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This is a diary I originally wrote in December of 2008, in a moment of grief and fury.  I'm republishing it because Paul was, in my opinion, a victim of the Republican Party's passion for killing the social safety net, and thus indirectly murdering those of us who depend on it.  I know those are harsh words, but I'm no longer able to cut any slack for those who consider me and my brothers and sisters in the hellish world of mental illness disposable and irritating.  Fuck being gentle about Godwin, folks, this is life and death for everyone who isn't Fit for the New World Order of Scott Walker and his ilk
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My brother-in-law committed suicide on Dec. 24, 2006.  He jumped off the Franklin Ave. Bridge sometime around midnight and died of blunt-force trauma injuries.   He had a severe depressive illness and was an alcoholic who couldn't stay sober.  Medication therapy was never effective for him, but ECT had medium-term benefits.  (ECT is modern-speak for shock treatments.)

I'm writing this today because today I read the letter about the investigation into his death, and the actions of the agencies and professionals who were involved with his treatment, and I'm angry and heartbroken.

We were all exhausted.  My sister had divorced him in 2002 because her daughter needed one sane parent.  Friends and family members took turns caring for him and cheerleading for him, and then retreating for respite.  He and I had a connection through our mutual struggles with mental illness, and I spent a lot of time and energy trying (oh so delicately) to help him stay sober.  That was a minefield I often walked out of muttering solemn oaths to never do that again.  (I've never been good at keeping my solemn oaths not to meddle.)

Paul was brilliant.  He was an amazing musician, a guitarist you'd be jealous of if you weren't so moved by his music.  He sang beautifully.  He was an artist who drew fantastically detailed pen and ink drawings.  He was a furniture-maker, and several of his pieces won awards.  Some can be seen in coffee-table type books, featured as examples of the art and craft of fine furniture making in the 20th century.  He was funny and charming, a passionate reader and complex thinker, and child-like in his wonder and love for the natural world.  

When Paul was enchanted by something you had to join him - he never took "no" for an answer.  My last adventure with him was a visit to an abandoned rock quarry he'd discovered.  We drove down dirt roads and hiked down the side of the quarry, and he showed me rocks, dozens of rocks, scores of rocks, and he talked me into carrying many of them back up that hill to the truck so we could make a really great rock garden.  That was about 18 months before he died.  We built the rock garden, and we talked about depression, about how depression sucks the air out of your soul, how it lies to you, how it convinces you that this pit is the pit you've always been in, the one you'll always be in, the one you'll never escape.  We talked about how death is for the sissies - it's staying alive that takes balls of steel (or, in my case, brass ovaries?).

Sometimes I wanted to smack him silly, sometimes I cried for him, sometimes I wanted to delete myself from his life.  He understood why my sister couldn't live with him, he knew how painful and confusing it was for all of us to be present when he was at his worst.  It ate at him, and was probably the core reason he jumped, finally.  

There were other reasons, equally compelling.  He had deteriorated to the point where he was building boxes, plain cubes with one open side, not Queen Anne desks or the unique, complex dining room furniture he designed himself, or the magical, quirky jewelry boxes he created.  He'd pawned and lost his Martin D28.  His hands shook so badly he couldn't draw, and he'd sold the remnants of the furniture he'd made for himself in order to buy food and pay rent.  He stared into the ashes of each of his innate gifts and carefully honed talents every day.

Minnesota had a very good social safety net when Paul first started to need one.  He had an excellent psychiatrist, a man he trusted, through the county mental health office.  He was hospitalized every second or third year, needing a series of ECT treatments which would put him on a smoother path until the next crash and the next hospitalization.  

Then Tim Pawlenty was elected governor, and signed a "No New Taxes" pledge with the Taxpayers League.  I'll leave you to figure out who the T. L. was.  And the social services net developed larger and larger holes, and Paul was more and more on his own.  On the day he died he'd had an ECT treatment, which were now considered "outpatient" procedures because it's very expensive to keep someone in the hospital for the 2 or 3 weeks it takes to complete a series of treatments and to observe the results.  He left the outpatient department alone, although he was supposed to be released to his sister, because he told them he'd take a cab to her house. They let him go because it was Christmas Eve and they were always short-staffed and it was worse at the holidays.  So he took a cab to his apartment and drank a bit, and took all the meds they'd given him to get him through the holiday season and drove to the bridge and jumped off.  

There were 7 pages to that letter, documenting his calls to the new psychiatrist who'd been assigned to him when the county quit reimbursing the doctor he'd seen for 12 years.  It documented calls to the head of the Day Treatment program that had replaced in-patient care, and visits to 2 emergency care centers where he waited 12 or more hours to be seen, and was turned away because there were no inpatient beds available for the indigent.  It documented his growing urgency, over 3 or 4 weeks, to be treated with ECT, which was horrible but effective for him.  It documented a change in medication, without much oversight, and calls about suicidal ideation which worsened the longer he was on the new meds, and a decision to take him off the meds and start ECT out-patient - all of this without any face-to-face meeting with the doctor.  It documented his cries for help, his determination to get better so he could be there to welcome his beloved daughter for Christmas with his family, it documented the utter, complete failure of the healthcare system to do what needed to be done.  

Many lapses were found.  The new Psychiatrist felt as though he had not provided the full extent of the care Paul needed.  The out-patient center had been reminded that patients should not be released on their own recognizance after an ECT treatment, and they intended to do a better job of documenting the follow-up calls that were supposed to be made after out-patient ECT.  There were questions about the wisdom of giving him enough drugs for a two-week period when he was reporting suicidal ideation.  The decision to do that was made based on his excitement about seeing his daughter.  And the investigation is closed with the following recommendations blah blah blah.  

Maybe he was done, anyway.  Maybe the wreckage was too painful to contemplate anymore.  But honest to god, in what kind of bizarre universe do you paralyze a body, shoot voltage through a brain, and not provide a protected environment for that body and brain for at least a day or two?

UPDATE:  I didn't know this diary was on the recc list until Safari crashed and I reopened.  I'm so touched by all the wonderful people who have offered kindness, understanding and support to me and my family.  I'm also so happy I've been able to tell so many people about Paul.  Thank you all.  

 

Originally posted to I love OCD on Mon Dec 29, 2008 at 04:22 PM PST.

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