Perspective: The Trigger Behind the Instability

I was talking to my sisters this week, and Sister pointed out that Daughter hasn't truly been stable for years. There have been brief stretches when she was doing better, but overall, it's been several very challenging years. She asked me when was the last time she was truly stable. I began to think.

In the spring of 2007, Daughter was doing well. She'd graduated from high school the previous year (which had triggered some challenging times), and was now settling into her new routine at the workshop with friends. She expressed a desire to make contact with her birth mother. I had always told her that when she was an adult and I thought she could handle it, I'd help her establish contact. Therapist and I had a long conversation about Daughter's desire. Both of us had concerns about the impact that contact would have on Daughter, but she was doing so well we didn't have any reason to delay it any longer.

Daughter had been referring to her birth parents by their first names for years. They had failed to keep her safe, therefore they didn't deserve the title of parents. Parents keep their children safe. So she wrote a letter to J. I showed her some of the material I had saved about her birth family, and we went through it together. J responded. Her response looked like it could have been written by a young child.

Daughter wanted to talk to her, so we called her. They talked for a few minutes, then Daughter handed me the phone. I was talking to J when Daughter came out of the bathroom, sobbing. I quickly ended the call. I held Daughter as she sobbed in my arms. "She didn't sound like a 49 year old woman. She sounded like a child."

"That's part of the reason she couldn't keep you safe. In many ways she was like a child."

One of the reasons Daughter had wanted to talk to J was so that J could answer her questions. Why had she allowed the abuse to happen? Had she known Daughter was being molested? Why hadn't she kept her safe? I had cautioned her from the beginning that J may not be able to give her the answers she was seeking, but she had been determined.

Over the next few days I watched Daughter deteriorate. Finally she couldn't talk about her feelings. She drew pictures: very graphic pictures of deep pain and her own death. We were waiting for an appointment with a new psychiatrist (hers had died). We called up to the hospital where the new psychiatrist practiced. They didn't have an adult psych unit. We had her admitted locally, with the request that she not see a particular psychiatrist.

That hospitalization was a disaster. The entire story is long and complicated, but she was treated by the psychiatrist we requested she not see. A number of things happened that were powerful triggers for her PTSD. Within ten days of discharge, I was having her admitted to a different hospital, one that was further away, and at the request of my insurance company writing a letter to the state licensing board about the first hospital.

She ended up being hospitalized 3 times that summer, and has averaged at least one hospitalization a year since that time. It's now been well over a year since she's been hospitalized, the longest she has stayed out of the hospital since the summer of 2007. I probably could/possibly should have hospitalized her this past month, but I didn't.

This time around she went around me to establish contact with Birth Brother. Once again she is in a spot of deep pain. Once again she is struggling.

I realize that for many adoptive children, contact with the birth family is healing. For Daughter, it has been disastrous. I find myself wondering what would have happened if she hadn't talk to J in the summer of 2007. Maybe we would still be in the same place. I think I remember reading someplace that schizophrenia often appears in young adults. (Her current diagnosis is schizo-affective disorder). But I also remember her late psychiatrist telling me that her problem was PTSD. He pointed out her psychotic episodes were related to the early trauma.

I can't turn back the clock. She hasn't talked to J since that initial, disastrous contact. I can't control her contact with BB, though she says she is going to back off now. I can't erase, though, what has already been done. I do think I'll mention to the team, though, that she may need some help working through the issues her contact with birth family raised. We can't turn back the clock, but maybe we can help Daughter process what's happened since.

Taking a Toll

Daughter's current emotional roller coaster is taking a toll on me. I've been walking almost 4 miles in the morning, which helps. It's hard, though, to continue to ignore the verbal abuse and threats. It's not easy, wondering what I can say to her that won't trigger a rage.

Therapist suggested to her today that Birth Brother is feeding into the current crisis. Daughter was furious. Turns out Birth Brother has not been responding to her messages. I think Therapist is on to something. We talked about it some in the car on the way home, and she cried. I reminded her he was damaged, too, and that this is why I had discouraged contact.

She is setting one of the men in her program up to break his heart yet again. They have tried to keep them apart, but as Program Manager said, it's like Daughter's attraction to food. She can't control it.

I'm tired. No, that's not quite right. I'm depressed. I never know when I open my mouth if Daughter will respond by screaming, growling, or laughing. It's hard to keep my balance. I made her the pulled pork she asked for tonight. I bought her pickles and salt and vinegar chips when we stopped at the store to pick up buns. When I had the nerve to ask her to do a chore before she turned on her computer or the TV, she went ballistic. She's done with this family. There are times when I wish it was that easy....

Psychiatrist

Part of the mystery of Daughter's recent behaviors is solved: she wants to be hospitalized. She knows the language well. In fact, this evening, she was trying again to convince me she needed to be in the hospital, and informed me that she is a danger to herself and others. She's not going to the hospital, but we are increasing her antidepressant. If she gets better, we'll know the problem is depression, if she gets worse, we'll know she's doing some rapid cycling.
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She also confessed today that she's been getting a hold of the insulin at her program and taking extra. We had suspected as much, but couldn't figure out how. We still don't know how, as she isn't able to explain in a manner we've been able to understand.
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I'm concerned about her grasp of reality right now. On the way to the psychiatrist she was trying to convince me she's pregnant, and insisted that you don't need sperm to get pregnant....
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She did work with me in the yard for a while this afternoon. We cut down some large bushes in the backyard. I'm also getting ready to move some flowers and other plants around. I offered her the option of staying home the rest of the week, but she informed me she needs to be at her program. I think she needs the stability and structure it offers her. I hope that the increase in medication will help her get back on track. I hope.

Chocolate

This afternoon I noticed that Daughter's Program Coordinator had sent me a text this morning. "We think we've located Daughter's brother. I went him a message telling him to contact me." I could feel my heart begin to race. I sent back a text telling PC that this was bad, very bad. Then I told Administrative Assistant, ending with, "Happy Holy Week. I need chocolate." I found some chocolate chip cookies in the kitchen.

The last contact with birth family was 4 years ago and led to 3 psych hospitalizations over a very short period of time. Since then, any discussion of birth family has led to psychotic episodes.

Apparently, Daughter told PC that we had been trying to locate Birth Brother. PC helpfully went on to Facebook and quickly found BB, sending off the message. She decided to give me a heads up, but thought I had been working with Daughter on this.

PC left for a meeting, and Daughter's group headed to the library. Daughter took advantage of the computers in the library to look up BB on Facebook. She entered his phone number into her phone, and called him. He answered. She told Staff he called her.

She called me, "Guess what! BB found me!"

"Would you like to rephrase that?"

"BB found me!"

"I talked to PC."

"Okay, I found him with PC's help."

She has no informed me that we aren't family and she needs to change her last name. I need more chocolate. I'm trying to be optimistic and think this might lead to some healing. It's hard to be optimistic, though, knowing what I know of BB. He has a girl with his second wife that he named after Daughter. Birth Mother told Daughter that BB's girl was just like Daughter. For months Daughter was trying to figure out how to get across the country to rescue BB's girl, because she wasn't safe. I finally told her that BB's girl didn't look like her, and that her mom had been smart enough to divorce BB, so I was confident she could keep her safe. BB is a charmer, a thief, a liar, and while Daughter claims he kept her safe, she has several times expressed deep concerns about the safety of young girls around him. I take that gut fear of hers seriously.

If she has been actively thinking about him and searching for him, it could explain many of her recent behaviors. Unfortunately, I don't see how contact with him is going to improve things. This Sunday is the 16th anniversary of our adoption. Right now it sounds like she isn't celebrating that. I hope I still want to celebrate come Sunday.

Memorial Day

We went to the community Memorial Day service yesterday, and Daughter was obviously distressed. I thought she was thinking about her grandparents, but as we talked following the services, it was her Birth Brother that was on her mind. He's in the military. Once again, she's wanting to make contact with her birth family.

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The last conversation with her birth mother resulted in a 3 psychiatric hospitalizations over the next couple of months. She wrote 2 letters to BB at that time, but he never responded. Psychiatrist has told her she needs to go a year without having a psychotic episode before she attempts contact again. Up until yesterday, she'd seem willing to accept no contact ever with any of them. Just looking at pictures a couple of months ago was enough to send her into a deep downward spiral.

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Yesterday was a down day for her. She was back to lying and not completing tasks. They're gong to have Sub all this week at the gift shop, which is slightly concerning to her. She also just doesn't do well with a completely unstructured day. She wanted to invite people over for a party yesterday-- she asked to do that late yesterday morning. I explained that wasn't something she could do at the last minute. It turned into a frustrating day for both of us.

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I'm very much aware that June 9th will be the first anniversary of Mom's death. A picture of Dad with Daughter and Short Niece taken a year ago has stirred up many memories. They were all so happy that day. It is a precious picture that I treasure. It is a gray, rainy day today. Hopefully a return to routine and a busy day will be good for both of us.

The Return Home

It was the fastest discharge we've had from the psych unit. When I got there her blood sugar was over 300. The nurse had the paper work ready, so we repacked the clothes we'd unpacked the night before and came back to Town. Daughter claimed her cell phone as soon as we got in the car, and began calling friends. She's worried about Cat, and disappointed when I explained that he's not in kind of hospital where we can go visit.

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Her blood sugar was acting up. She'd been very low before lunch, so she hadn't had insulin. We dropped of prescriptions and went out to eat. I gave her insulin to cover the high blood sugar with supper and by bedtime her blood sugar was back in range. As soon as we got home, she went upstairs and plugged up the toilet. That happens every time she's in the hospital, unfortunately. She didn't wet the bed last night, so that's good news. She still hasn't unpacked. She had cleaned out her locker at the workshop Tuesday before I picked her up, so she had a number of bags she brought in from the car in addition to the suitcase. I wouldn't let her take them all upstairs, because I figured she'd get overwhelmed and not get the things put away properly. I told her she can take them upstairs a little at a time.

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Psychiatrist reduced the strength of her catapres patch. I'm a little concerned about this, because it has been a miracle drug for reducing her rage and volatility. She did it because of the ER visit, when they decided she has low blood pressure and was dehydrated. We'll see how she does with it.

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Cat is improving. He had an appetite this morning, which was very good news. Vet had said some cats won't eat the special diet.

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Right now, things are going well, and hopefully that will continue. I bought a zippered bag for Daughter's mattress, and we'll put that on today. Hopefully that will get rid of the odor in her room. It's going to be a busy day, but a good busy for the most part. I'm grateful that I don't have to go back to Big City until her appointment with Psychiatrist on the 25th.

Brain Dump

Lots going on. Lots running through my brain. So prepare for a dump.
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Cat has been off the last couple of weeks, and yesterday I picked him up and he was light enough and off enough that I called and got him into the vet this morning. He has advanced kidney disease. Neither Daughter nor I need another death to deal with right now. They are treating him with IV fluids over the weekend in the hope he will perk up. We may be able to bring him home on a special diet and keep him going for a while, but it's not good news. The special diet will be a challenge with Kitten around. I've always just had dry food and water available at all times. That will have to change.

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I talked to Case Manager several times this morning. She needed more concrete details for an investigation. We talked about how to approach Daughter on getting the truth. I shared my concern that Daughter doesn't know what's real right now. We talked about pulling Daughter out and setting up respite for the days Flasher is at the workshop. If we'll be moving soon, that will work. Maybe it can be temporary until Daughter is stable on the new drugs and can handle going back. Daughter's supervisor moved to a different program, so they have had 3 floating supervisors for her group. I told her I think Daughter needs consistency. She agreed. They're rethinking the floating system, but I asked that if they keep that, they move Daughter to a different group with a consistent supervisor. She thought that was a good idea and was going to deal with that today. We talked about the challenges involved with Daughter's struggles with reality and the long term implications of it. Not a pretty picture. CM was quite adamant that I cannot continue to live with this kind of stress.

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Sister told me this morning that I was like someone who has lived in a war zone for so long I'm no longer aware of it.

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Social Worker from the hospital called. Psychiatrist has discharged Daughter. I can pick her up this afternoon. SW mentioned again the need for an investigation. I told her about my conversation with CM about it. SW mentioned "paranoid" several times in relationship to Daughter. Apparently Psychiatrist had observed that. Now I'm paranoid, and feeling the need to look up paranoid schizophrenia and the symptoms.

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Daughter called, sounding down. She wanted to know about Cat. (I had decided it would be good to warn her last night that Cat was sick). I told her Cat is in the hospital and they are doing tests. Then she told me she got to come home, and her voice perked up. She said she'd slept well last night, and had come up with a plan and wanted to go back to the workshop 5 days a week. I asked her if she had a better idea of what was real now. She assured me she did. I asked her about the story about Flasher touching her. Without hesitation she said, "Oh, I made that up." I told her she needed to tell Psychiatrist that. She said it was too late, she'd already seen Psychiatrist.

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I called CM to tell her Daughter had acknowledged that wasn't real, so we didn't have to worry about an investigation. CM told me to make sure Psychiatrist was told about this. I will make sure Daughter tells someone at the hospital who can pass it on to Psychiatrist.

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I had been looking forward to a quiet weekend without Daughter around. So much for that dream. On the other hand, it will be wonderful to not have to keep running over to Big City to visit Daughter.

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Monday we'll know more about how Cat is responding to IV fluids and if he's able to eat. By the time I got him to the vet, he'd dropped from 9 lbs to 5.4 lbs. Monday afternoon Daughter sees Therapist. Tuesday afternoon we already had a meeting set up at the workshop to modify Daughter's service plan. I'm not going to send her back until we've had that meeting. That means I'm going to have to find things to keep her busy and structure her time over the next few days, or we'll both go crazy.

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Since Daughter is coming home, I need to lock things up again-- the medication, knives, etc. It was just this morning that I realized I could leave them unlocked for now.

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Now that I've dumped all of this, I need go go write a Wednesday evening worship service before I leave to get Daughter....

Visiting Daughter

I made the journey over to visit Daughter this evening. It's always disturbing to visit-- I have to go through a metal detector and many locked doors to get to her. She was pleased to see me. Her blood sugars are now in line-- they figured things out. She's drinking lots of water now, because apparently she was a little bit dehydrated at the ER yesterday. She's always a little dehydrated, because she doesn't like to drink anything.

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She says the voices have stopped-- that they're scared. She still has only a tenuous grasp on reality. Tuesday she couldn't break up with Flasher. Tonight she told me she broke up with him on Tuesday. I pointed out the contradiction. She didn't have an answer. I said I wasn't sure she knew what was real. "That's the problem!" She seemed to think I was really slow for just figuring that out.

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Psychiatrist came in while I was there, and ordered another increase in the trileptal, which will put her up to the mid range of effectiveness. Psychiatrist sees Flasher as a predator, and wants him reported to adult protective services. She also sees Daughter as too child like to make her own decisions-- she'll always be too easily influenced, and thus people like Flasher are a real threat to her.

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Case Manager didn't take my concerns about Flasher too seriously. Therapist and I have a meeting at the workshop Tuesday on the respite situation. There will be much to address during the meeting. I'm considering pulling her out of the workshop the days Flasher is there. Interestingly, Daughter seemed to think staying home from the workshop on the days Flasher is there is a good idea. That tells me the situation there is very bad right now, because she hates missing any days for any reason. To be cut back to only 2 days a week there would usually generate big protests, but not today. I think I'd arrange respite care for the afternoons she doesn't go to the workshop. I'm generally around in the mornings working on sermons and administrative stuff. That would leave me free to do my visits in the afternoon. I'd have them work on her cleaning skills, as I see that as an area where she could eventually get community employment. This will work if we're moving soon. If not, the respite money will run out too quickly.

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God will provide the right place at the right time. Right now I need to keep reminding myself of that fact.

Good News or Bad?

Daughter hasn't called today. This could mean she's doing better and doesn't feel the need to talk to me. It could mean that she's mad at me because I didn't offer enough sympathy when she was in the ER last night. I admit that I'm a bit surprised, and have considered calling over to find out how she's doing. I'm going to see her tonight, so I guess I'll find out soon enough.

So Much for Being Proactive

So yesterday I was proactive in addressing Daughter's diabetic needs. My hope was that by doing this, we'd avoid the kind of problems we've had in the past. So last night, of course, they didn't have the orders and so didn't check her blood sugar and give her insulin before supper. This morning Daughter called me, sobbing.

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According to her (and I am aware of the fact that her reporting is not always accurate), they didn't check her blood sugar this morning or give her insulin before breakfast. When they finally checked last night, she says her blood sugar was over 300. They didn't give her anything to bring it down, just her regular bedtime basal insulin. She said she didn't sleep well and didn't feel well. High blood sugars can lead to ketoacidosis, so I'm not surprised she didn't feel well.

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I told her that it was her responsibility to keep herself safe. I told her that she needed to talk to the nurse and tell her she wasn't safe because they weren't taking care of her diabetes. I told her she needed to tell Psychiatrist what was going on when Psychiatrist came to see her. I told her it was her responsibility, and she could do it.

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Then I called Psychiatrist's nurse. I gave the standard disclaimer, "I don't know if this is true, but...." She was horrified and assured me that couldn't be the case. I told her we'd had problems in the past, and explained that I'd instructed Daughter to talk to her nurse. I explained I just wanted to make sure Psychiatrist was aware of what Daughter had reported to me, and that someone else knew in case Daughter didn't follow through. She was going to call the unit right away to find out what was going on.

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I get so tired of going through this every time she is hospitalized. I keep wondering, if highly paid RN's can't handle her diabetes, how can I expect the workers making less than $8 an hour in the supported living situations to do it?

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I called and talked to Case Manager this morning. They don't have a way to keep Flasher and Daughter separated if they don't want to be separated. I may have to pull Daughter out of the workshop. We'll see.

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The good news is that I have a rough draft done on the dialogue sermon for Sunday. I'm ready for tonight's worship, too.

The Story

Nothing like exploring Scripture with two fine young men to energize me. I love my job. Anyway, since I've been re energized, I'll share the story of how Daughter got herself hospitalized this time.

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As all of my readers know, Daughter has not been doing well lately. Some of the things that issues that were raised with Psychiatrist:

• She hasn't been sleeping well. She was up at 5:00 this morning.
• She doesn't seem to have a good grasp of reality.
• She has been trying to hurt herself in a variety of ways.
• She keeps going back to Flasher, even though she admits he is dangerous. Today she said he'd been "touching" her in "private" places. It's the first I'd heard of that. Who knows if it's real.
• It's unclear how much of this is medication related and how much of this is related to the toxic environment at the workshop. As Psychiatrist pointed out, she's claiming she's been molested, which would be a very powerful trigger for her PTSD. I said I thought Flasher was a symptom, and not the cause.
• She said she's not able to break up with Flasher. When I pointed out she did Friday, she said the only reason she could do it then was because I was in the room with her.
• She was presenting as very depressed, with her head down almost to her knees. It was hard for Psychiatrist to get her to say anything.
• She has been wetting the bed.

She wet the bed again last night. The three nights she was dry began with her breakup with Flasher. She agreed to be his girlfriend again yesterday, and wet the bed last night. She is putting herself in what she knows are dangerous situations.

When she left this morning, I told her to turn the ringer on on her cell phone, and I would call her when I got to the workshop so I wouldn't have to park the car and go in. She called while I was on my way, and I told her I'd be there in three minutes, so to be waiting for me. When I got there, she wasn't waiting for me. So I called her. I called her multiple times. She wasn't answering. When she finally answered, she told me I'd have to come in, because she couldn't go to the lobby until I came because there wasn't anyone there to watch her. I was not happy as I parked the car and went in, and then had to ring the bell several times before someone showed up to call her to the front. She had been busy talking to her friends, so she hadn't bothered answering my calls or telling me why she wasn't out there waiting for me. She said, "Are you made at me?"

I put extra effort into explaining her diabetic needs when I admitted her, hoping to avoid the problems we've had with that in the past. She called me a little before 7:00 tonight in tears. She wasn't safe there. They gave her a regular, high carb meal for supper without checking her blood sugar or giving her insulin. She wasn't happy. She also said they needed me to bring her birth control pill in right away. She told them I wouldn't be back until Thursday, and the nurse asked about someone else dropping it off. I called and spoke with the nurse. There had been a delay in getting her orders, but they were now in place. I pointed out that I live a distance from the hospital, that she is only on the pill to control her periods, and that they wouldn't be able to use the pills anyway, as I'd taken them out of their original packaging and put them in the pill boxes I set up for a month at a time. I warned her didn't have a clear grasp of reality right now. Apparently she was telling Nurse that Flasher had been slapping her. I doubt that story. But that doesn't mean that he isn't a danger to her.

I'm considering pulling her out of the workshop at least on Mondays. Then she'd only be at the workshop with him on Tuesdays and Wednesdays. I hope we'll be out of here soon. I hope the next place will have a healthier atmosphere in their workshop. Fortunately, God knows what we need even better than we do.

One More Time

Daughter had an appointment with Psychiatrist this afternoon. Psychiatrist admitted her. It only took 3 hours this time-- almost 5 when I include travel time. I had to cancel shut-in communion.

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Now I'm home. In a little bit I have two young men coming to work with me on a dialogue about the Prodigal Son. After they leave, I will head for bed. I am exhausted. I will share more tomorrow.

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If It's Not One Thing....

Daughter called about 12:45 today, sobbing. She was obviously very anxious. When I got her calmed down enough to explain the problem, she told me that she'd been sitting in the lunchroom, eating, when all of a sudden she had all these people hovering over her. It sounds like she had a seizure. It was not as bad as some of them have been, and I don't think she completely lost consciousness, but she suddenly started shaking all over. She is now tired and has sore muscles. She didn't chew up her tongue, though, so that is a plus.

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I was planning to pick her up within the hour to take her to see Therapist, so I offered reassurance and diversion-- telling her to go blow her nose and wash her face. By the time I got there, Daughter was sleeping and staff quickly came out to fill me in and seek my opinion. The more I hear about what happened, the more convinced I am that she is experiencing seizure activity again.

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Therapist agrees, and we discussed the choices we may be facing. The cymbalta has been a wonder drug for her. Once she got out of her lethargy and such from the seizure, she was the best Therapist has seen her in months. I just looked it up, and cymbalta has not been studied in people with seizure disorders, so caution is suggested in prescribing it for anyone with a history of seizures. So do we risk her having additional seizures? Do we try to medicate for possible seizures? Do we shift her to a different antidepressant/anti-anxiety medication? Do we try to get her back on the name brand of her seizure medication, since the tremors and such got much worse when we were forced to go with the generic? Why can't anything be easy with Daughter?

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If there is a bright spot in all of this, it is that tomorrow she has an appointment with the neurologist I saw last month. I liked him, and decided to see how he did with Daughter. He's 24 miles away, and her current neurologist is 100 miles away. It would be wonderful if we could shorten the mileage to one of her specialists. I hope he knows his stuff and is up to unraveling the mystery that is Daughter.

They're Back-- Maybe

The voices are back. She's not raging-- yet. She woke up complaining about cramps. She is very dramatic with just minor pain. I figured that the reminder of bowling this afternoon would do wonders for relieving her pain-- or at least the complaints. I was shocked when she said she might be too sick to go to bowling. I gave her a couple of ibuprofen with breakfast, and she made it through worship and Sunday School. We came home, and while I fixed lunch, she unloaded the dishwasher-- v e r y s l o w l y. I told her I wanted her to take care of the laundry before bowling. Instead, she sat down in a chair and fell asleep.

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She woke up just in time to leave for bowling (amazing). She promised she'd take care of the laundry as soon as we got home. She had a great time bowling, but the complaints started on the way home. She would be better off dead, she didn't belong here. So it was no surprise when she informed me she couldn't do the laundry. I broke it down into smaller pieces for her, "just fold 5 of the little yellow towels." She finally stormed off to her room, informing me she belonged in the hospital and couldn't do it. I folded the clothes in less than 10 minutes. At 6:00, she came downstairs for supper. She apologized and put the laundry away.

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I'm hoping that if she gets a good night's sleep and gets back into her routine tomorrow she'll feel better. I'm not sure if the voices are really back-- or what's going on. I hope the voices are gone. I hope that this medication increase stopped the voices. I'm hoping. Time will tell. We'll take it one day at a time.

Discharged

Daughter called me a little after 4:00, very excited. She had been discharged. The paperwork was done and I was to come get her right away. She wasn't eating supper there, I'd have to take her out to eat. Her call was unexpected, to say the least.

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I dutifully drove over and picked her up. We were given a prescription that needed to be filled tonight. I asked if they could give me one pill to cover tonight, but the nurse said she couldn't (I know another nurse did once with a late discharge.)

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We came straight back to Town, but our national chain pharmacy was closed, as was the independent pharmacy. We made it to the super discount store north of town 15 minutes before their pharmacy closed, so we got her pills and then stopped at McDonald's.

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I hope she's ready to be home. She thinks she's ready. On the way out of the door I paused long enough to lock up the medication and knives again. We'll see how she does. I need to call and make her an appointment with Psychiatrist for 2 weeks. I'll get her in with Therapist this week.

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I just told her I was not willing to take her to a friend's Halloween party tonight. I've driven over 100 miles for her today. I'm not willing to go out again to take her to a party 15 miles from here. She was not happy about that. We'll see if she's able to hold it together. I need to go write a sermon for tomorrow....

Today's Phone Call

Daughter missed 2 days of birth control pills, so her period started today. She asked me to bring supplies when I visit this evening. She has not had a bowel movement since she was admitted. She has informed me she's waiting until she gets home. I don't need that much practice plunging, so I will again ask them to give her something this evening. She says the voices were silent last night, and she slept well and was up early. That's wonderful news. She sounded better today than yesterday. I can hear the improvement in her voice.

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I've started my first load of laundry of the day, and am working in the kitchen. I've washed the dishes and now I'm going to make apple sauce. I'm pondering my sermon for tomorrow. I want to have it done before I head to Big City to visit Daughter. As she improves, I recognize just how exhausting her challenges have been for me. I have a wonderful story I often tell in pastoral care situations, particularly with caregivers. A frog who is dumped in a pot of hot water will immediately jump out. A frog that is put in a pot of cold water that is then gradually heated will not escape, and will be cooked alive. It's not until Daughter is safely hospitalized getting treatment (that is working), that I realize how hot the water was that I have been living in these past few months. I'm enjoying the cooler water.

Psych Unit Day 3

Daughter was much improved tonight. She said that the voices are getting quieter and are speaking more slowly. She told me I don't have to come over every day-- that it is important for me to take care of myself.

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The insurance company called today. They wanted to know about aftercare plans. Did I want to change Therapist and Psychiatrist? No, I don't want to change. They have approved 3 more days, so she can stay through Monday.

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At this point I'm cautiously optimistic. I'm also very tired....

Psych Unit Day 2

Daughter didn't call me today. When I got there she was in bed sleeping. I made her get up. She had napped off and on all day. Psychiatrist increased Depakote. Depakote was decreased because she had a bad tremor. Her blood sugar was 210 before supper. She said her tray didn't contain the food she and the dietitian selected. I raised these issues with her very nice evening nurse, who made notes and will follow-up.

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I left at 5:30 to go visit her, and got home at 9:00. My days are much longer when she is in the hospital. On a positive note, I had a good phone interview about a church that is located as the same metropolitan area as Sister and Brother. Far Away Sister thinks it would be great for me to be back in an area with more resources with Daughter. She may have a point.

Back to the Psych Unit

I admitted Daughter to the psych unit in Big City this evening. She had an appointment with Therapist this afternoon, and I told her I was concerned she needed to be hospitalized. Less than 5 questions into her assessment it was clear she needed to be hospitalized. The voices are growing stronger, and when she asked Daughter about her ability to resist them, Daughter began to cry and said she was afraid she couldn't continue to resist. During last night's rage, the voices were telling her to strangle me.

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Therapist called Psychiatrist and talked to her nurse. Nurse talked to Psychiatrist. Psychiatrist ordered a direct admission. I hate leaving her there. The nurse on the unit explained to me why they couldn't control her diet or follow her insulin program. I explained to nurse that if Daughter's blood sugar was running sky high they wouldn't be able to determine if high blood sugars, too much medication, or severe depression were causing her lethargy. I suggested that would not be helpful. They decided maybe they could find a dietitian after all.

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Her appointment with Therapist was at 3:00. I got home at 8:40. I'm a little bit tired tonight. That's an understatement.

Finding Answers

Daughter has had a rough few days. Tuesday she called me in hysterics from the workshop, insisting I come and pick her up immediately. She claimed she was being harassed again. I had her take some deep breaths, wash her face, and told her to listen to the Christian music on her ipod on the bus ride home.

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When she got home and told me the story, I told her it wasn't harassment, but teasing, and she needed to develop a thicker skin. She had another play date after supper. I was on the phone, so wasn't out there to referee. They hadn't been here long before she burst into the house screaming and insisted I send the boys home immediately. They were getting on her nerves. She then took off, saying she was going for a walk, but was back in the house almost immediately. I told her she needed to go for a walk to work out some of her adrenaline.

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I asked her if her period had started, and she said, "No, but it must be due, because I'm so emotional." Wednesday night she was irritable again. I don't even remember what the issues were. I decided that maybe it was because it was the night we change the catapres patch she wears, which is supposed to slow the adrenaline from her PTSD.

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Today she's still irritable, and she seems to be hearing voices again. Now I suspect she is manic again. I have an order for another Depakote level for her, but of course I can't find it right now.... If I don't find it this evening I'll call and ask them to fax one directly to the lab, and we'll get it drawn on Saturday morning.

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Even with all of this, she's still much better than she has been some years in May. This is often the time of year I'm wondering how much longer I'll be able to manage her at home. This year, I'm just seeking to find the answers that will help her maintain a more even keel. I am confident that someday we will find the proper mix of medication, and Daughter will learn how to cope with her remaining symptoms.