A Bitter Pill to Swallow- chapter 3
Angela, Tony, Mona and finally Samantha followed Dr. Friedman and the other doctor into a small room off the ER waiting room. All four family members were trying to control their nerves as they walked into the room. There was one table with about five or six chairs plus a desk with a computer and chair. The family sat at the table, looking at one another and then back at the doctors. The doctor who didn't introduce himself sat by the computer and started to take notes, while Dr. Friedman sat at the table.
"I'd like to talk about Jonathan's history as well as how he's been doing since he started school to hopefully gain a better understanding about what's going on with him now" said Dr. Friedman.
"Did his blood results come back? Did it show any substances?" asked Angela. She really wasn't sure how she would take the news if it showed something really serious like cocaine or heroin. She also wasn't sure how she would handle it if it came back clean.
"We are still waiting on the results but from the brief information we have of his behaviors over the past few days, I am anticipating the results coming back clean, but we have to wait and see. How long has Jonathan been in college?" he asked.
"He started last year and returned again this semester after taking a partial summer course load. He came home for about a month before going back up to school in the late summer. He skipped a grade when he was younger and went from fourth grade to sixth grade so he's younger than most of his classmates. He's always been a high achiever, getting very good grades" said Angela.
"He was top of his class, Valedictorian! He's so smart and kind and funny! This doesn't make any sense!" Tony said, practically shouting.
"Has he been engaging in or have a history of engaging in any risky behaviors? Seemed to struggle with impulse control? Have trouble concentrating or focusing? Have manic episodes or racing thoughts?" asked Dr. Friedman.
"No I don't think so. Tony, can you think of anything?" asked Angela.
"No Angela. He was stressed out last spring with finals. I think he pulled some all nighters but what college kid doesn't? He came home and slept away the next day and seemed fine" said Tony.
"Now that I look back on it, he seemed a bit on edge before he went back to school this semester. We talked the night before he headed back up to school. I didn't think anything of it then, but he was really jittery, like he'd had too much caffeine. He was kinda all over the place with what he was saying. I told him he'd be fine, just the start of school jitters and to lay off the caffeine. It wasn't anything like today though. I barely recognize him…" said Samantha.
"Samantha, can you let me know the details of your interactions with Jonathan yesterday and today?" asked Dr. Friedman.
"Well I called him and he sounded really down. Down enough that I was actually worried and told him I'd come up and visit. I hadn't spoken to him in a few weeks- him getting back to classes and me being busy with work, I… I just lost track of time. We would normally call each other each week, sometimes more often… maybe if I had been in better contact…" she started to say but Tony cut her off.
"Eh oh, oh eh! This isn't your fault! We spoke to him the week before and he sounded fine! I mean maybe a bit homesick and tired but he's got a busy course load!" said Tony.
"How was he this morning when you saw him Samantha?" asked Dr. Friedman.
"I've never seen him like that before… he was all over the place! He was talking a mile a minute and he had not slept in over twenty four hours. That went on for a bit but then he got so angry at me. He… he threw a mug against the wall and it shattered. He's never… I mean we've gotten into fights but it's never, ever gotten physical. I just left him because I didn't know what to do. He was even worse when I saw him just before… he should have been crying in pain from that cut to his arm but he was hysterically laughing. It was so scary…" said Samantha as tears began to pool in her eyes.
"Thank you all for giving me some additional information and insight into Jonathan. Based on your observations of his behaviors as well as his current behavior, we have assessed him to be a danger to himself or others. While it's not conclusive, it appears Jonathan is in a manic state, potentially coming off a depressive state earlier in the month. Once we get back the blood work and can rule in or out drug use, I need you all to brace yourselves for the very real possibility that Jonathan is in the midst of his first psychiatric episode of Bipolar Disorder. We can't definitively confirm his diagnosis until we observe him for at least seventy two hours. We have a bed open in our inpatient psychiatric unit that can accommodate him once he is medically cleared. We had to sedate him upon arrival due to his continued aggression and agitation but it hasn't had much of an effect. Thankfully his arm did not sustain more damage and it appears he will be cleared shortly. I will be his primary psychiatrist once he is transferred" he said as he gathered his paperwork together on the table.
"This can't be happening! Are… are you sure this is what this could be?" asked Angela as she tried to steady her voice and not let the tears in her eyes fall.
"Yes, I'm afraid the possibility is quite high" he said.
"But Jonathan's smart! He's pre-med!" said Tony.
"I'm afraid mental illness doesn't discriminate against intelligence, social standing, race, culture, religion, or any other factor. He's still the same son you love and have raised for the past eighteen, almost nineteen years. There have been a lot of break throughs with different medications and therapies to help treat Bipolar Disorder. I am hoping to get a better idea once he's here for a few days what we are dealing with" said Dr. Friedman.
"What if he doesn't want to stay? What happens then?" asked Mona, even though she already knew the answer.
"Because we've deemed him a danger to himself and others, my colleague and I have signed off on his involuntary commitment. He doesn't have a choice for the next seventy two hours I'm afraid" said Dr. Friedman.
"Can we see him while he's… here?" asked Angela, still not being able to say the words committed and hospitalized yet.
"You can see him now for a few minutes. Once he is admitted, we do have visiting hours on the unit twice a day. He's going to need some of his clothes. We have guidelines what he can and cannot have on the unit. Staff can give you an idea what he needs" he said as he stood up and headed for the door. The family followed him out of the room, along with the other doctor and headed back to the ER waiting room. They were taken through the main area and back to where the patients were being triaged. They could hear Jonathan way before they could see him as they approached the closed curtain at the end of the hallway. The family braced themselves as best as possible as the doctor pulled back the curtain. Nothing could prepare them to see Jonathan in two point restraints, struggling to free himself, two nurses on either side of him trying to calm him down.
"Mom! Tony! You've gotta help me! I'm being kept prisoner here! I need to get back to the dorms! The guys are going to head back out to the party without me! I don't want them to think I've chickened out on them!" he shouted as he continued to ramble on until the doctor interrupted him.
"Jonathan, I need you to try and calm down. These restraints on your arms are here to protect you from hurting yourself again. That cut on your arm is pretty deep and we want to make sure it starts to heal. As soon as you can show us you are calm, we can take them off" said the doctor.
"Jonathan, sweetheart you need to calm yourself down like Dr. Friedman said. Please!" she pleaded with him as she came to stand next to the nurse. She put her arm on his leg to try and soothe him, but he just kept flailing his arms and legs. Tony came to stand next to Angela, putting his hands on her back and shoulders.
"We are going to head back to your dorm and get you some clothes and other things for you. Is there anything you want buddy?" asked Tony.
"Why do I need anything when I'm leaving here? I just want to go back to school! I've got a paper to write and classes to go to! Why won't you let me up?" he shouted.
"Jonathan you need to stay in the hospital for a little while and see what is going on. It's… it's not safe for you to leave right now. We will bring you what you need and anything else you want that can be allowed in" said Angela.
"Wait what? I don't get it Mom! Tony? What's going on? I'm going home with you right? I'm not staying here! I need to leave now!" said Jonathan as his flailing intensified.
"Jonathan, you aren't going anywhere. We are going to admit you to our psychiatric unit for a minimum of seventy two hours to see what's going on. Hopefully we can get some answers sooner rather than later" said Dr. Friedman. A nurse came in with Jonathan's test results.
"As I expected, Jonathan's toxicology report came back negative for all substances and alcohol. This isn't a substance abuse issue. It's almost certainly a psychiatric episode. Let me see about getting him transferred and getting him another sedative. I would suggest saying your goodbyes for tonight and then coming back in the morning" said Dr. Friedman as he walked away.
"Okay buddy we are going to head out for now. Try and get some rest if you can. We will be back in the morning alright?" said Tony as he tried unsuccessfully to put his arm on Jonathan's leg.
"Wait! You can't leave me here! Mom! Tony! Grandma! Sam! Please! Please don't leave me here! I can't stay here! Don't do this to me!" screamed Jonathan as he continued to rage against the restraints.
"Jonathan it's for your own good! You need help! We love you so much!" said Angela as the tears started to fall. All four of them now had tears coming down at the sight of Jonathan so desperately suffering.
"No! I'll be fine just let me out of here! Don't leave me! Please!" he shouted again. The family started to head out of the area as Jonathan continued to shout and pull at his restraints.
"Fine! See if I care! I hate you all! Don't bother ever coming back! I hate you Mom! Please come back!" he shouted as they walked further down the hall. They all had to stop back in the ER waiting room as none of them could control their tears now that they were out of earshot from Jonathan. Angela was close to hyperventilating.
"Tony…I…can't…leave…him…" she managed to say through sobs as Tony came closer to her, wiping his own tears from his face as he wrapped his arm around her.
"Angela… we have to… it's breaking my heart to see him like this but we have to let them help him. I… I think you need to call Michael, Angela" he said as he began to rub her back.
"Oh my god Michael… I didn't even think about him! Yes I guess you're right I need to call him. I think I have his number somewhere in here…" she said as she started digging through her purse.
"Angela, before you dump out all the contents of your purse all over the place, let's head back to his dorm room and gather some stuff for him for tomorrow. Then when we get back to the hotel, you can call him" said Mona.
"Yes, yes you're right Mother. I… I don't even know what to do, what to think… I just can't believe this is happening!" she shouted as a new round of tears came falling down.
"Okay everyone let's go. Sitting here isn't going to make any of us feel better. Let's head over to his dorm and grab some stuff" said Tony as he helped Angela up, still having his arm wrapped around her tightly. Sam and Mona followed a short distance behind them.
"Mona… I'm so scared right now! What if he doesn't get better? What if the medications and therapy don't work? What if he… he ends up like your sister…" she said in a voice barely above a whisper. Mona stopped walking and turned to face Samantha.
"Look… I can't tell you I'm not terrified because I am. Seeing him like that… it breaks my heart and brings back so many memories of my sister but I… we all have to remember this is not the same situation. Times have changed and we are all in this together. Whatever happens, we are not letting him fall through the cracks. I'm not losing someone else I love… I just can't…" said Mona as she started to sob, putting her hands up to her face. All Samantha could do was wrap her arms around Mona and cry along with her.