TimberlawnThis happened on Friday, February 2nd 2007.

This is a continuation from Triage.

We awoke at 7:30am on Friday and I drove Stephen in to Timberlawn in Mesquite. As luck would have it, this place was across the road from Stephen’s mental health clinic, the MHMR (mental health, mental retardation) clinic of Mesquite. We were planning on going there anyway to talk to his case worker and pick up his new prescription.

I guess at this time I was thinking: “yes, these are the professionals, they can fix him. They will know what’s wrong with him and fix him, just like a car.”

The Timberlawn building is right out of a haunted house movie, or perhaps a movie about a 1950’s loonie bin. It’s a large vintage white-weatherboard farm house which would look far more comfortable on the set of “Gone with the Wind” than in a suburb of one of the largest metroplexes in the world.

I stopped the car in the shade of one of the beautiful old trees that surrounded the estate and glanced over to Stephen. He had been steeling himself for this moment since yesterday. No one wants to admit they need a place like Timberlawn, with its caring staff, observation rooms and special white jackets. Certainly no one in their right mind would look forward to admitting themselves to such a place.

We walked up the old wooden stairs and entered the lobby, I was holding his hand tightly. I walked up to the receptionist. “We’re here to see Dr. Shawn Leighton” please (I have guessed his surname here, I can’t actually remember what it was).
“Who?” came the bewildered reply.
I handed her the discharge papers from the hospital.

We waited about half an hour in the lobby and were treated to the rare sight of Laura Bush giving an interview on TV for some reason. The rest of the news was filled with excited Texas weathermen recounting how they had seen snow the other day and wasn’t it oh so very exciting?

Shawn eventually came over to see us.
“You came?” he looked at us in surprise, as though he had expected us to forget or something.
I just smiled and shook his hand vigorously. I had a good feeling about this guy. He really seemed to know his stuff. He also really seemed to care. No one would go through all this trouble if they didn’t really care. Something about the way he appeared to exude judgment also told me he was a Christian, which made me feel good for some reason.

We adjourned to a little meeting room and Shawn outlined our options:
“We’d like to keep Stephen under observation here for a few days. It’s very important we get to see him on a day-to-day basis so that w can monitor his condition and get his medication just right. We recommend keeping him on day-observation only, so you can take him home at night time.”

I nodded, this seemed like it was really going to work and it wouldn’t be too much strain on Stephen at all.

“Right, now, Stephen can go here or we can recommend another place. There is Green Oaks but…” Shawn frowned “we prefer not to send people there if we can help it.”

“Sure” I said, turning to Stephen for his approval “let’s do it, we like you guys.”
“Ok, let me just check with our financial people”

He disappeared and we were left to admire the nice wooden panel interior of this strangely opulent room.
Shawn returned with bad news: “I am sorry, but we can’t treat you here. We don’t accept NorthSTAR insurance”.

Now, NorthSTAR is a medical “insurance” paid for by the government. It is intended to cover people in the North Texas region who suffer from mental health or substance abuse problems and do not have enough money to afford their own insurance. In New Zealand, we would call it a public health system.

“That’s not a problem” I piped up immediately. “I’ll pay. How much will it cost?”
“Around $300 day I guess”
“Done” I responded emphatically. That was a small price to pay for mental health.

Shawn disappeared again and yet another neatly dressed professional entered the room. He asked the same list of questions from before (I am not kidding, it’s as if he and Shawn had never met). Shawn finally returned after talking to his finance people again. He looked a little more harried now, as though he had made a mistake he was beginning to regret.

“I’m sorry, but we can’t take him. We can’t take anyone on NorthSTAR ”
“What?” I asked incredulously, my voice rising unintentionally “You refuse to treat him, even if I can pay?”
“No, we don’t refuse, it’s just that we can’t. The government won’t allow it. But he can go to Green Oaks”

“Green Oaks? I thought you just said they are substandard?”
“No, Green Oaks is fine, they can still observe him”
“So, is that how it works then? There’s you” I held my hand out at eye level “Green Oaks” I held my hand at chest level “and Dr. Starla from MHMR” I held my hand at around my waist “Good, bad and worse, and Stephen’s not allowed to get good treatment, just because he’s poor?”

“Well, no, Green Oaks will still treat him”
I sighed. It looked like we didn’t have a choice.

“Will they sedate him?” My voice quivered as I finally voiced my most prominent fear. I couldn’t bear the thought of Stephen walking around like a zombie, high on some drug cocktail. I had seen too many movies about loonie bins.

“Well, no, the drugs they administer for psychiatric treatment are not sedatives, they just alter mood.”
“Well, actually, they are.” I said automatically “He’s on Ativan for panic attacks and Ativan is an anti-convulsant”.

“No, it’s not” Shawn replied hotly, he also seemed to be getting annoyed by this conversation.
“Yes it is” I said again, my voice dropping “I researched it myself”

It was at that moment that I realised Shawn knew less about these drugs than I did, which is a scary thought.

Ativan is a brand name for Lorazepam which is a Benzodiazepine type drug. Benzodiazepine is a sedative, a muscle relaxant, and anti-convulsant. If you hit someone up with enough of that stuff you can bring them down off of anything. Next time you’re watching House or ER and someone has a seizure or starts seeing spiders crawling up their skin, you listen carefully to what the doctor yells out for: Ativan, stat.

Anyone in that field who does not know what Ativan is used for should not be allowed to hold a syringe. I realised that Shawn couldn’t actually be a doctor, he had never claimed to be. He must just be their marketing guy or something.

Shawn let us go with instructions to take Stephen to Green Oaks later that day.

Couldn’t I take him over the weekend? I asked.

“Well, no, they don’t hold people over the weekends”
“What? You mean people don’t kill themselves on weekends?”

Yes, that seems to be it. Apparently, it was of the utmost importance that Stephen get to Green Oaks for observation that very day but we would have to take him home for the weekends. This was ridiculous.

We left Timberlawn and I was seething with rage. How could they recommend a certain kind of treatment as being vital, then refuse to give it? How could they insist such treatment be given immediately, but refuse to provide such treatment on weekends? How could they hire staff who don’t understand the effects of common pharmaceuticals?

We quickly drove across the road to speak to Theresa, Stephen’s case worker. I had been calling her on and off for the past two days and she had agreed to see us today. She sounded really nice.

The MHMR clinic in Mesquite is a whole other world I was not familiar with. As soon as I entered I was beset by the weight of bureaucracy and illness. I was suddenly reminded of South Africa: the third world. All those Americans spending time and money trying to save starving children in the “third world” need only look in their backyard to see people in desperate need of the first-world’s intervention.

We stood in line to wait to speak to one of the receptionists. He called Theresa and said that Theresa was expecting us and we could just wait in the waiting room. Stephen waited in another line to get his new prescription and we discovered that his prescription had changed to two Paxil tablets a day, not the four his mother seemed to think it should have been. I was so grateful we were going to get to speak to Theresa, his caseworker, a real professional.

We walked through what appeared to be a number of prefabricated buildings. You know the kind: buildings that were originally built to be temporary but ended up as permanent fixtures anyway. Once we arrived at a thoroughly unremarkable building Stephen announced this was where we should wait.

The waiting room was roughly rectangular in shape, the walls were lined with cheap cushioned chairs. I guess it could have held about 20 people sitting at a time. To my left, an old black woman with the face of a sage sat placidly. She was waiting to see the doctor so she could get more pills. To my far right and on the opposite wall was a white man engaged in excited conversation with a young man. They were talking about computers and hacking. The man related proudly about how his son had written a program to utilize 100% CPU. I cringed internally and tried not to pay too much attention.

Directly opposite me, an old woman waited in what seemed to be a state of mild agitation. It looked like she was getting impatient. Half an hour passed. The old woman left, hobbling painfully on her walking cane. A young white woman with wild hair replaced her and engaged the black woman next to me in animated conversation. The fact that they were conversing across a two meter gap didn’t seem to concern them at all.

“Did you see what she did to me?”
“No, what?”
“She said she’d call the cops ‘cos I was crying”
“She really? What’d she go an’ do that for?”
“Well, they booked me in to see the doctor today, to get more pills”
“Mmm hmm, I been waiting to see my doctor too”
“But when I got here, they told me the doctor doesn’t come in on Fridays”
“Tsk tsk”
“So, why the hell would they schedule me in on a day the doctor isn’t in?”
“Mmm hmm, it’s a damn shame”

The young woman then launched into a long and intricate monologue on the different medication she had been on, the side effects thereof and the relative benefits. It fascinated me that here was a woman, otherwise unable to hold down a steady job, who was up to speed on the latest mood altering drugs on the market. Perhaps she could teach Shawn a thing or two.

“I’m never taking that prozac stuff again. Last time I took it, I fell down the stairs.”
“Mmm hmm”

She also related to her captive audience (we were all captive at this point) the long and painful story of her sister’s turbulent relationship with her abusive boyfriend which involved (among other things) her sister sleeping with a metal baseball bat under her pillow. These were not my kind of people.

The old woman with the cane returned, she had obviously found a vending machine to see her through the day. She sat down near the man who was musing that perhaps his son could get a job as a freelance hacker. After all, he had modded his Xbox. For those of you not quite in the know, using up 100% CPU is not hard, it’s actually a mistake. Modding an Xbox requires no skill and, finally, freelance hackers earn nothing. They do it for the Lulz.

I glanced over to Stephen and noticed that he was receding more and more into his shell by the minute. He hated this place and I could see why.
“Are you ok?” I asked him “You want to just leave?”
“No, if we leave because of me then you’ll think badly of me. I’m here because you want me here.”
I rolled my eyes internally and sighed. No pressure.

Another half hour passed and a man walked past. He was drugged up so heavily that he literally looked like an extra from the Resident Evil movie. All he needed to do was stick his arms out and say “aaaah” and I would have been looking around for the camera.

Another half hour of this and I finally cracked. “Right, we’re out of here” I announced to no one in particular. “I won’t subject you to this any longer”.
“Are you sure?” Stephen asked, trying hard not to let the relief enter his voice
“Yes, this is not a place of wellness, and staying here is not making you better”

We were half-way out of the building when we ran across Theresa. She was a radiant young Columbian woman and reminded me a lot of Susan, my sister, in fact.
“I have been looking for you everywhere, let’s talk” she said.

We gratefully entered what must have been a shared office and she closed the door.
“So, tell me what’s been going on”
We related the story as best we could, answering the same old questions as before.

“So, the hospital didn’t change his prescription then?”
“Well, no, should they have?”
“They usually do”

I related the story of Shawn, Timberlawn and Green Oaks. She nodded her head “I recommend you take him to Green Oaks”.
I eyed her carefully “are they any good?”
“Well, yes, they are fine.”
“Would you send your sister there?” Stephen interjected suddenly. According to Stephen, Theresa made a sudden face.
She considered a moment.
“If it meant the difference between life and death: yes.”
“Ok” I sighed “I’ll do what I can, but I can’t force him, he is an adult”.

“Anyway, so, what can I do for you?” she asked comfortingly.
“Well…” this was my big moment, my chance to get real help for Stephen. “I would like you to recommend a really good therapist. I will pay. Someone who really knows their stuff who can give him the proper time to make him well. I mean, I know you have tried but you’re stretched for resources here. Dr. Starla can only see him every month and I know he needs more intensive treatment. I just… I just don’t want him to fall through the cracks.”
“I’m afraid I can’t recommend anyone, I don’t know any psychiatrists”

I boggled at that for a moment.

“But… you’re in the industry, you’re a part of it, surely you know how someone can get help?”
She shook her head.
“Ok, how about drugs, this particular cocktail you have him on is obviously not working, who can I speak to about changing his prescription”
“I’m sorry, but that’s our protocol, you see: we start them on the least effective drugs first and work our way up from there, normally, the hospital would have put him on something different if they thought it necessary.”

I sat in shocked silence for a moment. Had she just admitted to me that she was giving my boyfriend drugs that she knew probably wouldn’t work? That she was just waiting to see how long it took for him to crack so that he would be taken to the emergency ward so that they could change his prescription and send him on his way again, ready to fall apart the next time? How was this mental health?

“Look,” I said, my voice quivering with emotion “what I need is to speak to someone who went to medical school, who did all their homework assignments on time and studied really hard so they got good grades. I then want to pay that person to make Stephen well again.”

You see, I am a professional. I went to school with a single-minded purpose of becoming as good as I possibly could at my chosen profession. Don’t ask me to fix your plumbing or tune your car, but if you need some software written, I’m your man. If I don’t know how to write the software you need, you can be certain that I will find someone who can. This is my industry. If you come to me with some broken code, you can sleep soundly knowing that I have everything under control.

“I’m sorry. I can give you a list of providers supported by NorthSTAR but I don’t know anyone else outside the system.”

I sighed.
“I’m sorry, I guess I am really emotional round about now. I really appreciate your time and effort in seeing us today. I just don’t feel like he’s getting adequate care here.”

She nodded “I understand” she shook my hand and wished me luck, sending us on our way.

We stopped off at the International House of Pancakes to lick our wounds and consider our next course of action. Basically, the state of things was this: The MHMR felt like they were doing everything they could by prescribing him ineffective pills till he cracked. He couldn’t go to an effective mental health facility and so had to settle for substandard, because he was poor.

Stephen begged me not to take him to Green Oaks. I called his case worker and told him I couldn’t take him to Green Oaks against his will and that I would try convince him to go on Monday. She said that if I needed to, I could always call the police and they could force him. I also tried to contact Shawn from Timberlawn to tell him of my plans.

“I’m sorry sir, there is no doctor here by that name”

I still don’t know who the heck Shawn really is.

Stephen SleepingInstead of taking him to Green Oaks, I drove Stephen to my place and left him to sleep. I went and did some errands (such as replacing the light-bulb in my driver’s-side headlight), then came back to check on him. He was sleeping like an angel. Stephen always sleeps like an angel.

I snapped off this photo and then hurries off to pay the fine I had received for the broken headlight. Half-way to the court I stopped and an odd feeling came over me. “Was he breathing?” To my infinite shame I hurried back home to check on him, just to make sure he was still breathing and hadn’t overdosed on anything.

The title of this post is “DeathSTAR” because that is the name that professional psychiatrist Dr. David Crumpacker used to refer to the NorthSTAR system. I have also spoken to psychologists who confess that the American mental health system is absolutely abysmal. They use the term DeathSTAR, no doubt, because so many people fall through the cracks and end up dying on this ineffective scheme.

I wasn’t going to let it happen, not to Stephen. I was going to cover all the cracks myself if I had to.