Writing in Crayon: A Night in the ER

I’m in a hospital room with almost nothing in it. A bed, with a single blanket and pillow. A chair. One of those narrow little tables you can pull over the bed, where they put meals. They let me keep two paperback books, and my notebook. I’m glad I remembered to get a notebook before we went to the ER. I asked my brother if he happened to have anything around without any wires, and he found me an old green composition book. 100 pages, college-ruled. That should last me, I hope.

I ask if I can have something to write with. Sometimes they let you have plastic pen-like things. I saw a box of them once, and it said that they were for maximum security prisons. Sometimes instead they offer pencils. In one hospital I was in, I got frustrated with the regular pencils, which were those tiny golf-sized ones, and started writing in colored pencil instead. One of the other patients got mad when she saw me doing it, because she felt that the colored pencils should only be used for coloring. She took coloring very seriously.

The nurse says that he can get me a crayon. This is new; I’ve never been to a place that didn’t allow either pencils or pens. I say, okay. He asks what color, and I say that black would be best, but I’ll take whatever they have. He comes back with a black crayon. It’s at least new and sharp, though of course the sharpness doesn’t last long. After a while it breaks in half, making it even more difficult to use it for writing. It’s slow, and tedious. For a person used to typing, which I imagine is pretty much all of us these days, any kind of writing by hand can feel slow, but doing it in crayon is definitely an extra challenge. I find myself only writing on every other line in the notebook, because I can’t write very small. It’s easy to smear the letters, so I have to not rush, and take my time with each letter. But for all that, it’s good to be able to write. No matter how bad it gets, I’ve learned over the years, it helps me deal if I can just put it into words somewhere.

I’ve been in lots of ERs, but never one quite this draconian. Usually they let you keep your cell phone until you get admitted somewhere, but this one made me turn it in right away. It’s hard to be cut off from the world already, especially given how little there is to do here. They also took away my hardback books. I still have Inspired, by Rachel Held Evans, which I haven’t started yet, and a travel-sized copy of the Book of Common Prayer. And of course my notebook, and the black crayon they brought me. I ask for chapstick, and they finally track some down, but they say that I’m not allowed to have it in the room with me. They put it in a plastic cup outside the door, and if I want to use it, I have to come out into the hall, where I can be observed. I wonder what kind of dangerous thing you could even do with chapstick.

They gave me a piece of paper with the rules. It explains that it can take a day or two to find a placement, and until then they will care for me in the ER. It keeps using that phrase—”care for”—and it feels odd to me. I’m not allowed to leave the room, or close the door. I have to ask for permission to go down the hall to the restroom. They took all my clothes, and I’m wearing a flimsy hospital gown and slipper socks. There’s one available phone, and it only makes outgoing calls. The paper warns that I’m limited to 10 minutes per hour on the phone, and that “if phone calls become disruptive to your case, phone use may be limited.” I quickly copied down a few phone numbers before they took my cell phone, but it’s challenging to get in touch with people when you can’t leave a callback number. I don’t like making phone calls even in normal circumstances, and I’m really missing the easy communication that texting offers.

I can’t see any of the other patients, but I can frequently hear them. They ask the guy across the hall if he remembers anything. He knows that he was drinking in a bar, but is fuzzy about what happened after that. They let him go after a while. Some of the patients have been here often enough that the staff recognizes them when they come in. One is demanding that someone bring him a cheeseburger and fries, but that’s not on the hospital menu. It sounds like some people are getting discharged to shelters. The fact that homelessness and mental illness are frequently intertwined is not new to me, but it’s still a little unsettling to listen to this, to wonder how often people are going back and forth between the psych area of the ER and homeless shelters, to wonder about that kind of life. I deal with mental illness that could be accurately described as both chronic and occasionally quite severe, but I’m sometimes acutely aware of my advantages in life.

The social worker who met with me was not happy. When I admitted that I hadn’t taken lithium in ten days, she said irritably, well what did you think would happen? I believe the situation to be somewhat more complicated, as my psychological meltdown happened while I was still on the lithium. Afterward it felt pointless to keep taking the stuff, since it didn’t seem to be doing anything, and I made less effort to keep up with it. I’m not sure whether to share any of that, though. In some ways it will be easier if I don’t, and instead just go along with the narrative of my difficulties being a result of noncompliance with my meds. That’s a story the staff will be familiar with, and it will get me off the hook as far as having to try to further explain what’s going on, which I can’t say that I really understand myself. Saying that you quit taking your meds is a lot easier than digging through the wreckage of your life in search of clues, and also allows you to avoid talking about intensely personal matters with brusque people who are taking notes. I decide not to elaborate.

The social worker is also very annoyed that I didn’t go to a hospital right away when things fell apart earlier this month. I tell her that I didn’t want to do that, and that my therapist and I agreed to try something less drastic first, so instead I made the four-hour drive to where my brother lives, to see if just getting away from my life for a while would help. Sometimes that’s been enough. But I can see from the reaction of the social worker to this plan that my therapist is going to get an earful. Sure enough, my therapist later tells me that the social worker told her that she should have had police waiting when I came to my next appointment, and simply made me go to the hospital. I’ve thought a lot about just how problematic that would have been. My primary reason for avoiding the hospital was that I don’t have insurance, and I feared that having huge medical bills afterward would be so detrimental to my mental health that it wouldn’t be worth it. Given that, if I’d been forced to go there, I would have talked my way back out as soon as possible, and would have been extremely stressed about the cost the entire time I was in. That’s not really a recipe for an experience that’s conducive to recovery. Also, it would have torpedoed the relationship I have with my therapist; I’m not sure I would have ever gone back to see her, and even if I had, I would have been extremely hesitant to contact her the next time I was in crisis. I feel appreciative that I have a therapist who gets all of that, and who resists paternalistic approaches to mental health care.

Of course, I did land in the ER in the end. But I was there of my own free will. I’d made the decision in conversation with my therapist, who was supportive, but this course of action hadn’t been dictated to me. That matters. After three absolutely terrible nights of feeling such intense misery that I just lay awake and tried to focus on continuing to breathe, unable to tell whether the sick horrible feeling I was experiencing was physical or psychological, I felt beaten down, and not sure I could keep myself safe anymore. My suicidality tends to be chronic, which means having to constantly make judgment calls—if you want to kill yourself most days, you can’t simply reach out for crisis care every time you’re suicidal. You have to develop some sense of when you’re actually in danger. It’s not an easy call to make, especially when you’re having to rely on a brain that is operating under the influence of depression. I get frustrated. When I see heartfelt sentiments exhorting those considering suicide to ask for help, sometimes I want to scream. It’s not that I disagree, really. But I wish it were that simple.

I’ve been in the hospital a lot of times now. And every time, I feel a nagging sense of failure that it’s come to this yet again. It’s hard to make myself say the words, “I need to go to the ER.” I hate being that person, that planet that’s not entirely stable (“Not entirely stable! I’m glad you’re here to to tell us these things!”) I know it’s not easy to have loved ones who are dealing with chronic mental illness. The depression already tells me that I’m a burden, that people might be genuinely sad if I disappeared, but that on another level they would also be relieved. The thing is, it’s not easy to have friends with these issues. I know that from my own life, from being on the other side. I don’t want to be the person with the problems that make life more difficult for everyone. But I don’t know how to make it better.

Fortunately, my brother and sister-in-law were very matter of fact about the whole thing. At this point my needing “a higher level of care” (as one of my therapists always used to say) is not particularly novel to anyone in my family, I imagine. My brother came and stayed with me in the ER for much of the day. After he left I dozed for a while, then spent some time reading, and painstakingly writing in crayon. I listened to the entire saga of a woman who was brought in after coming to the hospital with stroke-like symptoms, and who attempted to leave after some kind of communications snafu left her thinking nothing was wrong, and was then apprehended by multiple police officers on her way out. It sounds like the concern on the part of the hospital was that she was inebriated and they didn’t want her to leave in that state, and also they wanted to run more tests. She kept saying that she hadn’t all that much to drink, and that being stopped by the police, brought to the psych ward, and having everything taken away, even her clothing, was incredibly humiliating. They eventually sorted it out, and sent her back to a different place in the hospital. She was quite emotional, and sounded somewhat volatile, but I felt sympathetic. I like to think of myself as fairly high functioning and articulate, despite my emotional instability, but I have at times found myself crying hysterically in hospital settings over what would seem like minor incidents, unable to stop, and hating the fact that I knew this behavior was making others draw particular conclusions about me.

It’s a difficult night. There is a television blasting down the hall, and I keep hoping that there will be quiet hours at some point and it will be turned off. But that never happens. 1:00 am, 2:00 am—it’s still blaring as loudly as ever. I’m cranky about that. The people coming and going all night, the staff talking; that’s all par for the course in such a place. But this seems ridiculous. Also, while you can turn out the light in your room, that doesn’t help much when you have to have the door wide open and the bright fluorescent lights in the hall are still on. I lie in bed and think about how I’ve read that people use light and noise to keep people awake when they’re torturing them. I ask a nurse for earplugs. She’s very kind; I hear her call for them multiple times, even though I don’t bother her again about it. The earplugs finally arrive, and I can still hear the television fairly clearly, but at least it’s not as loud. I eventually drift off, and the next thing I know, the sympathetic nurse is patting my arm to wake me up. She’s very apologetic about having to wake me—it’s not yet 7:00 am—but she has to get my blood pressure. She says I should be leaving any minute now, and sure enough, in about fifteen minutes, some paramedics load me into an ambulance and drive me out into a cold, gray January morning.

I will end up in a crisis care facility for people without insurance. I’m lucky that there exists such a place in the large city where my brother lives, since there isn’t anything like that in the much smaller town where I live. They are hesitant to offer services to someone from out of state, which does make sense to me, but I think they eventually decide that since I’ve been staying with my brother, they can count me as a resident. So all I’ll have to deal with is an ER bill, which will probably be fairly large, since they ran all kinds of tests before letting me go, and an ambulance bill. I’m grateful that it’s not more than that, but I know that when the bills arrive, I will question whether it was worth it. That’s the other tricky factor in weighing the question of when to ask for more help—what will the impact of this decision be on my future mental health, if the bill turns out to be a big one? (This is why I have a hard time taking anyone seriously who talks earnestly about suicide prevention but is also in favor of gutting any kind of social safety net.)

In the ER that night, I try not to excessively second-guess my decision to take this route, but it’s hard. I know it’s not helpful to get carried away with rumination, but there aren’t a lot of distractions to pull me back out of the circular thinking. I contemplate what feels like an enormous number of bad decisions I’ve made recently, and wonder just how badly I’ve wrecked my life this time. I think about how my therapist must be feeling relieved that she doesn’t have to deal with me for a while, since I feel like I’ve been unusually difficult. I feel distant and shut down. I listen to the sobbing coming from the next room over and think that I could probably use a good cry. But I’m not in that place. I think about God, and wish I felt more connected. My religious conversion has helped a lot with the sense I had for much of my life that God was generally angry, and quite possibly out to get me. I don’t feel that, thankfully, but I do feel distant. I flip through my Book of Common Prayer like a security blanket. I know that I don’t deserve to feel loved, because I keep making terrible choices, but I wish for that anyway. I read through familiar prayers because I have some belief that there’s value in doing that even when I’m not feeling much spiritual connection.

I recently had a completely unexpected 18-month run of being okay with being alive. With down times, sure, but without crises. Without depression. I still don’t know what to make of it. It was so different from anything I’d known before. That it ended was not a surprise; the surprise was that it happened. It’s been about six months since things got hard again, and I’m losing my ability to access that experience. I remember it, though, at least intellectually. I’m not sure if I can dare hope for such a thing to happen again, ever. I am out of crisis residential now, and soon going back to my regular life. I have very little sense of or even belief in the future—sometimes that’s a side effect of depression—so I’m trying to focus on small amounts of time. This is not a moment when looking at the big picture is helpful, because the big picture only reveals how big the depression is, which makes me feel overwhelmed and exacerbates the despair. Instead I try to think about what I need to do today and maybe tomorrow, and leave it at that. Sufficient unto the day is the evil thereof, I hear.

I’m typing this on a bitterly cold Sunday. A snowstorm last night caused church to be canceled, and everyone in my brother’s family is hanging out at home. I’m looking through the notebook I had that night in the ER, the blurry letters in black crayon. When I got to the crisis residential place, they gave me some forms to fill out, and an actual pen with which to do it. I thought surely they’re not going to let me keep this pen, and wondered if I could hide it somewhere without being noticed. But mercifully, they were okay with patients having pens. Sometimes it really is the small things that make a difference between intolerable and bearable. I know I still have a hard road ahead of me. I’ll doubtless keep writing about it. I don’t know what else to do.