Posts for category ‘Hospitals’

On Sunday it dawned on us that Max need his drug levels tested. His psychiatrist had been asking for weeks for a report. She needed to know how much Depakote was in his system. Too much can cause liver problems. It had been difficult to schedule because we had to take him before he had gotten his morning meds.

Today appeared to be the best day to get him up to the hospital. When he first heard our plan Max dug his feet in. He was not going; he hates having the needle stuck into his arm. We were able to persuade him that the last few times things had gone really well and it would be quick. Ha, ha, famous last words.

Once we were there it looked promising. The parking lot was empty and there were no patients in Admitting. We sat down with the intake person and handed over the order from Max’s psychiatrist. In the process of filling things in the girl noticed that the doctor’s full name wasn’t available. We didn’t know the first name and the hospital wasn’t willing to accept incomplete information. They looked the name up in the hospital directory but couldn’t find it.

I left my wife and son to drive home to get it. Just as I pulled into the driveway I got a call that the hospital had found her correct name. By the time I got back the paperwork was done and everyone was ready to walk over to the blood labs. There we turned in my son’s records and then had to sit and wait.

This wasn’t going well. The longer Max waits the more he starts thinking. We knew that if the technician didn’t get us quickly he would decide he really didn’t want to do this. But he was good. When he was finally called he went into the lab without a problem.

All the way down he talked about how he had done this before and he wasn’t afraid. He hopped up into the chair and presented his arm.

But this is where the fun started. Sadly, I am being facetious here. As the girl took his left arm he asked if someone could hold his hand. The supervisor came over and grasped his right hand. At the same time she took his left hand and held it down. After this two mistakes were made.

If you have ever had blood drawn you know that when you stretch your hand out there are several steps they follow:

• They wrap an elastic tourniquet around your upper arm long enough to find a vein.

• Once found they clean the area around it.

• You now clench your fist.

• The needle is slid into the vein. You might feel a pinch.

• Once it is in place you are told to unclench your fist. This allows the blood to run freely.

• The technician attaches a tube to the needle and takes some blood. She will repeat this step until the required number of tubes are filled.

• When done, the needle is removed. A cotton swab and band-aid replaces it.

• You are finished.

The first mistake the technician made was with the needle. She slid it into the vein after having him clench his fist but rather than leave it there she began to move it.

Imagine your arm lying stretched out on a clock; your hand is pointing towards the 12. The needle is inserted from the 12 in the direction of the 6. Being dissatisfied with the positioning she turns the needle to the 9 o’clock position. Nope, it didn’t work. It is now switched to 3 o’clock before settling back in the 12 to 6 position. In the process she lifts and lowers it a couple of times. Imagine how that would feel.

As could be expected Max howled and we were stunned. We had never seen such a botched job.

Once the needle was in place and the first tube was inserted Max was never told to open his fist so the blood trickled out slowly and painfully. He cried the whole time.

When it was done they congratulated my son on how brave he had been and gave him some graham crackers. Just before we left my wife turned to them and told them that we had never had problems bringing him in for blood tests but he would probably not want to do it again. He had never been in so much pain and in fact until now he had only ever felt “the pinch”.

I am convinced they sent someone new down to practice on my son. Why else would a supervisor offer to hold his arm down while she was working? That had never been done previously. It is true the first time Max gave blood he sat on my lap and howled but that was before the needle ever came near him. He was very young at the time. It took over an hour but when it was finally completed I think he was surprised how little it hurt.

Even though he has never liked having it done the only struggles we had were when we tried to get him there. Once he was in the seat he would always sit through it without a whimper.

And he always gets a prize when it is over. Today he got a pen with four different inks inside. He can switch to whichever color he chooses at any one time. He has been asking for one of these for awhile and today he got it.

Even though he has his prize my wife and I know it is going to be a real struggle from now on to get him there. Why do they have to let novices practice on our children?

Frankly, I would like to get Max off any drug that requires blood tests anyway. And I would be much happier if he could get off of the drugs all together!

I’ve been talking a lot lately about the med changes my 8 year old son Max has been going through.  To accomplish this we needed to find a new psychiatrist.  For us this process was fairly simple.  We belong to a program recommended by our local Department of Mental Health.  We are working with a Family Therapist, Child Advocate, and Play Therapist who are all part of this group.  Since they already had a psychiatrist connected with them we decided to check him out.   However, problems can arise when psychiatrists have different philosophies.

History
When Max started showing signs that things weren’t quite right.  We saw him as a discipline problem that we had to address.  However, it wasn’t long before we realized that it was something else that was causing our issues with him.  But, like other parents, we had no idea where to look to get help.  Friends were pointing out what they thought was obvious and recommending drugs.  We did a lot of research; every time we found a symptom list we would say things like:  “He has that one but he doesn’t have this one.”  We were diagnosing him ourselves and not having a clue whether we were right or wrong.

His Pediatrician
Then it dawned on us that we should be talking to our pediatrician.  They are generally an excellent start in locating problems and how to address them.  In Max’s case, his doctor is considered one of the best in the state so we were comfortable taking his advice.

His conclusion was that Max has ADHD.  He prescribed medication that vastly improved his situation.  My son was able to go through kindergarten without any more problems.  During the summer he went to camp and was a model camper.  This was a vast improvement over the previous year when the owner kept threatening to throw him out.

We saw only wonderful things in the future.

The First Psychiatrist
During the second half of Max’s kindergarten year, at his doctor’s recommendation, we took him to see a psychiatrist to get a more clear diagnosis.  This woman observed him at play in 3 sessions over a 3 week period.  Her conclusion was that he was not only ADHD but he was also PDD/NOS, OCD and had sensory issues.  The second one, she told us, was because she believed that he fell into the autistic spectrum but she couldn’t determine exactly where.  He seemed to have bits of everything.  She decided not to change his medications because they seemed to be working well.

Hospital Psychiatrist 1
In the fall Max entered first grade.  September went very well but then everything fell apart.  He became very aggressive and uncooperative.  As a result he was suspended several times and they were threatening him with expulsion.  His pediatrician told us that his problems had progressed beyond the doctor’s expertise and he recommended we take him to a specific hospital emergency room.  The idea was that it was connected to their psychiatric ward and they could help him immediately.  Ordinarily it can take up to a year to get a child tested by a psychiatrist and we wanted to get help as soon as possible.

They suggested putting him into their psychiatric hospital for a few days so they could diagnose him properly.  So at the recommendation of Max’s doctor we agreed.  This was a horrendous experience for my boy that I hope he never has to go through again.  The psychiatrist abruptly removed him from his medications; we have since discovered that he should have been weaned off of them gradually.  Then he observed him for the next few days before coming up with an added diagnosis of Bipolar Disorder.  The new meds he recommended however were for emotional issues and didn’t really address the diagnosis.

Hospital Psychiatrist 2
The we spent next few weeks finding a new school because his old one felt that he required special help that they were unable to provide.  During that time we felt like we were in limbo;  Max wasn’t any better but he wasn’t any worse either.  Within 6 weeks however, he was behaving so poorly he needed to be hospitalized a second time.  The psychiatrist in this hospital added yet another diagnosis while agreeing with all of the others.  So not only did Max have ADHD, Bipolar Disorder, OCD, PDD/NOS, and sensory issues he now had ODD.  This doctor changed his meds and also recommended we start watching  “Super Nanny” and the “Dog Whisperer” to learn out to deal with the ODD.

And, oh by the way, all of these doctors seem to switch back and forth between calling Max PDD/NOS or Aspergers.  I’ve gotten into the habit of using them interchangeably.

Regular Psychiatrist 1
After Max was placed into a special school and was following a new recommended med plan we found him a permanent psychiatrist who, we believed, would keep an eye on him and change medications as needed.  What we got was someone who believed that there was only one protocol which was to stay on a certain medication for life.  The only deviation from this was to increase the dosage over and over again as the situations warranted it.  He did not believe in observing the child; he acted only on what the parents told him about his or her behavior.  As a result he became a “rubber stamp”, writing prescriptions based only on what he heard.

In the beginning this was enough to get Max through first grade but he had a lot of problems again in summer camp.  This time I decided he would not be going back because I did not like the treatment he was getting there.

Regular Psychiatrist 2
He did really well in second grade.  When summer rolled around we kept him in school which made him very happy.  The first half of third grade was okay but when he was moved into the fifth grade class he started doing better.  The problem we had though was with the psychiatrist.  All we ever saw was Max’s meds being increased.  The man had never spoken to him except to say “Hi”.  I was also becoming more and more convinced that Max was being overmedicated.  We needed something different.  At the recommendation of our family therapist and child advocate we decided to try their office doctor.

He initially seemed to be a good choice.  He spent more time with Max and advocated a med change;  the first step being to take him off his ADHD medication.  This doctor believes that a Bipolar child will not also have ADHD; the stimulants only aggravate the bipolar condition.

Regular Psychiatrist 3
We were in the middle of weaning Max off his stimulants when the doctor abruptly left.  Apparently he was only temporary and his contract ended.  It is this office’s policy to only keep doctors for short periods of time and then bring in new ones.  We were disappointed that this happened right in the middle of the med change but unlike any of the psychiatrists before her the new one seems to be taking a real interest in Max himself.  She will talk to him directly instead of through us so that she can see first hand where he is at.

But, yet again, we have a difference in philosophy.  She believes that ADHD and Bipolar Disorder can coexist.  As a result she is reintroducing the stimulants.

Conclusion
Whew, that’s a lot of doctors!  It wasn’t until I sat down to write this that I realized how many.  Is there any way to find a good doctor before ending up working with so many?  From my observations I’ve come up with some suggestions:

1. First thing is to find psychiatrists that your insurance will cover.

2. After compiling a list it is a good idea to find out how quickly they can see your child; if they have a good background in your child’s area; and if they are flexible in their treatments.  Your child’s pediatrician may be able to help.  Remove the ones that won’t work from your list

3. Use the first couple of visits to check out a doctor; start with ones on your shorter list.  Make sure they can work with your child.  How well do they get along with him.  Does she respect your child?

4. Start with one doctor that you like and try his treatment suggestions.  Make sure you are comfortable with the way things are proceeding.  Are you happy with the results?

5. If one doctor doesn’t work, try another one.

We can’t give up.  Maybe we need to see more than the ones we’ve gone through all ready or we might be very happy with the most recent one.  All psychiatrists are different and unless we do our research, testing, and observing we probably won’t find the best one for our child.

I stopped at my Mom’s this morning.  As usual she had a lot of suitcases for me; I left with over a dozen of them.  Ever since she heard about this organization, Suitcases 4 Kids, she has made it one of her missions to collect as many as she can find.  I pick up 4 or 5 whenever I stop in.  Today was the mother lode!

Why does she have so much interest?  The organization’s goal is to supply suitcases for the 510,000 children that are in the foster care system in the United States.  These are the kids who are constantly on the move from hospital, to foster home, to group home, and hopefully to a family that keeps them.  And they move with all of their belongings stuffed into garbage bags. This is their life.  Suitcases help to boost their self esteem; they are not throw away kids!

Mom finds it amazing that there are so many children like this; and this number doesn’t include those that are homeless.  In her day these kids would have been absorbed into their families  She herself had several cousins that grew up with her when their parents could not take care of them anymore.  As a result I also had cousins living with us when I was growing up.

There was a time when families could do this.  Hillary Clinton once said that “it takes a village to raise a child”.  In those days  people could take care of their own.  Grandparents, parents, and children lived in the same home.  Uncles, aunts, and cousins lived next door and down the street.  Today no one lives close.  I have two friends that live in Massachusetts but each has family in California; a lot of my wife’s relatives are in Canada.

So where do these children go?  To state facilities; as more and more families break apart more buildings spring up to take care of them.  Just today Mom was telling me that her town is trying to build a small mental hospital just a couple of doors from her house.  The neighbors are up in arms about this and they are trying to fight it.  So again, where will these kids go?

The interesting thing is that this hospital will replace several Section 8 houses that no one even knew were there until now.  These are government-sponsored affordable homes for low-income families and individuals.  The neighbors are using horror stories that they’ve heard about these homes to try to stifle the hospital.  They are fighting to keep these places even though they hate what they’ve heard.  As I said to my mother, “they want to keep the devil they know rather than the devil they don’t.”  I don’t know who originally said this but it really fits here.  But don’t get me wrong I am not saying I believe the hospital is bad; the neighbors are afraid their property values will go down.  Apparently this is more important than our kids!

On a side note, Eunice Kennedy Shriver just died.  Today the Kennedys are having a public wake on Cape Cod today.  No matter what people’s personal or political thoughts are about them no one can deny that the Kennedys have done a lot for the disabled, homeless, and other disadvantaged people.  For example, Eunice started Special Olympics in her back yard.  Maria Shriver, besides being the First Lady of California works with Alzheimer’s.  Caroline Kennedy works with the homeless.  Ted Kennedy has sponsored many bills to help the disabled.

And now we have this small foundation, Suitcases 4 Kids who is looking to help foster care children as much as possible.  They would like new or lightly used suitcases, backpacks, and duffel bags.  Every day in her travels my Mom keeps looking.

If you have any please don’t hesitate to help these kids out.  The website gives locations where to send them.  Mom has it easy, she finds them and loads them into my car, and then lets me worry about how to get them to the foundation.

Have you been keeping up with everything happening with President Obama’s Healthcare Initiative?  I have found it confusing especially since I started watching the cable channel devoted to the goings on in the Senate.  Of course, the Democrats want one thing and keep going on and on about how the Republicans are trying to stop any reform that will benefit the country.  Meanwhile the Republicans are complaining that the package that the Democrats in both the Congress and Senate will bankrupt the country while limiting all the choices that Mr Obama promised.

Who is right?  I don’t think any of the politicians are.  And they won’t be right until they start listening to their constituents.  I recently came across a series of videos that attempts to put our current healthcare situation into some perspective.  There are 14 and are only 50 seconds to 8 minutes long (note, some videos have several parts to them).  None are slickly packaged; each is about someone like you and me who has had issues (good and bad) with our current healthcare system and what changes, if any, they would like to see.

All are worth watching but since they are all homegrown some are better than others. This is the first one:

“When I first brought up this video I was afraid it was going to try to sell me a position (pro or con) on government healthcare.  But like the rest of us Ms Keenan has only voiced her concerns about what the final outcome may be.”

Each video covers a different aspect, some talk about their insurance coverage, others tell stories of their harrowing experiences with the current health care system, and still others don’t even have insurance.  All would like to know what the future of healthcare is and what they would like to see included.

Most of them like the idea of a single payer system but they regret that it is not even part of the government discussion right now.  And of course there are those that argue along party lines, that is, why the Republicans are wrong and why the Democrats are on the right track.  But aside from that we can learn something from what each person has to say.  And for me it was a great start in understanding all the issues without having to listen to the politicians’ versions.

After seeing this video you can watch the rest of them and then think about your situation.  What experiences have you had with healthcare and what would you like to see happen.  If you are from Massachusetts what do you think of their healthcare plan.

For those of you who don’t know, besides the standard insurance company plans, Massachusetts has two of their own.  The first one is called MassHealth.  It is for people who are under 19, over 65, or are disabled.  The second program, Commonwealth Care, is for those people between the ages of 19 and 65 and are in good health.  Costs for these are based on your income level.  In this state everyone must have insurance so these were made available for people that can’t afford regular health insurance.

Chances are you or a loved one will at one time or another spend some time in a hospital. You may go in for something physical such as an operation or even tests such as a colonoscopy. A family member may need to go into a psychiatric hospital, perhaps just to evaluate the medications they are on.

Before going into a hospital remember: there are good hospitals and there are bad hospitals. It is up to you to make sure that the one you use is the best one.

There is a difference between regular hospitals and psychiatric wards. In the former an entry date is scheduled. You have time do your homework. In most cases going to a ward is done through an emergency room. The staff calls the different hospitals looking for a bed. They then expect you to be admitted that very moment. And you are taken there by ambulance; there are generally no walk-ins.

What do you do in this case? Be proactive and learn as much about the hospital as you can.

But how do you determine which are the good ones? These tips will help you make your decision. Some of them were suggested by Ron Nickerson. As a clinician he helped set up the children’s psychiatric ward at Tufts New England Medical Center in Boston Massachusetts. It is one of the best.

Ask for help. Don’t be railroaded into making spur of the moment decisions. Talk to other people. Talk to other parents. Find out who has used the hospital and get their comments on it. Don’t do it alone. Getting help can spell the difference between a good hospital and a bad one. If you have a time limit for bed space, get on the phone immediately. Do as much homework as you can before the ambulance arrives.

Make sure your Insurance will cover the hospital stay. Most hospitals will make the call for you but do it yourself also. There are many stories of people being told that their insurance will cover them in the hospital. Later on they discover when the bills start coming in that the insurance plan didn’t cover their specific case such as psychiatric care. Make sure your insurance will pay for other things besides the hospital. There are a number of items that may not be covered that will be billed later or separately. These include doctors, emergency room, emergency room doctors, and ambulances. Don’t rely on the hospital to check this out for you or even inform you of these extra charges.

Determine if hospitalization is needed. For regular procedures a second opinion is always necessary. If these opinions conflict get a third one, especially if we are talking about a major procedure. If a psychiatric hospital has been recommended perhaps only a medication change or a reevaluation is required. These can be taken care of a lot of times on an outpatient basis. Do your homework, there may be alternatives. In the case of a need for an immediate decision, call your psychiatrist and pediatrician/primary care physician to determine if the stay is essential.

Check out the cleanliness of the hospital. Have the floors at least been swept? Is there trash in the rooms? Are the windows washed? Are the rooms and desks cluttered? If there is a refrigerator, is it kept clean? Would you live in a house that is kept this way? Assume that however the hospital or ward is kept is the same way they will treat you or your loved one.

Observe the staff’s attitude. Do they grumble and complain? Do they mope around the floors? Are they bright and cheery? Do they enjoy working with children? Are they friendly? Don’t be afraid to ask them if they like working there. Their attitudes will affect the way you and or your loved ones are treated.

Find out the procedures used to handle out of control children. Are they restrained? Are they put in a quiet room? Are they ignored? How are the children calmed down? Be sure you understand the procedures. Better yet, try and observe them.

Make sure of the visiting hours and phone call procedures and find out if they are negotiable. Regular hospitals may have visiting hours from noon to 2 pm, then 4 pm to 6 pm, and 7 pm to 9 pm. Psychiatric hospitals are generally limited to the hours of 6 pm to 8 pm. It is tough on a child if they can only see their parents for a couple of hours in the evening. The main reason given is that with parents around a lot the staff cannot observe the child’s behaviors properly. However, will they allow you to visit more often?

Does your loved one have access to phones and what are the restrictions? How often will they be allowed to call you or you call them?

Does your child interact with older or younger children, adults, and geriatrics? A 6 year old child that is placed with older children can get quite an education. Not only that but their safety might be in jeopardy. Some psychiatric hospitals have been known to allow older children to supervise younger ones. The best procedure is to have all of these groups in separate wards.

Find out what the hospital offers for parent groups. Some will bring the parents together to discuss the problems each has with their children. There may be training sessions. There might be parent/child playgroups.

Get involved. Join the available groups; learn as much as you can. You can also learn a lot about how the hospital operates.

Get to know the human rights officer, director, and staff by name and number. Call and speak to them by name. Ask them a lot of questions and be in daily contact.

Check the nurse to counselor to child ratio. A good ratio would be 3 children per counselor and 3 counselors per nurse. If there is a larger ratio, for example, 10 children per counselor it probably means that less attention will be paid to your child.

Ask a lot of questions. There are some suggested questions listed above. Come up with your own. There are probably a lot you can think of that specifically concern you or your loved one.

You will notice that a lot of these tips are specific to psychiatric hospitals and to children. You may not need to use all of them if you are entering a regular hospital. But if you make small modifications, they can. For example, if this is about you wouldn’t you like to know the nurse to patient ratio (rather than counselor to child)? Will your nurse be supporting 10 or more patients? You could be waiting a long time to get your needs met.

It is tough enough having to spend time in a hospital. In the end following these tips can make your stay or that of your loved one more pleasant.

I hope everyone had a nice Memorial Day holiday.  Did you have a chance to honor anyone?  As most of us know this is the day we commemorate the men and women from the United States who died while in the military.  It first became a holiday to honor both the Confederate and Union soldiers that died in the Civil War but after World War I it included American casualties in any war.

It is also the day that I celebrate the veterans.  I applaud them as they pass by during the parades.  I go to the cemeteries and watch the ceremonies.  This year my town honored a young soldier that had fought in Iraq and won many medals, but was actually killed while on leave back here in the States.

I also honor my Dad.  He was a veteran of World War II and died in the 1980s.  For many years now I have gone to clean his gravesite on the Saturday before the holiday.  He has two stones, one at his head, and one that was installed by the military at his feet.  I rake the area, clip the grass around the stones, and weed and edge the dirt and grass around them.  After that I wash the stones to make them shine for when my Mother arrives on Monday morning to place a single red rose on the plot.

This year my boy Max joined me.  He was fascinated by what I was doing and immediately joined in.  He is 8 years old and my Father never had the pleasure of meeting him.  This didn’t stop my boy from honoring his Grandfather.  Towards the end of our work I realized I had forgotten something to clean the stones with.  Without a second thought Max took off his tee shirt and rubbed them both down.  It amazes me sometimes the initiative he shows at such a young age.

As we worked I told Max stories about his Granddad.

Dad, his brother, and their father all were in World War II.  My grandfather served in the south pacific while his sons were in Europe.  Dad was a prisoner of war camp guard before joining the army air corps (the precursor to the air force).  He loved to fly and parachute.  When I was my son’s age he would take me out to Orange Massachusetts where there was an airfield.  We would sit on the side of the road and watch the jumpers falling out of the sky.

After the war he got married, worked, and played hard.  He was an extreme skier, parachutist, hunter, and boater.  He gave all of this up when a friend ended up in a body cast for a year from a skiing accident.  In those days there wasn’t any insurance and he wouldn’t be able to afford supporting a wife and a half a dozen kids if he got hurt.

He was a school teacher who also worked several part time jobs to keep food on the table.  And he loved kids.  If he could have, he would have had a dozen.  As it was he had 5 of us; and along with our mother, a couple of cousins, a grandmother, and a grandaunt he had his work cut out for him.

In 1980 he developed throat cancer.  He had been a heavy smoker for years so his doctors weren’t surprised.  To combat his illness they buried gold nuggets into his throat so that they could give him radiation and that seemed to work.

For 5 years he appeared to have recovered but at the same time he was unable to stop smoking.  And then in the end it was discovered that the cancer had spread throughout his body.  It was time for chemotherapy.  This time he lost his hair and wore a wig from then on.  He began to waste away and still he could not stop smoking.  He used to joke about losing his teeth.  He could actually take them out of his mouth with the root intact and then place them back in.  When questioned about the cigarettes he would shrug and say that he had lived a good long life.

In the spring of 1985 I found and put an offer on a house.  Dad cosigned the purchase and sales agreement with me.  I had to keep leaving the real estate office at the time because I kept coughing uncontrollably.  I later found I had walking pneumonia.  I recovered but Dad kept getting sicker and sicker.  At the final signing I went to the office alone and signed the papers.  My Dad was not able to travel then so the agent brought them to his house so he could sign them too.  She actually guided his hand as he wrote his name.

After she left he couldn’t even function.  My brother and I put him in a chair and carried him out to the car while my mother towed his oxygen tank behind us.  After we placed both him and the tank into the car we drove to the hospital down in Boston.  After putting him to bed my Mother placed on the table the usual bowl of M&Ms that my Dad always kept for the nurses during his stays here.  Not long afterward he was loaded up with morphine and entered a drug coma.  This was Saturday, on Tuesday the doctors recommended we take him off of life support.

The doctors were amazed that he fought to stay alive even in his coma.  On Wednesday morning I went to work.  I just couldn’t imagine there would ever be a time when my Dad wouldn’t be around.  But part way through the morning I left the office and went to see him.  I took the elevator up to his floor and waited for the door to open.  At the very moment the door opened my family was standing on the other side waiting to go home.  I missed his death.

The death certificate said “cause of death: pneumonia.”

It took two years for me to finally mourn his death.  In 1987 I was in Jamaica with my brother.  Late one night I was lying on the beach and it finally hit me that he was gone and I wept until the early morning.  I didn’t go to his grave for 9 years after he died.  I don’t know if I blamed him or me for his death but I had dreams constantly of the doctors finding a cure and using it to revive him.

In 1994 I finally visited him at his grave and I have been going several times a year ever since.  And on Saturday Max and I performed our yearly ritual of cleaning his grave as we honored my Dad for all that he did for his country and for his family.

Max came home from his first trip to the hospital at the beginning of January.  Sadly, it seemed like we had brought a different child home.  Our happy-go-lucky 6 year old kid was now quiet, withdrawn, and anxious.  But it didn’t stay like this.  The anger that he showed before Christmas that resulted in several suspensions started to become more pronounced.  Unhappiness also began to emerge.  He seemed to spiral downward.

Looking back at it now there are things that we could have put in place to help him.  At the time we were into the first three months of these behaviors and we were stunned and didn’t handle things too well.  Other people continued to recommend spankings or more medication.  One person suggested he’d take my son away for a week and Sam would come back a changed boy.  He didn’t elaborate on what he would do in that week.

I went away at the beginning of February for two days.  By the time I came back the situation had gotten out of control.  The violence had become extreme.

We had to take him to the emergency room one day after he tried to hurt himself.  He became hysterical while we were there.  When the nurses tried to medicate him it was the final blow and he went wild.  As a result they locked him in a room expecting him to calm down.  But that didn’t happen.  My wife and I joined him to prevent him from smashing his head and body against the walls.  When he turned on us a security guard stayed in the room with us.

Later despite our protests they injected morphine into his inner thigh.  I had to hold him down while the nurses took care of the shot.  Late at night he and my wife finally fell asleep on a mattress on the floor.  I went home to collect changes of clothes, food, and toiletries.

What was the emergency room doing during this time?  Looking for a bed in a psychiatric hospital.  They first tried the place Max was in originally.  There was nothing available so they branched out, calling other hospitals in the state.  It took 36 hours for them to find a place for Max.  The whole time we were locked away.

An ambulance arrived to pick him up.  Psychiatric wards and hospitals don’t generally take walk-ins; you have to be transported by an ambulance.  Max and his mother settled in for the hour trip.  Max was calm now, I assume from exhaustion and morphine (though it had been about 20 hours since he had been given the injection).  I followed behind in my car thoughts running through my head about what a terrible dad I was for putting my boy through all of this.

It didn’t help that the emergency room psychiatrist working with Max told me to “suck it up and be a man” when I mentioned I thought Max would have a nervous breakdown when he discovered he was going back into the hospital.

We were admitted to the hospital but as we discovered from our first hospital visit our insurance didn’t cover any of this.  Not to worry Massachusetts has a health plan for kids who aren’t covered by other insurance.  The hospital helped us put the paperwork together and applied for us.  Max was covered within a week.

This wasn’t the only good thing about this hospital.  It turned out to be a “breath of fresh air” after the horrendous experience in the first one.

Max wasn’t thrilled about staying but he was a little more comfortable when he discovered that there were a dozen kids his age.  There were no older children.  He also had a roommate he liked.  The staff was wonderful and totally involved with the kids.  There was daily classroom instruction and they were very protective of the children.  We got to know the whole staff not just the ones that were assigned to Max.  They constantly gave us progress updates and we saw the doctors on a daily basis.

Even though visiting hours were from 6 pm to 8 pm they were very flexible. Max got to call us as often as he wanted but there was so much to do it wasn’t nearly as often as the first hospital.

What I found interesting and nice was the book the staff supplied us with included profiles, pictures, and phone numbers for everyone including the doctors.  It also contained any information that we needed about the hospital.

Did I mention that everything was clean?  Everyone took as much responsibility for the ward’s appearance as they did for the children.  It felt relatively good being there.  Home is better of course!

And the ward kept the parents involved.  We meet with the other parents once a week and talked about home life and got suggestions from the hospital on how we could change the structure here.  There were even sessions where the parents, kids, and staff got together and played games.

It turns out that some parents look at this as a place to dump their kids so they can take off on vacation.  Max’s roommate hadn’t seen his parents once since he got there.  He had been there before my son had arrived and was still there when Max left.  We visited my son at least once a day for 3 hours for the 15 days he was there.

Max was a little happier here but of course he wanted to come home.  And we wanted him home too!  He still clung to us and cried when we left at night but not as vigorously as before.  But he collected every little bit of trash he could find.  His hospital drawer was filled with elastics, broken toys, lint, and even the dose cups he got twice a day for his meds.

When he was released we didn’t go right home, we went to his favorite restaurant to celebrate.

Ever since we got home we have been working on procedures to help him.  We have a lot of retraining to do for both him and us even now over a year later.  In another post I’ll talk about them but for now he’s home and we are working to keep him from ever going back!

As a result of his stay we got a new med change that was much better than the last.  As far as diagnoses are concerned he still has pdd/nos, adhd, and sensory issues but three more have been added to the list: bipolar disorder, odd, and ocd.  Where will it end?

“Why?” is the first question I get when people ask me about Max going into the hospital.  But then they really don’t want to hear the answer.

We had noticed for years that there was something not quite right.  Max was a wonderful, happy-go-lucky 3 and 4 year old. He loved meeting people especially young women.  When I took him to the playground he would see a young mom, pick a flower and run to hand it to her.  He would pretty much know everything about her before he moved on.

He was very good one on one but had a very difficult time with groups.  He would hang on the edge and do his own thing instead of joining in.  When he started kindergarten things were devastating for him.  Not only was he in a classroom of 26 students but the bright neon lights and the clutter had a major effect on him.  There was too much sensory input and he began acting up considerably.  He had a wonderful teacher that worked with him, the special ed teacher, occupational therapist, and us to determine what he needed to survive.  She put together a program of breaks, occupational therapy, and rewards to get him through the day which became his individualized education program (IEP).  About that time he was diagnosed not only with sensory issues but also adhd and pdd/nos.  He started receiving medication for these conditions.  As a result of all of this he had a wonderful kindergarten year.

Things started going really bad in first grade.  First month was fine but it then went down hill from there.  The school refused to follow the IEP put in place the previous year.  They insisted he was older now and things had changed.  “Trust us,” they said, “we have been trained.”

And they kept saying this even though Max got worse and worse.  When the school tried to physically prevent him from doing things such as continuing one subject when the class would move on to another he would become aggressive.  To stop this he would be restrained by 4 teachers and was suspended several times.  Max was 6 years old and small for his age and my wife who is small as well has always managed to calm him without extra help.

Max’s pediatrician suggested we take him to be evaluated for a med change.  Though he was very experienced with helping kids with adhd and sensory issues the doctor believed that Max may have other issues.  He pointed us to a specific hospital and told us to bring our son to the emergency room because the psychiatric department was connected to it and they would be able to do an evaluation right there.   The idea was to get passed the 6 months to a year waiting period it now takes to schedule psych exams.

The day after Christmas when Max was 6 we took him to the hospital.  It was a Thursday.  As with all emergency rooms we had to wait, and wait, and wait.    We were finally seen by a psychiatrist who was more interested in letting us know what bad parents we were than checking Max out.

A short time after she left a nurse came in and started talking to us about our situation.  He told us that it was going to take a lot longer than a couple of hours to diagnose Max’s condition.  He suggested we admit him to the hospital’s psych wing for a week to determine what was going on.  He made the place sound very wonderful.  Great staff, a lot of kids Max’s age, schooling and playtime every day while the doctors examined him.

When would he need to go in?  We were informed it would have to be right now, there was a bed available and he could go right up but if we waited another child would get the bed.  This was not something we had planned for, when Max was initially diagnosed we had taken him to Boston over a three day period and he always came home at night.

When we both did a gut check my wife and I were very bothered by this.  While the nurse went off to see if we were covered by our insurance we started making our own phone calls.  We called Max’s pediatrician, who was out of the country at the time, he didn’t like the idea but thought it was the best thing for him.

We called a family member who is a social worker.  She hated the idea but thought it was the best thing for Max.  We talked to a child advocate friend of ours who was also against the idea but again, she thought it was best for Max.  And we even called my wife’s therapist who had worked with Max a little bit and she had the same reaction.

As a result we agreed that it was best.  Then the nurse came back to let us know we were covered by our insurance.  Okay, he’s going.  I asked for directions to the ward which it turns out is in another town.  Nope that’s not the way it works, to get into the ward he would have be taken by ambulance.

Max and his mother were loaded up in the ambulance, and with me in my car behind, off we went.  It was dark and I almost lost them a couple of times, or it may have been because of all the water on my face at the time.

When we got there, we had to go through two sets of locked doors.  On one door was taped a sign that read “watch out for elopements”.  I thought that was curious but found out several days later that an “elopement’ is when one of the children escapes from the ward.

We were given a tour and saw only one other child, besides Max, a teenager.  Where were the others?  The children had checked out for the day to be with their parents since it was the day after Christmas, they would be back later on we were told.

Max loved the idea of an overnight, he had never been away from home and we left after signing all the papers and promising we would see him on Friday.

We are only supposed to be able to see Max between 6 pm and 8 pm.  When we asked about this on Friday night they told us they could be flexible.  Well I sure hope so; there were still no kids there.  Max tells us that he plays with the one teenager.  We stayed the two hours; we read to him and had dinner with him.  This became the routine for the rest of the time he was there.

What also became part of the routine were the hysterics when we got there, begging to come home while we were there, and hysterics when we left.  While we were at home we would get constant phone calls from Max begging us to come see him.  There never were any kids his age the whole time he was there but more and more teenagers showed up.  There was violence and a lot of foul mouths.  It was not a safe place for him.

On Monday I told them I wanted him out.  I did not like what was happening with him there.  And as far as I could see there wasn’t much evaluation going on, no medication changes, nothing!  The doctors tried to reassure me they were working hard to help him and this was the best way to do it.  No, he’s coming home!!!  They then showed me a line in the contract that says that once a request like mine is made the doctors can take three days to decide whether they will let him come home.

And Max would still have hysterics as he watched us through the window go home at night.  And the staff kept telling us this was normal.  And his Mom and I knew in our hearts that this wasn’t right and we wanted him out.

On Thursday they informed us we could take him home on Friday.  We got him!  Their diagnosis?  Same as what we had before.  Medications?  Made some changes.  Recommendations?  None!

And the results?  This happy-go-lucky kid was now quiet, moody, and had very high separation anxiety.  He didn’t like to play.  His medications still weren’t right either.  Since then he has never picked a flower for a girl in the playground.

To add insult to injury it turns out our insurance didn’t cover the hospitalization and a month later the bills started coming in.

Today, a year and a half later, Max is 8.   If you ask him what the best memory he has of the last 8 years it is when they let him turn on the juke box in that hospital.  What is his worst memory?  Being there!!