Yesterday afternoon around one, my 21st hour in the UNC Neurosciences Hospital, I wandered over to get lunch in the Starbucks. I was running on less than three hours of sleep, and was a little slow on the uptake, but as I was waiting in line I realized that the Starbucks of the psychiatric hospital was playing a familiar album. There was precious little that I found funny yesterday, but that made me laugh out loud. Nobody batted an eye. I probably looked like I belonged there.
The album was “Kind of Blue.”
My husband has been struggling with depression for the last year. Up and down, all the time. He was on medication for awhile when we were in Chicago, but there were side effects, and then we moved and he was briefly without insurance. He has a therapist here, but he needs to be on medication. It took me most of December to find a local psychiatrist that both took our insurance and was accepting new patients. I finally found one but I couldn’t get an appointment until after the holidays were over. Meanwhile, Greg’s depression worsened.
It is terrible to see someone you love suffering so much, with little respite. His pain is real, and raw, and at times when he is feeling his worst, I can hardly bear to see it. It is as if the disease steals my husband from me, locks him away somewhere that I cannot go, leaves instead a shell of misery who can hardly put on his shoes. It began to feel that this was too much for me to handle alone; I was starting to worry that I could not leave him alone even to walk the dog.
Which brings us to Thursday afternoon. A bad day. The third bad day of a string of them, the worst I’d seen. I called Greg’s therapist. We decided to go to the emergency room.
Have you ever been to an emergency ward for psychiatric crises? We had to go through a metal detector. We had to put everything Greg had with him in plastic bags. We got there at 4pm and didn’t have to sit in the waiting room, but the regular ER was so busy that first they moved us to a stretcher in the hallway, right in front of the desk, right across from the trauma bays. We watched a team of doctors resuscitate a cardiac arrest. We watched ambulance after ambulance roll in with patients. Behind me I could hear the doctors and nurses discussing cases. A possible aortic dissection. CNS lymphoma with an enormous brain tumor.
I was amazed we were privy to such things, but I soon realized that medical staff have an amazing ability to tune out patients. No one looked at us, or spoke to us. It was as if we weren’t there. No wonder I heard them making jokes (“We brought back the mother ship,” one nurse quipped to another after the cardiac arrest was revived) and complaining about how busy they were. The paramedics brought in an agitated woman who was either manic or psychotic, yelling to the staff that she needed to get a car, she needed to see her mother. The attending told the paramedics “Welcome to room 100” and parked her just around the corner from us on the other side of the desk. She stood up, started yelling, swiped the badge off the doctor’s chest. They gave her some kind of sedative. For the next few hours, she lay there, mumbling to herself about her mother. I heard the doctors talking about a number of other psych cases – a woman convinced the dead were giving her messages, and addict who had threatened to kill himself.
“Psych will see him at some point,” a resident joked to the attending, and they both laughed. I knew that was not a good sign.
We waited. We saw an ER doctor after an hour or so, for about two minutes. She said she wanted us to stay to see a psychiatrist, but that Psych was backed up, and she had no idea how long it would be. Another attending said it was the busiest he’d ever seen it. We settled back and waited.
And waited. Six hours passed. At least the ER was interesting, and Greg was allowed to have his phone and his book and things I brought him from the vending machines. Around 10 o’clock, they moved him to a psychiatric holding area in another part of the E.D.
It was a locked ward, and we couldn’t take anything in with us, not even me. We sat on another stretcher in another hallway, with absolutely nothing to do except stare at the childish lake scene painted on the wall. Someone had drawn on it with a purple crayon. We both got on the stretcher and laid next to each other. We talked about the playoffs. We talked about books. The hours went by. Everytime I asked about when we might be seen the nurses said they couldn’t tell me. Every few minutes someone would come in through the locked door, but it was always for another patient, never for us.
We had both slept very little the night before, and hadn’t eaten a meal since the morning. The only thing the nurse could bring us was dry cornflakes without milk and styrofoam cups with ice water.
At 2 AM, after ten hours of waiting, I went to the nurse and asked about leaving. I figured that at this point, we were both so tired and hungry, so miserable, that it might be better if we went home. The dog needed to be walked. Maybe we could try another hospital the next morning.
They would not let us leave. They had put Greg on a precautionary hold, so he couldn’t go until he was seen by a psychiatrist. When might that be? When the nurse paged the doctor, she said – curtly, by the length of the conversation – that Greg was on a list of patients that wouldn’t even be seen until the morning, maybe after the shift change. Probably 9 or 10 am, they said.
Could they move him to a room? Someplace he could turn the lights off and get some sleep and read a book? There were empty rooms off the main desk, outside the locked area. No, they said. They didn’t have enough staff to watch those rooms. They didn’t have a video feed.
I lost it then, broke down in one of the weird foam chairs they had all over the behavioral health unit. He was too sick for them to let him go home, but not sick enough that they had to actually treat him anytime in the near future. I was exhausted. I had expected to wait, had expected that it would not be a pleasant experience, but I had no idea it would be like this. Greg was upset, angry. I felt like it was all my fault. I was the one who made him go, I was the one who had given the doctors the information that kept him on a hold.
At 3:30 I went home to take care of the dog and eat and shower. I took a cab. The driver let me smoke in the cab. He listened to my story and shook his head. “Depression?” he said. “Honey, I’ll tell you what you shoulda done.”
“You shoulda got him a big fat blunt.”
At this point, I told him, it would have been easier to obtain than medical treatment.
He said he could hear the stress in my voice. Stayed in the cab until I got in the house.
I walked the dog, made a sandwich, took a shower, made some phone calls. Napped from 5:30 a.m. to 7am. A friend drove me back to the hospital. Greg’s therapist called, aghast at the story I told him. He talked about a broken system, about writing to my Congressman. He said he would have a local psychiatric big shot call over there, that he would call himself. None of it came to any use. There were just too many patients, not enough staff, for the kind of reasonable care one can expect. When I got there, one of the nurses told me there were 37 psych patients with more in the waiting room, that most people were waiting an average of 12 hours for care. I pointed out that at that point (9 AM), we had already been there for 17 hours.
They had, at least, moved Greg into one of the rooms off the desk, and he had gotten some sleep. They brought him breakfast. The hours ticked by. I was exhausted, and eventually Greg let me have the bed and I slept for another hour, until 11. I woke up when I heard someone come in the room, thinking it might be the doctor, but it was only the orderly, coming by with lunch. Salisbury steak, mashed potatoes. I went to Starbucks.
Every hour or so I would go out and ask the nurses for an update. No one could tell me anything. They said they appreciated my patience. I was not aware that i had any patience left. I tried to raise a fuss, to express how exasperated I was, but I got nowhere. One of the other patients, an apparent veteran of the system, started listing other places where one could get mental health treatment in the area. I did not ask her why she had come here.
One nurse said they were finally “moving beds,” admitting people up to the floors, that Greg would probably be next. What do you mean, next, I asked. How can he be admitted when he hasn’t even seen a doctor? Well, he said, they’re talking about it. I said I didn’t want him admitted. He said, he probably will be.
I think at that point I was angrier than Greg. I am sure that if the nurses had taken my vitals, my blood pressure would have been high enough to get me into the ER myself. It was well past noon. I felt like maybe we would be there forever, that he had been forgotten. It was like being in limbo.
Finally, finally, at 2:15, we saw a nurse practitioner. Then they moved him again, to the behavioral health unit, another locked ward with green foam chairs, full of nothing, void of anything that might be used to harm oneself. They locked my purse up. The TV was playing Bill and Ted’s Excellent Adventure. In the room next to it a child rocked back and forth, back and forth.
The psychiatrist came and talked to Greg. I never spoke to her. Then we waited, flipping through channels. They came back at 4:15 with two prescriptions. They said they were sorry they couldn’t keep him. Greg laughed and said he was thrilled to go home. We walked out of the place 24 hours after we came in, almost to the minute.
I don’t know quite what to make of this whole experience just yet. This was supposedly one of the better psychiatric facilities in North Carolina, but it was obviously not working the way it was supposed to. It was a grim place. I hope that the wards might be better, but I suspect not.
But we are home now. I hope we never have to do this again, but maybe we will, and at least if there is a next time I will know not to expect anything.