In the midst of chaos there is opportunity” Sun Tzu
By June 2013, during the usual fail-replace-repeat treatment ‘plan’ of the state behavioral health providers, I found myself in the perfect storm of bad drugs and deadly ‘care’.
Within a 2-week period, it involved Risperdal, tardive dyskinesia-both eyes, Lamictal, NMS, the ER, more Lamictal, anaphylaxis, ER again….clubbed like a baby seal, to the ground.
I had requested, then demanded a psychiatric MD. I kept getting scheduled with the same PA prescriber. I finally stood up in the packed waiting room and loudly said NO when summoned. The other clients froze; boy, was I gonna’ get it. “It” was the Crisis Clinic in the back of the building where police dropped off “problems”. I had been warned once by a clinic nurse, to never end up there. Yikes.
I was yanked into an empty conference room with the prescriber and a supervisor, an attempt at intimidation. The PA proceeded to ‘explain’ himself. I told him to SHUT UP. He did. The supervisor in filthy t-shirt and shorts, tipped his considerable bulk back in his chair, hands clasped behind his head in a studied, insouciant attitude; he was amused. “What do you want, what’s your beef? You weren’t in any danger, it’s not a big deal.” He grinned.
After I finished explaining what I required regarding his response to my unfortunate situation, I politely questioned his commitment to his job.
The chair came crashing down, his face beet red. I apparently had upset him. I stood up and walked out…just in time as I had been decompensating for 2 weeks, deep in withdrawal, with a rebound ‘chaser’. I needed to get home right away; I had a tiny window of daily function.
He was insignificant in the larger picture; my strategy was 1) get qualified, expert medical help-ASAP and 2) get the hell away from this toxic dump-ASAP.
They were on notice.
“The most common way people give up their power is by thinking they don’t have any” Alice Walker
I only had 1 or 2 hours a day that I could sit up, scour the internet, send e-mails and make phone calls. I spent 22 hours a day for the next 4 months, on my side clutching a pillow, trying to remain calm and resolute. I put my car keys away and couldn’t walk without difficulty.
My cat was concerned about us.
Nevertheless, I used my ‘up’ time contacting outside ‘advocate’ agencies for advice and support. Reaching out to a variety of organizations, legal services of all kinds, and appeal agencies was a minefield of careful language. I was at an enormous disadvantage; they expected nothing less than calm, deliberate, evidence. Unfair, unreasonable, and unrealistic. Most were connected to the state. The clinic staff were viewed as embattled saints. I was viewed as ungrateful, a malicious trouble-maker, hurting the people that were attempting to help me.
The irony would kill me before anything else.
My strategy was to finesse the high school case managers, on-line educated PA’s and supervisors, and pick my way through the IED’s of procedural paperwork placed in my way.
Their vulnerability was their unanimous perception of lack of respect. Nobody appreciated them and they worked so hard. Many exhibited a disturbing, casual meanness of spirit, reminiscent of the flawed “Stanford Prison Experiment”. I saw it frequently in the waiting room; it was bullying and at times, thuggish. They were acting-at-will, with no objective supervision, mental health being the step-child of the state budget. The clients were deemed irrational, annoying irritants in their day.
It was irrelevant; I would remake myself into the opposite of that, going ice-cold inside with a great big smile. I was going to sell them by using their own psych methods; mirroring, a common sales technique, and vocabulary they felt comfortable with; meeting them where they were. I would be reassuring, outwardly respectful and civil. I would talk to them just a little over their heads; (not a heavy lift), just enough to flatter them, not to show off or embarrass them (“She thinks I’m smart!”). I would use familiar handbook terms, their work vocabulary (“She recognizes my professionalism!”). I assured them we were on the same page, (“I’m reaching her!). I let them win minor points; I gently, deftly won the bigger ones, always expressing gratitude for their guidance. Mirroring was fun.
I wasn’t always successful controlling my disdain and anger. But I learned about myself and them at every interaction. I made it count.
I grasped the synchronicity of the law and psychiatry. It was not about being right, it was about being effective and in this system, COST AND LIABILITY CONTAINMENT were key to understanding Every. Single. Thing.
I was a quick study. I called 2 weeks later and politely, firmly, respectfully and with a soupçon of deference, insisted on speaking to another supervisor. I explained quietly, confidently who I was, followed by a very concise ‘highlight-film” synopsis of my situation. I used the words safe and safety, unfortunate, hospital records, evidence (photos), quality-of-care, unresponsive, appropriate notifications, and reasonable. I shared my tactics going forward to safeguard my health: unlimited, frequent visits to ER’s as I felt poorly all the time. I didn’t feel safe at the clinic, as my file illustrated. No snark, no drama, no anger; reasonable, calm, appropriate….high stakes poker.
This strategy spoke directly to enormous budget overruns caused by a patient going ‘off the reservation’. Also, the chance of an ‘outside’ medical entity being informed and causing complaint issues on my behalf were possible as I was calm, articulate, and credible. Her boss and their boss would bring the lumber down on all of them. “How did you let this happen?” It would impact their annual job assessments and paycheck. In this regard, I made it business AND personal.
I intentionally ended with a request that was completely achievable for her, offering her a win-win. She would be a hero, a problem-solver; I would be gracious in victory.
“I require an appointment with a psych MD, NOW. Thanks a bunch, Tiffany”.
She replied “You will have an appointment by end of business today”. And I did.
Game recognized Game.
When I showed up at my 4:30 P.M appointment, I was aware that this was a clear message I had 15 minutes to complain. I was prepared for this moment. An hour and a half later I walked out with the promise of another appointment. The doctor was the clinic director and never said a word as I precisely laid out my outline, ending with my specific request. I required safe withdrawal from a well-qualified psych MD that would stay to see it through to completion. I wanted vacation of my bipolar and SMI designation and I wanted paperwork proving it. My Plan B was the state gaining entrance for me to go to the Mayo Clinic in town and, of course, ensuring payment for those services; audacious, but reasonably presented. Plan C was that I walk, titrating myself in this state and taking my chances. The implications were liability issues should I fail in my withdrawal ending up hospitalized and an attorney taking an interest, as I was presentable (for 2 hrs.), articulate, with my files in order, my facts on a meticulous timeline. My personal history per the clinic’s notes was solid, stable, compliant, and accomplished. I WAS CREDIBLE.
I wasn’t begging for help; I was offering him options; this was a polite negotiation.
He scheduled an appointment that week to stabilize me. I was in very poor shape. He formally accepted me into his service-of-one, after asking me quietly “What are your intentions?” I didn’t flinch, took a beat, and replied quietly, “I haven’t decided yet”. He never addressed ‘it’ again. This was a little dance; a hybrid of Queensbury Rules spliced to Robert’s Rules of Order. We were very polite and all business, with a smile.
He quickly ascended downtown to the corporate office as the CMO/VP of the largest behavioral health provider in the state and for 2+ years he committed to me as his singular client, with the caveat that if his position became more demanding, he would be obliged to stop. It created additional anxiety and I never stopped developing options for those years, just in case. This wasn’t a done deal until it was.
For a long time, nothing he tried gave me relief and there were some notable bumps in the road. I told him I was ready to move towards my goals; with or without him, I was leaving. We met once or twice a month, usually 2+ hours, late in the day, often closing the place up. He would remove his jacket, loosen his tie and listen. I was acutely aware that I was there to convince him that it was safe (for both of us) and appropriate for him to grant my request; I was auditioning for the role of a stable individual with a reassuring GAF score. He didn’t speak much until the last 9 months when I requested him to start. We would text when he traveled or was busy. I didn’t overplay my hand; it was a delicate, unusual situation. He once noted “You have trust issues” to which I laughed and blurted “Look where I am”. I sensed he wanted to get this right.
In March of 2015, I finally asked… “Do you think I’m bipolar?”
He took a long moment; “You’re slightly depressed”.
BOOM, there it was….and we set an exit date for December. There were slow bureaucratic hoops I would have to jump through.
In December 2015, at our final appointment, I awkwardly handed him a copy of “Invictus” by William Earnest Henley; “I am the master of my fate, the captain of my soul” stuff; obvious yet on point. I had no words of my own that day. I said thank you and walked away with wobbly knees. At my car door, I turned to the cameras with a great big, immature, one-fingered salute…and quickly got out of there. Ooooh, what a bad-ass.
But look what I did.
“We must let go of the life we have planned, so as to accept the one that is waiting”. Euripides.
Continued in Changing a Medical Record 4