just a bump in the road

So Elizabeth is back in the hospital and I'm just fine with it. After all, she has a chronic condition which has an acute flare-up every now and again. Some things I can prevent and some things just are. And this trip falls into the second category.

She has done well with a relatively unstructured summer. I signed her up for two weeks of camp with a couple of weeks in between. She did great at the first week right up to 4:30 Friday, when she had a freak-out and had to be briefly restrained. She was able to process this with a couple of people, something that just isn't her strength. Before she went back, the camp director, her community support team and I all talked. We made sure there was every support in place, constant one-on-ones, my talking to the staff, a crisis plan. But there is always something you can't plan for.

The unplanned thing was a lice outbreak. I had her checked and she was clear before camp started, but on Monday, they found a louse and a nit. We went into town, bought the chemical stuff, raced to a local friend's house, washed and combed her, and then I took her back to camp, all before 10:30 am. She was able to reintegrate into camp just fine. Tuesday she was clear, but she was pretty fragile by the end of the day. Wednesday they found more nits, so we drove all the way home (45 minutes) to do the washing and combing thing again. She was back by noon and seemed okay.

But she wasn't. She didn't want to leave when it was time to go because she didn't want to leave her favorite counselor, Addie. After the first camp, I could see she was becoming obsessed with Addie and I talked to her about it, as did her therapist. When it was time to go Wednesday afternoon, she became violent towards me, hoping that Addie would intervene. Which she did, but Elizabeth couldn't calm herself and I had to call 911.

The deputies they sent looked about 12, although they were driving, so they had to be older than that. I always worry with young cops; do they have the life experience to read people accurately? Will they see the sweet child having the breakdown or will they see someone dangerous? One thing I give thanks for is that Elizabeth is a girl because a black violent boy does not stand a chance. But they were good at their job as well as kind, and after they got her in the car, they gave her a stuffed dog which she held close the remainder of the night.

The ER gods were kind to us as well. We were sent right back to a room. UNC has a behavioral health emergency department, separate from the others. They have apparently accepted the fact that emergency rooms are the front lines in mental health care and have prepared for it. This is good except they won't let me take my computer or phone in, and so I look forward to a long night's stay without the online scrabble games that used to make these stays bearable. The drill is that she is seen by a pediatric resident, then the attending, then a psych resident, then their attending. Getting four docs down there can take hours. But within an hour we have the first resident, and her concern about lice brings the attending down to see us. She is one of the best we've ever had and she does what she can to make things easier for me. Elizabeth is so dehydrated that they can't get any blood out for tests; after three tries from three different nurses, the attending puts her foot down and tells them it will have to wait until the next morning.

The psych residents come down before midnight, two of them. One interviews Elizabeth and one me. Mine asks me for her history. If you've followed this blog, you know it's long and it ain't pretty. She finally puts her pen down and just listens. Within an hour, they've decided to admit. And there are beds so they can admit there. I'm home by 2:30 am; this may be our all time shortest stay in the ER. Our fellow inmates are moderately entertaining; one does a little dance for the resident and me before he is discharged.

Once in the unit, we also get the luck of the draw when she is assigned to a fellow and not a new resident. He keys in on my use of the word obsessive when I describe what happened. "Has she ever had a diagnosis of obsessive-compulsive disorder?" There are so many of her actions that I can ascribe to her anxiety or her language disorder or her sensory integration problems, but there are many that just won't fit. I visualize them lying around the floor like pieces of paper without a place to go and suddenly someone hands me a file and it turns out that they all belong there. He asks to do a test called the Y-BOCS which screens for that. I like him and I like that he thinks like a detective. He agrees not to change her meds and I appreciate that. Sometimes the residents get all excited and want to play with meds, but he's fine with leaving them as they are.

When I get home, I tell Claire what he said, and she goes into her ranting riff she does whenever Elizabeth gets a new diagnosis. She did it last when Elizabeth was referred to UNC Opthalmology for possible glaucoma: "I am relatively sure that what this black, mentally ill, gluten allergic, adopted kid does not need is TO BE BLIND!!!" Today she starts in, "Let's just give her ALL the diagnoses because she doesn't have enough as it is!" I have to agree with her. Lice are very unusual among African-Americans, but she's the one that gets it. Claire and I don't, just her. Why is she the one that's diabetic with thyroid disease plus gluten, dairy and corn allergic? Why does she have the sensory integration disorder and a speech disorder too? Anxiety? Mood disorder? No one promised fair, but could we just have a break? Apparently not; instead we get OCD.

But as we're cleaning up Elizabeth's room, Claire hands me ten sheets of notebook paper where Elizabeth has started writing a letter to Addie: Dear A, dea, Dear Addie, I ho, Dear Add. We look and see a tiny mistake on each which caused that draft to be rejected. We pick up her clothes off the floor and joke about how she tries on ten or twelve outfits each morning. OCD looks like it's in the running.

I look for grace and find plenty. Another piece of the puzzle is one of them. She has received intensive inhome services from a community agency; since it's working so well, it will be taken away from her, which is the way the system works. But this setback should earn us another two months. It's also nice to have some time to myself. Tonight I go to Claire's play and tomorrow night I have dinner plans. There's time to putter, to clean and to eat gluten. We all agree that this is just a glitch, one that can probably be resolved with a tuneup. And this time I don't see the psych ward as a sign that I'm a failure but as another tool to help Elizabeth towards health.