M's Family
An update regarding my sister's family is long overdue. The news has been so sad, overall, that I've battled a sense of defeat thinking about it, much less writing about it. However, there are some upsides worth reporting, even amid what is devastating and so, here goes...
HBH and HCH spent much of the summer here with my mom and stepdad. They had a wonderful and normalizing time, overall, though MCH struggled with having had his daddy move out and then having his siblings leave. They got home before his 5th birthday in August, by which time C had decided to leave town without waiting to say good-bye to his children.
He moved back to TX to stay with his parents -- not exactly Mental Health Central, and not exactly convenient to much of a support system. To say that where they live is rural can best be illustrated, perhaps by some of the story of the last week. (I'll get to it in a bit.) His mother, JH, decided that there was nothing wrong with him beyond wanting his family back, and suggested that he stop taking his meds, because they were, in her opinion, not only a waste of pharmaceuticals, but a waste of money. That was the answer he wanted, so he complied.
M told him that the kids would not come to visit him unmedicated, so he agreed (sulkily) to contact his CO prescriber and get a new set of meds. She changed them to just the lamictal, so that he'd feel less wiped out, since the others were for the acute crisis phase, which he appeared to have moved beyond. There's no telling whether or not he was taking it, though as some point his mom talked on the phone with his CO person and said she was just having him take half of one every couple of days. The prescriber explained why that was a bad idea, physiologically, but it's hard to say how much JH bought into what she said.
M was feelng so overwhelmed by the demands of her clinicals and the kids, and by being the target for all of HBH's rage regarding what was happening in his family (did I mention that they had to put their dog to sleep, as well?), that the idea of his staying here for the academic year was floated. It was a serious enough consideration that they even had an appointment with the principal and teacher at the school he would attend. This option provided the foundation for a wonderful conversation between him and M in which they looked at what would best serve the family. In the end, they decided that he would come home as planned so that they could begin to establish what it is to be a family of four. It seems to have been an excellent choice and it was nice for him to be able to participate, especially given the inconsistent and irrational disempowerment he experienced in dealing with his father.
Things were cruising along pretty well. M's schedule is murderous, but she's coping. She's just about completed her mental health clinical rotation and has found it very enlightening. She's also clear that she does not want to go into mental health nursing -- not because of the patients, but because of what it means in terms of the quality of care she would be allowed to offer. Too frustrating.
Then, last Sunday, C ate more than 70 lamictals while his parents were out hunting. That drug has a bioavailability of about 98% when taken orally, and it is not time-released. (Ah, the advantages of having a PDR at work.) When they got home he was unconscious and seizing.
M and the kids got home from errands and saw that the answering machine light was blinking. They were all in the kitchen, putting away groceries, etc., and so she just punched the button and let it play. That meant that the kids heard JH's message about their dad.
Here's where the part about how isolated the setting is comes in.
The local hospital had never heard of the drug. It's not a new drug. The PDR in which I looked it up was published in 2001. They didn't know what to do. Now, that seems crazy to me. My sister was required to get a PDA and install a PDR program on it. She could look up the overdose indications immediately and actually did so, passing the information on to the hospital staff. Yeah. I'm not kidding.
They did gastric lavage (pumped his stomach, in other words) and tried to stabilize his blood-pressure. The bottom number kept diving. There was concern about general kidney failure. He remained unconscious.
The hospital has no ICU and that's where he belonged, so they transferred him a town an hour away that had one. Neither his mother, nor he (when he woke up the next day) bothered to mention his mental health history to the medical professionals. They didn't think it was relevant.
M, who did, called the hospital. She figured that since they are not legally divorced yet, they would talk to her. She filled them in and they seemed grateful. Then, after a couple of days, they discharged him. He's got no health insurance and the VA won't help because he was diagnosed after he left active duty. No matter that he was in the Army for ten years and fought in a war...
Backing up, he went apeshit when he found out she'd called. He called her and started playing the Grand Emperor, demanding, name-calling, etc. At one point he was insisting that nothing would keep the kids from coming for their scheduled visit at Christmas because they were his fucking kids and he'd bought their fucking tickets (so to speak). M pointed out her sadness that he didn't seem to prioritize the kids' feelings, safety, etc., at all. He validated that by saying, "That's because that's not what I care about right now." Great.
He called the kids, full of the sorrowful tale of how much his throat hurt from having the gastric lavage and how scary it had been for him to wake up in the ICU, etc. HBH cut him off and said, "Daddy. What you did sucked and I want to know why you did it."
C started in with the noble act, "Well, son, there were a lot of reasons..."
"OK. Tell me one. Tell me one good reason why you did what you did."
C couldn't come up with one.
"All right, Daddy. In that case, I have to conclude that you dit to hurt us. And that sucks. What you did had 20 people scared, mad, worried, and hurt. I'm disappointed in you. And you made it so we might not come at Christmas time. But I'll tell you what: if we come then, or if not then, if we ever come to visit you -- if you act manic around us or do anything that makes me feel not safe? I'm calling my nana and she's getting us out of there and I don't know if we'll ever come back. I'm done, Daddy. It's time for you to act like a father."
Yeah, he turned 11 last month. No shit.
M was stunned. Afterwards, she was telling him that she was proud of him for sharing his feelings so openly. HBH said, "Well, what choice to I have? This is who he is. He's sick and he does terrible things sometimes. That's just how it is. But I don't have to act like it's ok just because he's sick. Because it's not."
Out of the mouths of babes, indeed.
M's still toying with whether or not to send them at Christmas. K, of K&P, says absolutely not (she's a psychotherapist who has extensive experience with his demographic), that no one goes from being that unstable and suicidal to Ok To Parent in on month. M's thought is that there'll be three adults there. So, she's not committed yet. He's signed up with a shrink down there and has agreed to let M talk with her / him after he goes and to have the shrink talk with HBH's therapist. And M's going to talk with her therapist, etc. It could go either way. I just wish that if they are going to go, the window would be narrowed. The original tickets are for a ten-day stay. That seems way too long, in my book.
We'll see.
I'm trying not to weigh in too heavily, both because she's got everyone and her aunt Petunia offering her opinions and because I really don't know what's best. So there.
So the upside is that HBH is experiencing some liberation from the tyranny of his father's instability. This tells me that what M has created / is creating is working, including the group counseling sessions each of the kids has at school. (Apparently MCH, who is the most stoic at home, has been talking a blue streak in his group at school, which is excellent.) HCH, who was devastated by her daddy's suicide attempt, took some backbone lessons from HBH and connected with being mad at dad, which is utterly appropriate.
It's a step in the right direction. For as long as C is alive, he'll be their father. And he'll likely be unpredictable and inconsistent. So, the sooner they grapple with that and find their peace with it, the better.
The prognosis for his kind of mixed state BPD is grim. And I love him. And it's sad beyond the telling of it. AND... the kids are more important. So bless them all.
OK. That's the update. Thanks for reading.
-Dot
Copyright 2007 Dot's Stuff. All rights reserved. Want some beans?
HBH and HCH spent much of the summer here with my mom and stepdad. They had a wonderful and normalizing time, overall, though MCH struggled with having had his daddy move out and then having his siblings leave. They got home before his 5th birthday in August, by which time C had decided to leave town without waiting to say good-bye to his children.
He moved back to TX to stay with his parents -- not exactly Mental Health Central, and not exactly convenient to much of a support system. To say that where they live is rural can best be illustrated, perhaps by some of the story of the last week. (I'll get to it in a bit.) His mother, JH, decided that there was nothing wrong with him beyond wanting his family back, and suggested that he stop taking his meds, because they were, in her opinion, not only a waste of pharmaceuticals, but a waste of money. That was the answer he wanted, so he complied.
M told him that the kids would not come to visit him unmedicated, so he agreed (sulkily) to contact his CO prescriber and get a new set of meds. She changed them to just the lamictal, so that he'd feel less wiped out, since the others were for the acute crisis phase, which he appeared to have moved beyond. There's no telling whether or not he was taking it, though as some point his mom talked on the phone with his CO person and said she was just having him take half of one every couple of days. The prescriber explained why that was a bad idea, physiologically, but it's hard to say how much JH bought into what she said.
M was feelng so overwhelmed by the demands of her clinicals and the kids, and by being the target for all of HBH's rage regarding what was happening in his family (did I mention that they had to put their dog to sleep, as well?), that the idea of his staying here for the academic year was floated. It was a serious enough consideration that they even had an appointment with the principal and teacher at the school he would attend. This option provided the foundation for a wonderful conversation between him and M in which they looked at what would best serve the family. In the end, they decided that he would come home as planned so that they could begin to establish what it is to be a family of four. It seems to have been an excellent choice and it was nice for him to be able to participate, especially given the inconsistent and irrational disempowerment he experienced in dealing with his father.
Things were cruising along pretty well. M's schedule is murderous, but she's coping. She's just about completed her mental health clinical rotation and has found it very enlightening. She's also clear that she does not want to go into mental health nursing -- not because of the patients, but because of what it means in terms of the quality of care she would be allowed to offer. Too frustrating.
Then, last Sunday, C ate more than 70 lamictals while his parents were out hunting. That drug has a bioavailability of about 98% when taken orally, and it is not time-released. (Ah, the advantages of having a PDR at work.) When they got home he was unconscious and seizing.
M and the kids got home from errands and saw that the answering machine light was blinking. They were all in the kitchen, putting away groceries, etc., and so she just punched the button and let it play. That meant that the kids heard JH's message about their dad.
Here's where the part about how isolated the setting is comes in.
The local hospital had never heard of the drug. It's not a new drug. The PDR in which I looked it up was published in 2001. They didn't know what to do. Now, that seems crazy to me. My sister was required to get a PDA and install a PDR program on it. She could look up the overdose indications immediately and actually did so, passing the information on to the hospital staff. Yeah. I'm not kidding.
They did gastric lavage (pumped his stomach, in other words) and tried to stabilize his blood-pressure. The bottom number kept diving. There was concern about general kidney failure. He remained unconscious.
The hospital has no ICU and that's where he belonged, so they transferred him a town an hour away that had one. Neither his mother, nor he (when he woke up the next day) bothered to mention his mental health history to the medical professionals. They didn't think it was relevant.
M, who did, called the hospital. She figured that since they are not legally divorced yet, they would talk to her. She filled them in and they seemed grateful. Then, after a couple of days, they discharged him. He's got no health insurance and the VA won't help because he was diagnosed after he left active duty. No matter that he was in the Army for ten years and fought in a war...
Backing up, he went apeshit when he found out she'd called. He called her and started playing the Grand Emperor, demanding, name-calling, etc. At one point he was insisting that nothing would keep the kids from coming for their scheduled visit at Christmas because they were his fucking kids and he'd bought their fucking tickets (so to speak). M pointed out her sadness that he didn't seem to prioritize the kids' feelings, safety, etc., at all. He validated that by saying, "That's because that's not what I care about right now." Great.
He called the kids, full of the sorrowful tale of how much his throat hurt from having the gastric lavage and how scary it had been for him to wake up in the ICU, etc. HBH cut him off and said, "Daddy. What you did sucked and I want to know why you did it."
C started in with the noble act, "Well, son, there were a lot of reasons..."
"OK. Tell me one. Tell me one good reason why you did what you did."
C couldn't come up with one.
"All right, Daddy. In that case, I have to conclude that you dit to hurt us. And that sucks. What you did had 20 people scared, mad, worried, and hurt. I'm disappointed in you. And you made it so we might not come at Christmas time. But I'll tell you what: if we come then, or if not then, if we ever come to visit you -- if you act manic around us or do anything that makes me feel not safe? I'm calling my nana and she's getting us out of there and I don't know if we'll ever come back. I'm done, Daddy. It's time for you to act like a father."
Yeah, he turned 11 last month. No shit.
M was stunned. Afterwards, she was telling him that she was proud of him for sharing his feelings so openly. HBH said, "Well, what choice to I have? This is who he is. He's sick and he does terrible things sometimes. That's just how it is. But I don't have to act like it's ok just because he's sick. Because it's not."
Out of the mouths of babes, indeed.
M's still toying with whether or not to send them at Christmas. K, of K&P, says absolutely not (she's a psychotherapist who has extensive experience with his demographic), that no one goes from being that unstable and suicidal to Ok To Parent in on month. M's thought is that there'll be three adults there. So, she's not committed yet. He's signed up with a shrink down there and has agreed to let M talk with her / him after he goes and to have the shrink talk with HBH's therapist. And M's going to talk with her therapist, etc. It could go either way. I just wish that if they are going to go, the window would be narrowed. The original tickets are for a ten-day stay. That seems way too long, in my book.
We'll see.
I'm trying not to weigh in too heavily, both because she's got everyone and her aunt Petunia offering her opinions and because I really don't know what's best. So there.
So the upside is that HBH is experiencing some liberation from the tyranny of his father's instability. This tells me that what M has created / is creating is working, including the group counseling sessions each of the kids has at school. (Apparently MCH, who is the most stoic at home, has been talking a blue streak in his group at school, which is excellent.) HCH, who was devastated by her daddy's suicide attempt, took some backbone lessons from HBH and connected with being mad at dad, which is utterly appropriate.
It's a step in the right direction. For as long as C is alive, he'll be their father. And he'll likely be unpredictable and inconsistent. So, the sooner they grapple with that and find their peace with it, the better.
The prognosis for his kind of mixed state BPD is grim. And I love him. And it's sad beyond the telling of it. AND... the kids are more important. So bless them all.
OK. That's the update. Thanks for reading.
-Dot
Copyright 2007 Dot's Stuff. All rights reserved. Want some beans?