How to Survive a Night (or Two) in the Psych ER.

The psych ER can be a miserable place, and almost anyone with suicidal thoughts or intentions ends up there for a night before going home or transferring to the psych ward. During my first hospital stay, I was in the psych ER for two nights. I didn't have access to anything; I had nothing of my own. Here is what I learned to do:

• Stretch. I did this a lot, and it really soothed my tense body as it gave me something to do. Try all kinds of stretches. 
• Use the phone. Usually, one is available if you ask. I had to talk on the phone while standing in the hallway. Hearing a loved one's voice is grounding. I brought a list of phone numbers with me to the hospital, and the nurses let me keep it, so try that or memorize numbers.
• Try to tune out. Since everyone is talking to doctors and using the phone, you may hear some disturbing things. Try not to think about it.
• Watch TV. A psych ER bay usually has a TV. Watch it. Ask the nurse to change the channel. I don't typically watch TV or find much comfort in it, but the silly sitcoms on the Disney Channel helped the time pass.
• Walk. If you have space in your bay to walk a few steps back and forth or around your bed, do it. You won't be allowed to walk in the hallway. 
• Sleep. As much as possible, close your eyes and sink into sleeping. No one is going to judge you for it, and you literally have nothing more important to do. Sleep until the next meal, the next check-in with the doctor, the next time you have to go find the bathroom.
• Remember. Carefully retrace anything you've memorized, such as poems or scriptures or even song lyrics. Take yourself step-by-step through a dear memory. 

It seems endless, but it will end. Once you get to the psych ward, you'll have more space, you might have your own clothes, and you'll be able to talk to other people. You'll feel more like yourself. 

Your Hospital Bag.

 You can find plenty of articles and posts about what to pack in a hospital bag if you're expecting a baby. But a bag for psychiatric hospitalization is just as important. Having belongings you've chosen is a great comfort in a behavioral health ward. 

Remember that at first, you won't have your belongings. A hospitalization begins in the ER. The psych ER is locked down, and patients don't get to keep anything. If you think of it, leave your jewelry at home. You'll get a hospital gown. You won't even keep your underwear. But the staff will store your bag and bring it to the ward when you transfer. The psych ER is a real bummer, but the last time I went, I wasn't even there for 24 hours.

Buy or set aside items for your bag. Assume that you won't have the chance to pack anything before you leave for the hospital. Have everything ready. After I was diagnosed, I went to Target and bought everything for my bag. Everything in your bag should be extras.

Pack in threes. In my experience, a psych ward will allow you to have three changes of clothes, so don't bother bringing more than that. You'll be able to do laundry if you need to. 

Don't bring toiletries or cosmetics. You probably won't be allowed to have them. The staff will provide you with a toothbrush, toothpaste, a comb, shampoo, body wash, deodorant, and lotion.

What to Pack

1. Underwear (3). Choose comfortable extra underwear for your bag. If you need a bra, pack two or three sports bras. Underwires and other hardware usually aren't allowed.

2. Pants (3). A lot of psych wards won't allow drawstrings or zippers. I bought three pairs of identical black leggings. 

3. Tops (3). Go for soft, short-sleeved T-shirts (in case the ward is hot). Choose colors you like. 

4. Cardigan (1). Remember to avoid jackets with zippers or drawstrings. An open cardigan is best. That will keep you comfortable if the ward is cold.

5. Socks (3). They just need to be comfortable and extra.

6. Shoes (1). Most wards won't allow shoelaces, so buy an inexpensive pair of slip-on sneakers.

7. Slippers (1). You may prefer to shuffle around in slippers. I bought pink ones with polka dots to cheer me up. 

8. Pads or period underwear. If you menstruate, bring what you need. Remember that health changes can alter cycles, so be prepared. Tampons may not be allowed. Having the pads you prefer will be so much better than using the bulky hospital pads. The staff will probably give you several pads at a time and keep the rest locked up, so you can just ask when you need more.

9. Journal or notebook. Avoid spirals. Even if you don't usually like to write, it can be quite soothing at the hospital.

10. Crayons. These are likely the only writing utensil you'll be able to use without supervision. Make sure they're new and sharpened, but don't bring a set with a sharpener. 

11. Paperback book. Hardcovers are usually not allowed. I pack two large paperbacks that I've already read and liked. This way, the books are comforting instead of unsettling.

If you have an unusual prescription medication, you may want to bring it with you in case the hospital pharmacy doesn't have it. This happened to me with Seasonale birth control.

Some wards will allow you to have other items such as blankets or pillows from home, but wait and ask when you get there. Your visitor can bring these to you if they're allowed. 

Pack your bag now. I thought I'd never use mine, but I've used it twice. It will give you peace of mind.

Taking Steps.

Getting groceries is complicated. 

Most of the time, Josh and I go to the grocery store together on Wednesday mornings after we take Oliver to school and before Josh goes to work. Occasionally, this doesn't work out, and I get groceries by myself. 

Getting groceries alone a few weeks ago made me notice how much I need to divide tasks into steps. Grocery shopping requires six steps:

1. Shopping
2. Getting everything on the belt
3. Paying
4. Loading groceries into car
5. Bringing groceries inside
6. Putting away groceries

I have to think about each step and mentally check them off. I have to be deliberate in my thinking and action, especially if the task has a social element.

When I taught college English, I made massive to-do lists, breaking down my work:

• Make test
• Make answer sheet
• Copy tests
• Make test key

I couldn't just think or write Get test ready. 

This may seem fastidious, but it's a great way to get through tasks particularly if you are overwhelmed or dealing with anxiety or depression. Most days, I think through steps with something as simple as a shower:

• Face wash
• Shampoo
• Razor 
• Body wash

I also have the get-ready steps of brushing my teeth, drying off, getting dressed, and brushing my hair. When I wear makeup, I think through those steps too:

• Powder foundation
• Eye shadow
• Eyeliner
• Mascara
• Lipstick/balm/gloss

If I'm really ambitious, I may start with face primer and eye shadow primer and add highlighter or blush. These steps are a lot more enjoyable that shower steps or grocery shopping steps. But I did have to stop using liquid foundation and finishing powder because that was too much. Find ways to reduce the number of steps or the difficulty of the method. But don't just combine steps.

If your task seems too big (and some days, everything just seems impossible), break it down. You've heard that before. But I mean really break it down. Every step you complete is a great accomplishment. And every success makes you stronger for the next step. And sometimes, you won't be able to finish all the steps. That's okay. Skip the eye shadow. Put away the cold groceries and leave the rest on the counter until tomorrow. 

Write it down. It's less scary when it's not just filling up your head. Make a checklist. Make a checklist on a small white board and write with wet-erase markers for tasks you do regularly. I like to use a vertical layout planner so that I can have my appointments and my to-do lists in one place. Rather than scratching items off the list, I now mark them with a glitter highlighter. That's more fun, and it's lets me see how much I've already done. 

Give yourself credit. I know I have to pick up my son from school every day and make his lunch, but I put these on my list every day, and I highlight them. Celebrate your progress even in tasks you often do. This can only help you.

One Year.

 This week hasn't been easy for Josh. Yesterday marks one year since I last went to the ER for myself. That was the night of my suicidal intent. I don't think of it as an attempt because I never took any pills or used the razor. But I think everyone else thinks of it as a suicide attempt, and I can understand that. I did write notes. 

I'm sorry. I'm sorry I all but gave up. Suicidality is a hard thing to forgive. I know this. And with fear, I remember how gone I was. I was all hurt and dread with no end. For those minutes, that hour, everything else was gone. Hope was certainly gone. Integrity was gone. Responsibility was gone. Even love was gone. It is the ultimate selfishness. I was no longer a person but a void. 

But I didn't hurt myself. I was still talking to my best friend, texting. He said GET JOSH NOW and I did. I showed him everything. He said, "You know you have to go to the hospital, right?" My friend came and took me there. My son was asleep.

I spent one night in the psych ER and two nights in the psych ward. I journaled with a blunt black crayon. I slept often. I went to group and individual counseling. I showed nurses my body, free of self-inflicted wounds or scars. I lifted my breasts so they could check underneath. 

That was a year ago. It hasn't been an easy year, but I've not come near where I was. I was deeply depressed through much of the winter, unable to do much but sleep. Showering was impossible some days. It's still hard. My son, most likely aware of my state, had major behavioral issues and anxiety. He hit and grabbed me often, leaving bruises up and down my arms. I couldn't fix myself. But I did not give up. My doctor prescribed a new medication. And another. And another. I took my meds, went to telehealth therapy sessions, dragged myself forward. 

I track my daily overall moods with colorful hexagon stickers. Last month, only two or three days were blue for depression. Only one day was brown for mania. My illness is in check. Josh and I are connecting better than we have in years if not ever. My son is now going to a school just for kids with autism, and he's now on a medication that dramatically decreases his anxiety and limits his meltdowns. He hasn't bruised me in a long time. 

I look out. I look forward. At least once a day, I just want to hide in bed. I buy too many pretty little things as if I'm trying to embroider the tatters and anchor myself to the physical world. I play loud music to distract me from the exhausting and anxious task of taking care of myself, of showering, of dressing, of putting on eyeliner on a good day. I show Josh my mood charts. I coach myself, often through writing, on every step of every day. Now, I can pick up my son from school. I can do a load of laundry. And I've been taking writing classes that show me I still exist, that I still have substance and intelligence and passion. I read books even though it's often like scraping my brain.

I'm not all better, and I probably never will be. But I am okay. I get many glimpses of better-than-okay. I get lonely. I get scared of what I have to do, whether it's an online meeting with Oliver's therapist or a trip to the grocery store. Sometimes, I wonder what the point is. The days keep coming on. But I don't live in dread anymore. I see hope and beauty and humor. I'm glad I'm here. Most of my days are pale pink for hopeful. 

We're all traumatized, and a chunk of that is my fault. Death has been an airborne infection. But I'm alive. I plan on being alive next year when this hard time comes again. I plan on saying I'm sorry, and I plan on forgiving myself. Forgiveness isn't a one-time endeavor. Forgiveness is a cycle, something I have to replenish, to choose again and again. I'm ever in a present progressive state of forgiving myself and everyone else. 

But I'm one year away from it now. 

Duality.

 I just started using the journal/planners from Silk + Sonder. This is one of my favorite pages.

Return to Purgatory: A Journal.

 10/7/20

I'm in the psych ward, trying to write with a black crayon I found in a drawer. It's hard, but it still feels good. The crayon is blunt. I'm glad to be out of the ED. It didn't take two nights this time! I wish I had a pen or marker. My journal got there, but my markers didn't. Two girls have been talking to me--T and M. T is loquacious and had bipolar. Apparently, crayons are allowed, so I'll ask Bruce to buy me some for tomorrow. He's supposed to come in an hour for a one-hour visit. It would be too hard for Josh to come. Mom says she and Shane will come on Friday. I hope I won't be here much past then. Dr. A (whom I saw last time) said a short stay, a couple of days.

Dinner was better than ED food. Pasta with meat sauce, salad, broccoli, and an orange. I want to eat a bag of potato chips. I miss Josh's touch.

Sleep time.

10/8/2020

I feel different today. Not really about my situation--it still seems pretty hopeless, but my mood is light. 

I got a pencil. I'm not letting go of this crayon though.

Anyway, I'm smiling. Do I like it here? Having a journal makes a difference. I slept a lot last night, better than I have in a long time. I'm sure that's related. 

Weird--when I got up, I saw [Oliver's psychiatrist] at the nurse's station! I almost fell over. He said, "Hi," and I said, "Hi, Dr. F." I don't know if he recognized me or just noticed my bizarre pause. It would be interesting if I saw him. I saw 5 or 6 doctors around all at once. So I'll probably see someone else.

Here's breakfast. I see bananas. Pancakes, eggs, bacon. I didn't eat everything; we get a lot of food. 

Maintenance just reset the fire alarm. Nobody freaked out.

Mom tried to call me last night, but the nurse couldn't wake me. I'll try to call her this morning before group at 10:30. T is getting a call at 9, in about 5 minutes, so I'll wait until after that. I don't know when I'll see the psychiatrist. I'm kind of sleepy again. I saw a PA at around 6:30 this morning.

Dad called last night while Bruce was here.

I don't have much. I'm hurting in ways I hate. I should be over that. I posted an Asia lyric on Tuesday night. Mom Googled it. The whole song is about betrayal.

Well, I met with Dr. F and two other doctors. It was really hard. I cried, and I've been crying since. He knew me. He had told the others about Oliver.

Now, I have a marker because I'm in group therapy. I think I'll be here for a while. Dr. F said, "a few days." Oh. I was thinking I might be done tomorrow. But my kidney function is low, so they're not increasing my lithium. 

Group therapy wasn't too bad, despite the ball tossing. I'm super thirsty. I miss my big ice-filled water bottles. I don't have my little pitcher because someone was cleaning my room when group was starting. 

I'm starting to miss Josh. I'll try to call him soon. We don't talk well on the phone, so calls aren't usually satisfying. I have no idea how he feels, if he feels anything. Maybe he's just trying not to feel anything. Well, Mom will be here tomorrow. I don't know if I'll see her or Josh. I'd like to see either. But I really miss Josh. 

I don't know if Oliver's new meds are doing anything. Dr. F asked, but I hadn't been there to see.

I miss cold cans of Dr. Pepper and Cherry Coke. When I head home, I want to stop for a drink. 

Lunch is in about an hour. I'm excited because of a drink--I'm not hungry.

Group again. I had lunch, not so great. Salad and mandarin oranges were good. Meatloaf, carrots, mashed potatoes, not so much. Best? Ginger ale with slush-like ice. My kidney function is still low, and my veins are slow--people are asking if I'm dehydrated. Water access is tough. I drink warm water from the bathroom sink. Is that what everyone does? I wish there were an easy way to get ice.

After lunch, I called Josh. I don't know how he feels. But I'm glad I heard his voice. He won't call me. me. Mom will. I'll see Bruce in about 3 1/2 hours. That will be a relief. 

After the call, I got my blood taken again. I've been stuck 4 times today. My hands and wrist are sore.

I napped a while, and then, I meant with M, a social worker. She was young and nice. We talked about writing and theatre. 

I'd like to have an exit plan. Did I even spend a full day here last time? I know I didn't go to group. Now, I've gone three times. What will I do all day on the weekend when there's no group?

I'm just glad to have my journal. And I have some access to writing utensils. I brought this journal because it has thick pages. 

After group, I'll shower and change. Then, it will be almost time for dinner. After that, it will almost time for Bruce's visit. Then, I'll go to bed. Maybe I'll have another good night's sleep and wake up feeling good. I wonder if I'll see Dr. F again. Do doctors get a couple days' rotation or just here and there? I wish I hadn't been weepy--that hurt my chances of leaving. I'm not going to say I'm ready if I'm not ready to try. But I feel close. THree nights seems to be kind of magical. Of course, this time was different. 

Squirrels are chasing each other. 

I wish I had letters from Josh. I would press them to my heart. 

Last night, Bruce and I were so excited to see each other. I was so sleepy, but we talked and laughed. Getting hugs was a relief. I look forward to more. I wish Josh could come though I understand why he doesn't. Maybe I'll see him tomorrow. I wish I knew how he feels. Would that be too hard? Is it a mercy right now that he's not emotive and he's made that such a part of his identity? 

Dinner is done. I had a burger and fries. D, the kind nurse I remember from last time, just gave me some ice and a pencil. And Bruce arrives in 40 minutes. So things are pretty good. 

I have a building headache. Is that from dehydration? Stress? Neck tension? I'm surprisingly not tired. My neck is rock solid. No massages for me. I've watched a lot of Chicago P.D. This headache is bothering me, and my breathing isn't great. I don't think I'm allowed to take anything for pain because of my liver, so if I told a nurse, it would only be for documentation. 

I could watch Crimson Peak again. I'd like to see more with Tom Hiddleston. 

D will be leaving soon, and I overheard that he has a 3-day weekend. Bummer. He's so nice. I'll miss him. 

20 minutes. I'm cold.

I miss Oliver. All the kid commercials make me miss him more. He's my baby. I'm not a good enough mom. I wouldn't be so stressed and hopeless if I were. I would be able to absorb it all somehow. I don't get energy from motherhood like others seem to. I wish I did.

It's a'time. Whew. It's been a long day. 

10/9/20

I feel pretty strong today. I just had breakfast and expect to see the doctors soon. I saw Dr. F go by. 

I feel ready to try again.

My dreams were full of group therapy and crime drama. But I slept well. I miss Josh but not too badly. It doesn't hurt. 

I'm cold. I turned off the unit in my room, and I have the blanket over my lap. I would lie down, but I'm expecting the doctors. 

Will I be able to read any of this later? The blunt crayon is bad. 

I think most people sleep most of the time. T takes 3 showers a day. I took a longer one yesterday. That was nice. My showers at home are quick. I could wake up earlier.

Mom thinks it's time to homeschool Oliver. The thought gave me some relief. No more computer or performance. Real focus on where he is--colors, ABCs, counting, writing his name. The breaks we need. I am a teacher--maybe I'll thrive on it. Bruce thinks it's a good idea. Mom is going to help me set it up. 

She also wants me to stay at the hotel with them after I get out--step down. Sounds smart. 

I guess I'll call Josh after group or after lunch. I don't know if he's trying to work. 

My bleeding and pain have decreased, thank God.

That awful headache follow me into the night, but it was gone this morning. Whew. 

A new girl, T2, is very unhappy. Of course. Do we all just act okay because we want to go home?

No familiar staff now. But the doctors and the social worker are the same as yesterday. Can they tell I'm smiling at them behind my mask? 

I need to use hand sanitizer more. I forget it's there. 

I have the first 2 Mark of the Lion series books. Should I try to read? How many years ago did I read them?

I'm just glad I have a journal with quotations and stickers.

I'm thinking happy thoughts about Oliver. He's so cute and smart and determined. We have so many love-filled memories. When we got ice cream the day before his birthday, he gave me a real kiss. 

The blood draw bruise on my wrist is awful. Blue and rose.

I don't know when Mom is coming today. I just hope someone will visit tonight. I'd be really sad if not. 

30 minutes until group. Being outside will be good. Everyone gets excited about that. We're all just kids. 

Words are scratched around the window. I can't read them. Except HATE and MAKE ME. Yikes. 

Maybe I won't see the doctor this morning? Surely they wouldn't skip me. 

A sweet nurse just spoke to me. She had a seahorse on her ID! She actually sawm with them in Bermuda! I didn't see her name. 

When I get home, some new clothes should have arrived. Did I send off my Stitch Fix? So many little things. 

In group. It's cooler and cloudier. A noise--thunder? Artillery? Yard equipment? The fence is high, but nothing like the pine trees. That seems like a poem line. Maybe the last two lines. Maybe I'll write a poem about this stay.

The doctor came and got me right after group started. Two more male doctors were in the room. I mostly talked to her at first, telling her some of what I've written. My hep panel was negative, whew. But my kidney and liver function are still concerning enough that I need to stop Topomax and take something other than lithium. Dr. F said that I'll need dialysis or a transplant in the next 5-10 years otherwise. Scary! Not having lithium is scary too, but it's not saving me. They're going to make an appointment with Dr. D. 

Dr. F asked me what would be different at home. I told him Josh said that Oliver is waking up less on the new medicine. I told him about the homeschool idea, and I told him about the removal of the ABA cap. He seemed satisfied and said, "I don't think we need to make any changes or keep her over the weekend." She seemed to agree though she impressed upon me the importance of my results. I agreed to work closely with Dr. D. And Dr. F said I could go home today! They said it would probably be this afternoon, which is soon! I'll try to call Josh after group and let him know. He can inform the council. 

What would be different if Mom had answered the phone? If Josh had gotten up? But Bruce was connected. He said, "Go to Josh now." And I obeyed. I told him last night, "You did good." He said he thought a direct command would be effective. Not a suggestion. I don't know what Mom knows about what happened. She may not want to know. I won't volunteer. I wonder how she will help when she is here. 

Whew, I'm tired of wearing a mask so much. Group is almost over. I'll miss this marker. But soon, I'll have all my own pens. 

I talked to Josh. Unsurprisingly, he didn't react to my discharge. But he did sound concerned about my kidneys. He's going to tell Mom and Bruce. 

Will I blog about this? Mom won't read it anyway [so I won't edit].

My Mania.

These are pieces of what mania typically looks like for me.

1. Trouble falling asleep or less need for sleep.
2. Less appetite but
3. Greater tendency to cook.
4. Tendency to clean walls, doors, or cabinets whereas I usually don't even notice them.
5. Need for constant stimulation, which may include a
6. Need to listen to music constantly or 
7. Drive to remain in constant conversation with others.
8. Tendency to sing or dance frequently as part of a 
9. Need to perform.
10. Psychomotor agitation that may include
11. Inability to sit still,
12. Shaking hands,
13. Fidgeting or odd posture, or a
14. Need to walk or pace, usually while listening to music.
15. Tendency to open my eyes too wide.
16. Racing thoughts, including
17. New ideas that may or may not make sense and a
18. Tendency to talk to myself or intense have one-sided conversations aloud.
19. Pressured speech, which can manifest as
20. Rapid speaking,
21. Interrupting (or struggling not to interrupt), or
22. Long, frequent text messages or E-mails along with a
23. Desperate need to say everything I think and feel.
24. Grandiosity, sometimes including a
25. Belief that everything I think and feel (23) is vital to me and some others, a
26. Belief that I am or should be fascinating to everyone (and great disappointment if I'm not clearly so),
27. Specific and often unrealistic moment-by-moment, emotionally-charged expectations of others (exactly what one will say or do), or an
28. Inflated belief in my abilities and even interests.
29. Overthinking and over-analysis of everything, including
30. Scrutiny of everything important people say and do, word-by-word, glance-by-glance, and a
31. Likelihood to become hurt, insecure, and combative with little provocation.
32. Obsessive thinking, which can include a
33. Desire to become completely enmeshed with someone or someones, a 
34. Conscious or unconscious belief that my happiness or wellness depends an individual or individuals, a
35. Need for hyper-intimacy, sometimes to the point of disrupting another person's routine, 
36. Intense bouts of research on a particular topic, or
37. Fixation on certain objects or ideas.
38. Intense attraction to lists, systems, categorization, and ranking, whether or not it is significant or makes sense.
39. Irritability, often related to 27.
40. Perfectionalism or a critical perspective, related to greater noticing of details (as in 4).
41. Impulsivity, which can include
42. Excessive shopping, particularly online and usually with a certain fixation such as makeup or paper dolls,
43. Starting arguments or escalating conflicts in a (usually futile) effort to get something I need, or
44. Making sudden changes in plans (which is usually unlike me) or making new plans.
45. Tendency to excess in activities such as
46. Prolific writing in some form,
47. Highly-focused reading or reading from numerous sources, or
48. Intensely-focused tasks or projects, whether or not they are valuable or appropriate at the time.
49. Greater awareness of and confidence in personal appearance.
50. Almost self-destructive vulnerability.