Archive for January, 2010

Told Ya So!

January 29, 2010

Dr. Kroll, A’s doctor at Meridell calls today. “There are some abnormalities on A’s EEG.”

She goes on to explain to me that both his right and his left temporal lobes had abnormalities on thevisual evoked response and the auditory evoked response. It happened from some sort of trauma to his brain- from a virus, a fall, or maybe at birth. Dr. Kroll says we will never know. It means he has uncontrollable emotional outburts.

A has a new diagnosis added to his list, “Mood Disorder caused by cerebral dysryhthmia.”

The findings indicate that keppra is the right meds– and the doctor is going to increase it. But, we have to keep a close eye, because A’s liver enzymes are high and it can be from the keppra. I didn’t ask what we would do if his liver couldn’t tolerate it, I don’t think I could deal with it right now.

I guess some people would be very upset to hear their child has brain abnormalities. I am actually happy. There is a concrete, quantifiable reason for A’s behavior. I’m not crazy, and either is he- he has a brain abnormality. It’s a real medical condition.

Dr. Kroll is also adding amantadine. I’ve heard from other Meridell Moms that the amantadine has worked wonders.  She wants to wait until Monday to start because A has had weird reactions to meds before and she wants to make sure she is around when he starts.

I need to learn more about the meds and about this whole brain thing. It’s a good project and will keep my mind off schools for now.

Conflicted

January 28, 2010

So life is good. It is easy. I’m relaxed. I am almost all caught up. I don’t feel like I have huge bags under my eyes anymore (I fear I still look like it, but at least I don’t feel like it!) I am contemplating exercising again (That’s how I start– a few days of contemplation, followed by a few days of shopping for the right gear and then, if all is well, I start.)

Life is so good, in fact, I don’t want this to end. When A comes home, I fear it will end. I want to just freeze time and enjoy what we have now, but I am so conflicted. Enjoying what we have now means acknowledging that A will ruin the sweet family we have. I try to picture how he will fit back in- we are out to dinner, where will he sit? How will he handle it when the waiter brings the wrong soup? Or when B makes a weird noise? Or H is rambling on and on about her day in school? D isn’t too tired to be patient?

I speak with A’s therapist today and she tells me they have spoken about school. A told her he won’t go when he comes home. She asked why he goes there. He responded that the consequences are more severe there– that they would give him a shot if he wasn’t compliant. Therapist tells me that is not true. They don’t do that. But, they did do that in Atlanta. Therapist says she is trying to get A to do things he doesn’t want to — like write. She had him write his name. He said it hurt his hand. Therapist told me that she told A there is no medical reason why his hand would hurt.

I bite my tongue. Then I can’t help myself and I tell her that I thought hand pain was a symptom of dysgraphia.

“You are right. I apologize- I forgot about the dysgraphia. I am so sorry!”

We move on, but I hope she apologizes to A. I am disappointed but don’t want to lose faith in therapist. I want to let my guard down and trust professionals again.

I speak to A tonight and he isn’t crying. He tells me his roommate is bipolar. I ask if it is helpful and he says yes, they can talk about it. I never want him to leave Meridell. What is wrong with me?

I tell D that I feel horrible that I want Ato stay away and D tells me its because I only remember the bad stuff. I ask if there has been any good stuff in the last few months. “No, but there once was.”  I am so scared we will never be back to where we once were.

I am also so conflicted about meds. If A does so well in highly structured therapeutic environments, and we are considering keeping him in one, then why medicate him? If he comes home and decompensates even when he is on meds, what is the point?

Why can’t this be easier? Why can’t we be like other families who’s to-do list include soccer practice an dance class, not psychiatric medications and boarding schools?

A New Day

January 26, 2010

Today we had family therapy over the phone. I was nervous, as our history with family therapy has never been great. It’s usually the therapist telling A he needs to pick a coping skill to use when he is upset and A saying he can’t and then me finally intervening and saying that we believe without proper medication A won’t be able to employ coping skills.

But this was different. At first, it was just the therapist, me and D. She went down the observations from the week. “Very teary, shows a lot of anxiety.” We asked if his display of sadness was more than to be expected and she said yes. It shows the high level of anxiety. So far, no acting out, which we expected would be the case. I tell therapist I am worried that he will never act out there–they will never know if he is stable if they never see him unstable. She assures me this won’t be the case. Somehow I believe her.

We discuss his birthday- send a present, celebrate when we visit– which looks like the weekend of February 19th, but we will know for sure tomorrow when the teachers, the doctors and the therapists all discuss A together– very impressive!

No med changes yet. QEEG today. Results in one to two weeks.

A is participating in school.

She has him join us for the last few minutes. He sounds good. No crying. Says he isn’t hearing voices anymore. Says he did at home, but knew they weren’t real. Therapist reads his therapy goals- which are pretty general right now- mood stabilization, no sexual acting outing out (A doesn’t flinch on this, but D gives me a weird look,) participate in therapy. A tells her he can’t do these. She tells him they will be adjusting meds nad they will help so much- trust her. He says okay.

It’s time to say goodbye and he cries, but therapist is with him and D and I hang up- we have an afternoon of afterschool activities to attend to.

H has a spelling bee tonite- so exciting! I fantasize she wins and I feel guilty because I never knew what an incredible speller she is because my life has been so wrapped up with A– it’s just a fantasy- she loses on round two- “Exist. E-G-G-I-S-T. Exist.”

D and I take her out to ice cream after and she is thrilled that it’s just the three of us. B is home with Nanny.

The evening ends with a phone call to A. He sounds good. No crying. He tells me he has a roommate now. We discuss his birthday present and he places an “order” but tells me not to send it- just send small things and leave his spy remote control car home. I tell him when we come down to visit we will celebrate– he doesn’t seem upset that we won’t be together on his birthday. Tells me other kids might need to use the phone, so he has to go.

“Bye Mom, love you.”

Opposite Day

January 26, 2010

I realized today that the same survival mechanism I used in Atlanta to get through the separation from B and H is what I am doing to get through A being in Texas. In Atlanta I couldn’t think about the two kids back in New Jersey, and now I can’t think about A. When I let my mind drift there, it is so overwhelmingly painful. I am, however, able to block him out, as sad as that sounds.

I spoke with A’s nurse this morning. She said that so far, an hour into it, A hadn’t left the classroom to cry in the hallway. He was making progress today. I can’t wait to speak with his therapist tomorrow.

D and I went to a Child and Adolescent Bipolar Foundation Support Group meeting tonight. I never would have thought, six months ago, that an evening with the parents of disturbed children would be a great date night, but it was. I felt like everyone in the room was speaking the same language as us. They all understood. And we understood them.

Same

January 24, 2010

The day runs smoothly. Everything is so much less stressful without A. I am ablet o bring H to Hebrew School and go food shopping and then to Target without worrying about anything. D and B have a fun boy morning. I think it might be the first time in my parenting history that I don’t feel an urgency to finish my errands so I can go home. That’s the good news.

The bad news is A is still crying. He calls this morning and is crying. We call in the evening and he is still crying. The staff tells us he is crying most of the day. A tells me he can’t do “this” without me. I tell him he can. He is stronger than he realizes. I tell him he is doing a really hard thing, but he is doing it. I want to go down there and bring him home. It feels like too much for a little boy.

I hope he sleeps well and that tomorrow maybe they can start doing something with his meds to make him feel a little better.

The New Normal

January 24, 2010

I  had a restless night but had to get up and get H and B to school. It’s so easy. I make breakfast and they eat it. They get themselves dressed. They speak nicely in the car. I start thinking I hope they keep A for a long time. And then I feel so guilty.

I have the whole day to myself. I go to work for the first time in a very long time. I unpack at home. I also have lunch with a friend. We haven’t seen each other since October. It’s so unreal.

I get a call from A’s new school- they keep the treatment center and school very separate, even though they are on the same campus and all the students are in the residential program.

They want to discuss A’s IEP and his needs in the classroom. I’m impressed. The voice on the other end explains that they will implement A’s current IEP for 30 days and then we will have an IEP meeting –I will either be there in person or on the phone–to discuss any changes he may need. I feel, for the first time, that A’s  academic needs are in the forefront. What a relief.

I spend the afternoon with H. She has plans to go with D to a hockey game, but she says she doesn’t want to go. Finally, she starts to cry and tells me, “I am afraid you won’t be here when I get home. You are going to go to Texas.” She needs a lot of TLC now. There were too many times that I was suppossed to be there for her and I disappeared- for weeks. We do convince her to go and I make a point to tell her that all of that is over. I am here and will be able to let her know in advance before I go to Texas.

B and I spend the evening together. He seems unfazed by my absence. He’s not as complex as his sister. I think it’s a gender and age thing.

The phone rings and I am suprised it is Meridell staff saying A would like to talk– it’s not a phone call night .Staff explain that A was very upset and they told him he could have  short call. A is crying and I assure him we love him and he will feel better soon. I really have no idea what to say.

_______________________________________________________________________________________________________

Saturday- H and D go skiing. B and I get haircuts, mail A a package and take the dog to the dog park. I am struck by how easy B is. I’ve been secretly worrying about his behavior and was concerned that he may have ADHD at the least- maybe even bipolar. But today I see that he is so compliant, he is eager to please and is happy. I am so glad. I think the other behavior was a reaction to the chaos of A being home.

I spend some time today researching schools for A. I am sadly disappointed in the lack of programs for him in our area. I am not ruling out a residential program, but I think of how nice it would be to have him home and thriving in a special needs school. Hopefully we will find one.

A calls and he isn’t crying. Staff says he is doing a little better. I am relieved. I tell him he is strong and brave and we love him.

H and I see a movie tonight. It’s nice to be out with her. I know she needs the time with me. I just wish it was enough. It never seems to be enough for her. After the movie she doesn’t want to go home. When she does finally get ready for bed she complains no one ever does anything for her. I hope time heals this.

Throughout the day I worry that A will be the only child that can’t be helped at Meridell. What if they don’t keep him long enough? What if  they say he needs to stay for a long time.  I also can’t stop thinking that things weren’t as bad as I made them out to be and that somehow I escalated his behavior. The delusions and hallucinations still stump me, but there must be another explanation. I guess this is denial. I just can’t understand how A went from being really difficult to “severely mentally ill.”

That’s what our insurance company calls him. It means they will cover 100% of Meridell for as long as he needs it. But, it also means that he is really impaired. I spent so many years trying to get friends, family, doctors, school, to see that there was a problem. I guess you need to be careful what you wish for.

I look forward to the day when A is settled in Texas and our lives here are busy and my mind can take a rest.

Home

January 21, 2010

I wake up very early and cry. This is the day. Today I leave A in Texas and head home to be “normal.” The excitement I felt yesterday about him getting better here  is gone. Now it’s sadness.

Being the historian that all the experts are relying on for information on A’s health is the worst job in the world. What if I am not relaying accurate infrmation? What if I am exageratting adn things are that bad? Maybe I am misinterpretting what he is saying. Maybe he didn’t really mean God put him here to kill people. Maybe he just feels so badly about his behavior.

In truth, neither is good and both mean he needs more help than i could give him at home.

During one of the sessions I had yesterday I asked the clinician (can’t remember if it was the nurse, the therapist or the doc,) if “God talks to me and tells me I need to kill people,” could be anything else other than an auditory hallucination. She doesn’t think so.

I still don’t know how we went from coming home from Georgia to leaving him in Texas. It’s like the beginning again- how did we lose fall? Now winter.

If I let myself, I can be led down a haunting path of what kind of a life can a person have if they are already do seriously impaired at 9? Of course, the right answer is that he is getting help at 9, so at 19 he can be a productive contributing member of society. But its so uncertain.

I try to reign my thoughts back in and stay in the now. My mind drifts to a few months ahead and I wonder what we will do when he is discharged. Yesterday I was asked if we had plans to have him come home after discharge. My heart sank and I said I was unsure. That wasn’t an answer on the questionairre, so SHe had to handwrite it in.

My fear and my hope are the same. What if he does so exceptionally well there that he needs  to live away from us to have a successful life? But then why do we live in families? Certainly there is value and strength that children get from growing up in a family.

I think back a few months, right after A was discharged from Four Winds. D, A and I were in Dr. Greenberg’s office we are discussing A’s behavior in the hospital compared to how he is now at home. I tell Dr Greenberg that I am unsure that A can control himself without being properly medicated. It’s a thought that has followed me for years. Reading through notes and reports from doctor’s and therapist’s appointments since first grade things like, “Mom not sure how accountable to hold a for behavior when he is unmedicated.”

Dr. Greenberg snaps at me at says,”This is the attitude that is going to get your child institutionalized for a lifetime.” I am stunned. I, for once, don’t know what to say.

Her words stay with me for a long time. I talk them over with D, with my mom. What does she mean? Didn’t she, literally, write the book on this? Didn’t she say that with the right medication your child will be the child you once got a glimpse of on his very best day?

A lot has happened since that day and I forgot about what she said. Until now. Until the day I did have to institutionalize my son and I worry it is forever. What if they never get him better? What if he does get better but everytime he comes home he finds it so stressful that God talks to him and tells him to do terrible things?

After speaking with Dr. Kroll and telling her everything yesterday, I end the session with a question, “Can you get our boy back?”

She says she may not be able to get him all back, but pretty close. What if close isn’t enough? What if our new life consists of weekly/monthly trips to visit A in a “special school,” a euphamism for a home for crazy kids.

I’m not sure why I think this. I have nothing to base it on. Everything I have heard about Meridell is how they are able to stablize the children and get them home better than ever. I’ve even met a “graduate.” When we were in Atlanta, the family who had us over for Hanukkah one night had a daughter who was just back and was stable– a phone call to them last night confirmed that she was still excelling.

Yesterday, between appointments a during my only brief cry, a man approached and asked if I have a child here. I tell him yes. “I was you six weeks ago,” he tells me. “My daughter was so sick when she came in. Nothing else had helped her. Now, she is doing so well. In six weeks you will be me.”

 I should be thrilled with A being a part of the program.

Instead, I am sitting on the plane bawling my eyes out. I tried to hide it- I put my face as far into the window as I could. The tears kept pouring out and I cry silently. There is a tap on my shoulder and I turn to the flight attendant who is reminding to put my seatback in the upright position for takeoff.  I think I surprise her and the guy next to me. She returns with a tissue.

She’s back a little while later to offer beverage service. I’ve gotten my act together and I order a glass of wine– but they are only taking credit cards. Truth is, I have one in my wallet, I’m just too lazy to get it out from my bag stowed according to FAA instructions,neatly under the seat in front of me. She comes back with the wine and smiles, “It’s on me.” The guy next to me says if I need another, it’s on him. Boy, I must really be a mess.

Somehow the offer of a drink leads me to giving the guy a brief rundown of why I am a pile of tears on a plane. “We have a 9 year old son who suddenly [figured I’d spare the details] started having psychiatric symptoms. We had to put him in a residential program in Austin and don’t know when we will be able to see him again. It is the best place in the whole country.” He says he will say a prayer for us. I wish I could shut up, but I keep going. “He thinks God is talking to him and telling him to kill people. It was just so hard to say goodbye today. Not to be able to say when we would see him again.” I am sure the guy things the fruit doesn’t fall far from the tree.‎

I did it

January 21, 2010

I’m nervous this morning. It’s hard to be so deceitful to A. We have breakfast and he browses the brochures in the hotel lobby, saving the ones that look interesting. “Let’s do this tomorrow, okay?” I nod. I don’t know what else to do.

Our ride arrives. Travis drives us the 10 minutes to Meridell. He has obviously been clued in to our “story.” He talks about our “visit” today. I keep A busy talking about fishing and animals. We pull into the Meridell driveway and I comment to A how calm and quiet it is. He agrees. I want to set the stage for him, without letting on too much.

Travis drops us in the parking lot and I am surprised by the lack of big scary men and security measures. The campus is very ranch-like and the occasional staff person and child walk by. No one is dragged or restrained. It actually looks nice.

As we walk, I think A is starting to understand what happens. “I AM NOT STAYING HERE- YOU PROMISED, RIGHT?”

“A, let’s hear what they have to say and we are going to do whatever it takes to get you better.” We are just a few feet away from the office — we hold hands and keep walking.

Jerry is waiting at the door and he walks us to the breezeway- I told him A throws up when he cries, so we talk outside at a picnic table with concrete under our feet, and not the carpeted indoor area. They really think of everything!

Jerry tells A he knows he has been in hospitals before, but this isn’t a hospital. “See, the kids are walking all around- they spend a lot of time outside. Over there is the school, next to it is the dining hall.” Jerry points out the different buildings. We are joined by two staff members. Jerry wants them there when he “breaks the news.”

I expect them to loom over us, but they sit and immediately engage A in conversation– about his shoes, but it’s a good start. Jerry continues.

“A, I have spoken to your doctor and the insurance company and they both agree you will really do well here so we are going to have you staying in our children’s unit.” A starts to cry. “I don’t want to stay!”

I reassure him that this is where he is going to get well and that he can handle it. I actually really believe it. I’m even excited about the opportunity. But now A  is told he has to separate from me, but he will come back in half an hour to see me again. They are going to show him around and also look for the five cats that live on campus. He won’t budge. He is clinging to me. I know they are about to grab him and drag him away.

But they don’t.

Everyone is patient. They take their time. “A, what will it take for you to trust me. I promise you will come back to your mom in 30 minutes.” They wait. I say some encouraging things. A hugs me and goes. I am shocked.

I am whisked into a nearby room. I am offered snacks, drinks. I am okay. I am not even really sad. The hard part is over.

I meet with A’s therapist. She asks a lot of questions and we fill out  a lot of paperwork. There is a knock on the door and now it’s the nurse’s turn with me. More questions. More paperwork. It’s very thorough. Nothing is shocking to them. Nothing seems like they have never heard it before. I get comments like, “Yep, lots of our kiddos do that,” or “Aha, very typical of our children here.”

Abe and I are reunited for lunch. I meet him at the recreational therapy area where he and his cottage-mates are painting pottery. He is sitting with four other  boys in  a pavillion. No one is acting out. They are all happy- except A who has obviously been crying.

We walk together to the cafeteria. There is something very different about this place. No one escorts anywhere. No one does a body search.

A says he doesn’t want to eat, but I put food out just in case. And he eats. A already went to school today! I ask him about it and he says there were too many children and it was overwhelming. I tell him it will get better. Meridell has a Charter School on campus run by the University of Texas and the children attend from 8:30-2:30 each day. I am thrilled. A, not so much.

 Jerry reappears. He has a knack for popping up and moving things along. He tells us that I have an appointment with the psychiatrist and A is going to join his group. Jerry lets us know the plan. “You will see mom tomorrow at 10:30 and she will get to tour your unit. You will have lunch tomorrow and then say goodbye and mom flies out.” I don’t think A heard the “flies out” part. We hug and kiss and he wipes his tears-but he goes. I’m not sure if he is defeated or he knows he needs this.I am hoping for the latter.

I meet with Dr. Kroll. She wants to hear everything and I have come prepared with A’s medication history. We go over it with a fine tooth comb. She asks me questions about A’s rages that no one has ever asked. “Does he repeat the same thing over and over.” He does. “Describe his face, his body, his hands.” “Does he remember after?”  He says he doesn’t. “Do you believe him?” I’m not sure. “Believe him.”  She orders a Q EEG.

“He clearly has very limited frontal lobe control.” I’ve already gathered that, but its good to have confirmation and she is going to get to the bottom of this.

Dr. Kroll is going to continue the keppra and keep increasing it. D/c the B6- A’s itching from something and it seems to come and go with the B6.Keep the intuniv. Wean him off the valium. Add amantadine. She feels the amantadine will do the trick-he was just on too much other medication at the time.

A’s therapist tells me that they want to give A time to adjust, so we can’t visit for a few weeks. I am actually relieved. It means I can go home and D, B and H and I will get to settle into our new normal, and it’s better than the old normal.

I’m driven to Target to pickup some supplies for A- a few larger sized shirts and shorts, extra pair of sneakers, shampoo. Next back to the hotel. Alone. But I’m still okay. I catch up on phone calls and relax in the room. I read the Meridell Parent Handbook. I learn about their philosophy:

“The Children’s Neurobehavioral Unit’s policy is to respond to a patient’s dysfunctional behavior with an intervention taht has a therapeutic rather than a punitive intent…The strategy is to traet dysfunctional behavior as “off target” behavior that needs to be redirrected, rather than ‘bad’ behavior that needs to be punished…”

I like what I am reading.

I learn that they use the Satori Althernatives to Managing Agression (SAMA) method.

The Critical Beliefs of SAMA:

Ø We all have the right to physical and interpersonal safety.

Ø We all have value because we exist and not because of our behavior.

Ø Cooperation, not competition, is needed for mutual benefit in times of crisis.

Ø We all deserve to be treated with respect.

Ø We all deserve to get our needs met but not at the expense of other people.

Ø We all deserve to be taken seriously.

Ø No one has the right to judge the worth of another person.

Ø Learning is most beneficial in a safe, supportive environment.

After our experience today, I really feel like they take SAMA seriously and we have made the right decision.

Texas

January 19, 2010

A knew Texas was a possibility, but I didn’t tell him that it was going to be long term. He tells me he wants to go for an outpatient program there. I tell him we are going to fly down and find out about their programs. If I tell the truth I will never get him on the plane. I feel terrible.

All our travel arrangements are made by Meridell (www.meridell.com) They pay for our plane tickets and a portion of the hotel. They have bought A a one-way ticket and I have a round-trip- returning Thursday- just two days. I want to stay longer. But, I also really want to come home and give H and B my full attention.

 I am already so comfortable with how the staff at Meridell are handling things. They have things down pat. In the  other hospitals sometimes it felt like they were doing things for the first time. Today I get numerous phone calls and emails with important information- the name and cell number of Ernie, the man picking us at the airport, a list of things to pack, a list of documents to bring.

A is okay with going. But that’s because he is under the impression that we are doing a day program, or, at the very worst he will be inpatient and I will be nearby. He does pretty well on the plane ride. He is well medicated- valium and benadryl. He sleeps for a good portion of the trip. When he wakes up I get him interested in watching a video D has loaded onto the laptop. A’s earphones aren’t working and he gets mad quickly. He hits me and pinches me. I am almost glad. It confirms this is the right thing to do. He does settle down and we arrive, no worse for the wear.

Ernie is holding a sign at the bottom of the escalator, just as planned. We drive to the hotel and he helps check us in. A asks him if Meridell has a day program. “Say ‘yes’,” I whisper. Ernie says yes. “Hey you told him to say that!” But A doesn’t flip out.

“A, I know you want to feel better. We are going to go tomorrow and find out what they can offer you to get better and we are going to do it.”

“I’m only doing outpatient.”

We order food to the room and eat. A spends a long time experimenting with the coffee maker and ice. I speak with Jerry, Meridell’s admissions coordinator. We make a plan. 9:30 we will be picked up. Keep the suitcase here and when I am dropped off later in the day the driver will take the suitcase back with him. Jerry will meet us both and tell us that the Dr J and the insurance company have been in touch with him and they both think A will benefit from their program. A will then be taken (more like dragged) to the children’s unit to start his day. He will be told that if he can be calm enough he can visit with me later. (I doubt that will happen.) They will also let him know that I am flying home the next day, but that we will be visiting very often. D may come down this weekend.  Jerry is quick to tell me they won’t make it sound punitive. I am shaking. I feel so badly to trick him like this. I wonder if he will have a hard time trusting me again?

Jerry has set appointments up with me for the morning- the nurse, the therapist, the doctor. It’s such a  well-oiled machine.

A and I have visitors tonight. Fourteen years ago, when D and I lived Florida, I worked as  a nanny for a 4 year old little boy. His 18 year old self and his mom came over bearing wine and tuna sandwiches. Its such a relief to have a distraction. A falls asleep and I try not to think about the morning.

Too Much

January 19, 2010

A was a superstar at the memorial. He looked handsome, he was socially very appropriate- more so than I ever have seen him actually.  He sat next to me and he cried about my dad. He had tears rolling down his face the while time. He is so sensitive.

He even handled a visit to my sister’s house following the memorial. He had no issues there. He played with B and did great. I let him know how much I appreciated him being there and being so good all day.

We decided there really was no need to go to Texas. We would make it to the new doctor on Friday and she would see he was on his way to stabilization. Yahoo! I did remind myself that we raised the keppra in the morning and, if my theory was right, tomorrow might be a tough day- he may even have a psychotic episode, but it won’t be too bad.

I was wrong. It was bad. Really really bad.

It would have been a hard day under any circumstances anyway. School is closed for Martin Luther King Day and all the kids were home. Morning started off well. We made rice krispy treats. K comes and A even agrees to go outside- they take a walk through the woods to the park. I am so glad he is going outside.

K calls and says A is refusing to walk home. I don’t want to negate K’s power, but I tell her I have no problem picking them up. I think we’ve pushed A too far- one good day and everyone thinks he’s cured and is regular again. I pick them up and he shows me all his rocks he has collected. We pile them in the car, away from his reach and head home.

All is well until he finds out that the plans to see a movie include his brother and sister. He says he is afraid they will annoy him and then he will hurt them. He ends up hitting and kicking me and I restrain him. K helps with the other kids. He does eventually calm down and watches tv in my room and H and B stay busy downstairs.

D comes home. Home Boud instructor comes for an introductory session. I sit with A for most of it. I remember R saying I am his medicine right now. And if this is going to be successful then he needs me next to him. I do leave for a few minutes for a phone call.

What seems like at once, D announces he and B and H are going to a movie, I return from my phone call, and the teacher stops her break-the-ice exercises and pulls out “real” work. A stands up and throws things. “I’m not doing fucking work!” He falls on top of me kicking and biting. Restrain him again. Eventually teacher leaves.

Now it’s time for us to go to a new doctor that will do a psychiatric evaluation for our school district to determine if A needs a special school or not. A won’t get in the car. I tell him its the car or the hospital. He gets int he car, but, of course, when we get there, he won’t get out of the car. The office staff tries to cajole him out, I try a few of my tricks. “It’s a quick appointment, you can do this.” It finally comes down to the hospital threat again. Only, it’s really not a threat. He is so unable to function that I think he really needs the hospital again.

He comes out and we work with the doctor’s assistant on general paperwork. A can’t sit still, he is touching everything, he’s tryign to bite my nails, sticking things in my ear. He can’t really carry on a conversation. It flits from topic to topic. Suddenly he jumps up, looks out the window and sees it has grown dark outside.

“YOU SAID IT WAS GOING TO BE A SHORT APPOINTMENT!!!!!!!!!!” He’s on top of me again with the usual kicking, biting, punching. I restrain him for half an hour and the assistant continues with her questionaires. “Does he ever rage?” Hmmm. Let me think about that one.

A does calm down and the doctor is able to see us. Apparantly the assistant has gotten word to him about A’s behavior and the doctor is happy to recommend a special placement. I just worry it will be too restrictive, not the small sized, nurturing environment I have pictured, but a cold place with large people looming over the kids who are sedated into compliance. Then again, maybe that is what he needs.

A and I have dinner out. I want to avoid getting home too early and having too much time with B and H.

D has the them getting ready for bed and get A set up watching tv on my bed. At least he has migrated up from the basement.

I go to H and B and start tucking them in. D is with A and I hear commotion. I shut H’s door and all three of us are locked in there now. I try to pretend all is well until I hear things spill into the hallway. D screams ‘NO!’ and I run into the hallway to see A with a large picture frame over his head ready to throw it to the ground. D wrestles it away and I hold A. D goes to H and B and I stay with A.

“He tried to kill me mommy, really! He attacked me out of the blue!”

D and I text from our hide outs.

“I need meds. valium 5mgs melatonin 3mgs keppra 750”

“On its way”

“thks. what happened?”

“He pretended he wanted to tell me a secret and instead smack me across my face. When i tried to stop him he grabbed the dog leash and was going to hit me with it. I had to restrain him but he kept getting away.”

Poor D. Poor A. Ugh Poor us.

A takes his meds that D has left at the door.  We have discontinued the lithium as per Dr J- the keppra wasup high enough and A’s lithium level was so low Dr J says it wasn’t doing anything anyway. But I am worried. Lithium has anit-suicidal qualities to it and today A is talking about killing himself. After he crused at me he picked up a remote for a video game and started hitting himself in the head with it. He’s punching and biting himself today. I also worry the keppra is causing this.

At the doctor’s office he told me about God’s putting him here to kill people again, only this time he says he talked to God about it- that he talks to God a lot.

TO BE CONTINUED  — we are headed to the airport. Abe is being admitted to Meridell in the morning.