Tuesday, September 27, 2016

notes from a psychotic episode

I have apparently just survived psychosis with catatonic features.  I was convinced I was dreaming, and kept waiting to wake up, but I didn't.  It was very unsettling.   I think most people sometimes feel they are in a dream state, but I was convinced.  Something was wrong with the nerves in my hands, I was holding my arms in a cramped position, and couldn't keep my eyes open or focus them clearly.
I was inpatient for the first ECT and 2nd, then went home.  I wasn't allowed to eat until after having the ECT, and Dr. F slots were later, so I was HUNGry.  I couldn't feed myself.  Jer took a video of mom feeding me soup.  I was holding my hands out in front of me like claws, and had my eyes half-closed.
Sharp had 3 hallways intersecting in a trident.  They had a nice patio with molded concrete tables and chairs.
Kept looking for ways to prove I was alive, tether to reality - for example, ordering food from Bread and Cie, or seeing my family, or eating sushi or thai food.
I thought i was dreaming, but the dream was taking way too long.  I kept waiting to wake up, trying to wake myself up, opening my eyes to only see a sliver of the scene in front of me, having my focus caught between the hands in front of me and the scene beyond - i couldn't adjust the focus of my eyes for depth perception
Sunday - spoke only a few words at a time, in low, difficult to hear voice.I kept sliding down in the chair, almost falling out, then pushed self back in , so dad put his knee in front of my knee to give me a guide.  My glasses also kept sliding down my nose.
  Monday speaking more fluidly.  I took a medication from a spoon - before took it, non-responsive.  1-2 hours later, Otto arrived, and became more animated, and helped me break out of catatonia.  Couldn't slow the thoughts down enough according to Jeremy.  I remember taking medicine in applesauce.
Hardwood floor in my room at UCSD, nice big windows, but shabby old wooden furniture in the lounge.  Room had a bed adjustable like in a regular hospital - could recline, sit up supported, etc.
Once i started to suspect I was NOT dreaming, I had to find was to prove I was alive, in the world, that things were happening, or that I could control what was happening, in which case it would be lucid dreaming.  I thought I was in a boring version of Inception - instead of explosives and folding over skylines I was trying to manipulate what kind of dessert I would get served.
Aurora outpatient - there were people who came to an all-day program and a part-day program.  The all day program had really supportive fellow patients in it, and this counselor named Terry who....
Bar-code scan on patient bracelet for meds.
I thought it was night when it was day.  The only ways I felt alive were to be in motion, walking in cirlces, to kiss Otto, or to pee.  They had me pee in cups a lot.  I also vomited at REI.  There were things I thought were dreams that apparently were real.  For instance, a man with a plastic bladder and catheter coming out of his zipper, just sitting in public as it filled up.  There was a very round large young woman with short hair who was constantly yelling - I pictured her like the Queen in Alice in Wonderland.  Apparently she was real too.  Yelling about her parents being mean to her.  I shared a room with an Amanda, and people kept mixing us up - or i kept getting mixed up thinking they were addressing me when they said her name.  I kept trying to open my eyes to wake up, but I just kept seeing little slivers of a room, not the whole thing.  My eyes were stinging too.  I remember going under for the ECT, a loud ringing coming into my ears.  The staff there were nice - but my Dr. was kind of arrogant, i felt.
  They took my blood pressure and temperature multiple times a day.  I had to pee in funnels, and they always wanted to know if I had had a bowel movement yet that day.   But I was SURE i was dreaming!  I couldn't wake up, so then i started to wonder what was up.  I saw my hospital room in the dark, and a very ugly green and grey carpet in teh hall.  Nurses kept asking me how i was, and i couldn't answer.  I couldn't make any works come out.  I would nod yes or no but somehow it came out in reverse, like:  Jessica, do you want to go outside?  Me:  thinking yes, but shaking my head no.  Dr. Fidaleo in his black leather jacket telling me I have to talk, i have to tell h im what's wrong or he can't help me.  But I couldn't speak!
I threw up in mom's car.  She was looking for a backpack to replace what she gave Otto.  Otto got food poisoning and was vomiting all night, so mom took me out to let him take a nap.  I couldn't coordinate my hands to feed myself so mom and Otto had to feed me for a few days.  I was walking with a ahuffle and couldn't walk in a straight line.  I didn't shower for several days so Mom rinsed me off in Jer's shower.  I don't think I brushed my teeth either - Otto and mom ahd to do it for me.  I was grabbing at things that weren't really there and wiping things offof myself that weren't there.  Thinking you are in a dream is a psychotic symptom.
I couldn't use the restroom alone.  My  mom had pull down my pants and sit me down on the toilet.  They turned on the water to get me going.  i emitted high-pitched giggles that were apparently quite disturbing.  I held my hands stiff in front of me.  i had my eyes closed for several days.  Whenever Otto came I would get more alert and happy.  He did some music and movement with me - he played the ipoad for me.  I wrote a maze and wrote 'what am i doing here?'
asking what do I need to do to get out of here?   Couldn't pass mental status exam - couldn't keep track of where I was, date, season, time.  Jer said my skin was 'waxy'.
 Otto and I spent night at mom's house. after REI trip I threw up my meds and dinner.  Mom and Jer talked, we came to his house,  Jer said should take me to Dr. Fidaleo for assessment, but shouldn't have another ECT.  Dr. F. said clearly psychotic, needs stabilized inpatient.  I couldn't control my hands well enough to connect my pen to the paper to admit myself voluntarily, but they admitted me anway.
Bathroom, and chairs - I couldn't coordinate to get my butt in the chair, or on the toilet - my spatial relations and depth perception were all messed up.   They had to push me down onto the chair .

I used my email and web pages to prove to myself that i was alive - I was catatonic, but i was able to remember my gmail name and password!  Email cuts through psychosis.  Then when I remembered my website!  I had external proof I existed!  I did research on myself - watched all my videos, looked and my postings, and 'got to know myself' again from the outside.  I wanted to wake up and get back to life because it looked like I had some interesting things to do - I got notice I was invited to a residency, and I wanted to make sure it was real.

Katie and Jer came to visit me at Sharp and showed me videos of Alice on his phone.   My limbs were 'waxy,' in the sense that I held them in a single position in front of me.  And left them where they were placed.   I remember rubbing my thighs and not having full sense of feeling in my fingers or my feet.  Standing up was a trick, as was sitting down.   I couldn't speak but I could sing, so Otto put me on the iPod and i sang and danced around.
"We're going to get you good medicine.  You're safe"  These reassurances helped me a LOT.  They asked me if I was restless, if that's why I was moving my hands in such a funny way.

I had to drink with a straw.  When I was drinking something, or peeing, or eating it was like proof I was alive and awake.  I kept getting hair in my mouth.  I was seeing only a slice of what your eyes normally take in.
Catatonia - once started getting treatment with Klonopin started being able to feed myself.  When wore off I went catatonic again.  Had to titrate K at higher level - 0.5mg 3x day - was a lot.  Signified my thoughts must have been racing around.  I moved my hands quickly in circles, then clasped them to show I felt stuck.
Apparently my face was fairly expressionless - I would show some recognition of family members and hug them stiffly, but when Otto came I would smile.  Otto also got me to dance and move more freely than otherwise.
I was at Aurora inpatient, then outpatient.  Aurora inpatient - did lots of community meetings where we had to rate our mood, our level of depression.   Got to go to gym sometimes - but there weren't enough machines for everyone.  I would jump on the stationary bike for ten minutes right away, then try to fit in between the guys using the weight machines.  We played some silly 'therapeutic' games, one called Mexican Train I think.  We had arts and crafts.  They have two units for returning military, PTSD cases, and there was a woman named Natalie who slept on our unit but did everything with their unit.  Our unity was combined substance abusers and mentally ill, so there were people going through detox, some of whom were in a very bad  mood about it.  There was a lot of complaining about the staff, about other patients.  Everyone hated my roommate, I think - she had had a surgery to reduce her size - gastric bypass - so she couldn't eat very much at a time.  How did I get released from there?  I moved to their day program, and didn't want to run into the people I knew from inpatient at lunch.  Did I imagine all this, or did it happen?
Otto and mom had to drive me - got a ride at Fashion Valley twice.  Was getting much more desperate to end my life.  I wanted to get ECT started right away, and they thought it would go faster if I was inpatient, so I checked in to Sharp Mesa Vista.  I remember being in my room waiting for my treatment, and I was so hungry.   I checked in at the ECT unit, then the staff hooks you up to an iv which drops in the anesthesia.  i woke up a few hours,? later the second time it hurt a lot - i had sore muscles, headache.
  i said i would give ECT 2 weeks and if it didn't help I would kill myself.  Since ECT induces a seizure I had to stop taking the gabapentin and Klonopin and instead took requip to control my restless legs - these are dopamine agonists, stimulates dopamine receptor - Doxepin is a tricyclic antidepressant that has a sedating side effect, but may have been activating also.  Makes you sleepy, and can make one delirious.

Catatonic disorders are a group of symptoms characterized by disturbances in motor (muscular movement) behavior that may have either a psychological or a physiological basis. The best-known of these symptoms is immobility, which is a rigid positioning of the body held for a considerable length of time. Patients diagnosed with a catatonic disorder may maintain their body position for hours, days, weeks or even months at a time. Alternately, catatonic symptoms may look like agitated, purposeless movements that are seemingly unrelated to the person's environment. The condition itself is called catatonia .
A less extreme symptom of catatonic disorder is slowed-down motor activity. Often, the body position or posture of a catatonic person is unusual or inappropriate; in addition, he or she may hold a position if placed in it by someone else.
I wanted to shave my legs but had to do so supervised by a nurse, since razors were considered dangerous.  I didn't do a very good job.
Food poisoning - dehydration, so got concentrated levels of meds I was taking, several things contributed to my psychosis.

I didn't communicate.

"Nods yes when asked if thoughts are racing, no when asked if feels safe'
Senior Behavioral Health Unit - super nice people - special favor to Katie and Jeremy.  All their beds were full monday, but got a bed in the evening and Dr. Kim called.  Dr. Fidaleo was not cooperating, so we had no records to show insurance - luckily, they did cover it mostly.  Dad paid $3k out of pocket, but could have been much worse.   Hospital room is $1800/day, plus meds and doctor care.  They had made a garden out of round concrete outdoor ashtray containers with flowers and fruits and veggies, and I got taken on a walk there a few times.  We sang karaoke - I did "yellow submarine".     There was a grumpy New Yorker named Anchel, a woman named Artemizia who kept calling for help  in Spanish, and Patsy who wore a kerchief over her bald head.
I was transferred "Against Medical Advice" because Dr. Fid wouldn't sign the forms.  
I remember having to sign lots and forms at all these different hospitals, agreeing to be treated and I guess not holding them responsible for what happened to me.
The ECT clinic - the women who worked at the check-in were always friendly.  I remember getting a needle in my arm to start an IV, then a huge ringing starting in my ears, then nothing - blacked out.
Otto brought me music I recognized - having things I recognized helped me connect to the 'real world'.  He plugged me in to the iPod but I wasn't coordinated enough to operate it.  I couldn't make it through a whole song without getting impatient and flipping around to a different one.  I was dancing, but couldn't get on the beat, and felt like I think Dad and mom look when they dance - awkward.  I was listening to Manu Chao and Citizen Cope, plus the happy morning song.
Went kayaking one day on Mission Bay.

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