Bipolor Disorder - J Lovon's Story

I am J Lovon and this is my story.

On Saturday, January 31, 2009 at approximately 5:00 P.M., I entered the ER for treatment at a major health care system in Maryland. I suffer from a "mild" mood disorder misdiagnosed as bipolar disorder. Medication and therapy manages my mood disorder facilitated through a comprehensive program at an adult outpatient psychiatric clinic.

The previous week, my physician prescribed a new medication in addition to my current ones. The pharmacy brochure listed adverse side effects, of which included increased depression and suicidal thoughts. I began feeling extremely sad and my depression seemed to worsen. The previous night I was thinking about my departed loved ones. I lost my grandmother in October 2007, my brother in January 2008, and my grandfather in December 2008. My heart wrenching grief surged from my body. I mourned their deaths collectively which I had not done before. It was so devastatingly painful. I thought how painful it is to lose someone from "natural" causes, why would anyone ever take their own life and leave grief stricken loved ones behind. Furthermore, why do people choose one method over another? I even thought why do people cut their wrists, was painful, and how long before they loss consciousness. My thoughts varied barring the thought of hurting myself. I have never had a thought, a desire, or intent to cut my wrists. I was extremely sad but never hopeless.

My fragility was apparent the following day. Usually very guarded in exposing my vulnerability, I could not contain my emotions while speaking with a cherished friend. No one ever knew my pain because I never trusted it to anyone. Therefore, when my trusted friend, newly reunited after 28 yrs, asked how I was doing, I began to sob and retreat to a bathroom to hide my tears. I shared with her my broken essence and incredible loneliness. Alarmed, my friend began purposefully assessing my state of being while consoling me. She thought that I might be having side effects from my medications. Remembering the listed side effects from the pharmacy brochure, I told my friend of my thought of why people cut their wrists. I felt apathetic to the thought even still. Nevertheless, given my burst of emotions, could this be a suicidal thought. Maybe this is how people behave when they have suicidal thoughts and want to harm themselves. I do not know. All I know is that I am sad with no desire to hurt myself. Amplified alarm, my friend urged me to go to the emergency room. The [thought] did not consume me as I traveled through my many thoughts that night. I did not stop to imagine or ponder on it. In fact, I felt indifferent to it. The thought to me was no different from the ones I have while watching a forensic or crime and justice show on TV. I had no desire or thoughts of hurting myself or anyone else for that matter. Nevertheless, given the fact that I have a mood disorder, was experiencing increased depression, and had that [thought] which could have been associated with the listed side effects, I considered going.

I first attempted to contact my therapist and run it by them, but it was the weekend and they were not available. The message on their voicemail instructs one to go to the ER if there is a problem of an urgent nature. I had great reservations about going to the ER because of sharing a thought that was perhaps misconstrued to be a legitimate threat to my wellbeing. I thought my beloved friend was overacting, but reluctantly, I agreed to go to ease their mind. I will go to have some tests done to see if there is indeed a problem with the newly introduced prescription. I should be out of there in no time.

I am a very private person and have great difficulty sharing intimate information about myself. Moreover, to be honest, I was quite embarrassed to have to repeat this. I thought about the stigma associated with mental health, but hoped that I would be treated with sensitivity and discretion. Nevertheless, trying to keep things in perspective, I thought that I might be remiss if I did not go. Besides, I was having some other concerns that I could have addressed as well. What is the worse that can happen?

It was bustling with activity as I entered the ER. I proceeded to the women who sat front and center at the counter. She directed me to either side of her to women who were completing the registration process. The woman to my right beckoned me over. There was not a booth or anywhere to sit. In fact, I had to lean into the counter competing for space with some kind of portable equipment, to lend some privacy to my registration process in this open environment. I carefully articulated my first and last names in a discreet tone especially since other patients now joined me at the counter. To my dismay, the woman proceeded in echoing my responses. Suddenly, she caught me off guard when she asked me [why] I came in today. I struggled to find a general response. However, none came to mind. Therefore, I simply said that I think that I am having an adverse reaction to my medication. She then proceeded, in a non-discreet manner, with [what] kind of reaction. Again caught off guard that I had to share this with the receptionist in the open air setting with others standing behind me, I stammered mental health issues. She was satisfied with that, placed a bracelet on my wrist, and instructed me to listen for my name.

I tried to find the darkest corner to hide because I thought that everyone had overheard my registration process. Moreover, I did not want to see any familiar faces. I was hoping that I did not have to explain to everyone that I encountered the embarrassing [why] and [what]. As I waited, I overheard a woman who sat at a kiosk, located behind the greeter and between the registration women, slightly to the rear, which was adjacent to the triage areas to the left and right of her, talking with other patients. I could almost hear the entire conversations from across the noisy room. She discussed with one patient his dialysis procedure and an injury to another patient's leg when she fell. This set up reminded me of a three-ringed circus, with the kiosk woman as the ringmaster. I sat there thinking of how I could escape the loud announcement of my complaint when it was my turn to speak with her. Then after a brief wait, I heard my name called.

A male triage nurse met me. He proceeded to ask me [what] brings you here today and [what] symptoms are you having. To my delight, he showed discretion and sensitivity. He then asked if I had hypertension as my blood pressure registered 148/ 90, a bit on the high side. I do not have hypertension so he commented that it was probably the stress of the visit. That was indeed an understatement. I shared with him my concern of the "ringmaster's" lack of discretion when discussing other patients' business. He suggested that I ask her to step into the triage area to speak with me and use the computer that is there.

She looked at me and asked my name. Before she could get started with her part of this process, I asked if she could step into the triage area and use the computer there. I explained that she was a little bit loud with the other patients. She appeared a bit irritated that I had made such a request; after all who did I think I was that she should have to log off of one computer and sign on to another as she explained it. She remarked that the patient was hard of hearing. Which of the two patients was hard of hearing I asked myself? When she stepped into the triage area to ask the [why] and the [what], she seemed a bit hurried in this process. I did not expect her to spend all day with me, just show some compassion when she asks these very sensitive questions. I took a deep breath to collect myself as I attempted to tell the third person my story as she rushed me along. When I mentioned that I was taking medication, she asked what they were; the names of them escaped me because of her rushed process. I informed her that I had them with me. She asked very hastily to see them as she extended her hand impatiently waiting for them. I had not even opened the bag that held my prescriptions yet. Actually, the zipper was stuck as I fumbled to get it opened. Although I started to feel anxious, I tried to keep things in perspective. She went to her kiosk, entered some information of which I had hope did list me as suicidal, because I was not. She returned the prescription bottles. I then returned to the waiting area to listen again for my name.

As I slipped in and out of a snooze during my hour and forty-five minute wait, there was this periodic announcement of a bed being available on the ER unit. This announcement in a loud male's voice was so unsettling that it felt like I was at a grocery store and the call was being made for a clean up in isle 2 or perhaps that the patients were dispensable and after disposing of the bodies, a bed was now available. I thought there could have been a better way of communicating the availability of a bed. These loud announcements in conjunction with the names for the next patient being called out in loud empty voices, as if the patient should have gotten there sooner, felt as if the patients were being hustled through a factory assembly line. I do not know, maybe my expectations were too high.

Now, it was my turn. I hear my name bellowed out as if everyone was hearing impaired. Wanting to hide I rose to my feet. It seemed that all eyes were on me as if they knew why I was there. My instructions were to go through a door that was not initially apparent to me. When I asked for clarity, the female exhaled slightly and pointed, "Right there", as if I was disturbing her as she kneeled on a chair while having a private conversation with another staff person. I proceeded through the half door leveled between the two counters thinking that I made it through the worst part.

A pleasant male nurse, who treated me like a person requiring care, greeted me. As he led me to a room, he also asked the dreaded questions now for the fourth time, "Why are you here? What symptoms are you having"? Saying something as simple as my depression appears to be getting worse and I made a comment that might have suggested a suicidal thought, still did not come to my mind. Once again, I struggled with a response. The nurse instructed me that the doctor would be in to speak with me. I sat wondering, what is the reason for everyone to ask me the same questions repeatedly. What is the function of the computer systems or the information on the forms attached to the clipboard? As I sat in the chair, a doctor came into the room through the door to my left. I turned my head slightly left to meet her eyes. I do not remember if she announced her name or not. I say announced because she stood to the left of me albeit there was ample space for her to stand in front of me, introduce herself, and discuss my issues. She proceeded with the [why] and [what]. Being a very private person, having to repeat my story started to overwhelm me. It was if everyone wanted to hear what a [suicidal] patient sounded like. Instead of asking perhaps, having read the chart, what kind of symptoms I was having and assessing my stability. Even though there are many people treated for mental health disorders, there is still a stigma attached to it and talking about my disorder and symptoms was difficult for me. I took a deep breath looking slightly towards the floor and for the fifth time now, I started to recount this story yet again.

To my puzzlement, as the doctor spoke to me, she did not reposition herself so that we were facing each other; she continued to stand to my left. In fact, I literally had to turn my head to my left, leaning slightly to my right and look up at her. This is how close she stood next to me. I felt as if I was an insignificant person who did not deserve respect. I felt minimized. Even after I commented that she was too close for me to focus with my glasses, she stayed in her position. Instead, she remarked about whether I had a bifocal lens or not. She proceeded to listen to my heart and lungs. She informed me that they would perform some tests to rule out anything biological and we would go from there. This sounded reasonable because this was my reason for coming in. A female nurse came in and directed me to the restroom to collect a urine sample and upon my return, to undress down to my bra and my panties and put on the gown that was on the bed.

I returned to the ER examination room with my specimen and donned the gown. A male nurse returned and informed me that I will be going to the urgent care unit. I was fine with this as my concerns were not an emergency and I did not want to occupy a room needed for a true emergency. The male nurse then lead me down what seemed to be the longest corridor, perhaps I went around some corners, I cannot recall. What I did recall was feeling reduced once again as I hurried to try to keep up with him. One arm full with my coat, jacket, blouses, pants, shoes, purse, and the bag that held my prescriptions while I struggled to keep the back of the gown closed with the other hand as I navigated around what appeared to be a crowded hallway. We went past a female patient, I presumed, stretched on a bed against the wall in the hallway. I did not think much of it at the time. I was trying to keep up and avoid making eye contact with anyone for fear of a returned familiar gaze.

As we entered the urgent care unit, it seemed as if the whole room stopped and all eyes were on me. It was as if an alert went out prior to my arrival. Listen up everyone; we are getting a crazy woman who is suicidal, when in fact, I was not suicidal at all. I never gave any cues in my demeanor verbally or nonverbally. In fact, no one up to this point ever asked me. The nurse led me into the first room, which was adjacent to the nurse's station, which appeared to be your standard examination room. My new nurse came in, introduced herself, and explained that they were going to take some blood samples and send them to the lab along with my urine. The same urine specimen by the way, the male nurse escort held up as if the urine container was a burning lantern lighting the way from the ER to urgent care.

My blood was drawn and the nurse summoned another nurse to sign off on the several vials of blood. My nurse then informed me that she will get a couple of plastic bags to put my things in and that she would lock my belongings in a secured room. I did not think much of it at the time. I just assumed that perhaps I would be leaving that room for some tests and locking up my belongings was for safekeeping. The nurse came back with a couple of large clear plastic bags. She further explained that after the test results come back, the doctor would come in and talk to me followed by the social worker on call. This still seemed okay to me.

As I was folding my clothing so meticulously and placing them in the bags, the nurse told me that, I also had to take off my bra and my panties. This seemed odd and a little unsettling since I was not there for a gynecological exam, I was simply waiting for test results. Therefore, I asked why I had to take off my bra and my panties. The nurse very politely stated that it was policy. Before I could inquire further, the nurse also informed me that security would inventory all of my belongings. Now this is getting stranger to me by the minute. The nurse while still polite was not forthcoming with information. I was trying to grasp why security would be touching and examining my belongings especially my bra and my panties because I was here just to have tests done. I never expected the tests would involve taking off my bra and panties, especially since the ER did not require it. So at that moment addressing my immediate concern, I told the nurse that I did not want [them] touching my bra or my panties, while complying and removing them from my body. Suddenly I realized that I was wearing a panty shield. I informed the nurse. I did not think in that split second of disposing of it; in fact, I was embarrassed when I discovered that I was wearing it and that someone else was looking at it. I especially did not want the security guards looking at it. The nurse instructed me to throw it away. I always wrap my used sanitary products discreetly before disposing of them. The nurse told me just to toss it into the red biohazard bag (where anyone can see). Just then, the door opened and in walked a female officer. Taken aback because she wore the city's police department uniform and the hospital's employee badge, I thought to myself that this seems serious. Especially since I knew that, she carried a gun. All I came here for was to have some tests done. I did notice some unarmed hospital security officers in the ER and expected to see one of them perhaps. I certainly did not expect to have an armed city police officer inventorying my clothes.

The police officer began taking my clothing, which I so painstakingly placed into these bags, out of the bags. I told her that I did not want her to touch my bra or my panties. The officer replied in a patronizing slowed tone as if she was taking to someone with cognitive deficiencies. I am not going to touch your bra or panties Miss (using my first name). While the nurse is instructing me to dump the contents of my purse onto the bed, another security officer, this time a male employee of the hospital, was knocking on the door as he was entering the room. I felt this was further invading my privacy because he was entering my room without knocking or announcing himself. He asked the female officer if she was okay, to which she replied yes. He asked her if she was sure, she again replied yes. At that moment becoming increasingly agitated, I asked, who is that, backup? She then explained that when the "call" goes out, several officers might respond at the same time. By the way, what kind of call did she mean? Was the call simply to inventory property or was it to summons all available officers to assist with a psych patient? She then noted that there was no need to have all those officers standing around talking. I asked her talking about what. She replied that the additional officers would talk about sports, their kids, or what ever. I assured her that I would remind them of their lack of professionalism. With that, she continued to check my clothing, feeling them, and turning them inside out.

I was so confused and disturbed by what was happening to me, I asked the police officer for what she was checking. She said contraband. What kind of contraband I asked. The nurse then stated that people bring all kinds of things in here with them. I asked what kinds of things to which she replied, you would not believe the things. The police officer pulled a tissue from my coat pocket and asked me if she could throw it away. The audacity of her throwing my tissue away, as if she decided amongst my belongings what was significant to keep or discard.

Oh, I am getting it now. I am a psychiatric patient listed perhaps as [suicidal] and this is how [suicidal] psych patients are treated. I have no say. I have no voice. I am just another insignificant psychiatric member of society stigmatized, degraded, and business as usual. Not one person asked me if I felt [suicidal] or conducted a proper assessment. Up to this point, no one felt the need to expedite my assessment or to have me guarded as I waited for one and a half hours in the waiting room. No one felt the need to have me escorted by security through my registration and triage processes. No one felt the need to escort me to the restroom to collect my urine. Not even security and the police officer inventorying my belongings felt the need to increase their coverage. Could one assume, that all [suicidal] patients are passive, compliant, and not really [suicidal] at all, that no other precautions are taken to assure that no harm is done to oneself? Alternatively, was it that I did not become [suicidal] until I entered the urgent care unit? Does it not matter that I came here for assistance in explaining my increased depression as it relates to my new prescription?

This dehumanizing experience was standard policy one size fits all. I am not in a schizophrenic or delusional state. I am not combative or belligerent. They witnessed no uncontrollable sobbing or any indications at all that I was at my wits end. In my opinion, a truly [suicidal] person most likely would not have wasted time by coming there. I am articulate and coherent. My only crime here is that I suffer from a relatively "mild" mood disorder. My symptoms present, in my opinion, as cyclothymic disorder of which I am under a doctor's care. No one asked me anything, except [Why] and [what]. I was not a risk to myself or anyone else. It all seemed so surreal. This is not happening to me, yet it was.

I felt so powerless to do anything about this. I came here for help. Yet I stand here with nothing but a gown to shield my nakedness. I am in a hospital's urgent care unit treated like a criminal, treated like a person displaying psychosis, stripped literally of my belongings and my dignity. I just stood there, stunned.

The nurse instructed me to empty my purse and my wallet. She instructed me to pull and spread out my cash, my credit cards, and every item in my possession all over the bed, which they inventoried and toke away from me. Through the clear plastic bags, I could see my clothing stuffed in them like rags with my bra and panties showing. The police officer attempted to offer me a compliment; saying that I had some nice things. Her remark went unrecognized. I asked the nurse what harm one could possibly do to themselves or anyone else with their clothes. I was trying so hard to understand this and trying to comply, but no matter how hard I tried, it still did not make sense to me. It simply did not apply to me.

Still very agitated and perplexed about what was happening to me, I remarked that I hated people. The police officer proceeded to tell me that I did not hate people and that there were many people, who liked me. She continued with her rhetoric babbling about what, I do not know. I heard her voice, but I was not listening. I finally asked her if she had some letters behind her name (implying M.D.), as she appeared to want to engage me in her sophomoric psychoanalysis. She so proudly announced (displaying her ignorance by showing her first name on her ID badge instead), that she was a psychology major when she was in college. At this point, extremely annoyed, I told her to stop talking. I did not want to hear another word come out of her mouth. She accomplished what she came to do. How dare she engage me? I was not a patient who is seeking conversation, but I an alleged [suicidal] psych patient who is incensed by this victimization. It was as if she got some kind of pleasure getting a rise from me. I thought the police officer was about to leave, when she turned to me and asked if I went to church. I looked at her in disbelief, and rebelliously replied no. When she asked me why, it was at that point that I became confrontational. I told the police officer that it was none of her business why I did not go to church and that I was tired of hearing her (expletive) mouth. When I told her to get out, he seemed to smirk as she left.

The nurse surprise by my outburst finished whatever she was doing and left the room. The nurse returned shortly to inform that the doctor would be in after the test results came back and that this process is a lengthy one. She offered to dim the lights as she was leaving, I consented and she left leaving the door ajar. I sat there in utter disbelief that this is happening to me. I telephoned my beloved friend who urged me to come here to have the tests done. As I began to tell her of my horrific experience, my fragility came through with a flood of tears. I was so upset. I told her that I do not belong here. She stayed on the phone with me for some time. It was comforting to talk with someone who helped me maintain my perspective.

Periodically, maybe once an hour, someone would stick their head in without knocking and ask if everything was okay. Nothing was okay! One person who presented herself as a housekeeper took the trash from the can. At some point during the evening she stuck her head in again, without knocking, not seemingly interested in the trash at all, but in me instead as she looked right at me first for a few seconds, and then peered into the trash can that she emptied not two hours before. I wondered if the "policy" required that a person who was [suicidal] be under constant watch. In theory, a [suicidal] person would have more than enough options left in the room to carry out their intentions, left for hours in a darkened standard examination room. There were sheets, gowns, utility cords, hooks on the door, electrical outlets, and my eyeglasses with glass lenses to name a few. Why does there exist, a blanket "policy" that may not apply to every psych patient especially not having a proper assessment or supervision. It is unconscionable that I received this treatment.

Why is it that in every other department, the physician comes in first to assess the patient, even if another physician had done so before them? The protocol I have come to know is that whenever a new physician, nurse, or other staff person resumes responsibility for a patient, they come in and introduce themselves. They may need to gather additional or confirm information particularly if there [exists] a threat to the life of the patient. Never have I been in a situation where the physician comes in, six hours later to ask [Why] and [what]. It was apparent from her short visit, that there was no need to keep me here any longer. I wondered if leaving on my own ever an option. If I had attempted to leave against medical advice, could I have expected restraints or some kind of injections, or worst, to be a shooting victim if I became combative or perceived as a threat to others? The thought sickens me.

The doctor was in my room all of 2 minutes and the first minute and a half I was talking. She seemed more interested in pulling up her maternity pants than my mental stability. If an actual threat to me or anyone else were a viable concern, would the doctor, above all a pregnant one, come in unescorted? I doubt if her specialty was even psychiatry. I was however, able to share the appalling experience that I had with the female police officer. The doctor noted that while listening to my heart and lungs. She seemed more interested in reporting the officer to the nursing supervisor than to me.

The doctor never asked me what medications I was taking. The doctor never offered an explanation as to why the increased depression. The doctor did not advise me to stop taking or even reducing the medication that I thought was the culprit. The doctor did not see the need to bring a clipboard with notes, pen and paper to take notes, or read test results. The doctor did not even turn up the lights to do a visual assessment. Are you kidding me? I sat here tormented all this time. Oh, the doctor did inform me that my tests results were "normal". I am glad that something was "normal" about me. By the way, what were they testing for anyway? No one shared that information with me.

The clinical social worker on call came in next. [They] did not hear a peep out of me in four hours. Yet, the social worker's demeanor was very defensive and business as usual. Once we engaged in conversation, she was noticeably more at ease. We shared stories of our daughters who are close in age and delighted over the fact that my psychiatrist is a good friend of hers. I felt mildly euphoric as I engaged in this very casual conversation, notwithstanding, back to business. She was the only one in six hours and forty-five minutes from the time that I entered ER, who asked me if I was [suicidal]. I told her in fact, that I was neither suicidal nor homicidal and would never do anything that would devastate my children. I shared with her my unimaginable experiences for which she apologized and promised to get me out of there as soon as possible before remarking that at least I had a room. Can one imagine a suspected [suicidal] patient stripped and abandoned on a bed in the hallway because there were not enough rooms? Should I feel "lucky"? After all, I had my degradation experienced in the privacy of my very own room.

Moments later a male security officer entered my room once again knocking while he was entering. What happened to protocol? With him, he carried two small sealed bags that he proceeded to open and dump onto the bed its contents. The bags just happened to carry my valuables in one and prescriptions in the other. It was then that I realized what he was doing. He never introduced himself or explained why he was there. It felt as is he was dumping food onto the floor to feed a wild animal. He compared each prescription bottle to the receipt without uttering a word, except to sign here when he was finished, as if I was a patient familiar to this process. He left the door wide open when he entered. Anyone passing by could see clearly into the room. I figured that they knew this was a psych patient because this sight is routine. On the other hand, if they did not know that this was a procedure associated with a psych patient, what would they have thought? There was this very large male officer going through my belongings, spreading them all over the bed while I just stood there holding the back of my gown closed while trying to shield the outline of my breasts. I guess the psych patients do not deserve to be "treated" with discretion or privacy. It was so painfully embarrassing that all my belongings were once again, touched and scrutinized by yet a different person who offered absolutely no empathy. The psych patient is now free to go. I gathered up my things as quickly as I could before anyone changed their minds and took them away again. It was as if they allowed me to have "control" of my belongings again.

I was devastated as tears rolled down my face while donning my bra and my panties that everyone had seen because there were no efforts to hide them discreetly from view. I felt so defeated, so broken and battered as I continued to cover my body with my now wrinkled clothes. No one came to offer therapeutic consolation. No one came with empathy to smooth over my experience. There appeared to be no one around at all. I was simply left there feeling discarded. I felt violated in a place that I thought to be safe, and helpless to do anything about it. I got dressed, composed myself as much as I could, and quietly left.

I went home and showered, but could not wash away the pain and stigma that I felt. I was so embarrassed to face my children as if they knew. I did not want to alarm them or share with them this experience. In an effort to explain my irritability and frustration over the next couple of days, I simple told them that I had a bad experience when I went to the hospital. It upsets me and causes increased anxiety every time I relive my experiences in the urgent care unit by way of the ER. I struggled with this over the next two days while I stayed in bed and home from work. I felt that if I went to work I would come across someone who remembered me from that day. Oh, I forget to mention that I am an employee of this prominent organization and the fact that my employer information is in the system for all to see in addition to the $50.00 co-payment for the ER visit, adds insult to injury.

I came to one of the most prestigious hospitals in Baltimore, Maryland for help but I left with deep emotional scares. Should I expect now to get more prescriptions to address my increased anxiety and depression because of this experience? Nevertheless, my discharge papers instructed me to be good to myself and follow up with my physician (who is not available on the weekends or after hours). Moreover, if my symptoms persist or worsen, go to the emergency room.

J Lovon