Saturday, July 17, 2010

The Hospital

Here's the full story I referred to in my last post about the ER.

So you all know this has been a long period of instability and even more importantly, increased aggression towards our daughter Chica. I have been fighting hard against the hospital route because I don't want to traumatize Taz by sending him somewhere overnight without us. It's a lot for any kid especially one so young.

But everyone kept telling me that's what had to be done, professionals included. After talking with our psychologist yesterday to get her opinion on it (she's known us for a year now and is also experienced with adoption issues) I felt more confident about the possibility of impatient if we really needed to keep Taz and Chica safe. Dr. B had worked in that hospital and knew all the ins and outs and it does truly sound like a remarkable program. This has been repeated over by several people.

When I picked up Taz from a drop-in daycare after the appointment he was already wired. Like I said, he's been escalating for a couple weeks now. He can usually hold himself together for other people but was even having a rough time with the childcare provider (had hit other kids, been defiant, yelling, etc). When we got home it spiraled downward immediately.

First he was just shouting, calling names, telling me to shut up, even though I wasn't doing anything to him. Or my favorite, he asks me a question, I answer it, and then he screams to shut up. Gotta love that logic huh?

I started getting lunch ready during this verbal attack. This is not unusual for him but it is a sign that worse things are coming. Then he escalated to kicking anything in his path and throwing random objects around. Not exactly at me but just around.

I was changing Chica's diaper and that's when he threw a toy directly at me. DH feels that Taz has absolutely no concept of the consequences for his behavior, be it natural (throw a toy and it breaks) nor controlled (hurt someone get time-out). So after weeks of consistently enforcing a negative consequence for every act of aggression and seeing absolutely no positive result from it, we decided to make a change in our technique. Instead we were going to keep everyone safe by shadowing him to stop an aggressive act before it happens and talk him down verbally by using a calm voice and trying to find out what he needs.

So I attempted that. I followed Taz while he threw things around trying to catch them before they did any damage. I tried to figure out what he needed and calm him down. This did not work. I think he was just so out of control of himself that it didn't matter what anyone said, he could not stop himself from being destructive.

The destruction was so imminent that I couldn't even leave him long enough to clean up Chica who had apparently grown bored of eating yogurt and threw the cup of the floor (which the dog licked up) but not before using it as a lovely hair moisturizer. So poor Chica had to sit there with raspberry yogurt all over her until I could get Taz sequestered somewhere safely and attempt to clean her off.

I tried to keep Taz in the playroom, which he destroyed, throwing toys around, ripping up mail, then finally coming out to attack me. I just stood in his way and blocked him whenever he tried to throw something or hurt me. Then he wanted his pants changed cause they were wet so I told him to go to the laundry room and I would help him. On the way he knocked over a stool, then swiped everything off of one of our counter tops. Then he attacked me while I attempted to change him. I stepped back and told him I can't help him when he's hurting me and he was able to maintain control just barely enough while I changed him. But as soon as he saw Chica coming towards the room we were in, he was full force attack mode. I used my body as a shield but she kept getting in the line of fire so I had to lock her out of the room until we were done. I felt so bad for her crying for me in the hallway and I couldn't comfort her.

After that point things are a bit blurry. I remember trying to call Dh to see if he thought Taz should go to the hospital. I was on the phone with Dh when Taz suddenly jumped on Chica, laid on her back and shoved her face into the floor while trying to scratch her head. I grabbed him of course so he wasn't on her for long, but it can happen in an instant. I tried to hold Taz back while he clawed and kicked at me while talking to Dh about what to do.

Finally I just realized this was ridiculous. Taz obviously needed something that we just couldn't give him. And I think he still does. But I'll get to that. The fact that I had to stand in front of him blocking his every move for so long that I couldn't even clean up my daughter in her high chair (the yogurt is still on the wall by the way) is just no way to live!

So I decided to take him to the ER. My initial plan was to get them in the car and drop Chica off at a friend's house. I couldn't even get to the door. I was trying to let my dog out while holding on to Taz (who was still being destructive) and Chica followed me to the door (probably cause she was scared), and Taz got a good swing at her. I realized I couldn't even get him to the car in the state he was in. I put him on the couch and stood in front of it so he couldn't get off. Chica, luckily, got busy playing somewhere else (I don't know where. She was probably eating sand or something).

So with Taz on the couch I called the 211 number for Emergency Mobile Crisis Team. I was a little more than shaken at this point. I was trying really hard to keep myself together. But I must have sounded like a wreck on the phone because coupled with Taz screaming in the background the operator told me to call 911.

I wasn't about to send my 4 yr old on an ambulance to an ER for the first time by himself. So I called Dh to come home. Of course, by that time Taz had calmed down. But I knew it wasn't over so I pushed Dh to drive him into the city to try to get him admitted.

Our first option we would have liked to happen was to be admitted to the special cares unit which is a little bit like a regular hospital room and the parent can stay with the child while the doctor's and clinicians change medication (which Taz desperately needs). But they wouldn't take a child under 5 there. There are 3-4 hospitals in our state that will take a 4 yr old (if absolutely needed) but all of them that take state insurance were full.

The good thing is that the ER saw Dh and Taz right away. Apparently if you say your child is unsafe they take you immediately into the back of the ER (there's a special corner) where there are observation rooms and special psychiatry staff. Dh and I are calling it the "crazy corner" because apparently that's where they hide the psych patients so they don't scare the others.

Oh, yeah, and you can't wear shoes, bring a bag or toys, food or drink into the room. I understand because of kids who are at-risk for suicide but he's only 4, you'd think there would be an exception. BUT THERE ARE NO EXCEPTIONS. Apparently. Honestly, a hospital is no place for a young child. But unfortunately, neither is in a home with an even younger child.

So after a few hours of intake and observation (in which Taz was slightly anxious and agitated) the clinician said she understood the severity of the violence and danger but didn't really want to admit him impatient and there were no beds available anyway. Dh asked how to get a bed if we really needed one and she didn't seem to hopeful about that. There are never enough beds for kids who need them. They are always full. You have to just keep coming back over and over and hope one opens up while you're there. There was a child in the ER who had been there for 4 days waiting for a bed. Yikes.

While Dh and Taz were there I had driven Chica to my mom's for the weekend so I was only involved over the phone. Now let's face it....sometimes.... in some families....the moms are the fighters. At least in my family. I have no problem being "that mom" once in a while. So I wasn't going to accept that there were no beds, go home, it's not our problem. Not when my child needed help. So I made Dh tell the clinician that he wasn't going anywhere without a plan or we would just be back on Monday.'s what's going on with the psychiatrist. Dr. S is not around until Tuesday. So the earliest that we can see him for a med change would be an emergency appointment possibly Tuesday night. To some people that doesn't seem too far away. But what most people don't understand is that come Monday, Dh is back at work and I have both kids by myself all day again. Think about that. Eight hours of total instability trying to keep both kids safe. I literally have to shadow Taz's every move. How can I possibly do that while also parenting a toddler, feeding kids, letting the dog out once in a while, and even using the bathroom myself a couple times (I know, imagine that!)?

Since no one else seems to be thinking through all of this, I have to! I'm living it. I'm the one who is going to be right back in the ER when things go down the same way first thing Monday morning. Even if we could hold out until Tuesday afternoon...what chance is there that whatever new medication Dr. S is going to prescribe is going to work the next day anyway? We've already exhausted most of the quick acting AP's. Dr. S said himself that we needed to get more creative with medications and start trying different combinations because Taz is very hard to treat. So even with a med change, this is going to take time. Time that costs a lot. With Chica's safety being the highest price.

The clinician at the hospital didn't think it was a good idea to admit Taz under any circumstances but everyone we see in the community thinks it is appropriate. The ER clinician (we'll call her Dr. Er) was very concerned about Taz's issues and the level of aggression so she came up with another plan instead of admission. By the way, she did speak with our psychologist who confirmed the safety issues we were having so I know Dr. Er believed us.

The plan at discharge stood that EMPS (Emergency Mobile Crisis Team) would come today (which they did and I'll update that too) to make a plan for getting us in-home help and possible enrollment in a therapeutic preschool immediately. At least that's what I was told.

I'm going to post this so people can catch up then I'll write out what the EMPS clinician said.


  1. oh honey. I'm sorry. I wish there was something I could do to help!! If only you lived in NY

  2. When our daughter was pre-proper med combo, we had to lock the DOG up so she couldn't hurt her. I can't imagine having a toddler to protect. You are amazing handling them both the way you did!