Caged (part 1 of 3)

I found myself wandering around Target last Thursday morning, at a ridiculously early hour.  I was amazed at how many people were there and seemed not only to be awake, but also seemed bright eyed and almost frenzied in their collecting of Tupperware in what felt to me to be the middle of the night.  “No one should ever be up this early in the morning, let alone be out shopping,” I thought to myself as I walked in slow motion, sucking down a fresh cup of Starbucks like my life depended on it, and waiting for the caffeine to get me onto the same planet as everyone else.

This might reveal something about me, since Target doesn’t actually open until 9am.  But I had been awoken prematurely by a sharp knee, bearing the entire weight of a very wiggly almost six year old, standing on my left hip.  “OWW!” I had yelled, as I pushed Cale off of me.

I had just rolled over to go back to sleep when I felt the cold glass of water that had been left on my nightstand the night before, pouring over my entire body.  And that, I’m afraid, was it.

We’ve been without respite care for over six months now.  And it’s summer time, so we’re all at home for most of every day.  And, during the past few weeks in particular, every one of us (Shane, myself, Alden, and Isabel) has become so sick of Cale (and, as a result, irritable with each other as well) that our house should really consider auditioning as one of the levels of Hell for Dante’s Inferno.

You wouldn’t think that a glass of poured water would be that big of a deal.  And, in and of itself, it isn’t.  But it doesn’t stop with one glass of water.  Cale turns on the bathroom sink, or sits in the bathtub at bath time, and fills his cup full of water.  Then he pours it onto the bathroom floor. 

He does it while no one is looking.  And he does it while everyone is looking.  And, if left unattended, he does it over and over again until the floor resembles a swimming pool, and until it actually begins to rain in the basement underneath the bathroom.  I can’t keep enough towels laundered these days because every time I get a stack of clean towels into the linen closet, all of them are used by the end of the same day just to clean up after Cale.

“Then why do you let him into the bathroom, or let him take baths at all?” you might wonder.  And there’s only one, very simple answer to that question.  It’s because when Cale is playing with water, he’s not screaming and/or breaking things and/or hurting people.  And sometimes, especially when the other option is cleaning up shattered glass and/or kissing your daughter’s wounded face, sopping up the swimming pool seems the best choice. 

If you try to actually keep Cale from going to the bathroom sink, then he simply runs to the kitchen sink.  And when you follow and try to keep him from going to the kitchen sink, then he simply runs back to the bathroom sink.  And he could play this game all day long if you didn’t finally lock him in his bedroom to get a little break from it.

If you hide Cale’s cup so that he can’t pour water onto the floor with it, then he simply opens up a bottle of shampoo, or a bottle of body wash, or a bottle of liquid hand soap, or whatever else he can find, and pours it out onto the floor somewhere, so that he can use the empty bottle to pour water from the bathroom sink onto the bathroom floor with.   

He also likes to pour entire bottles of bubbles, and juice, and soda, and entire boxes of cereal, and plates of food, and bags of chips, and bowls of dog food, and bins of Lego's, and baskets of clean laundry, and anything else that he can get his hands on, onto the floor.  And he never stops moving.  Not for one single second.  So he never stops pouring.

Have I ever mentioned that the words, “NO CALE!!” never, EVER, get you anywhere with him, no matter how forcefully these words are delivered?  In fact, if you’re across the room and you see Cale in the process of turning over a box of cereal, there’s a slight chance that he’ll only pour a few pieces onto the floor if you stay quiet.  But saying, “No Cale!” absolutely guarantees that the contents of the entire box will be dumped onto the floor faster than you can get over to it. 

I, of course, have provided a whole variety of consequences after nearly every pouring incident, things that he’s absolutely hated - time outs, hand slapping, spanking, and putting his hands into the cereal, which he can’t stand because of his “sensory issues,” and making him pick up every single piece (I’ve continued this last one because I think it’s a very good, natural consequence) - but these things have never reduced the frequency of these behaviors in the slightest.  And ignoring the behaviors doesn’t make them stop either. 

The cold, hard reality is that these behaviors aren’t going to stop.  I’ve been trying to make them stop for over three years now, with all of the best of my parenting skills, knowledge of Autism, and prayers, yet they’ve only become increasingly more frequent and intense.  They’re not going to stop.

Shockingly, the pouring is the LEAST annoying of his behaviors.  He’s also managed to actually break nearly everything he’s seen over the past two weeks.  He’s pulled nearly all of the picture frames off of our walls, for example, and shattered the glass in them.  My home currently resembles a prison cell, with nothing but the bare necessities in view.  And even the bare necessities are looking tired and trashed.

I finally moved Cale into Alden’s bedroom in the basement (to the bottom bunk of Alden’s bunk bed) because there’s only one small, high up, basement window in that room, and there are two relatively large windows in the room that Cale was in before (which I feared he would soon shatter if he stayed in there).  And Cale has destroyed Alden’s bedroom.  It’s been cleared to the bones, and Alden has relocated, permanently, to the family room, since Isabel has moved into Cale’s old bedroom. 

The scariest thing about Cale lately has been his aggression towards other people.  He’s been coming after me mostly, but has occasionally gone after one of our other two kids as well, in ways that he knows will hurt.  And it’s completely intentional.  This is how I’ve known that something is wrong.  Cale’s aggression isn’t ordinarily about actually hurting people.  It’s ordinarily about communicating something.  But lately, it’s been about doing damage.  I’ve actually become rather afraid of him.  And I’ve actually contemplated, in depth, calling CPS and asking them where I can drop him off permanently.

You can’t sit down for one second when Cale is at home, unless you just give up and let him start flooding the house or breaking things or beating on you or one of the other kids.  And I get so incredibly tired that there are moments, I must admit, when I know that I’ll be cleaning up shattered glass in two seconds if I don’t get up right then, but when I decide that it’s worth it in order to sit still for one more.  And there are other moments, especially when I’m still sore from his last assault (my jaw, for example, still hurts from him kicking me in the face as hard as he could with both feet while I was trying to latch his seat belt last week), when I just have to leave, to get out and do anything at all besides deal with him.  These are the moments when I have to talk myself out of buying a one way ticket to Europe.   

I had forgotten to grab a cart, so I muddled through the tank tops and yoga pants for awhile - my usual thirty seven year old mother attire.  And I had just thrown a fresh gray tank and new sweater over my arm when, all of a sudden, I found myself in front of the cutest, most impractical, yet delicious little thing that I’d seen in ages.  It was a bright pink, satin and lace, push up bra. 

I wanted to put it on, but I couldn’t figure out why on earth I should do so.  So I just stood there staring at it, chugging my coffee, and thinking about how selfish it was of me to leave Cale with Shane.  I could just picture Shane trying to work virtually over the phone in the rain under the bathroom floor.  And that’s when I was struck with a brilliant thought.  Since I was already right in the middle of a pure, unadulterated act of selfishness, why NOT put on the bra?

I’ve had the same two bras for the past five years now, and I’ve washed them over and over and over again.  They’re almost as worn and as tired looking as I am, so I’ve wanted a new bra for some time now.  Finding a new bra isn’t as easy as it sounds, however, for someone in my condition – condition being that I used to have breasts, that I trusted those who said that breastfeeding wouldn’t deflate them, and that I’m now… well… deflated.  I reflected back on my last bra shopping excursion, which was just last week, in fact, when a friend of mine was in town from Phoenix.  She and I went to Victoria Secret to find me a bra.  

I knew that I had to get back home to relieve Shane of Cale before his next virtual meeting, so there was just no time for beating around the bush.  Therefore, when the sales lady asked me if she could help me find something, I said rather anxiously, “Yes.  I need an inflatable bra.”

Silence.

“You know?” I said, while making the motions of blowing up a balloon on each side of my chest, complete with blowing noises and everything, “I need a BRA.  More to the point, I need BREASTS.”

“Well,” she said, trying hard not to laugh, “I have several styles of push-ups that I think might be just perfect.  What size do you wear?”

“I wore a 36B the last time I bought a bra,” I answered.

“Oh no, that’s not right,” she said, “Let me measure you.”

She whipped out her little string of measuring tape, tied it around what’s left of my breasts, and said, “You measure at a 34 C.”

Wide eyed and absolutely delighting in her outright lie, I had to fight the urge to kiss her.  But the feeling quickly faded when I actually put on a 34 C.  “Can you see the problem here?” I showed her. 

The problem with a “push up” bra, when there’s nothing left to push up, is that you end up with a shelf that you could actually set a can of beer on.

“Oh dear,” she said, “Let me bring you a box of different push up styles.  We’ll find one that works for you, don’t worry.”

As she was bringing me the box of size 34 C bras to try on, she was interrupted by another sales lady who had almond sized breasts herself.  And why is it that everyone wants you to be just like them?

“You need a smaller cup size,” said the nasty little interferer.

Between the two sales ladies, I must’ve tried on twenty bras.  But the problem was that they kept getting smaller and smaller.  I mean, I didn’t mind the bras themselves getting smaller.  But the cup size kept getting smaller too.  And that was just plum unacceptable.  I mean, had I not asked for breasts?  I kept trying to convince them that it was the style (the push up), not the cup size, that wasn’t working, but they knew better.  They were professionals. 

At the incessant urging of the interferer, I finally tried on a size 32 A push up.  And when I came out of the fitting room to show her the sheer pointlessness of hoisting up nothing, I asked her, “How, exactly, is this supposed to make me look like I have breasts?”

“The 32 is the correct size around, but I think that you’re going to need a double A cup,” she actually had the nerve to say to me.

I stared straight into her thick blue eyes, just to make sure that she was being perfectly serious.  And she was.  “Okay,” I finally said, ripping off the Barbie doll sized cups and handing them back to her, “I’m outta here.”

That poor woman had spent almost an hour helping me, and I hadn’t bought a thing.  But at least I hadn’t told her to fuck off.

I grabbed the pink bra that was in front of me at Target.  It was a 34B push up that advertised a two cup size enlargement.  Perfect.

I took it into the fitting room and put it on.  And it looked awesome.  But when I put my t-shirt on over the top of it, I was genuinely baffled by what I saw.  It actually rounded out on each side just underneath my armpits.  “My GOD,” I said to myself, turning to the side.

The nasty little interferer, it seemed, was right.  She wasn’t trying to offend me.  She was trying to keep me from looking like a porn star. 

I bought three practical but very pretty A cup sized bras that morning, ones that lifted and rounded and placed everything properly.  It was the first time, in a very long time, that I had felt lovely.  And even though I was in my usual, boring, thirty seven year old mother attire when we got to Cale’s psychiatrist’s appointment the following afternoon, I felt better knowing that I had beautiful underwear on underneath.

“How’s Cale doing on the Prozac?” the psychiatrist asked.

Cale had been on Prozac for a little over two weeks.  “Well,” I answered (it’s a lot to try to explain in just a few sentences, isn’t it?), “the duration of his tantrums seem to have decreased, but the intensity of them has increased.  He’s actually attacking people with the intention of hurting them.  And he’s become more hyperactive and destructive than usual.”

I told her about some of Cale’s recent destructive behaviors, and cited some examples of his hurting others.  “And this,” I said, “has to stop.  If he kicked one of my other two kids in the jaw as hard as he kicked me in the jaw last week, he could really do some damage.”

“I think he’s bored out of his mind because he’s not in school all day right now,” Shane added.

“He ordinarily likes to listen to music and watch certain T.V. shows though, but he won’t even do these things lately,” I continued.

She prescribed 20mg per day of Vyvanse (a stimulant based ADHD medication) to be given to Cale along with the Prozac.  But she had said, just two weeks before, that she wouldn’t be adding an ADHD medication to the Prozac for at least a month, so that she could get a very clear picture of what the Prozac was doing to him first.  Yet there she was, adding an ADHD medication after only two weeks.

Cale started screaming and hitting Shane and trying to get out the door about then, so Shane took him into the waiting room to play with the toys while the psychiatrist and I discussed how to open a Vyvanse tablet and dissolve it in juice in order to give it to Cale (because he can’t take pills).  Then I asked her, very specifically, “Are you sure that you want to leave him on the Prozac?”

“Well, if the duration of his tantrums have decreased, then I think that it’s helping him a little,” she answered as she stood up (the signal for me to leave).

“Okay then,” I replied, “I guess that we’ll see you in a couple of weeks.”

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.

Caged (part 3 of 3)

“Running from my feelings kills me, but feeling them never does.”

Bonnie

After I had settled down a bit in our room in the Children’s Unit, and had had a little breakfast and some coffee (I had Starbucks Vias in my purse, thank God, to add to the brown water that they call coffee), I finally looked at the CNA.  She was sitting in a chair across the room from me, and was watching Cale sleep.  She had long red hair, light freckles, and very white skin, the exact combination that I would’ve chosen for myself had I ever been given the choice.  “Do you have any kids?” I asked her.

“Three,” she answered, not taking her eyes off of Cale.

“Me too,” I said.

“In fact,” she continued, cocking her head slightly to the side as Cale began to snore softly, “I have one like him.  She’s five years old too.”

You never meet anyone by accident.  Ever.  I really do believe that.  I could actually see the anger that is so familiar to me, swelling up underneath her skin as she decided whether or not to continue telling me about her daughter.

“And she’s been so wild lately,” she decided to continue, “I’ve gotten so damn sick of her that I’ve been seriously contemplating dropping her off on the doorstep of the mental health center and leaving her there permanently.”

The mental health center, now I had never thought of that one.  I had thought of CPS, certain doctors’ offices, and even the police department.  But the mental health center would be a kinder option for sure.  I quickly filed that one away in my mind for possible future reference, and couldn’t help but let out a quiet chuckle while I was doing so because I could relate with this woman so intensely.  That’s when she finally managed to rip her eyes off my son and flash a look at me.  “I’m not kidding,” she said.

“I know you’re not,” I said.

She had heard me talking to my mother on the phone a bit earlier, and she said, “You know, my daughter’s on an anti-depressant and an ADHD medication too.  Maybe I should have her medications re-evaluated.”

We talked about psych. medications for a little while longer - Risperdal, in particular, because it’s a pure, unadulterated anti-psychotic with no selective serotonin re-uptake inhibitor (anti-depressant) in it.  “Oh, how I miss the days when Cale was on Risperdal,” I told her.

I didn’t make it very far into our conversation though, before I collapsed onto the bed next to Cale’s bed (I didn’t dare chance waking him by trying to snuggle up in his bed) and fell fast asleep.  Cale slept until 10am.  Five hours.  “That’s hardly all day,” I complained (I was a bit crabby, as I had only slept for about an hour by the time Cale woke up).

He started wrestling again, this time requiring four of us (including Shane, who had gotten Alden and Isabel into the care of his mom by that point, and had come to the hospital), to keep him from pulling his I.V. out, and to keep him in the bed.  From 10am until just past 11am, there were six of us on Cale, four holding him down, and two re-doing the I.V. again and trying to figure out the best way to secure it into him.  I cried the whole time, probably because I was so tired, and I tried really hard to send a little telepathic message to Cale, “Son.  Son.  Quit fighting it son.  Please.  It would hurt so much less if you would just stop fighting it.”

The message apparently didn’t get through though, because he didn’t stop fighting.  They gave him an adult sized (2 milligrams) dose of Verset (you know the stuff that they give you and then ask you to count backwards from 100, after which you barely get to 97 before you’re out cold), which, shockingly, didn’t make him sleepy at all, but at least it only took two of us to wrestle with him after that.  He didn’t actually go sleep again until a few minutes later, after they’d given him another 2 milligrams (another adult sized dose) of Atavan in addition to the Verset.  

I had some idea about what was going on with Cale by the time the pediatrician came to talk with us, because I had spoken with my mom (who’s a psychologist with a lot of clients who take various psychiatric medications), and because I had discussed her little theory in a fair amount of detail with our CNA.  But, to be perfectly honest with you, I was still just a tad surprised that my mom had hit the nail so accurately on the head.  The pediatrician explained to me that Cale was suffering from a condition called Serotonin Syndrome.

“What happens,” the pediatrician explained, “when you take a selective serotonin re-uptake inhibitor (an anti-depressant, the Prozac in Cale’s case) when you don’t actually have a deficiency in serotonin (when you’re not actually depressed), is that there can be a gradual build-up of serotonin.  The symptoms of this include agitation (and this is an understatement), hyperactivity, high heart rate, fever, sweating, and muscle spasms in the feet.  See his feet?”

They were, in fact, twitching.

“So this is probably what had been going on with this little guy in the first place," he explained, "Then you guys added a stimulant (the Vyvanse) to the top of it.”

I almost vomited. 

“I would think that this was simply a Vyvanse overdose (a psychiatrist prescribed Vyvanse over dose, just to be perfectly clear here),” he continued, “if his feet weren’t twitching like that.  But this particular type of spasm in the foot is specific to having too much serotonin in the system.  And, seeing as how his feet are twitching like that, not to mention the fact that we’re having such a hard time keeping him sedated this long after his one and only, tiny dose of the Vyvanse, I’m diagnosing him with Serotonin Syndrome.  But the treatment is the same either way.” 

“I want to keep him asleep for the rest of the day and all night tonight, because the Vyvanse actually takes about sixty hours to completely clear the system, and because we need to monitor his vital signs while he’s on all of these sedatives.  Then we’ll just have to see if he acts calmer tomorrow, because I’m afraid that the Prozac could actually take two to four weeks to clear his system.”

The doctor set up a schedule of sedatives.  Cale had another dose at noon, which they administered while he was still asleep.  And he was scheduled to have another dose at 3pm, but didn’t actually get it until 4pm (after Shane had played the part of Shirley McClain in Terms of Endearment), so he woke up of course. 

We wrestled with him for the next four hours, during which they gave him every dose of every kind of sedative that they could safely give to him.  And, by 8pm, they had completely given up on him going back to sleep.  That’s when they pulled out the cage.

I had threatened Cale, periodically, throughout the day, that if he didn’t chill out then we were probably going to put him in the pink cage behind the curtain in the corner of the room.  They called it a crib.  They had put a mattress in it, had filled it with soft, cotton baby blankets with tiny yellow ducks on them, and had spray painted it pink.  But it was metal, had a barred top on it, and stood high on top of four metal legs.  It was really a well decorated cage.

They didn’t use the pink one though, I’m guessing because Cale is a boy.  Instead, they managed to produce a gray one.  And it was kind of amazing to me just how much the pink helped the other one, because this gray one literally looked like something a circus animal would be kept in. 

We put an industrial sized crib bumper around on the inside of it, so that he wouldn’t get hurt when he tried to slam himself into the bars.  We succumbed to the idea that he probably would pull his I.V. out, but took comfort in the fact that we didn’t have to wrestle with him anymore.  And we played Bob the Builder on the T.V. set, because it somehow made us feel more humane.  Then we rested.

Cale screamed and flailed around in the cage until around 10pm (about two hours), after which he had the next dose of sedative that he could safely tolerate.  He eventually settled down, watched Bob the Builder for a little while, and then finally fell asleep around 11pm.

Shane told me to go home and get some sleep, as I had been up all night the night before, and had been up all day as well.  But I wanted to stay.  I wanted, if Cale woke up, for him to be able to see that both of his parents were there. 

Shane was exhausted too, from everything that had happened all day.  So I lied and told him that I’d go home and go to bed in a little while if I felt sleepy, and that he should lie down on the bed next to Cale’s cage and get some sleep.  So he did.

I sat up and read my book, The Girl Who Played with Fire, until the words literally blended together from barely being able to keep my eyes open.  Then I tried to go to sleep in the chair, but just couldn’t get comfortable enough.  So I went behind the curtain in the corner of the room, where they kept the other cages.  And I crawled into one of them, a friendly looking red one, and lay down.   

It still took me a long time to doze off, because I felt so angry about everything in the whole wide world.  I felt angry about the kinds of things that kids have to go through.  I felt angry about the kinds of things that parents have to go through with their kids.  I felt angry about the powerlessness.  And I felt angry that the ones with the power (the doctors) don’t always know what they’re doing.  I thought about the CNA and her poor daughter.  And I thought about the children of some other people that I know and love.  I thought about Alden and Isabel.  And I thought about Cale.

For a little while, I thought that I might actually drown in my anger.  My son, right then, was inside of a well decorated cage.  I was inside of a well decorated cage.  Hell, even my boobs were inside of a well decorated cage.

I had been wearing my not so fantastic, A cup sized bra, all night and all day.  It was so pretty, but it was like the thing had a malevolent little mind of its own.  During all those hours of wrestling with my son, and all the sedatives, and all the crying, etc., that stupid little bra crushed and poked and squished and jabbed.  Even right then, the nasty thing was busily chewing on my right boob while I lay there.  I thought hard about taking it off as I drifted in and out of sleep, and I began to dream about getting up to go to the bathroom in the middle of the night, bra-less, in front of the CNA.

I suddenly had national geographic boobs, hanging out the bottom of my t shirt.  They hit the ground as I stood up, and I had to be careful not to step on them as they dragged across the floor in between my feet while I walked to the bathroom.  As I entered, I had to turn around and kick one of them the rest of the way in so that I wouldn’t shut the door on it.  Then I caught a glimpse of the horrified look on the CNA’s face as she stared at me, just before I closed the bathroom door.

I startled awake.   

“Nope, it’s staying on,” I thought to myself (Heaven forbid a certified nurse’s aide, working in a hospital, see something undignified).

I thought about the CNA.  She had been there all day long, helping me wrestle with Cale.  And she was still there, watching over him so that Shane and I could get some sleep.  I thought about all of the people who had been with us throughout this whole thing – the reception who’d helped me in the E.R., the nurses and all of the extra love that they’d shown to Cale in spite of the way that he’d been behaving, the doctors and all of their extra concern, the extra medical staff that we were provided with, the visits from friends and family, all of the texts and phone calls, etc.  And I realized that even though we have to go through really shitty things sometimes, we never have to go through any of them alone.

I knew this already, of course, as this is something that one would hear at church on Sunday mornings.  But somehow, this was a new realization of it.  And thinking about it seemed to poke a little hole in mind, allowing my anger to drain away so that I could go to sleep. 

I woke up around 8am the following morning, crawled out of the red cage, and stretched out all of my limbs.  Everything looked better in the daylight.  The room was bright.  People were smiling.  Cale’s cage had even turned into a crib.  Shane and I went down to the cafeteria and had a long, leisurely breakfast.  And Cale was still asleep when we got back up to the room.  They had given him another dose of Atavan at midnight, and had given him his last dose at 4am.

Cale finally woke up around 11am.  We got him out of the crib and, thankfully, he was much calmer.  He didn’t try to wrestle at all, so Shane and I took turns rocking him in the rocking chair.

Cale did try to stand up on his own a couple of times, but, realizing that he couldn’t yet, he stopped trying to.  He just sat in one of our laps, or rocked in the rocking chair, or sat in the bed, for the whole rest of the time that we were at the hospital.  We fed him a big breakfast of bacon and cereal and apple juice, and they let us leave for home around 2:30pm.  It was only Monday, but Saturday night in the E.R. felt like it had happened a month ago.

As we were getting into the car in the parking lot, I put Cale’s seat belt on him.  He immediately unhooked it and began to cry when he couldn’t get it hooked again.  So I hooked it again and said, “Leave it alone now Cale.”

And he did.

He couldn’t walk for the rest of the day, so we put the baby gate up on the stairs, and stayed with him in the family room in the basement where it’s carpeted, clear until bedtime.  He quickly grew used to having to roll everywhere that he wanted to go.  The sedatives didn’t wear off entirely for the next couple of days.

You can still see the damage on Cale’s poor little body.  He’s got bruises all over his arms, legs, back, chest, and tummy.  He’s got one black eye, two I.V. holes, and one small clamp wound (they used a clamp to hold his I.V. in place, but accidentally clamped it directly into his skin during all of the wrestling in the E.R. – they noticed this later and fixed it once we got up to the Children’s Unit). 

He’s back to all of his usual behaviors now – my bathroom floor is flooding as I’m writing this.  But I must confess that I have a whole new appreciation for this, because the behaviors that seemed like such a big deal when I went underwear shopping last Thursday are nothing compared to what I saw at the hospital over the weekend.  The house is just a house, after all.  It’s nothing at all compared to my sweet, wild little boy, who is thankfully smiling and laughing again.

I wish I could tell you that Cale’s psychiatrist has called to see if Cale is okay, and has offered consult on how to proceed from here regarding the psychiatric medication.  But she hasn’t.  The pediatrician from the hospital called her first thing Monday morning and let her know what was going on.  And he recommended that we follow up with her as soon as is practically possible.  So we’ve called her and left messages every day this week, asking for consult on how to proceed from here.  Neither she, nor her office, has returned our calls.  But there is one good thing that has come out of this whole ordeal.  At least I now know, beyond a shadow of a doubt, that I still need a B cup sized bra.