When the Doctor is Away

Many people I know who experience symptoms of mental illness have partnered up with a therapist, psychiatrist, prescribing nurse, or general doctor to aid in their care. These kinds of relationships may take a lot of time and effort to grow, and from my own experience I can say that things like trust and understanding don’t come immediately, they generally take some time to form.

That said, it can be a harrowing experience when you have built this kind of relationship and lose access to it when your professional partner in care is sick, experiencing an emergency, or taking time off.

I know I’ve talked a little bit about this before, but my recent circumstances (basically experiencing intense symptoms and being unable to work while my psychiatrist is out of town) have been something of a reminder that it is never a bad time to create a plan in case of future emergency -and know what you need to do in case that emergency occurs when your professional support person is not available.

Now that the weather in Seattle has finally started to turn and it is obvious that fall is upon us, I thought this might be a good time to bring this up again as well. Winter can be a particularly difficult time for people who experience depression or mood swings, particularly in the Pacific Northwest.

So, here are some suggestions that could help you avoid unnecessary risk and potentially make a difficult situation much easier.

1. Talk to your professional support people about what to do in the event of an emergency in their absence. Your therapist or doctor may have special instructions on who to contact if you are having an emergency and they are gone, so speaking with them before and emergency occurs is a great way to start setting up an emergency plan for yourself. At the same time, you may want to request that your support person give you notice if they will be going out of town so you can be well prepared in the event of an emergency.

2. Consider the needs you might have in an episodic emergency and discuss with your doctor if having an emergency medication (such as an antipsychotic you can take as needed) is a possibility in your situation. If an emergency medication is not a possibility, at the very least I would suggest making sure you have enough refills to last the duration of your doctor’s absence.

3. As discussed in In Case of Emergency, I would highly suggest taking the time to create a card or sheet of paper you can carry in your wallet/purse with the following information on it:

  • Your primary care doctor’s name and contact information
  • Your therapist’s name and contact information
  • Any diagnoses you may have
  • Your current medications and dosage information
  • Your medication allergies, if any
  • Any previous hospitalizations
  • And if I am in a situation where I might be given a new medication to try, I like to include previous medications I’ve taken, dosages, and what effects they had (namely the reason I am no longer taking them).

This information can be extremely helpful to have in an emergency when the professionals attempting to help are unfamiliar with your particular situation. It might even be wise to add notes on things like, “do not give antidepressants” in the medication allergies section if you have a history of switching to mania when given an antidepressant. Just last week I had to wrestle with my general physician because the seemingly obvious thing to do (in his opinion) was to give me an antidepressant for my current situation of depression. My psychiatrist absolutely knows better, but my physician isn’t familiar with my history -which is why it is important to be able to relay this information to someone new.

4. Create a plan with someone close to you that defines exactly what an emergency situation is, and when emergency procedures need to take place (such as the emergency room or potential psychiatric hospitalization). It might be helpful to consider the following questions to help define what an emergency looks like to you:

  • Are you someone who is more likely to seek emergency care because of a depressive episode, a manic episode, or a mixed episode?
  • Have you sought emergency treatment before? What symptoms made it an emergency? (Ex., suicidality, homicidality, psychosis, self harm, etc.)
  • Have you experienced a range of severity levels in these emergency symptoms?

For example, I have a 0-3 rating scale for suicidality. If it is at 0, it is not occurring. At level 1, new suicidal thoughts begin occurring in a fleeting way. At level 2, I begin flirting with the suicidal thoughts, and that is where suicidal ideation begins (imaging different acts of suicide). Level 3 denotes a place where I feel convinced suicide is the correct course of action.

So even though “suicidality” might be my emergency symptom, I often feel stages one or two without feeling concerned enough for hospitalization. If I reach a stage 3, I have a contract with myself and my doctors to seek hospitalization immediately.

For issues of psychosis I generally consider severity and length of psychotic period. If you are someone who typically has long psychotic episodes, I would suggest considering any psychotic symptom a cause for emergency.

The idea here is to consider what is the worst you can foresee, based on what you have experienced. I would take those symptoms and make a checklist, and perhaps fill out that checklist twice a day, once your mood begins going into a more intense area.

Talk with someone about what you would consider an emergency, and share the scores you get from the emergency checklist with that person. This way, if you reach a point where you can no longer discern what is an emergency and what isn’t, your friend/family member can make that judgement call for you. And the checklist is a great tool if you do go to the emergency room, they can look and see exactly what the emergency is about.

5. Maybe you don’t have access to a friend or relative that you feel comfortable sharing this kind of information with, and that is ok. I would still recommend coming to conclusions about what you would consider an emergency, and if you ever find yourself at a loss for someone to talk to, contact the Crisis Line. 

I am pretty sure the number varies from region to region, but I am under the impression that most states have one, so it may be worth your while to google it and jot the number down on a card in your wallet/purse. The people on the other end of the line are used to receiving calls from people who are in crisis, so in lieu of a physical person who is present and able to help give direction in an emergency, I would highly suggest this route. These folks are level-headed, and if they are under the impression that your or someone else is in danger (which really trumps whatever your definition of emergency is in the case of most medical professionals), they will suggest going to the emergency room.

Ok, so those are a few ideas on how to handle emergencies in the absence of our professional support team, and I would suggest taking a look at In Case of Emergency as well where I talk a bit about mapping out emergency rooms and hospitals in your area to be prepared in the event of a psychiatric emergency.

For all of this, and for all emergencies, it is much more helpful to begin working on a plan of action when feeling fairly stable, as opposed to waiting for an emergency to happen first. By having a plan worked out, knowing that your psychiatrist or therapist or whomever is out of the office will be a lot less stressful, and less risky in the event an episode does occur.

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3 responses to “When the Doctor is Away

  1. Reblogged this on Just Half-Cracked and commented:
    This is a great post from bi[polar] curious. I haven’t implemented this kind of detailed emergency plan yet, but will now, after reading this post.

  2. Here in the amazing UK we have a thing called a CPA which means Care Plan Approach and why the fuck the words are in the wrong order I have no idea and they call US the nutters…? Anyway somehow I DON’T HAVE ONE. The only option you have apart from calling your community nut nut nurse (if you have a CPA which I don’t) is to turn up at the nuthouse and say you want help. They’re v good the last time I was there I had psychotic mania but kept saying I didn’t want to be a patient I just wanted some fucker to write down what was happening to me because I was 39 years old and had been experiencing accelerating symptoms for years with NO DIAGNOSIS ~ I mean, the last time a shrink had interviewed me before that I walked away realizing “hey that was completely the wrong set of questions” I KNEW something was wrong and it was not straight “depression” then I went fucking CUCKOO and was so very ANGRY with all the manifold doctors who had let me down and it got so bad I went into Delirious Hyperacute Mania every single day for nearly a week ~ which means complete mental meltdown. Absolute incoherence. Completely unable to read or to say anything except things like “dadadadadadadadada!!” and unable to follow what the fuck anyone else was saying unless it was addressed directly to me (and was about me) and spoken very slowly and clearly. Basically I was yelling and screaming and completely out of it and AT HOME. Fucking hell I try not to be bitter and twisted but NEVER EVER AGAIN, PLEASE. Every time I think about this issue I am wound up and upset. I think I actually need counselling now not because I “am” mentally ill because I’m not really but because I WAS and how fucked up is that?

    We’re really lucky in this country: if you’re bipolar or schizo they do NOT force counselling on you as a firstline treatment but you can have it if you ask for it. I really resent being expected to tell some condescending stranger whom it would be “unprofessional” for me to know anything about all about my inner crap and to have this weird structured one-way “friendship” which I suppose the Therapeutic Relationship is. But now I think I actually need it and how TERRIBLE IS THAT???????? 😦 🙂 😉 hey I love these yellow faces!

  3. You have a scale of suicidality? If you’re a 3 would they actually believe you? And would you really get instant hospital admission? Because here the only point of mental hospital receptions is to turn away those who are completely fucked up and suffering intolerably.

    I mean I’d far rather have an NHS which is free at the point of use than to have to pay. If I had to pay to see a doctor I’d never go, except to get painkillers and stuff like that. No wonder America has such a vast prescription drug dependency problem. If you are paying to see doctors, the customer’s always right so if you want dilaudid or oxycondom/whatever it’s called you have to have it! Of course if your pain is mental they don’t give a FLYING CRAP do they. Except for the need to cover their arses in case you do slit your throat they really do not care.

    I came up with a 4 point mania and depression scale for myself but I had to add a 5th level because I went so raving mad I was OFF THE SCALE.

    By the way don’t you think bipolar books and websites are crap? they’re totally dsm-oriented. The DSM implies that the severest level of mania is mania with psychotic features ~ and yet any good Victorian psychiatric text will describe a level over that where a person is delirious, disoriented and completely incoherent (and incapable of doing the ridiculous things like flying a plane full of prostitutes across that Atlantic having just seen an angel like you’re stereotypically supposed to)…. ukh anyway. American Healthcare does seem way better than ours. But hey at least in this country nobody ever goes medicinally bankrupt or whatever they call it.

    Did Obama ever manage to put those health reforms through? Not to be snobbish but bloody hell he’s giving a tiny hint of what we all get in Europe for free and they call it radical/a completely untenable waste of money. Hmmmmmmm %-///

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