“What a Head Case”

This post is inspired by one of Koanic’s comments¬†on another of my posts. It is mostly just a full transcription of the summary of my latest ten day tour in the psych ward; nothing edited, added, or removed and all [sic] intact except for people’s names. I checked myself into the ER at NMCSD at approximately midnight on 4/20/2012 for suicidal ideations. Enjoy.

PROBLEM 1: DISPOSITION …….. TARGET DATE 27APR2012 DATE CLOSED 30APR2012
Disposition: SD VA Psychiatry – Dr. XXXXX 858-###-#####; fax 858-###-####
Evidenced by: Admission to 1 North

Goal and/or Discharge Criteria:
Discharge with mental health follow up plans
Team Interventions:
Social Work Assessment
Recommended Patient Contact Focus:
Discharge Planning

Progress:
20Apr2012: Chart reviewed: No civilian holds, certifications, mandated reporting issues, or domestic violence issues noted. See Social Work Note for clinical encounter(s). Social Worker to follow for disposition plans as indicated by patient’s treatment team. XXXXXXXXX, LCSW
23Apr12: Social Worker contacted VA La Jolla to schedule follow up. Social worker spoke with XXXXXX. Pt. scheduled with Dr. XXXXX Tuesday, 01May12 at 1100. MO and Attending informed of appointment. XXXX XXXXX, LCSW.
24Apr12: Per Treatment Team, patient will discharge Friday, 27Apr12. XXXX XXXX, LCSW
30Apr12: Per Attending, patient not stable to discharge. Social Worker re-scheduled patient with Dr. XXXXX at the VA for Tuesday 08May12 at 0830. Pt. will be referred to Psychology at this time. MO and Attending informed of appointment. XXXX XXXX, LCSW.
Addendum: Per Sub-Attending, patient will discharge [against medical advice]. Pt. reported plan to follow up with Dr. XXXXX next Tuesday, and the VA Sacramento this weekend for labs. Pt. encouraged to contact VA Sacramento to schedule labs. XXXX XXXX, LCSW
Addendum: Per patient, Attending told him he would order labs for Tuesday. Pt. reported plan to come to NMCSD for labs. XXXX XXXX, LCSW

PROBLEM 2: Potential for violence against self or others. Target Date: 30Apr2012 Date Closed: 26Apr2012

Evidenced by:
Pt brought himself to the ER due to “on and off suicidal thoughts for a couple months.”
Goal and/or Discharge Criteria:
Patient will remain free from harm to self and/or others. Patient contracts for safety once a shift, during admission and least [sic] 3 days prior to discharge from the unit. Also, patient will verbalize ways to channel destructive impulses into more constructive expressions prior to discharge from the unit.
Team Intervention:
1:1 Interaction, Recreational Activities, Group Therapy, Scheduled Safety Rounds and Milieu
Recommended Patient Contact Focus:
Crisis Plan, Constructive Communication, Reflection of Current and past behavior, Goal setting and Future Orientation.
Progress:
20APR2012: (+)SI/HI (Suicidal Ideations/Homicidal Ideations) “I am on a fast from food, water, sleep, and medication” (with intent to kill himself this way). Patient refusing to answer this question directly but is requesting to be put into restraints because “I am unsafe right now.” Pt not elaborating on what he might do. “You’ll see when I do it.” Pt not able to contract for safety at this time. Dr. XXXXX aware as nurse, pt and Dr. all present during clinical interaction. 21APR2012: Pt stated in the milieu earlier that he was feeling suicidal. pt stated he was feeling this way because time was going to slow and that he wanted to see the “holy father’s face.” afterwards pt stated he was not feeling this way because the “father” would probably not approv of him killing himself. 22APR12: Pt denies SI/HI and verbally agrees to contract for safety. 23APR2012: Pt denies SI/HI at this time and agrees to seek staff should this change. 24APR2012: Pt denies SI/HI and agrees to seek staff should this change. 25APR2012: Pt denied SI/HI and agreed to contact staff if feeling unsafe or if SI/HI occurs. Pt. reported that he already had five reasons to live and listed them as his country, his family, his community, his friend Max and “the holy father.” **problem closed-patient is not suicidal**

PROBLEM 3: Alteration in mood and thought process Target Date: 30APR2012 Date Closed: (blank)

Evidenced by:
Pt states his mood has been unstable, and that he stopped taking his medication about five months ago. Pt reports having increased motor activity, and difficulty sleeping. Pt presents as religiously preoccupied and makes frequent delusional statements that are religious in nature, he states his goal for admission is “to see Jesus.” and that he must waste his flesh to do this, and that he has been refusing water, food, medication and sleep “for as long as it takes.”

Goal and/or Discharge Criteria:
At time of discharge Pt will be able to state five effective individual coping skills he can utilize to maintain a stabilized mood. Pt will report his mood has been stable for at least 24 hours prior to discharge. Pt will be able to carry on a reality based interaction for at least five min. with no delusional statement or content.

Team Interventions:
One on one staff intervention for at least five min Q shift to asses pt’s mood, provide pt with nsg education on effective individual coping skills he can utilize to maintain a stabilized mood, and on the need/advantages of medication and compliance in the treatment of mood D/O. Milieu groups and activities.

Recommended Patient Contact Focus:
Reinforce and focus on reality, recreational therapy/diversionary activities

Progress:
20APR2012: Pt is religiously preoccupied and continues to answer specific assessment questions with “check for yourself” and then pointing to the Bible. Loose, D/O. 21APR2012: pt has been preoccupied with religion, practicing religious rituals while by himself in the quiet room. pt had stated that during his brief period of feeling suicidal that he does not feel the “father” would approve of him doing so. 22Apr12: Pt states that he is motivated to go back to active duty even though he has already been medically retired. Pt states that he would like to come back as a Chaplain, if he can become stable without any medication. 23APR2012: Pt reports that he has found the way to the truth and it is his job to show others the way. 24APR2012: Pt denies AVH (audio/visual hallucinations) at this time, but remains very fixated on religion. Pt states that he has found the way to the truth and it is his calling to spread the word. 25APR2012 Pt continues to walk around the unit with his bible. Pt continues to read scriptures to people. Pt stated he was “possessed by an evil spirit last week” Pt talked about how this has happened before. 26APR12: Pt is preoccupied with religious ideations; delusional thinking; but redirectable. Pt is medication compliant. 27APR2012: Pt is focused on realistic goals such as getting his parents here to see him and working on discharge. 28APR2012: Pt was very goal oriented asking for step three and looking forward to his father visiting. 29APR2012: Pt stated he was feeling very good today because he was visited by 3 very important people in his life. Pt stated he is ready for d/c. 30Apr12: Pt states that he is ready for D/C and is goal directed. Pt’s mood has been stable at “ok” throughout the shift. Pt is being Discharged against medical advice. ***problem closed***

Here’s the medications I was discharged with. I’ll let someone else do the research (I suggest “uptodate.com”):

  1. clonezePAM 1mg daily
  2. risperiDONE 4mg daily
  3. ESKALITH CR 450 mg daily

Here’s the medication I took at one point or another over the 9 days I was medication compliant, many multiple times in multiple doses:

  • Tylenol 650 mg
  • Benztropine 1 mg
  • Benadryl 25-50 mg
  • Ativan 2mg
  • Maalox 30ml
  • Milk of Magnesia 30ml
  • Pitrex
  • Trazodone 100mg
  • Haldol

And some others I can’t remember. Continue reading

The Confession of Sins

This post was originally written by hand just hours before I checked myself into a psychiatric ward for the fourth (fifth if you count an ER visit that was over in one night) time, for suicidal ideations. Additional commentary not in the original handwritten manuscript will appear [in brackets].

[1 John:7-9]: But if we walk in the light as He is in the light, we have fellowship with one another, and the blood of Jesus Christ Yeshua Messiah His son cleanses us of all sin. If we say that we have no sin, we deceive ourselves, and the truth is not in us. If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.

[Your sins need only be confessed to the Holy Father, AHYH ASR AHYH or YHWH, in order to be forgiven. However, it can be edifying to confess your sins to fellow Christians, and that is why I have written this post. I hope you can join in my example and confess your sins publicly in the comments below, and feel the freedom it brings.]

I have sinned. When I was young, I came to hate my mother. Though I understood she had come from a massively abusive home and left at an early age; though I understood her first husband had left her to raise her first son on her own; though I understood she supported me and my sister on her own without child support from our father (her second husband), I could not forgive her the harsh words she spoke to me. I refused her love and refused to love her. And now I ask — Lisa, will you forgive me of this?

I have sinned. I have dishonored my father. I have spoken harsh words about his financial stewardship and refused to seek him out because he refused to seek me out. [I harbored bitterness and resentment for the way he seemingly abandoned our family.] I have refused his love and refused to love him. And now I ask — Ross, will you forgive me of this? Continue reading