No Job
It felt unbearable and was destabilizing
Introduction
My intention in writing this blog is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. Also to provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in mental health, how to work with treatment providers and medication issues. My hope is that reading this may be helpful for people with mental health issues and also their families and friends.
No Job
I think for Bill this was the final blow. He had built up his hope that if he could get this job, he would finally be able to help people with mental illness and feel like he was making an important difference in the world.
One morning he called and said, “Don’t you think I should email them again and ask for another interview?”
“We’ve already been over that a bunch of times,” I said. “You’ve already sent them too many emails, so now it’s going to be a nuisance. You need to come up with other options. Have you applied to other social work jobs?”
“No, I have to get this job. It has my name written on it.”
Over the next couple weeks Bill went from obsessive worrying to disorganized and thought-disordered, jumping from talking about the job he wanted, to past jobs, to his special status, his thoughts only loosely connected:
“That was the perfect job for me, picture perfect, like carrying around heavy crates, easing the burden for patients, peer support specialist, don’t take the time, don’t give a dime.”
He started to get paranoid, demanding that I not speak to his social worker (even though I hadn’t been in touch with her). He lost his phone, a sure sign that he had decompensated. He walked off his job without giving notice.
A week later the police picked him up for driving erratically. Before stopping him, they called me while they were following his car. They had gotten my number from their files on Bill, after looking up the license plate.
“Yes, he’s my son.” I was in the kitchen stacking dishes but put them down with a clatter to focus on the conversation.
“We’re pursuing his car through a wheat field. We need to know if he’s dangerous. Could he be armed?”
“No, he doesn’t own weapons and he’s never been violent,” I said emphatically. I spoke slowly and distinctly, trying to make sure they understood that they had nothing to fear from him, terrified that they might misinterpret a sudden movement and shoot. “He is probably hearing voices. He has bipolar disorder which makes him act impulsively and irrationally at times when he doesn’t take his medication, but he has never hurt anyone.”
“ Ma’am, could he be a danger to himself or others?”
“I’m not concerned that he could be a danger to others, but I am concerned that he could potentially be a danger to himself because he has recently started to talk about ‘The Kingdom of Heaven.’ This is what happens when he gets sick—he becomes fixated on religious ideas--in the past it has meant he believed he would ascend into heaven as a saint. Can you take him to the hospital for evaluation?”
“We can do that, but we can’t guarantee the outcome. We have no direct evidence of his intent to cause self-harm, but we’ll make a note of it. “
“What hospital are you taking him to?” I wanted to call the evaluating physician with information about Bill’s medication and history. I never did get to discuss his care with anyone because initially, there was nobody at that hospital who had seen him yet, and by the next day he was discharged home.
He was back in the ER a day later. A friend from across the hall had noticed that he was agitated and not making sense and took him to the ER. They couldn’t find him a bed anywhere, and he ended up sitting there for 30 hours. While this is an unusually long time to wait, I understood from personal experience the intense pressure that physicians and nursing staff are under to juggle the competing demands of very ill patients—those hospitalized and too ill to go home, and those awaiting evaluation. The long duration of waiting for evaluation is a common indicator of how overwhelmed our medical systems are with mental illness patients.
That didn’t assuage my anxiety as I waited for any news about Bill’s status. I made repeated calls to his friend and to the ER, trying to monitor what I could. Finally, they told me they were sending him to Winnebago, the only state mental institution open to Bill now that Mendota was closed to all except for the criminally mentally ill. I initially felt relieved; during Bill’s previous stint at Winnebago they were able to stabilize him. But at the last minute they sent him to Bayside, a crisis facility that’s meant to be temporary. He stayed for a week and improved slightly. They tried to help him get SSI benefits reinstated, a critical step toward having an affordable apartment. His social worker at Bayside tried multiple times to sit with him while he called, but to no avail; each time Bill had to wait on hold he got too anxious to remain on the line. We even tried it as a three-way conversation with me on the line, gently coaxing him. “OK, Bill just hold on a little longer. They will come back on the call soon.” He would wait for a couple minutes, then agitation and impatience would get the best of him: “Too long. Gotta go,” he’d say. Or else he’d hang up without saying anything.
I would call him back with, “Bill, we need to talk to this person so they can help you get your benefits restored.” After repeated attempts and having it become clear I was not getting through to him, I was ready to give up.
Looking back—isn’t there a way that someone could do all the waiting and transfers with him until he got to the final step—and then intervene if he needed help once he confirmed his identity? There must—or should—be a mechanism for people who aren’t able to do this for themselves.