If the person is not a danger to him or her self or others, the person cannot be held if there are responsible family members, friends, or others who are voluntarily willing and able to care for the person.
– Description of the limitations on issuing a 5250 Involuntary Psychiatric Hold under the category “Gravely Disabled.”
That’s all you get!
He was being released.
He was getting out.
Today was the day.
Or was it?
The day in the ward started at around 6:00 am for almost everyone because that was the time that decaf coffee arrived. Coffee addicts gravitated to the day room like bees to flowers, and the psychotics – who had not been medicated since 10:00 pm – were the noisiest that they got.
(His roommate was not among these. He seldom uttered a sound and never raised his voice above a near whisper).
It was a time for bleary-eyed staring, finger-sticks, blood pressure tests, cheery greetings from the staff, and repetitions of the same old joke “How’d you sleep?” The mood was nearly universally positive among the patients – bonds formed quickly on the ward. Seeing your peer group after a restless night listening to the woman with glossolalia sing and clap, hearing the occasional panicked outburst, being shocked into wakefulness by the jet engine noise of the toilets, and having near strangers walk into your room every few minutes to check on you was both a comfort and a relief, releasing the tension of the night spent in unfamiliar surroundings.
He learned that he was not the only one getting out – there were at least four patients, possibly five, leaving the ward that day (there was an issue regarding medication side-effects for one patient. Everyone hoped for the best.)
Everyone getting out was nervous, skittish, at some level not quite able to believe that it was really happening. It was like waiting for a magical spell to be cast. He couldn’t quite believe it himself, even when staff members came by and said “I see you are getting out today.” He remembered the report that had 5250’ed him. He remembered what the physician had said beforehand.
A bond of trust had been broken, he thought. It would not easily heal.
At 8:00 am he called the patient advocate’s office to let her know that he would not need a hearing today because he was going to be released. Then he went to the cafeteria for breakfast. It was bacon and eggs and scones. But for whatever reason, the institution had suddenly decided that they would put him on a low-salt diet. This after days of feeding him pasta and hot dogs and cake and rice. So what he got instead was an ice cream scoop of dry eggs and a single piece of dry, whole-wheat toast.
“That’s all you get!” said the cafeteria worker emphatically. It felt like a slap. He could understand at least the reasons for the low salt diet (his blood pressure was a bit high). But here, in the last day, in what he thought were the last hours of his involuntary hospitalization, he encountered the first real, overt rudeness and contempt by a staff member. It was deflating and discouraging, and particularly cruel because he had been voluntarily eating really well all weekend, avoiding things like cake, sugary snacks, high carb foods, drinking lots of water to keep his blood sugar down (it got low enough that they stopped giving him insulin). Now on his last day in his last hours, when he wanted a bit of comfort food, there was this instead.
He largely skipped breakfast, eating just enough so that his morning meds would not sour his stomach.
the patient advocate didn’t get his message and showed up in the ward to get him ready for his hearing. He told her he was being released. Her first question was “Are you absolutely SURE?”
She worked with all sorts of patients. Some had tenuous understandings of what was happening to them or why. It was only common sense that she would ask a question like that – it was probably as automatic and reflexive as a McDonalds worker asking if you want fries with your meal.
But the bond of trust had been broken. So the first thing he thought was “might they actually play around with him like that? Schedule his release AFTER the hearing to get him to cancel, and then yank it out from under him? Would they really do such a thing?
(The question of whether they COULD do such a thing never entered his mind. Of course they could – his release was completely at the discretion of his doctor and case management team. And they had already proved themselves willing to lie).
The bond would not easily heal.
He checked with the nursing station. They were filling out the paperwork for him. That, said the patient advocate, indicated that they were, in fact, planning on releasing him. Once again he was so grateful that he was practically in tears. He thanked the patient advocate profusely, honestly, and in as much length as he thought was both seemly and did not delay her too much. She had a job that must have been rough – her livelihood was going against the practices and recommendations of the institution that employed her to support broken and often dysfunctional people. She must be a very special person, he thought, even among a staff that seemed generally competent and willing to work for the best interests of the patients as they saw it.
He couldn’t hug her. He couldn’t shake her hand. There was no touching allowed in the ward.
His wife arrived almost exactly four days after he had been 5150ed. He was meeting with his case manager at the time. He got the impression that his case manager didn’t like him much. but was professional about it. For his part he really had no use for the case manager who hadn’t even met with him until yesterday, who had spent virtually no time with him, and yet had great say in deciding his fate, who had tried to convince his wife to show up in the afternoon to pick him up instead of the morning. Honestly, he had little to judge his case manager by, because they hadn’t spent enough time together for him to form an opinion – the case manager was simply a position with a frightening amount of power over his life that walked and talked like a person. Still, he was getting out, and he was getting out in the morning (his wife could be very persuasive) so there was no point in making waves. The two of them sat in a conference room, filled out some paperwork that looked suspiciously like the sort of thing done more for liability protection than to provide him any sort of support or assistance (maybe not, it was hard to tell – the bond of trust had been broken) and suddenly it was time to pick up his things, say goodbye, and walk out the suddenly unlocked doors. He said goodbye to the other depressives who had helped him so much. He said goodbye to the staff who had been kind to him. He said goodbye to the psychotics, who were after all people and who had shared the ward with him and had shared some jokes and conviviality. He said goodbye to his roomate who responded only with a glassy stare.
Then the doors were unlocked and he took the two steps through them.
Into the arms of his wife.
Into the sunshine.
Into the air.
Past the cherry tree.
Into the car.