But they refused to bring me anything but crackers.

A couple hours later, after a lot more complaining, they finally agreed to order me a dinner tray.  The dinner tray arrived at the same time the ER physician arrived to tell me I was being admitted and to treat my wounds.  As you might imagine, that killed my appetite.

The most traumatic thing that occurred while I was in the hospital was the treatment I received from the ER physician.  He announced that he was going to staple the wounds on my arms rather than suture them.  I have no clue how one determines if staples or sutures are most appropriate and I did not care whether they were stapled or sutured.  He said that two of the cuts on my left arm and one on my right arm needed stapled.

And then I realized he was getting ready to start stapling.  I had not been given any lidocaine or anything to numb the area.  I've had stitches in the past on two occasions, once when I fell and cut my lip and once when I cut my wrist (I was treated at a different hospital then, and the doctor there was extremely compassionate and gentle and caring; I remember he injected lidocaine before doing anything, including before he cleaned the cut, so that it would not hurt when he cleaned it), and both times I was injected with lidocaine and didn't have to ask for it. 

Those of you that know me know I'm typically not shy about speaking up with health care providers.   So I said, "Hey!  Aren't I supposed to get some lidocaine or something?"

The doctor said, "It's not necessary," and started stapling.

Now, I've since been told that sometimes doctors feel it's more painful to inject the lidocaine than it is to just put in the staples, depending on how many staples are needed.  I was told by the director of the emergency room that stapling wounds doesn't hurt that much (I'm not sure how many staples she's had put in her body, though).  And I acknowledge that the perception of pain is sometimes not just a physical thing but that one's emotional state affects the degree of pain one feels and how well one copes with it.   But I was depressed enough that I'd cut myself a bunch a few hours earlier, and then I was extremely anxious about the idea of being admitted to the hospital, and I'd been cold and hungry for several hours.  How do you think my emotional state might affect my perception of pain or my ability to cope with it?

But also, keep in mind that, while the doctor had decided only three cuts needed to be stapled, there were significantly more cuts than that.  The psychiatrist that treated me while I was in the hospital (the same one that admitted me over the phone, because mine was out of town) estimated that there were about 50 cuts on each arm.  I guess he felt it would be too much work to count them to get an exact number.  My point is, my arms were sore.  They were swollen.  If the tissue hadn't been so damaged, maybe the staples would not have been so painful.

It was painful.  I said, "It hurts," more than once.  I'm pretty sure I cried.  I recall kicking one foot against the bed at one point.

But I didn't say no.  I didn't say stop.  I didn't say, "I don't consent to this."  Because I was pretty sure I would not be allowed to refuse treatment.  All patients should have the right to refuse treatment, including psychiatric patients.  For the most part, the law even says so, although there are laws that allow patients deemed dangerous to themselves or others to be involuntarily committed to psychiatric hospitals.  But I had already been told I could not refuse to put on a hospital gown, that I would be tied down and undressed if I tried to refuse.  I figured the same thing would happen if I tried to refuse treatment of the cuts on my arms and I didn't want to do anything to make things even worse for myself. 

I felt, and still feel, as if I had been assaulted.  I was physically hurt, without my consent.  People stood by and watched the assault.  A friend was with me at the hospital and he sat right be that bed and didn't say a word.  There were nurses around.  Apparently no one thought there was anything wrong with what was happening.

And there was nothing I could do.  I was helpless.  Powerless.

As you might imagine, all of this reminds me very much of my childhood.  I was abused.  No one intervened.  I'm not sure anyone knew what was happening when I was a child, but someone should have known.  And some people probably did know.  And no one did anything.  And I was powerless.

After the ER physician was done, I had three staples in my left arm and four in my right arm.  I asked for pain medication.  He ignored me and left the room.  I asked more than one nurse for pain medication and was told they would have to check with the doctor.  I don't know if they ever did check with him, but I was not given anything for pain.  It was nearly five hours later, after I'd been taken up to the psychiatrist unit, before I finally received oral pain meds.

Hospitalization (Part I)

I've mentioned a couple times the fact that I was briefly hospitalized in November of last year, but I haven't written too much about it.  I wasn't sure how much I wanted to share, and I was also feeling very emotional about it and wasn't ready to get into those feelings yet.  Now, I think I am ready to write about it.  Actually, I think it might be helpful to do so.  I'll see how it goes.

It was the day after Thanksgiving.  I'd actually had a nice Thanksgiving.  I was home alone, just me and Isaac and the cats.  Mike had dinner with his family and I made myself a nice dinner and then took Isaac for a long walk.  I was feeling pretty good.

But the day after Thanksgiving, I got an email from my mother.  I feel unsure of how much to explain about this, because I want to respect the privacy of other people but I want to be able to speak my truth, too.  The bottom line is that my mother and my sister both got angry at me because I mentioned something publicly about being abused as a child.  Apparently in my family, it's not such a bad thing to abuse a child, but it's really not acceptable for someone that was abused to talk about it.  So my mother send me this email in which she said, among other things, that she did not believe I was telling the truth about the abuse.

Now, my  mother has gone back and forth over the years about this.  For a while she insisted I was lying about it.  Then she told me she believed me but that she hadn't know it was happening at the time.  Now, apparently she has decided she no longer believes me.  As if there would be any reason for me to lie about it.  Like there would be anything for me to gain by lying.  And as if I could fake all my symptoms of PTSD.

So, she sent me this email saying she didn't believe me.  And...I had a sort of break down.  I can't really explain what happened.  It's all sort of foggy now.  It's hard to understand why it had such a severe impact on me.  But it did.  And I ended up injuring myself.

If you've never had to go to an emergency room for a psychiatric issue, especially for a self-inflicted injury, well, let me tell you, it's not like going to the ER for another type of injury or illness.  Some ER doctors and nurses are excellent, compassionate, caring, sensitive, respectful, etc.  But many are not.

You know how doctors sometimes don't want to listen to patients?  Well, they are even less likely to listen when they think you're nuts.  It's like they think having a mental illness means you're stupid.  Like it means you are incapable of making informed decisions.

When you go the ER with a self-inflicted injury, they also often act like they think you are wasting their time.  Like you brought it on yourself, so it's not like you have a real illness or injury.  They would rather be caring for "real" sick people.  Often, they are not very  kind to patients with self-inflicted injuries or those who have attempted suicide.  Sometimes they act like they think they need to "teach the patient a lesson" so the patient won't do it again.

It's not always like that.  I've had positive experiences in emergency rooms before.  But often, it is like that.

Mike and I agreed that I probably needed some stitches, so he drove me to the ER.  I was still sort of out of it, so I didn't think things through like I should have.  But I had a pretty good idea in my mind of what I thought would happen there.  I thought they would have a social worker talk to me, I'd explain that I wasn't going to harm myself anymore and why I did not need to be admitted to the hospital, the social worker would call my psychiatrist who would understand and agree with me, the ER physician would stitch up my arms, and I'd go home.  Looking back on it, I should have at least phoned my psychiatrist myself before leaving for the hospital.  But I didn't.  I didn't think of it at the time.

So I got to the ER and right away things started to go bad.  The nurse wanted me to change into a hospital gown before talking to the social worker.  I could see no reason I needed to wear a gown to talk to a social worker.  I didn't need to be in a gown for the doctor to treat my arms, either.  It was really cold in there and I felt more comfortable with my clothes on.  When I told the nurse this, she became very threatening.  She told me that I could do things the easy way or the hard way and that if I didn't change into the hospital gown myself, she would have me put in restraints and have my clothes removed.  Does that sound like a good thing to do to someone with PTSD?  I complied because I knew that being restrained and undressed like that would be too traumatic for me to deal with.

Last Night's Dreams

Last night I dreamed my back was really bad and I was taken to a hospital via ambulance.  I'm not sure which hospital I was taken to, but it wasn't my local hospital (which sucks royally) because I specifically told the paramedics not to take me there.  I wish I knew which hospital it was, because the nurse there was really nice.  She gave me some wonderful pain medication in my IV and then she brought  me this big chocolate cookie.  How great is that?

I've decided to interpret that as meaning it might be OK to seek some medical care after all.  I had a good experience with the nurse in my dream.  Maybe I can have a good experience in real life.

Do you think it also means I should eat a cookie?

Then I dreamed that I was babysitting all these little kids.  I don't know whose kids they were or whose house I was at, but there was a skunk in the house.  It fell in through a hole in the roof.  Anyone want to guess what that might mean?

I looked up skunks in one of those dream dictionaries and it said skunks represent unexpressed anger.  Then I looked up skunks in a dictionary of animal totems and it said skunks are good at self-protection and knowing when to act in self-defense (apparently they don't spray every time they feel threatened because it actually takes a couple weeks to build up a new supply of stinky stuff, so they have to save it for when they really, really need it). 

So I think I do have some anger I need to deal with, although I feel like I have expressed it, it just hasn't gotten me anywhere.  And I need to learn that I can protect myself and I need to learn to discern when I am really in danger and when I am not.

If I can become better at discerning when I am in danger and when I am not, I can seek medical care at least some of the times when I need it, because it won't always be risky to do so.

Don't you love it when your dreams make sense?

Medial Branch Nerve Block

Yesterday I underwent I procedure called a medial branch nerve block.  I have a herniated disc in my lower back and have had ongoing severe back pain for more than a year now.  When the orthopedic doc I had been seeing told me he didn’t think I should be experiencing so much pain and that he didn’t know what else to do for me, I made an appointment with a specialist at the Cleveland Clinic.  The specialist there pointed out the herniated disc, which was so obvious on the MRI images that even I could see it, despite the fact that the orthopedic doc apparently missed it.  He’d told me I had degenerative disc disease, but the new doc disagrees with that diagnosis.

So anyway, yesterday I had a diagnostic medial branch nerve block, which is a procedure in which the doctor injects pain medication into the spaces around the medial branch nerves, tiny nerves around the discs in the back.  The pain medication is supposed to temporarily prevent the nerves from transmitting pain signals.  If the medial branch nerves are the nerves transmitting the pain signals, then back pain should be significantly reduced.  However, if other nerves are sending the brain pain signals, the procedure may not help much.

If back pain is relieved by the medial branch block procedure, another procedure called a radiofrequency neurotomy can be done.  That procedure involves inserting needles into the spaces around the medial branch nerves and using a small jolt of electricity to burn the nerve endings, which prevents them from transmitting pain signals.  The nerve endings eventually regenerate, but it can take nine months to a year or longer.

If all this sounds rather icky, well, it is.  I mean, the idea of burning my nerve endings sounds pretty painful, plus I think pain serves a purpose.  It warns us that something is wrong, that we’re injuring ourselves in some way.  If the nerves in your hand did not transmit pain signals, for instance, you could accidentally put your hand on a hot stove and be severely burned before you realized what was happening.  But the nerves in my back are sending near-constant pain signals to my brain, and it’s no longer serving the purpose of warning me about injury.  Just rolling over in bed at night is so painful it wakes me up, and rolling over is not akin to burning your hand on a hot stove.

Plus, when you are in enough pain, I guess you’ll be willing to try just about anything for relief.

The procedure yesterday was somewhat painful.  I got two doses of Versed by IV, so I didn’t much care that it was painful, though.  But I got six injections in all, and I didn’t look at the needles because I didn’t want to know, but I can tell you it felt like they were HUGE.  They hurt, but in between injections, I was all relaxed and feeling floppy as a rag doll from the Versed.

Half an hour later, I was able to sit up in bed with no pain.  I think that was the first time I have been able to sit up without pain in more than a year.  I feel like my back is a little bit bruised or something, it feels a little tender where I had the injections, but I’ve had no muscle spasms and none of the sharp, shooting pains I was getting regularly since the procedure.

I see the specialist again in two weeks and we’ll decide where to go from there.  I’m assuming we’ll decide to schedule the radiofrequency neurotomy.  And then I am supposed to start physical therapy, which the doctor has informed me will not be pleasant.  It’s nice to have something to look forward to, isn’t it?

 
If I had my service dog, I would have taken it (him? her? I hate using the word it for a living being) to the hospital with me when I went to have the medial branch nerve block.  I would have kept the dog with me in the prep area, but had it wait with Mike in the waiting room while I was actually having the procedure done.  Once I was back in the recovery room, I would have asked for Mike to bring the dog back to me.  I wouldn’t have been able to control the dog while I was having the procedure done, and seeing me in pain might have frightened the dog.  I would have wanted the dog with me the rest of the time, though.