head
   He who fights with monsters should be careful lest he gaze long into the abyss... only to find his own reflection.

Arbour-HRI Hospital psychiatric facility, Brookline, Mass., December 2009 - January 2010

These are my diary notes from my stay at Arbour-HRI Hospital psychiatric facility, Brookline, Mass., from December, 2009 to January, 2010. The text is a near exact transcription (spelling and grammar fixes only). I abbreviate a lot in these.

This stay started out as Outpatient, but then when Inpatient, and then I asked to go back to Outpatient — but ended up just leaving.

After the transcription notes I record the medications in full.

(I am working on how to properly format these entries, so things may be odd and/or different for each one for a while.)

12/30/09

Was off the ami. & sero. for 2 days and 2nd day out of McLean -- fear (no longer calling it anxiety) came back to an unmanageable level. Just the neurontin did/does not work (1200mg).

The prazosin (2mg) just made me dizzy.

This morning 600mg N. at 7:30am. At group so anxiety is high.

Anxiety: a whole-body fear based upon proximity to people or events one must appear at (legal, doctors, etc.).

Fear: a heart-centric fear that causes mild to intense physical pain in chest, abdomen and arms. Sources of fear can be real or imagined or unknown.

Panic (Attack): chest/abdomen-centric fueling terror, causing extreme physical pain in chest, abdomen, arms, stomach and sometimes whole body, along with a feeling that some unknown entity is hovering nearby which will hurt/kill you.

12/31/09

I'd rather be in a room filled with people with mental illness than a room full of alcoholics.

Because alcoholics only think about, and want to work on, their "substance of choice."

I need to work on my mental illness, not my drinking.

Crap. In the DD program the "Doctors" treat the "patients" as children; as if their IQ is low.

Some people talk too long, unrelated to topic. Group goes off topic. Too much casual talk about nothing to do with sobriety. Freq. being interrupted (even by Drs). People do not adhere to the 5 min. rule. People freq. talk of using. One in the group has only days of sobriety and knows NOTHING about the "Program."

What they don't understand: It is a different kind of pain!

It is not depression.
It is not anxiety.
It is not lack of exercise, lack of healthy eating.
It is not withdrawal from alcohol.
It is different.

All those are symptoms only!

If you do not address the root cause I AM DOOMED!

1/5/10

"Why do you live here?" DS9

I am repeating... For forty years I have been repeating the same day.

That is how I feel today -- like I saw that this day is so much like so many other days going back to the beginning of memory.

The same day repeats. Stuck. In a loop.

How do I break out?

~

In county jail in KS... that old guy's words... "Don't wait, because it will eventually be too late."

~

It just felt like a giant hand grabbed me. My head tilted to the right and my muscles tensed. So, "go away" I repeated to myself over [and over].

The act of reaching for this notebook made the feeling go away.

1/6/10

At BMC CSU for "signing a release" -- which is std. for every other. WTF

The phone calls...

The first person did not know what I was trying to convey to her. We finally worked it out that she could transfer me to another dept. -- which -- when I said I want to talk to someone about release form -- transfered my call to someone else...

After trying to convey what I wanted, we finally worked it out that I would just have to come in in person.

The next afternoon I walked through Back Bay -- noticing a Sushi place -- and found the building... -- we finally figured it out.

Then, I went to that Sushi place and picked up.

The "trigger," what set me up, was, 1) the confused state I was in, 2) seeing the sushi menu and the thought of having some sushi and sake...

I was confused, lost (almost), and this of course started my mind dissociating from myself (my situation, life, etc.).

1/7/10

Why did the mention of "Bravery" in group trigger tears in me?

It still hurts. Fuck, rather, I still hurt.

I would love to know what changes in a person's nervous system -- enzymes, hormones, neurotransmitters, etc. -- when a sad person is held, embraced, comforted by someone they love.

Why did the mention of "bravery" in group trigger tears in me?

It still hurts. Fuck, rather, I still hurt.

I would love to know what changes in a person's nervous system - enzymes, hormones, neurotransmitters, etc. - [happens] when a sad person is held, embraced, comforted by someone they love.

1/12/10

The first 10 min. of group pissed away. WTF

Saw Dr -- "Your anxiety is caused by your drinking." Double WTF

"Absolutely not," I said. "I was six years sober and at the end of those six years I was very anxious and having panic attacks."

"There were benzodiazepines in your system."

"That is impossible," I said. "Which ones," I asked as they took many urine samples.

"The first two," Dr said.

"I was just out of Inpatient and they had me on librium and other medications," I told the Dr and she seemed to believe me.

It does not make any sense! The system is completely fucked up.

Just give me some sedating medication that I can take when I feel a panic attack coming on!

WTF WTF WTF WTF WTF WTF WTF WTF WTF WTF

The Dr offered propranolol -- but I was on that for two months and "it didn't help," I said.

In the hall, later that morning, I met the Dr. I was initially going to say that I would take the Propranolol.

"I'm going to drink again," I started off saying. "I have a court appearance and I am going to have panic attacks..."

"Come with me," the Dr said.

We met with another staff member and when asked if I was suicidal, I said "yes."

I am now involuntarily Inpatient in a madhouse designed by a madman run by incompetent Drs. Old cartoons play loudly from a TV set.

They want to take this notebook and my pen during "shift change" and at 10:00pm.

I tried to argue about it -- the staff then said, "I just need the pen by 10 o'clock."

Shit.

And all my thoughts for the last 45 mins. are lost forever.

~

Each "visit" I have been asked -- and in the ER each Dr has asked -- the same routine mental health questions: date, president, memorize 3 words, and various count back by... or recite months backward, etc.

By now it makes me sick to think of it.

I need to just say, "I have successfully answered those questions a dozen times in the past 2 months."

(There is, of course, a medical name for this questioning process.)

1/12/10

The most exasperating thing in all this inpatient/outpatient... debacle, is when a Dr retorts to my statement, "I am afraid I will get hurt" with regard to people, with, "But how can they hurt you?" or some other similar question, as if all I have to do is "know" that people are not going to hurt me. [And my fear will go away.]

The utter failure of Doctors to understand the fears and phobias of PTSD is astounding!

Such utter failure can only be attributed to incompetence.

~

And I remain here, now, as I write, in pain and staring at the walls -- the absolute worst things for me to go through.

Fuck Shit Piss--

~

After dinner.

Saw another "Doctor" after dinner: looks in ears and mouth, bangs below kneecaps, "touch my finger and then touch your nose," checks two breaths -- WTF!!!!

Yeah, yeah, yeah... they are standard, basic health function the Dr is checking -- but the fact that I am walking and talking and communicating well should also indicate basic health functioning.

~

"The devil was coming out of my song!"

"I lost all my hair down the sink!"

The people are fucked... but then, so am I.

1/13/10

No caffeine, but tons of sugar. Skim or 1% milk, pancakes and sausage.

It's still a madhouse this morning.

The fucking TV has the Haiti earthquake in it's teeth and is shaking every little bit of "stink" out of it. G.S. is a poor journalist -- the minute [beyond?] "search and rescue" of emoting sid-- fuck it.

It's so fucking disgusting. "Haiti has the worst health care in the world so this..."

One patient did pick up on their repeating of bits of "the news."

"-- dirty water is better than no water at all." Asshole commentator.

Commercial: Symbicort medication. Well, well, well...
Commercial: Political ads fear mongering.
Commercial: Schwab will "rule." Are you ready to rule?
Commercial: Weight loss "proven science."

~

Mid-morning and it is still insane -- am I really one of these people?

~

Urine test, blood test. I wanted to ask what was being tested and when would the results be back. I failed to ask on one, forgot to ask on the other.

~

Finally saw the Dr today. Why did I think it would go well?

Again with the "You're depressed," bullshit. I am only slightly better at doing this. I tried to explain, "PTSD due to childhood trauma. Generalized anxiety disorder and panic disorder," I said, all seemingly good so far.

"Child abuse, sexual abuse?" he queried. If he could read my body I am sure mine would have been clear: exhale, cringe, turn head lower and to left, eyes nearly closed. I hesitate before speaking again. I do not want, nor should I need to, go into the details. What of "PTSD, childhood trauma" does he not get? Why go into the details?

"It's not fully clear. I have missing memories."

"Do you have intrusions," he asked. "Memories or thoughts of the trauma," or did he say past?, "entering you mind?"

"No," I said, hardly with absoluteness as I had not heard of this before -- "intrusions" with regard to PTSD and trauma.

"I ask," he said, "because PTSD means having this condition..."

You have got to be kidding me. Is he really ready to write me down as NOT having PTSD?

At points like this when talking to doctors about my diagnosis, when they go all, "I'm much smarter than you" on me...

(Oh, sure, he is [smarter than me] but he is also not the only doctor I have been discussing my condition with. But every doctor I have spoken with has this problem -- like each one needs to put his/her mark on me just a bit above all the other doctor's marks on me -- like Psychedelic Graffiti he has to "tag" me with his own signature.)

Meds.

This is always such a downer, documenting my "meds".

With each new "symptom" I come up with they come up with a new med. (One doctor to whom I complained of not being able to concentrate wrote me a script for amphetamines.)

So, now I have the basic anti-depressant, Ami... The basic anti-psychotic: seroquel; and added on are Neurontin -- for it's anti-anxiety, off-label use; Campral -- because I told the doctor I was tempted to drink.

So, the new Dr talks of SSRIs. "They do work," he assures me (for panic attacks), "at higher doses."

And I die a little inside. "Zoloft..." he was saying and a bit more of me dies inside. [SSRIs never did anything for me.]

(I should have taken notes. He did.)

The conversation seem to deteriorate by then until a pause where I told of what meds I was on. He smiles and seems on the verge of laughing at times. "All of the dosages are too low to do anything," he says.

I can only agree and have a little life come back inside of me as it just goes to show how each doctor differs in what they believe will work.

Since the Dr believes in no changing meds in "mid-stream" I'll stay with what I have and double the doses of Amit and Remo. And the new meds will be Ativan and Antabuse.

"See ya later."

Turns out though -- and I die a little inside -- that he left the Sero. and Neu. at the current, too low, doses.

It is late afternoon and having just this morning's dosage, and one just a few minutes ago, I can say that the Lorazepam is too low. And I die very much inside. The Lorazepam 1mg 3X a day does nothing.

~

Med Summary:

Mirtaz - 30mg bed
Ami. - 80mg bed
Sero. - 50mg 3X
Neu. - 300mg 3X
Ativan - 1mg 3X (PRN)

1/14/2010

Third day and still all is mad.

"So," Dr Z says, "It looks like we are not going to take you to court, so if you don't sign in we will let you go."

So that's how it works, eh? Use a threat of court to start, followed by a big talk about treatment plans...

So they'll let me go, but, the Dr says, "I can't help you outside."

"I would go back into the GAP from here, right?" I ask.

"Yes, but I won't be able to help you there."

"Could you talk to them?"

"Well, they could get in touch with me, sure, but all I could do is recommend -- it would just be a recommendation."

So, what he is saying, it sure seems like, is that he knows what is best for me and should stay with him.

No thanks. I'd rather go back to the streets alone.

Dr Z. I should look up his name online. I have a habit of not remembering names -- now I should make it a point to do so.

Oh yeah. When we first met today I told him that the Ativan had no discernible effect on me.

"We can go up to 2mg," he said. But latter added, "But I won't be able to change it until possibly this afternoon," with a broad smile. I can't help but think of him as a sneaky, little, controlling bastard. We talk a 1/2 hour before med call. And there is just a sheet to write in to make a change. And, uh, I see 2 hours later that he is still there. fuck

Med Call

"Meds," the med nurse calls down the hall. "Meds. Time for meds." I go the the hall quickly and see a line of six with people headed down the hall.

"This place sucks," a movie-attired, white striped, guy mumbles as he walks by.

(THX 138)

Everybody here lives by their meds.

They don't work for me. [the meds] I sit it out. I can wait until everyone is done.

"If I don't get a cigarette I'll burn this place down."

"... I'll fucking hit her..."

"I just want a damn cigarette."

Oh, the skinhead. [?]

This place is giving me a headache. I don't get headaches other than the once or twice a year alcohol withdrawal headache. It's just so fucking noisy here. This is one step below an institution perhaps; one step sideways to prison.

The system is not working. The system is failing us and you. Us patients and you our families and communities.

There is a certain "you" I am sure, that would like to see us all simply locked away. But that would be the same as sweeping a broken plate under the rug. Eventually "we" will be let back on the streets, most due to insurance run-outs, so the problem is still there.

~

I don't like my tattoos showing in places like this, inpatient and outpatient both, for they always can attract two kinds of people. The crazies who ask questions; "You are from Arizona?" "Those are Indian symbols, aren't they?". Or you get the "I like your tattoos, I'm gonna get one right here and..." And the people who, also tattooed, start talking to me like as if we belong to the same club. Well, we do not.

~

Everything I know is wrong. It's all wrong.

1/15/10

"He's got a spider tattoo on his arm. Yo bro!" I knew I should have worn my long sleeve shirt this morning. "I got one too," he shows me as I pass him by later. I just give him a half smile and a nod. (Stay away from me Bro!")

Bloodwork sheet, but it is dated 18th and this is 15th, so nurse says, "Bye." Okey, dokey.

Breakfast was waffles and pancakes, sugary cereals, bananas, sugary juices or soda. Can you imagine what things would be like in this country if good food was served?

~

Saw Dr Z just now. "I see the ticket(?) that you will be leaving today." Yes," I said. Blah, blah, blah or something he said. He talked to the GAP people and said that (he assumes I will be back) it will be okay as long as they watch me take the Antabuse 3 times a day.

"I left a message anyway," he added. "Did someone from GAP see you yesterday?" he asked. "No," I said. He was perplexed about that. We continued. I said that I thought the Ativan dose was too low. He did not seem to even acknowledge I said that -- poker face -- smiley guy.

And I asked about taking it 3X a day but just before a panic attack.

He said no, "We want to keep base level," and he moved a hand in a line along the wall. "If we take one dose it goes up like this." And he ran a hand up the wall. "and when we go down like this," moving his hand down, "There is the chance of another panic attack. Okay? So we want to keep you at a base level."

Fine, fine, fine. See ya later Doc.

~

They only provide me with Ativan if I request it. "Can I have my PRN?" I have to ask each time. "Ativan?" each nurse asks every time. "Yes," I say every time.

And while I am at the med station a nurse comes up to me and says, "You are being discharged today, right? Before you go you will see Dr D for a 2nd opinion. And a nurse-something-or-other for a 2nd opinion..."

Yeah, yeah, yeah, I say to myself. Whatever.

~

Dr D

I just had a fucked up conversation with Dr D.

Every time I answered a question he would re-ask in the form of "Why?" or "How?" He questioned every response...

I wondered, do these Doc always and only try to get their way with people? I said, "You're just trying to manipulate..." and his face went angry and red and he blurted out, "Okay. You may leave."

And that was that.

~

Just now Skinhead acted out... bang, shout. "This place... Suck my dick... I'll hit him... gay this, gay that.." This place goes, wham, nuts.

I took this opportunity to see if Dr D was visible. Yes, he was. I got his attention and we talked a bit.

"Don't you see? I can't get well in a place like this." He then became quite, um, normal, whereas before he had his Doc Face on an acted all "tough" or something. Now he was calm and clear. We have a quiet floor upstairs were we could put you. We just want to help you. You are not suicidal, have a place to go. We cannot keep you here if you want to leave."

He asked about another med. No I said. He mentioned campral -- blah, blah, blah.

"Dr Z is the best doctor in dual diagnosis."

"I have PTSD and that need to be treated before alcohol," I tried to explain.

"I have worked for the VA for thirty years. Dr Z is the best..."

Ya know, he is probably right. Inpatient under their supervision would be great, however, not is a ward full of noisy and crazy people where I only get to see the doctor for 15-20 minutes a day.

~

So, I am out. And when I get home and go though the "discharge papers", and of the six "discharge medications" scripts for only four. One, Antabuse, I am to get during the outpatient program I am to go to when I leave the nurse said. He mentioned nothing about the other. I suspect that it too (Ativan) will be provided to me, and along with the Antabuse, watched as I take them in the GAP.

But the nurse did not say and I want to make sure there has been no mistake.

I called back [and, after very long struggle and several calls, confirmed my suspicion].

Well, that's it, isn't it?

I don't know what I am going to do at GAP. I am certain though, that 1mg of Ativan will NOT help whatsoever!!!!

I shall try to convey that to them, but if they argue with me about it I shall, simply, walk away.

1/16/10

[When I came back the next day I had a change of mind and wanted to go back Inpatient -- but the managing nurse did not like that, getting all pissy and wanted me to "Spend 8 hours in the ER first." So I left the program altogether.]

[The following entry was written in a "Heavy Metal" kind of a bar, not to far from my apartment, that I frequented.]

Oh yeah. What did I learn from being in "2 South"? I understood everyone of them, and many in a loud way [?] as it begins to fill up, I see the same people. Different names, different faces, but the same fears. the same below the surface anguish of un-fulfillment, the same... pettiness. I don't want to be here. There is none for me here. Only the booze is our common denominator.

I shall leave... as soon as I have another shot... but, after the shot I am fascinated by the clientele, it filled up so fast... The the DJ speaks and that perplexed me -- so many people here -- is explained...

So... that is what people do.

I don't get it though.

But -- and yes, I have had 3 shots and two beers. I am not afraid and see all the people here as... as just simple, non-arrogant people. I don't like it, this seeing a person as vulnerable and open...

Never before have I looked around and seen everyone as vulnerable -- overweight or insecure or paranoid or... but, looking back, I remained alone and lonely and desperate as usual...

And I don't think any one of these people enjoy what they are doing.

~

Postscript:

That last sentence I wrote is, of course, wrong. It's just a reflection of my own cynicism at the time.

At the time of this (and a few other Inpatient Journals) I was living lonely and alone in an apartment in Alston, Mass. It should have been a good time for me, living in the middle of Boston and surrounded by so much culture.

There were a great many excellent International restaurants and shops that I enjoyed. But I was wallowing in fear and pain and alcohol for most of the time. And kept to myself.

Notes
  1. Deep Space Nine was an excellent show. One episode the "beings" in the Worm-hole asked Sisko during a flash-back when his Wife was killed: "Why do you live here?" He was like, "What?" "Why do you live here?" they asked again, meaning that he in some manner "lived that moment in time" in his mind over and over. It was one of the best episodes of the series.
  2. I once spent two nights in a Kansas jail for a DUI. There were two other occupants. One guy who slept the entire two days, and an old guy who was constantly on the phone working on his case. "What's he in for?" I asked the cop on duty that weekend. "He killed his father.
  3. Librium is nearly always given to people who may be in alcohol withdrawal. (It was one of the first of the group of drugs known as benzodiazepines to be synthesized.)
  4. But I have written in my diaries — in the hospital and out — of having "intrusive" thoughts.
  5. This is not to say that I make up symptoms — though that is the way I wrote it at the time. For someone with GAD and SP it is often difficult to converse with people about my feelings, often made all the more complicated because my feelings are always in a turmoil and I difficulty with the vocabulary to explain things. Like "intrusions". No, I do not have "memories or thoughts of the trauma". I have "missing memories", blanks, years of nothing. I do have though, intrusive, sudden, waves of fear and panic for no reason I can attribute the feelings to. And THAT means PTSD.
  6. Little did I know I was actually correct in my thinking here about taking some medication right when I feel a Panic Attack coming on. It just took me five years to prove it to myself.

Definitions:

GAP General Adult population
PHP Partial Hospitalization Program
DD Dual Diagnosis
BMC CSU Boston Medical Center Clinical Studies Unit
PRN "As needed" (from Latin Pro re nata)
PTSD Post Traumatic Stress Disorder
GAD Generalized Anxiety Disorder
SP Social Phobia

Medications:

Amitriptyline
Quetiapine (Seroquel)
Chlordiazepoxide (Librium)
Lorazepam (Ativan)
Prazosin
Mirtazapine (Remeron)
Propranolol
Disulfiram (Antabuse)
Acamprosate (Campral)
Benzodiazepine, "Benzos"

#
Writing Down the Pain
I'd like just once to fall asleep feeling good about myself. Just once. Drunken stupors do not count.