Monday, January 11, 2010

Talking the Walk (18)

My Medic-Alert Bracelet

Dear Mental Health Professional:

If you are reading this, I assume it is because I am not in my right mind and someone has directed you to this page. Unless you believe that my long history of mental illness renders my advice useless, I hope you will take a minute or two to read these instructions which I have set down while of sound mind. They are too long to put on a bracelet, but brief nonetheless. They could save us both a lot of time, and grief.

Sedation is likely a good idea. I am sure that before I landed in your emergency ward, my sleep had been dwindling to three, two, one, zero hours a night–possibly for a long time–so that my most pressing health problem is extreme exhaustion. It might even be the principal cause of many of the symptoms confronting you. Let me sleep as much as possible for two or three days. Make no attempt, or as little as possible, to hurry me back into a “normal” routine. I don’t need normalization as much as I need sleep.

When my brain and body have rested a little, ease off on all drugs to take a look at my baseline condition. I have come back spontaneously many times from where you see me; try to get a read on my ability to do so now. If my frame of mind is even halfway reasonable, give me some time–a few days perhaps–to see if I can restabilize on my own. Allow me to spend the time quietly, doing little or nothing, with as little contact with others as your facility will permit. Resist the urge to intervene. It is tough, I know, to feel that “standing by” is legitimate treatment, but it is sometimes the only legitimate treatment.

If you feel you need to begin a course of drugs, do so extremely cautiously. I am a slow metabolizer of drugs, so it is best to start me at a half, a quarter, an eighth of what you are used to thinking of as the normal therapeutic range. Trust me: if the drug you prescribe can benefit me, it will do so at a far lower level than its manufacturer recommends; and if it can harm me, it will do so rapidly even at low doses. I have thirty-five years of drug disasters to attest to this. Start small, and advance in minuscule increments. Continue mild sedation so that my sleep schedule is maintained.

As soon as I am even halfway stabilized, ask me what further course I would recommend. I realize this may be difficult in front of your colleagues; do it in private if it helps. I have been through this many times, and have a wealth of suggestions about what could help and what will definitely not. Seek my advice, and I will be more likely to seek yours. Each of us has information the other needs.

Do not panic. Try especially to avoid the type of panic that calls itself “aggressive treatment.” Remember that the patient in your interview room (or on your examining table if I have hurt myself physically) is the same person who wrote these notes. The note-writer will return faster if you follow the steps above, and the faster he returns, the better the chance that he will remain. He is the best colleague you can hope for.

Trust yourself. Try to trust me. And good luck, for both our sakes.

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