Last week I wrote about having a psychotic breakdown. Please read that post first if you can, although note it may be triggering for some. This week, I’m going to share what it was like to go to the ER for a mental health emergency. By that, I meant to say “this is what my personal experience at one specific ER was like during a mental health emergency” and I don’t assume my experience is in any way universal.
When we were in the car on the way to the hospital, the “noise” in my head was still loud, although not as loud as it had been. I was aware of my own thoughts and felt like I had some control over my body. The ugly cry had calmed to a constant sobbing. I was a blubbering mess. I still felt my speech was restricted.
Often, my bipolar disorder manifests itself as auditory hallucinations. It sounds like a radio on in another room somewhere, like you can’t quite make out the tune, so your brain fills in the rest. This music was loud, though. It was violins.
I was very aware that I wanted to open the door while the car was moving, so I was very focused on not doing that. Contrary to popular belief, there is still a strong survival instinct, even in people with strong suicidal ideation.
Carrie spoke in a soothing tone. I remember them telling me it would be alright, that we were almost there. And then they accidentally turned into the doctor’s parking entrance instead of the ER entrance, which took us around the back of the hospital. It was dark. The lights were yellow. It was a back alley leading to a parking lot that required authorization to get in. Suddenly a man was singing very loudly in my ear in an operatic baritone and I could feel his breath on my ear. “WHO’S SINGING?!” I screamed over and over again. It was all Carrie could do to calm me down while doing a 3-point turn and making it to the ER entrance.
When we pulled in, I was crying for real. The ER waiting room was empty. “Oh no! They’re CLOSED!” The suspicion that we were the only two people left on earth crept up on me. Carrie convinced me to go inside, and when the reception desk was empty, I nearly lost it.
The receptionist returned from bullshitting with her co-workers. I suddenly realized the hospital was staffed, and security guards had to be part of that staff. If I didn’t behave, I’d have security called on me. People with mental illnesses die in police custody all the time. Hell, police kill mentally ill people all the time without bothering to take them into custody. I was suddenly terrified this would happen to me. I did everything possible to quiet the noise in my head. My thoughts were a Picasso painting. The sobbing had turned into a silent, mournful stream of tears as I became aware of this embarrassing, shameful event. I pulled some coherency together and texted my therapist:
I’m sorry. I’m here but not here. There is no logic here. At hospital. I’m scared. I’ll be good.
Finally, they brought me back to check my vitals. The thoughts in my head were so disjointed. Nothing made sense. I knew we weren’t the only people alive in the world. I knew the maintenance guy who walked by and awkwardly said hi to me just didn’t know what was going on and wasn’t a government agent. I knew that there hadn’t been an apocalypse. Yet these were things that seemed absolutely true. This is how mentally ill people seem so lost in their delusions. They swallow you whole.
“There is no logic here,” I said out loud, plaintively. The girl had just asked Carrie why I was there. I had looked lucid. I may have even automatically given answers. They’d told her I was there for a mental health emergency. And then I said that. She widened her eyes with a shit-eating look and typed something in the computer. She was surprised I’d managed the last 4 years without medication.
I had to wait for a triage room. They had to clear everything out because of why I was there. They had to leave the door open at all times. Time seemed to pass so quickly to me, though.
As I came down, I became very talkative. It’s like the floodgates were loosed on my ability to communicate, and it was all verbal diarrhea at twice my usual talking speed and an uncontrolled volume. My mind came back to me and I wanted everyone to know. I told the phlebotomist drawing tubes and tubes of blood that I’m really a normal person. I told the ER physician I’m smart, articulate, and a good mother. It was weeks later I realized I was repeating the positive affirmations my therapist has been giving me, that I’ve practiced, that I didn’t think were working. My attempts to control my depression and anxiety were working, but they were being choked out by the bipolar pollution.
The ER doctor himself looked like the Greek god of Crossfit life that had been handed his whole life on a silver platter. He was fatphobic, telling me his prescription was walking. Let me say that again. The doctor told me walking 30 minutes per day was the solution to a bipolar disorder during a psychotic breakdown when my thoughts were suggesting I kill myself. He said it would get me out of the house when I was depressed and give my energy something to do when I was manic. This “doctor” had a looser grip on reality than I did. I was having suicidal ideation with command hallucinations. This doctor would have released me to my death because I’m fat. Thank God a psych consult was required.
The on-call psychiatrist wasn’t available to come to the ER. I’m not sure if he was on another floor, in another location, or sitting at home in his study, surrounded by walls of books at a great hardwood desk in a fancy leather-backed chair, pipe in hand. I imagined he looked like a distinguished, old professor. Actually, I imagined him as the criminologist from Rocky Horror, but with a moustache. That’s how he sounded, at least, and it was the calmest hallucination yet. Grand and thoughtful, he graciously and patiently listened to my rambling over the cordless hospital phone. He called the walking idea “rubbish” and asked me pointed questions about my psychiatric history.
“It’s clear to me you’ve had a psychotic breakdown. This is not unheard of for people with your condition. There is something biologically misfiring in your brain, and you need medication. I imagine, it’s been difficult to get in to see a psychiatrist?”
I admitted it had, and that I had a habit of quitting going to my psychiatrists and stopping medication that made me feel emotionally flat. I recounted trying to get appointments while depressed, having months-long waits to get in to see someone, only to go into a hypomanic state and cancel or forget those appointments, thinking I didn’t need them any longer.
“There is a psychiatrist shortage here in our city,” he said. “It’s not uncommon to wait months to see someone. I recommend you be admitted. We are required by our own policies to get you in to see a clinician within 2 weeks of your discharge, and you can even try different medications while you’re under a physician’s care. I think it’ll be the best thing for you.”
If I hadn’t agreed with him this was a fabulous idea, which I did, I was looking at an involuntary admission. I didn’t realize that was still possible, to be honest. It is, and it’s done frequently, at least where I live. I figured I could stand a night away from my phone. For some reason, I thought I’d be in and out the next day. If you’re ever in this position, please remember that you don’t just check in and check out. You’re going to spend a couple of days without Internet.
In my head, it must have been somewhere near 10PM by now, but in reality, it was closer to 4AM. I wasn’t tired in the least. I was still incredibly chatty. This particular hospital was in the medical district, but didn’t have a psych ward. They needed to transport me to the old hospital downtown, so we waited until almost 5AM for the ambulance. Harry followed behind. When they delivered me to my floor, we were briefed by the security guard. I was scared.