Thursday evening Kitty was hospitalized. I gave her her regular meds before I left the new psych hospital. I warned them that she hadn’t had her laxative in almost a week (because I’d run out and so had the store) and was already having trouble.
Friday, I was told they wanted to take her off all her meds except for the Trileptal (weak mood stabilizer), because the doctor thought she was on too many meds. It was my understanding that this would be almost a med wash. I approved adding Seroquel XR to help her sleep at night.
Over the weekend I was told they wanted to add Wellbutrin (an anti-depressant, that can help with weight loss). I said I wasn’t thrilled about adding an anti-depressant, and that I thought she’d been on it before, so I wanted them to review her records before I approved it. It didn’t make much sense to me in light of them wanting to see what she was like without meds. I gave Kitty a heads up that she would be at the hospital for longer than usual while they adjusted her medication.
On Monday I was informed by Kitty’s case manager at the psych hospital that she and the psychiatrist had told Kitty about the “med wash” and that she wouldn’t be able to “skate” through this hospitalization waiting for her five days (what Medicaid typically covers) to be up. That they could keep her up to 6 weeks. She said Kitty looked like she was going to cry and admitted that she does pretend she’s better whenever she’s ready to go home. I tried to assure them that Kitty probably isn’t trying to manipulate the system. She’s mostly just homesick, and psych hospitals are not going to fix her issues anyway. Her biggest problem is trauma. You can’t fix that with meds, or a couple of sessions on calming techniques (she could probably teach the class! – she just can’t access it when she needs it). This is why we’re trying to get her in residential treatment.
The case manager gave me more information about why they wanted to replace Depakote with Wellbutrin: that it would help with her weight, worked as an anti-psychotic as well as an anti-depressant, and didn’t typically cause mania (unlike most anti-depressants). I questioned how this was a ”medwash”? but really didn’t get a good answer. Just that the doctor has a preference for different meds. I also wanted to know how do you replace a mood stabilizer with an anti-depressant? They’re not the same thing. I questioned why we’re not trying Lamictal, which is a mood stabilizer. Basically she didn’t have an answer.
So Tuesday I went to family therapy. I was late, and the therapist apparently didn’t hear the page that I was there so we got off to a great start. Kitty came in, and they announced that it was up to me, but she could be discharged as early as tonight. I WAS FLABBERGASTED! Kitty and the therapist start talking about all she learned in therapy (BS! BS! BS!). I just sat there stunned.
Finally, phrasing it as gently as possible to not trigger Kitty’s abandonment issues, I told Kitty of course we wanted her home, but how in the world can the hospital believe that taking her off most of her meds and then sending her home is at all the right thing to do?! The therapist had no idea that we’d been told Kitty would be staying for weeks. The case manager of course wasn’t working today and the pdoc was on rounds and unavailable. They got the case manager’s supervisor on the phone, but she didn’t know anything specific about Kitty.
When they finally realized I was REALLY unhappy, they assured me that when I approved the Wellbutrin, which I was assured was really a miracle med that wouldn’t cause mania even though it’s an anti-depressant (Bear takes it so that wasn’t actually my concern), they’d be happy to keep Kitty for several more days to make sure that she didn’t have a negative reaction to the Wellbutrin. I repeated that I was more concerned with the fact that this was a child with mega trauma issues that “presents well,” who is barely able to stay emotionally stable (6 hospitalizations!), and they’ve reduced her meds by more than half, and then are dumping her right back into family and school. I explained a little bit about the problems we are having with the school.
I asked for them to write a note stating that Kitty needed to be homebound for awhile. They agreed to fax us an excuse for 7 to 10 days while we wait to make sure there are no negative side effects from the Wellbutrin (– school is out for the holiday, but that only gets us through next Wednesday if we’re lucky, and then we’ll be right back to being “punished” by the school). With that taken care of albeit temporarily, I told them I was taking Kitty home right then.
When Kitty had left to get her stuff and the therapist continued to express that they could keep Kitty a few more days if I was worried, because she obviously recognized that I was NOT happy. I finally told her flat out that I wanted Kitty out of there, because I felt they’d messed up her medications and I didn’t see a point in delaying getting them fixed.
When Kitty came out with her stuff, the therapist let us out of the building and the main gate and waved at us as she drove past us walking to our van. As I was sitting in the car, still fuming, I suddenly realized there was something really wrong with this discharge. It should have been more complicated than walking off campus with Kitty and her garbage bag full of stuff. While we were still sitting in I finally called the hospital and asked if it was really that simple. They asked us to come back in and fill out the discharge paperwork.
As we drove away, I realized that it wasn’t too late to call Kitty’s pdoc. The next available appointment wasn’t until the end of December, but by a weird fluke (or Godincidence as I prefer to believe) the appointment I’d cancelled for tomorrow (Wednesday) hadn’t gotten cancelled (I cancelled it because I thought she was going to still be in the hospital) or she’d had two appointments for some reason and I’d only cancelled one. So joy of joys she has an appointment tomorrow.
She was a little manic all evening, but seemed OK, especially after she’d found out she didn’t have to go back to school right away.
Wasn’t sure what to do about meds tonight. Gave her the Trileptal, and the constipation meds they hadn’t been giving her, but didn’t want to fill the prescriptions given to me by the hospital. The only Seroquel we have in the house is 300mg and she only needed 50mg so we skipped it.