Caged (part 2 of 3)

“Courage is fear that has said its prayers.”

Anonymous

We spent $153 on Cale’s new Vyvanse prescription right after our appointment with Cale’s psychiatrist on Friday afternoon, but the directions said to give it to him in the mornings with food.  So we waited until the next day (Saturday) to give him his first dose.  He took it at 10am right after he’d eaten his breakfast.  And he seemed the same as usual until noon, when I left to go to a baby shower in my fantastic new bra with my thirty seven year old mom shirt over the top of it. 

When I got home from the baby shower (around 3:30pm), Shane said to me, “I don’t think that we should give him that ADHD medication anymore.”

Cale had become increasingly more agitated than usual (if you can imagine that) all afternoon.  And, a little while later, after we’d all decided to go for a little drive to get everyone out of the house (an activity that usually calms Cale down), Cale seemed to go absolutely crazy in the car. 

He unhooked his seat belt, but then he couldn’t get it hooked back up again.  So he screamed until Alden hooked it back up for him again (don’t bug me with ABA right now, sometimes you just want the fucking screaming to stop).  But then, he unhooked it again and screamed until Alden hooked it for him again.  Then he unhooked it again and screamed until Alden hooked it for him again.  And then again.  And again.   And again.  And again.  And faster and faster and faster and faster.  He absolutely HAD to unhook it, but it made him crazy when it wasn’t hooked.  And finally, after about the 600th time that Alden had hooked it for him again, Alden finally yelled, “I don’t want to keep hooking it for him Mom!  Why won’t he just leave it on?!”

So we left the seat belt unhooked.  And Cale screamed such a loud, strange scream in the car all the way home that he sounded like he was actually dying.  We got him home and, when I tried to get him out of the car, he attacked me with the full force of his strength.  So Shane carried him down to his bedroom and locked him in it, because there are times when this is the only thing in the world that will calm Cale down.  And this certainly seemed to be one of those times.

We put him in his room at 5:45 pm, and he screamed that scream, and produced loud crashing noises even though I was sure that I had cleared the room of anything that he could actually move, for over an hour.  Now, Cale has done this kind of thing lots of times before, I must admit.  But this time was different, even though I had no way of explaining how.  For some reason, I was really scared about it, so I called the on call psychiatrist (who was a different person than Cale’s psychiatrist) and told her that Cale was locked in his bedroom and that he had been screaming and crashing into things for an hour.

She told me that the Vyvanse only stays in the system for twelve hours.  “The only thing you can do is to wait for the Vyvanse to wear off,” she said rather apathetically, “He should start to calm down around 10pm if you gave it to him at 10am.  Then, discontinue the Vyvanse, because it obviously isn’t working for him.  And good luck.”

“Hold on,” I said, “I need to know what I can do for him right now, because I’m really scared that he’s going to hurt himself.”

“Well, if you’re actually worried about him hurting himself,” she said, with just the tiniest drop of sarcasm oozing from each word, “you can take him up to the emergency room and see if they’ll give him a sedative.  They probably won’t, but you can try it.”

“So, let me see if I’ve got this straight.  I can take a completely out of control child up to the emergency room, with no way of containing him (he’s way too big for a stroller now), and wrestle with him while he beats the crap out of me for four hours in the E.R. waiting room, while waiting for a sedative that they probably won’t give him?”

“You can try it,” she said.

“Wow.  Thanks,” I said.

At 12:10 AM, Cale had been screaming that same strange scream, non-stop, and making loud, crashing noises, for over six hours straight.  10pm had come and gone, yet there was no end in sight.  Both Shane and I had gone in, multiple times, and tried to get Cale to lay down with us (he had thrown dresser drawers around the room, and had upended an incredibly heavy table that I didn’t think he’d ever be able to move, let alone flip).  He wanted to lie down and snuggle by then, he really did.  But he just couldn’t stay.  He’d lie down for two seconds and then get up and literally run circles around the room.  Then he’d lie down for two more seconds and then get up and literally run circles around the room, etc., all while screaming and screaming and screaming and screaming.

This is a child who ordinarily can’t keep his eyes open past 9:00 at night, no matter what kind of a day he’s had.  So, sobbing, I finally succumbed to taking him up to the emergency room, while Shane decided to stay at home with our other two kids.  I put my beautiful new bra on under my tank top, instead of my comfortable old one, because I figured that I’d be coming back home later that night.  Then I put together a diaper bag complete with wipes and crackers, got Cale dressed, and put him into the car.

I sobbed, while Cale screamed like he was dying because he had unhooked his seat belt and couldn’t get it hooked again, all the way to the hospital.  He had torn all of his clothes off by the time we got there, so I had to wrestle clothes back onto him in the parking lot in the middle of the night.  And, once we’d finally gotten inside, I could barely talk in between sobs for long enough to tell the receptionist why we were there.

“I’m probably over-reacting,” I almost couldn’t breathe, “but he can’t talk.  And he’s been screaming for six hours.  And he threw the dresser drawers and upended the little table that my husband made for him.  And it’s sooo heavy.  I mean, I should’ve taken it out of there sooner, but it just never occurred to me that he’d be able to move it.  And the psychiatrist said that the Vyvanse would wear off by ten o’clock.  But now it’s 12:30.  And what if he’s screaming because he’s hurt and can’t say so?  I I I I guess I just need to know that he’s not h h hurt.”

I think it’s amazing that the woman understood anything I said at all.

She got on the phone immediately and I heard her say, “Yes, I’ve seen some aggressive behavior already (Cale had hit me a couple of times, not very hard though, while I was talking, but I was too upset to say, “Oh sweetie, that was nothing compared to earlier.”).

“Oh yeah,” she continued, “They’re definitely going to need a private room.”

Then she hung up the phone and said to me, “I have a close friend who has a daughter with non-verbal Autism.”

I could’ve kissed this woman.  She had us in a private room within ten minutes. 

There was a toilet and a sink in the room that we were placed in, but it was nearly 1am by then, and I had a headache the size of Mars, so I decided not to wrestle and get beat up by Cale.  Instead, I let him do his thing.  He tore through the diaper bag, and tore through my purse, and threw stuff out all over the floor (I think he was looking for a cup).  And he must’ve flushed that toilet twenty five times, and must’ve run five gallons of water down the drain of that sink, in the short amount of time that it took for the doctor to get into the room.  It was the fastest that I’d ever seen an emergency room doctor ever.

I wasn’t actually expecting a sedative for Cale by then.  I mean, I can’t say that I wasn’t secretly hoping for one, but, especially after what the psychiatrist had said, I didn’t think that they’d actually do it.  But what I didn’t know was that they had successfully taken Cale’s pulse (he kept ripping the little thingy off of his finger, so I didn’t think that the nurse had actually gotten it).  So, when the doctor entered the room, he said, “I could hear him from clear down in the other hall!”

“Oh, I’m so sorry,” I replied.

“And I thought to myself,” he continued, “that boy needs a shot of ATAVAN!”

“Oh, THANK YOU!!” I jumped up and only just barely stopped myself from hugging him with my fantastic new breasts.

“You’re welcome,” he said, “Now, after he’s had the shot, I want you and him to snuggle and sleep for a couple of hours before I send you home.  That way I can monitor his heart rate for awhile and make sure that the sedative sits alright with him.  Okay?”

“That sounds wonderful, thank you,” I replied, “but would you mind checking him over too, just to make sure that he’s not hurt?  He can’t talk, so he can’t tell me if he is.”

The doctor checked him over and, with the exception of a few small bruises, Cale wasn’t hurt, and I suddenly felt so much better about everything in the whole entire world that I finally began to relax.  Within just a few minutes after that, Cale had had a .25 ml. shot of Atavan.  But then, after twenty more minutes, I finally asked the doctor as he entered the room again, “Are you sure it was a sedative that you gave him?  I don’t mean to be impatient or anything, but I’m rather looking forward to the snuggling and sleeping part.”

The Atavan hadn’t done anything at all, and what I hadn’t realized yet was that the doctor and the nurses had already been discussing this for several minutes out in the hallway.  The doctor said to me, “I’m sorry about this, but I clearly haven’t given him enough.  It’s hard to know for sure just how much is safe for such a little guy.  I think that we should start an I.V. so that we can administer further doses without having to keep giving him shots.”

“Okay,” I agreed.

It took four people, even though he’d had a shot of Atavan, to hold Cale down so that they could get the I.V. into him.  “Wow, he’s really strong,” one of the nurses said to me.

“Yeah,” I said, but what I didn’t say was, “I don’t think he’s ordinarily this strong though.”

From 2:30am through 5:00am, it took three of us literally wrestling with Cale to keep him from ripping his I.V. out, and to keep him in the bed (he was too wobbly to be out of the bed safely, yet he kept trying to wrestle his way out of the bed).  And he screamed, non-stop.  

We tried everything to sooth him.  We sang him every song that we could think of, we tried picking him up and holding him, and we tried bouncing and rocking him, but he was too determined to get down onto the floor for any one of us to be able to hold him for more than a few seconds at a time.  And, when we did let him get down onto the floor, he wouldn’t lay down there either.  Instead he tried to run, fell right over, and landed his sweet little nose right onto the linoleum (this only happened one time and then we didn’t let him get down onto the floor again). 

It was so strange.  He seemed to have two different trains of thought going at the exact same time.  On the one hand, he liked the nurse that was near his face, the one who was holding one arm and half of his chest down.  And he would look her in the eyes, and pet her arm, and softly touch the shiny bracelet that she was wearing (which she immediately took off and gave to him).  But on the other hand, and at the exact same time, he was screaming at her and trying desperately to get up.  The bracelet didn’t distract him at all.  It couldn’t.  Nothing could distract him, not even his fondness for this nurse. 

He knocked glasses off of peoples’ faces, and hit and kicked peoples’ faces and arms and chests and legs, in between his soft touches on peoples’ faces and arms.  And he actually managed to almost get out of the bed multiple times, even with three of us holding him down, all while getting receiving another .25ml. of Atavan, and then another .25ml. of Atavan, and then another .25ml. of Atavan, and then getting a .5ml. of Atavan, and then another .5ml of Atavan, and then another .5ml of Atavan, and then another .5ml. of Atavan, and then another .5ml. of Atavan, and then another .5ml. of Atavan.  He had four milligrams of Atavan in him by 5am (two adult sized doses), and it hadn’t even slowed him down, let alone put him to sleep.

Shortly after 5am, after the nurses had started begging the doctor for a concrete plan because all of our muscles were getting so sore from the two and a half hours, straight, of wrestling (they had explained to me that they didn’t have child sized restraints, and that putting him into adult sized ones would be more dangerous than continuing to wrestle with him would be), the E.R. doctor finally managed to get a hold of a pediatrician from children’s unit upstairs.  Then he came back into the room with a full milligram dose of Atavan (the fifth milligram), but Cale had managed to bend his I.V. needle into a z shape in the process of all of his wrestling, so they had to poke him again and start a new I.V. 

I had to visit the bathroom while they were doing this, because I couldn’t stand it anymore.  While I was in there (or, rather, I was eavesdropping in the hallway) I heard the doctor ask for two vials of blood, which the nurses took directly out of Cale’s freshly replaced I.V.  I’m sure that the doctor wanted to find out just exactly what was in Cale’s bloodstream, just to make sure that I hadn’t given him crank or something.  I mean, I would’ve wanted to know if I had been that doctor.  Then, as I was entering the room again, the doctor put the one milligram dose of Atavan into Cale’s new I.V. all at once.

It still took about ten minutes, during which the doctor said something about admitting Cale to the hospital, and the nurses and I discussed whether I should hold him tightly in the bed on the ride upstairs, or hold him tightly in a wheelchair on the ride upstairs (everyone, including myself, had completely given up on the idea of Cale actually going to sleep), but then, Cale laid back and fell, peacefully, to sleep.

None of us could move.  We all waited, for another ten minutes or so, for him to spring up out of the bed again.  But he didn’t.  He finally seemed to be good and asleep.  Then one of the nurses looked up at the heart monitor and said, “88 beats a minute?  That is so much better than the 180 beats a minute that he showed up here with.”

I nearly choked on my own tongue, “His heart rate was 180 when we got here?!”

“Yes,” she answered.

I looked down at my son.  His sweet face was as puffy and white as a ball of cotton, and it was as if the whole night caught up to me all at once.  I began to cry. 

One of the nurses in the room looked at me and said, “You did the right thing bringing him in honey (I had been worried, earlier, that I had over reacted by bringing him in).  You’re a good mom honey.  A good mom.  A really good mom.”

All four of the nurses that had helped us through this process looked at me at the same time and nodded.  And my mind felt a little embarrassed that they were treating me this way, but my heart sucked up the praise like it had been starving to death for a month.  And, just as I had started looking forward to snuggling and sleeping for a couple of hours again (I had actually forgotten, for a moment, that they were going to admit Cale), the doctor came in and said, “It’s time to go upstairs to the children’s unit.  He should sleep for the rest of the day now.”

“Really?” I asked.

“Oh yeah,” he said, “If I gave you or me that much Atavan, we’d probably sleep for a week.  He’s had so much that he’s going to need to stay in the hospital for the rest of the day so that they can keep monitoring his vital signs until it wears off.”

We said “thank you” and “good bye” to all of the emergency room nurses that had helped us, who said things like, “Good bye Cale,” waving at his little, sleeping face, “I sure hope that I didn’t leave any finger print bruises on you honey.”

“It’s understandable if you did,” I told them, “I probably left my fair share on him too.”

Then, the same nurse who told me that I was good mom rolled Cale’s bed upstairs to the Children’s Unit.  And when we got to our new room, there was a CNA there who explained to me that she was scheduled to be on duty in our room for the entire day.  And I was so glad that I’d brought him to the hospital.  I mean, not only was there clearly something more going on with Cale than I had originally thought, but he was also being so well cared for considering all of the circumstances.