Wednesday, October 9, 2013

Our Story: Tossed Aside

Monday, September 16, my husband had a VA appointment with his psychologist and psychiatrist, both of whom know that he’s had suicidal thoughts and had hurt himself intentionally previously.  He had an anxiety attack during his appointment and told them he felt like nothing would help and that he wanted inpatient treatment.  His psychiatrist instead changed his medications and said to hold off on inpatient treatment. 

Tuesday, September 17, my husband spent the day sleeping and was incoherent, confused, and unable to walk.  The new medications obviously weren’t working.  That evening he had a major meltdown that got out of control.  After coming down, he slept and slipped into major depression about his future.  I knew I needed to do something, so I began searching for treatment centers that could help him since his doctors at the VA would not admit him to inpatient treatment there. 

Wednesday morning, September 18, we went to an appointment at a center to discuss treatment.  He was still very out of it and having problems.  The treatment center agreed to take him but told me it would be a couple days before they could admit him because they needed Tricare approval.  I absolutely knew I could not take him home and wait.  I was terrified he would hurt or kill himself.

After we left the treatment center I took him to the VA ER because I knew he needed help.  In the ER I explained what had been going on at home.  My husband lost control of his anger because he wanted to take our son to get ice cream.  I told him he couldn’t because of the medications he was on but that I’d go get them ice cream.  He began screaming and yelling, mostly incoherent things that made no sense.  I asked him to leave the house to cool down and he refused.  I told him I would take the kids and leave so he could cool down and he said, “Do that and see what happens,” insinuating that he would hurt himself.  He had never been violent with me or our children, or anyone, but he is often hurting himself and had cut himself before, superficially, just to cause pain.  He then ran to our bedroom closet where I keep my pistol and said he was done with everything.  My pistol has a trigger lock on it and I have the only key, but I honestly don’t believe he thought about that when he was digging for it.  I got him out of the bedroom and he punched a hole in the wall.  I could see the struggle within him and the things he was saying, I know he wanted to hurt himself.  He calmed down and doesn’t remember what happened, but even after calming down he continued to say that he felt as if it were hopeless, that he was worthless, and more phrases that had me worried.

He admitted to the ER psychiatrist that he was feeling suicidal and had thought about killing himself.  The ER psychiatrist seemed to understand exactly what was going on! I felt relieved to finally have someone understand what I was saying and provide us some help.  This psychiatrist said that he would prefer my husband voluntarily admit himself to the psychiatric ward but if he would not, then he would have the paperwork done to involuntarily admit him as  there was no way they could release him in his current state.  My husband agreed to go voluntarily. 

While I was at the ER with my husband, however, I got a phone call from day care that my son had a high fever and I needed to come get him.  I have no family around so I had no choice but to leave the ER to go get my son.  The psychiatrist said he did not know if they had beds available at the VA but if they did not he would be sending my husband to one of their sister hospitals, and that they would have a release of information for him to sign so I could communicate with his doctors. 

After I got my son home I still had not gotten any calls from the hospital about my husband so I called the ER to check on him.  They said they had sent him to the VA’s psychiatric ward and gave me their number then transferred my call.  I explained to the receptionist who I was and that my husband should have signed a release of information so I could find out his status.  This receptionist was extremely rude and cut me off mid-sentence stating she would not give me any information.  We had been trying to reach his regular psychiatrist all day Wednesday, and had left messages, but never heard back from her.

Thursday, September 19, my husband called and told me he was going to be released the following morning.  I asked him what they had done and he said, “Nothing.”  So I called his regular psychiatrist and asked her what was going on.  I explained how the receptionist wouldn’t let me talk to any doctors.  His psychiatrist said there was nothing in the system about him being released and that she would look into the release of information issue.  She called me back a short time later and said that when my husband was admitted my caregiver support coordinator had sent a release of information.  I called the psych ward again and asked the receptionist actually search for it.  She found it and then transferred me to his charge nurse.

By the time I finally got a hold of someone at the psychiatric ward it was Thursday evening, so the charge nurse I spoke with was part of the night crew and had just recently come on shift.  She wasn’t sure what had been done during the day.  She said he had been asleep since he was admitted and they had not changed any of his medications.  There were notes that he had gone to group therapy and that he did not participate.  I asked her if they were planning to release him, and she found nothing in the notes to indicate that was the case.  She assured me that a patient cannot be released without a treatment plan in place and having an evaluation, so the soonest they could release him would be the following afternoon.  She told me someone would call me the following day to touch base.  I was relieved that my husband wasn’t going to be released without getting any treatment to help stabilize him.

Friday, September 20, I got a call from a student intern at the VA who was part of my husband’s care team.  She was very nice but did not have any information except that his medications had not been changed with the exception of reducing his klonopin from 1 mg to .5 mg.  I explained what had been going on and she assured me she would let the rest of his care team know.  She did ask if I wanted to have a “family meeting” with the team and my husband prior to him being released.  I said I did.  She said she would call me if she had more information.  Around noon I got a call from the same intern who said my husband was being released and I could come pick him up.  I was so confused and caught off guard!  I hoped to talk with the doctors and ask why the meeting hadn’t been scheduled. 

I arrived at the VA and went to the psych ward.  The nurse there asked if I was a visitor and I explained that I had been called to pick up my husband as he was being released.  She directed me to the waiting room.  After about 15 minutes someone came to tell me they were finishing up his discharge and it would be a short wait.  I told this lady that I would like to speak with his doctors and she said she would let them know.  Then the student intern came out.  She tried to get permission for me to enter the psych ward so we could talk, but her request was refused.  Although she tried to visit with me about my husband, she didn’t have enough information to answer my questions. She stopped another employee and told him about my questions regarding their discharge process and he said, “Honestly, I don’t know.  Patients are here and then they’re just gone.”  I didn’t get answers for my questions.  The intern mentioned that while treating him she had asked about contacting my husband’s regular psychologist for information and was told that was not allowed. 

I do not understand why the team would not work together to provide the best possible care.  According to my husband this intern was the only provider he saw or talked with.  The intern told me the plan was for my husband to continue his appointments as he had been doing before—which obviously wasn’t helping.  I was floored that their recommendation was to continue doing exactly what led up to this inpatient stay!

When my husband came out of the psychiatric ward with his discharge papers he was still agitated and needed to get out of that environment.  I did not get to speak with any doctors nor did I receive any real information.  His discharge paperwork (which no one reviewed with me) did not contain a treatment plan despite having been told the staff was making follow up appointments.  The paperwork showed no follow up appointments.  The only appointments listed were appointments for mid-October which had been scheduled prior to his hospitalization.  Klonopin was still on his medication list at 1 mg dosage, not the .5 mg dosage that I had been told he was receiving while in the facility.

I immediately called his OIF/OEF clinic doctors and his psychologist.  I explained to what had happened with his discharge and that no follow up was scheduled.  I felt that we needed to have a follow up within the next week.  She scheduled appointment for him.  We also spoke with his regular psychiatrist who took him off klonopin and started valium.

I felt lost.  The entire situation left both my husband and me feeling totally hopeless about getting any treatment.  My husband said he felt no better, that it had not helped at all.  He did say he had an anxiety attack Thursday night and was injected with something to calm him down.  This incident was not mentioned to me.  They released him the following morning, despite witnessing his anxiety attacks which required sedation.  They released him in the same condition as when he was admitted.  I have since been scrambling to find treatment for him outside the VA because I feel as if we’re just tossed aside. 

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