Wednesday, April 4, 2012

Alex's Hospitalization: Emergency Room

As I described in my last blog entry, an especially bad meltdown last month required my calling 911 and having police officers restrain Alex in handcuffs so that he would stop physically attacking Ed and so that I could give him an Ativan injection to sedate him. Once he was calm, Ed and I decided that even though it was the middle of the night, we were going to take him to St. Anthony Memorial Hospital in Michigan City in hopes that their Behavioral Medicine Department could help his extreme anxiety, agitation, and aggression. After printing off maps and directions from Google, I quickly packed a bag for Alex with his toothbrush and toothpaste along with a change of clothes. Since my dad knew how to get there, he led the way with my mom and me in their car, and Ed followed in our car with Alex.

Sleepy from his middle of the night awakening and the Ativan injection, Alex thankfully was calm during the half hour ride to the hospital. All the way, I kept praying that he wouldn’t erupt again en route because I wasn’t certain what we would do if he did. Armed only with Ativan pills, our cell phones, and my dad’s car equipped with OnStar, I guessed that we’d try to give him Ativan and call 911 for help. Fortunately, he seemed to enjoy the ride, and we didn’t need a contingency plan. About three-fourths of the way there, we passed a gas station that had a large brightly lit sign with the gas prices advertised. Since Alex has been fretting over high gas prices, I was extremely nervous that he’d see the sign listing gas prices over four dollars per gallon and get really upset. However, he didn’t seem to notice, which was a blessing. The good thing about leaving at 4 A.M. was that the two state highways we took to get to the hospital were free of traffic, so we the trip went smoothly.

Once we arrived at St. Anthony’s Emergency Department, we were relieved to see that the spacious and attractive waiting room was completely empty. As Alex, Ed, and my parents sat in the waiting area, I gave the emergency room clerk all the necessary information about Alex, his medications, and our insurance. A nurse soon took us back to an examination room, where we explained the two major meltdowns Alex had experienced within the past 24 hours. The nurse weighed him, took his temperature, pulse, pulse oxygen, and blood pressure while Alex remained calm and cooperative. She then took us to another room in the emergency room where Alex would spend the next few hours.

They had Alex change into a hospital gown, and we were able to convince him to lie on the hospital bed to rest. A doctor came in to examine him, and we again explained the day’s events surrounding Alex’s anxiety and aggression. The doctor ordered blood and urine tests, and we weren’t certain how cooperative he would be for those. I asked if they could use a “nun’s cap” specimen container in the toilet so that Alex could sit to give his urine sample, knowing that he’d be able to do that better than to urinate in a cup. Within a few minutes, he was not only able to provide a urine sample, but he nearly filled the large specimen collector. Two registered nurses, strong young men, came to take his blood samples, and Alex was remarkably calm and cooperative, even though they took five test tubes of blood. At that point, they told us we’d have to wait 60-90 minutes for the test results to come back from the lab before any decisions would be made about his treatment.

Since the room was small, Ed suggested that he would stay with Alex and that I should join my parents in the waiting room; the two of them would try to get some rest while we waited. I felt guilty about leaving them, especially since the waiting room had comfortable chairs, a large screen tv, and vending machines with food and drinks, but Ed was right that it was better for just the two of them to stay in the ER room. Concerned about how Alex was doing, several times an hour, I would check on the two of them and was relieved by the calm and quiet that he was fine.

Around 6 A.M., we knew that Alex would need Ativan, or he was likely to have a meltdown. I asked the nurse for an Ativan tablet, and we tried to give it to Alex, who was not cooperative at all. The nurse tried various tricks to get him to swallow the pill, but Alex became more and more upset. Since he wouldn’t swallow the pill, they had to give him an injection, and he fought that mightily, as well. Held down by the two male nurses and Ed, another nurse gave him the injection. Later these young men commented that they couldn’t believe that Ed had been able to restrain Alex by himself because Alex is so strong. Despite the injection, Alex continued to be agitated and aggressive, and he resorted to the only thing he could do with his arms and legs restrained: yelling and spitting. Because he refused to quit spitting, one of the nurses put a disposable face mask on Alex, which angered him even more but prevented him from spitting on them. After a while, they decided he needed more sedative, so one of the nurses used the call button to ask someone at the nurse’s station for a syringe with Haldol. Whoever answered his call told him that he’d have to ask his nurse for that, to which he responded, “I AM the nurse!” Soon another nurse came to give him the injection, and finally the sedatives kicked in, allowing Alex to calm down and rest, and giving the guys a rest from restraining him.

Once Alex was drowsy, I asked Ed if there was anything I could get him, and he asked for some coffee. He probably regrets that request; he later told me that he hoped the coffee I brought him was free because it was the worst coffee he’d ever had. Since it cost 50 cents and came out of the vending machine, I guess he couldn’t expect too much. The longer we had to wait, the more we worried that Alex would once again erupt, so I began hanging around the nurse’s station and asking questions. After finding out that Alex’s lab test results were back, I asked what they were waiting to decide. The shift changes had meant new nurses and doctors, and I had to figure out who knew what was happening.

Fortunately, I spoke with an emergency room clerk who had a take-charge attitude and was willing to make phone calls to find out what was holding up Alex’s admission. She checked with his nurse, the ER doctor, and the psychiatrist on call, and then we started to make progress. However, we encountered a potential setback when his nurse asked if we had a medical power of attorney document for Alex. Assuming that we as his parents could make medical decisions even though he’s legally an adult, just as spouses can make medical decisions for each other, we didn’t realize this was something we needed to have in place. When I told the nurse we didn’t, she explained that the ER doctor would have to have Alex placed under 72-hour emergency hold for psychiatric evaluation, and the ER doctor was willing to approve the emergency admission. However, we would need to get the legal papers drawn up quickly to have him hospitalized for longer than three days. Not long after that, a nurse from the Behavioral Medicine Department came with a wheelchair to transport Alex for admission to her department. When I saw that she wore her identification card on a lanyard bearing the name and logo of my favorite NASCAR driver, Jeff Gordon—similar to the Jeff Gordon lanyard I wear at work with my school ID—I knew God was sending me a sign that we had brought Alex to the right place. While we weren’t happy that we would have to leave Alex at the hospital, I knew I could entrust him to another Jeff Gordon fan, LeeAnne with her maternal compassion that put me at ease.

I’ll share more of our experience with Alex’s hospitalization in the Behavioral Medicine Department in my next blog entry.

“When you pass through the waters, I will be with you; and when you pass through rivers, they will not sweep over you. When you walk through the fire, you will not be burned; the flames will not set you ablaze.” Isaiah 43:2

No comments: