I’ve often wished to be a fly on the wall, able to hear what others are saying about me when they don’t know I’m listening, my curious nature trumping the potential psychological damage of what could be a double-edged sword.
So it was with voyeuristic relish that I pounced on the opportunity to peruse my own medical records, invoking my legal rights under HIPAA—the Health Insurance Portability and Accountability Act of 1996. The prospect of comparing a professional outside-in view of myself with my own inside-out view intrigued me. It would be like reading my secret FBI file.
In 2010 I submitted the necessary authorizations to all the hospitals I’d been in for psych reasons, paid up to seventy-five cents per page, and soon received thin or fat envelopes with reports ranging from sketchy to comprehensive, by all ranks of medical personnel who evaluated or treated me.
The similarities and differences in our perceptions were enlightening, surprising and disturbing, especially the discovery that not all doctors contact a patient’s outside psychiatrist or therapist to get the patient’s background, recent circumstances or medication rationale, and that there’s no follow-up after patients are discharged.
Due to the dearth of time devoted to meaningful discourse in some hospitals and their failure to contact the outside professionals and loved ones who might have important information to share, life and death judgments are made based on whatever information hospital personnel manage to reel in during fifteen-minute fishing expeditions. It may metaphorically be bunker, but it’s all there is to fillet before declaring a patient ready to go home. It must be terrifying.
You’d think there would be a system in place for tracking patients, but there isn’t. If I were a hospital psychiatrist I’d want to know if someone I pronounced well enough for release happened to commit suicide two days later. I’d also like to know if former patients had successfully lied to me or broken the rules, or if I’d made erroneous assumptions affecting treatment that could have been disproven with a single phone call.
A “Findings” chapter from every psych ward I was forced to temporarily call my surrealistic home will be compiled from the observations and conclusions in my records. This first depiction of how doctors, nurses, social workers and other staff members saw me and made decisions affecting my treatment and prognosis is from the records of St. Catherine of Siena Hospital in Smithtown, NY.
According to my patient registration record, I arrived at St. Catherine of Siena Medical Center by ambulance at 4:16pm on June 28, 2007, after two days in the ICU at Eastern Long Island Hospital in Greenport. Although I was sent involuntarily, my admission type is listed as “elective,” but that would change after I was cleared physically for transfer from the ER to the psych unit. The admission diagnosis and description read, “Bipolar Disorder Depressed Mood,” ignoring the hypomanic hyperagitation that led to my suicide attempt and the fact that I was only depressed about being alive and in the hospital.
A lot of handwritten entries are illegible, but I am described as awake, alert, comfortable and intelligent. I don’t do drugs, am a social drinker, work part-time and live with my spouse. My current condition warrants admission to Three East.
The page called “progress notes” spells out the circumstances that led me here—in a nutshell that I went to the beach, took an overdose of pills including Xanax, Percocet, Valium, Celexa and something I can’t read, wrote a suicide note, and couldn’t remember the past two days. (What I said at the time could be different from what I know now to be true, or the records could be wrong. Unless I know otherwise, I’m assuming they are accurate.) I stated that I had been experiencing rapid mood swings and cycling, constant suicidal thoughts for several weeks, and had started seeing Dr. Fink a month ago for those symptoms as well as sleeplessness, excessive energy, anxiety, hopelessness and feeling helpless. Three weeks earlier he had started me on the mood stabilizer Lamictal, which hadn’t taken effect yet.
I said “I have issues” but was “guarded” about them. Having wised up, I initially denied trying to kill myself but apparently blew that contention, since records also state that “she at present regrets suicide attempt.” I cited a history of mood swings and said I had recently been diagnosed with bipolar affective disorder by Dr. Fink. I denied psychotic episodes, alcoholism and drug abuse. This was my first psychiatric admission and first suicide attempt. (I refuse to count the time in 1979 when I put all of my antidepressants in my mouth but didn’t swallow.)
I reported “a close relationship” with my current husband and denied “relationship dysfunction.” Of course, I went into therapy in 1978 saying that and came out divorced.
The intake person described me as “pleasant and cooperative”—a note I wanted to Fed-Ex to the disgusted nurse at the first hospital. I was taken to the ward and slept until that night when I was oriented to the unit, my peers and staff, explained my rights and given a late dinner. I was adjusting to the ward with some difficulty and was encouraged to seek support from the staff when needed. I wandered in and out of my room from 11pm until I fell asleep at 1am but remained “pleasant upon approach” and slept through the night.
Progress notes are filled out by people from various departments several times a day and typically reiterate the major points, such as diagnosis and reason for admission, before reporting on present status. The next morning the social worker described me as keeping a low profile with a depressed mood in affect (how I appeared). I complained of mood swings, denied active suicidal intent but admitted to passive intent. My insight was listed as “fair,” meaning I didn’t have a good handle on what I’d done.
Later that day I supposedly met with the recreational therapist and attended groups with “minimal prompting.” (I have no recollection of any groups except meals and morning meetings about “house” issues.) The psychiatrist’s update noted that my suicidal ideation led my therapist to send me to Dr. Erik Fink after ten months of therapy. On June 26 I became unstable and hopeless and went to the beach to kill myself. There’s a comprehensive accounting of my hypomania and depression in my twenties, and relevant family history. I was described as having low-grade depression and fluent speech. My “serious suicide attempt” was now being minimized by me “in order to be discharged.” (Busted!) After four hours of sleep my energy level was fine but my insight and judgment were poor, as evidenced by denying suicidal intent while blurting, “I’d be doing my family a favor” by killing myself. (Add asshole to diagnoses.)
A social worker met with Joe and me that afternoon to discuss factors precipitating admission. I stated that I had come to a place in therapy that was very painful “and felt it was easier” to kill myself than deal with it. I didn’t elaborate but the pain resulted from my therapist’s recent announcement that he’d been doing me a disservice by sometimes acting more like a friend than a therapist, and that it had to stop. We were not friends and never would be, he said. His adamant bluntness hurt so deeply that I tried to quit therapy, which is sometimes a warning sign of impending suicide. He called Dr. Fink, who called me and insisted that I go back.
According to the social worker, Joe was “not angry about my attempt,” since he had been depressed in the past, and she believed me when I said I regretted my action and “will not repeat it.” Patient “is anxious to go home,” she wrote.
My pleasantness, cooperation, dysphoric mood (malaise, anxiety, restlessness), denial of suicidal ideation, minimization of attempt, lack of sleep and concentration, and focus on discharge were a recurring theme. But by the second evening I was observed being “social with select peers,” compliant with the so-called “therapeutic milieu,” and had good eye contact. I denied suicidal ideation and falsely expressed remorse for my attempt.
The next morning, June 30, the psych note added “irritable edge” and “superficial response to support” to my low profile. It said I was depressed, expressed remorse, denied suicidal ideation or intent, socialized with select peers and cooperated with the medical regime.
I had already contracted for safety, promising, “I’ll never do anything like that again,” but I guess everyone says that. I remained on suicide watch, under constant observation but less intrusively than at the first hospital. A staff member checked on me frequently but didn’t hound me. The psychiatrist commented on my fluent speech—a possible sign of hypomania—but also called my affect “bright” and my insight and judgment up from poor to fair. We discussed why I didn’t reach out to my psychiatrist or therapist prior to my attempt, (because I didn’t want to be stopped), and why I should have, (because they might have stopped me). She noted her insistence on reviewing my suicide notes, which Joe had at home.
I remember feeling by then that I had turned a corner in terms of acclimation and sociability. I spent most of my time out of the room, joked around with other patients, walked outside regularly and conversed at length with the patients at my table during meals. This didn’t go unnoticed, but my denial of self-harming thoughts was considered “somewhat superficial” and special safety precautions continued.
These behavioral and psychological observations were interesting, but what jumped out at me when I got my records three and a half years later was what I weighed in the hospital: one hundred twenty-five pounds—practically my pregnancy weight. (I now weigh one hundred, thanks to the stress diet that kept me up all night a few times a week, prevented me from sitting still and made food an unappetizing afterthought.) This attention to the mundane, such as my weight, and detachment from the pathological has been an ongoing theme that disarms health professionals and keeps me from taking myself seriously. I am now able to experience anxiety, sadness, regret, anger and other negative emotions, but never in connection with this serious stuff. There’s still, and hopefully always will be, a chasm between the feeling and the doing. I don’t want a day of reckoning.
According to the records, the next time I saw my psychiatrist in the hospital for our typical fifteen-minute visit was July 1. Although I was still “pushing for discharge,” my affect was “appropriate to content,” my mood “neutral,” my insight and judgment “fair,” and my speech “fluent.” (I wonder if she’d ever met anyone from a big family in New Jersey before.)
Then the suicide-note bomb was dropped, sending shockwaves of panic from my feet to my head. Joe couldn’t be there when the doctor was so she made him read her my notes over the phone. That’s when she discovered that one had been written weeks prior to my attempt and the other while I was taking pills. She also knew I had “researched overdoses online prior to my attempt and learned of the best way to dissolve tablets.”
She spoke to Dr. Fink and the floor nurses, and my case was addressed for forty-five minutes at the morning medical meeting. It was thumbs up for keeping me involuntarily that day, but if I continued to stabilize I would be discharged late the next afternoon to the care of Dr. Fink and Mal. I took an Ativan that night for insomnia and anxiety, and left the next day denying suicidal intent. My parting words were, “I will handle situations differently.”
The connotation was that I would handle situations better, but the meanings of “differently” and “better” are completely subjective. I was so upbeat about being released that my “differently” did partially refer to the good kind of better. It also referred to what I thought at the time was fact: that I wouldn’t make the same mistakes twice and would succeed if driven to suicide again. I would handle the situation differently, and better.
When we got to Dr. Fink’s office an hour later, he had both of us come in so Joe would understand the severity of the situation, be on the lookout for signals that I might be in danger again, and notify him at once if I seemed headed in that direction. “He had to realize that you were at high risk,” Dr. Fink later explained, adding that Joe needed to listen, to watch for changes in behavior and to call him if I said I wasn’t feeling well.
I immediately complained to Dr. Fink about the intolerable length of my stay, unaware that he had been in on the discussion of my discharge and the decision to keep me an extra day. “I think they let you out too soon,” he said. “I would have kept you longer.”
“You’re kidding? Why?” I asked, my shock showing the extent of my failure to acknowledge the dire circumstances. He told us five days wasn’t long enough to determine my state of mind after such a serious suicide attempt, especially when my stay encompassed a weekend, when medical attention is minimal at best.
What I told him after Joe left the room was, “I can’t say I’m happy to be alive,” and that “I’d rather die than go back to the hospital.” He marked me down as a moderate to high suicide risk.