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September 3, 2018

Denise Herrenbruck

Fifth Recipient of the Honored Guest Blogger Award
in  Ethical Human Sciences and Services

The HONORED BLOGGERS AWARD recognizes “Inspired and Courageous Contributions in Human Sciences and Services” and provides recipients an open platform to publish whenever they wish without fear of censorship. We aim to create a blog site where a limited number of outstanding contributors can freely publish their pioneering ideas and where viewers can easily locate them.  The first Honored Bloggers Award recipient is Peter C. Gøtzsche, MD, the Danish physician and scientist who cofounded the Cochrane Collaboration in 1993, whose courageous scientific and advocacy work helped to inspire this award.

Introducing Denise Herrenbruck

The Honored Guest Blogger Awards have thus far gone to well-known individuals who have spent many years, if not a lifetime, in the public arena of psychiatric reform. Meanwhile, there are untold numbers of people who devote a large portion of their lives to caring and advocating for their own family members who have been victimized by psychiatry. Many of these heroic people wish they had a voice, not only for their own sense of worth and accomplishment, but for their loved ones who have suffered so much at the hands of psychiatry. Beyond that, the world needs to hear their voices.

Denise Herrenbruck’s story about her father so touched my wife, Ginger, that we arranged for Denise to visit me in Ithaca. She brought with her a book-size journal about what had been done to her father, accompanied by significant medical records to back up her story. I was deeply moved by her descriptions of her sensitive dialogues with her wounded father. I quickly learned that Denise is a skilled writer and a wise and thoughtful representative and advocate for those who care so much but have so little opportunity to be heard.

I had no way of helping Denise get published—or so I initial thought. On further thought, it then occurred to me that I did have a way—that I could publish her in the Honored Guest Blogger’s Series, providing her the opportunity to post in installments the entire story about herself and her father. And she certainly deserves to be honored, not only for herself but for so many others who do so much and yet never get heard.

Denise has spent a lifetime in the field of Disabilities Studies & Special Education, acting as a teacher, manager and consultant. Among her many educational activities, she is currently an instructor in the Lewis & Clark Graduate School of Education. She invites you to contact or learn more about her on www.deniseherrenbruck.com.

Denise, thank for accepting this fifth Honored Guest Blogger award.

 

Nightmare in the Geropsychiatry Unit

By Denise Herrenbruck

 

Dad stirs in his hospital bed. It is 2 a.m. and I’ve been dozing across three hard chairs I pilfered from the day room. He is 85 years old and it’s his fifth night in the Geropsychiatry Unit of a well-regarded university hospital, following several transfers of care after he broke his leg 12 days ago.

Now Dad tugs restlessly at his sheets and bedclothes, struggling, looking distraught. I sit up and remind him of my presence. As I stand, he looks in my direction.

“Watch out, Denise! Those are live wires on the ground.”

“Dad, are you having a nightmare?”

His leg is encased in a full-length splint. His neck is stiff and drawn forward, bolstered by pillows. But he still moves about, antsy. He has been immobilized since his fall but was walking around town immediately before. While his restlessness has increased, his mobility has deteriorated. During yesterday’s physical therapy session he had difficulty standing up straight, citing pain in his “spine.” Gripping a walker, he could not stand and balance, let alone walk while favoring his non-injured leg.

Now he insists that he needs to take action before somebody gets hurt. I remind him of his fractured tibia and move toward the bed to block his fall if necessary.

“STOP RIGHT THERE,” he shouts.

I freeze. “Dad, I’m afraid you’ll fall and get hurt. Remember you’re in a hospital bed because you fell on the sidewalk and injured your leg.”

I am hoping to wake him with reality testing. His eyes are open, but he doesn’t seem to be registering my words.

“Look at this damage!” He sweeps his hand across an imaginary landscape. “The hurricane ripped the roof off the house!”

“The hurricane?”

“Yes, don’t you see this?” Dad responds, apparently frustrated at my obliviousness and lack of urgency.

Natural disasters have been on his mind all week. On March 11, the day after he was admitted to the hospital, the worst tsunami in Japan’s history demolished its coastal cities. On the TV in his room he watched waves subsuming buildings. Perhaps subconsciously, the desire to restore order after a catastrophe might reflect his current personal crisis.

Dad ended up in the Geropsychiatry Unit after an incident during inpatient care for his leg. After he broke his leg, he couldn’t keep his balance on crutches. He had checked into the nursing center in my parents’ retirement community to receive occupational therapy and assistance with personal care until he could regain some mobility. There, in my mother’s absence early one morning, he grabbed a crutch from the bedside and waved it threateningly at nursing staff while bellowing at them to stay away. We were perplexed at the unprecedented –and uncharacteristic—behavior in my sweet-tempered father. Perhaps he had awoken disoriented and mistaken the nurses for intruders? He could be fiercely protective. Regardless, the staff summoned the sheriff and Dad was whisked to the hospital. I flew cross-country to support him and Mom, 83 years old with her own aches and pains. One thing I did know: Dad needed a family member by his side. Mom and I would tag team. When I arrived the next day, Dad had received an emergency psychiatric evaluation and was scheduled to transfer to the Geropsychiatry Unit.

The unit has restrictive visiting hours. Its stark white rooms have no TVs or bedside tables. Cell phones are prohibited. We entered under video surveillance and our belongings were searched and held behind the counter. My father’s saline eye drops were confiscated: forbidden without a prescription from the hospital physician.

When Mom objected to these conditions, we learned that Dad had been involuntarily committed. Two physicians had affirmed the treatment as necessary. We could petition in court in 10 days to argue otherwise.

I was flabbergasted. My father, a kindhearted, retired college administrator, was apparently so dangerous that neither his advanced directive nor my mother’s power of attorney protected him from potentially traumatizing treatment. It seemed impossible in a twenty-first century hospital in America.

I don’t mean to portray Dad as completely healthy. A few years ago he was diagnosed with “non-amnestic mild cognitive impairment due to vascular disease.” Last year, he suffered a significant stroke. But in medical jargon, he is still independent in all the “Activities of Daily Living.” And he still enjoys movies, theatre, dining out, and playing jazz piano. Still, my mother’s constant companionship is important; sometimes he calls me when she does errands. And he struggles to sleep well. At home he reads in the living room during bouts of insomnia. More recently, he’s been occasionally waking, showering, and dressing at 5 a.m. and then asking Mom about the day’s agenda. She quips that the first item is to sleep a few more hours.

After three nights haranguing the hospital, my mother and I got permission to stay with my father around the clock. During his first three nights he had apparently awoken and become combative. It had taken three people and a sedative to restrain him in bed. But why must he stay in a bed? He has a hairline fracture to his tibia, and a removable splint. I think he needs mobilization. But a psychiatric resident told us that the priority was treating his behavior.

Now, fretting about the hurricane damage, Dad appears to be acting out a dream. If that’s the case, it is not the first time. A decade ago he broke his wrist hitting the bedside table while dreaming about a karate movie.

“Which house, Dad?”

 “Our house.”

“The Palisades house, or your retirement house?”

 “Palisades”

My parents have owned a home in a retirement community for 20 years. Previously, they raised their family in Palisades, 12 miles north of Manhattan, during my father’s 35-year career at Columbia University. Recently we helped Dad edit a story he had written about building the Palisades house and we plan to publish it to his blog. It will follow his post about the community of young people living in former army barracks in the 1950s. Several couples had jointly purchased a 20-acre plot to build their first homes.

A history and writing buff, Dad drafted dozens of short stories earlier in his retirement about his life experience and genealogy. As his health declined he struggled to finalize and consolidate these into a memoir. So our family helped him start a blog, editing and publishing his stories piecemeal. Dad has been thrilled with the process, including the online responses after each monthly installment. I also cherish this project, a venue for our far-flung family to stay connected, and a way for Dad to leave a written legacy: a family history and testament to his life as a nurturing husband and father.

Tonight, however, we have a more pressing problem.

“I need to get down now,” Dad insists. “This is an emergency.”

Adrenalin is coursing through my veins. I’ve never witnessed Dad out of touch with reality and he has always been extraordinarily reasonable. How can I possibly ease his mind?

A nurse enters. I explain the situation and discreetly ask if he needs medication. We have been told that Risperdal is considered effective for decreasing “hallucinations, delusions, and paranoia” associated with Dad’s new dual diagnosis of “delirium” and “dementia with psychosis.” Although there are documented side effects, the resident physician and his supervisor claimed their patients never experienced any problems. Since his hospital admission a week ago, Dad has received scheduled and “per need” doses of Risperdal, which I learned only yesterday during a family meeting to discuss his diagnosis and treatment. At that time, his medical team—which includes a rotating cast of interns who examine him daily using a Mini Mental State Exam—also prescribed the anti-depressants Celexa and Trazadone to help him relax and sleep.

Yesterday was the first night I stayed with Dad in the Geropsychiatry unit, and I watched the nurse administer Risperdal when he awoke restless. Dad fell back asleep almost immediately. But tonight there’s a different nurse who doesn’t seem to know his pattern.

She says there is no Risperdal on the floor, but she can place a pharmacy order that will arrive in a half hour. Meanwhile, Dad is increasingly distressed and still wants to get out of bed.

The nurse departs and I hear a call for assistance over the PA speakers. She returns with two other staff members who advise Dad to calm down. They stress the importance of staying in bed for his own safety and appear ready to restrain him if necessary.

Now I realize what Dad’s dangerous behavior looks like and grasp how it might escalate in our absence, without an empathic response—one that validates his feelings, if not his facts. I ask the staff to leave so I can talk him down. To my relief, they agree.

“Dad, I see you are worried and frustrated. I love you and want to help. Can you be patient while we figure this out?”

He seems convinced, and then frowns. “Wait a minute. Why are we even having this conversation? You’re just a pipsqueak, my itty-bitty daughter.”

True, I was a pipsqueak once. Maybe he’ll recognize other truths from the past.

“Dad, remember how you converted the playroom into my bedroom after Chris was born? Remember how you helped me pack that room and drove me off to college? I’ve grown up now. Can you bear with me while I try to help?”

He looks pensive. This has registered. I have another idea.

“Remember when I filled in for your secretary at Teachers College during her summer vacation? You used to dictate your memos. Maybe now you could dictate a memo about how to address the hurricane damage.”

“Do you have something to write with?”

Heartened, I get out a pencil and paper.

“One: Call a roofer.  Make sure he’s local. Call the lumberyard for a referral.”

He pauses, skilled in dictating at the proper speed; then resumes, speaking clearly and succinctly.

“Two: Buy tarps from the hardware store: With grommets.

“Three: Hire carpenters for temporary repairs. Have them bring hammers and nails to secure the tarps.”

“Four: Install a telephone in Villa #380. We’ll stay there while we’re fixing the Palisades house.”

Villa #380 is his current address.

“Five: Tell Mom we need anti-clotting stuff. But don’t order anything unnecessary, especially medical stuff.”

“Six: Reinstall telephones.”

“Seven: Run the hot and cold water lines to remove sediment. Drain the hot water tank with the ¾” garden hose.”

“Eight: Call a plumber to inspect the water lines to ensure we have a clean water supply.”

“Nine: Use a black felt tip pen to mark where we need outlets, about 10” above the floor. Get Mom’s approval.”

He continues his detailed action plan. For items 10 and 11, he requests “more towel racks” and “space for recycling,” apparently upgrading the original design, then concludes:

“Twelve: Order medical records. Find out the associated charges.”

I read the list aloud. He approves.

“If you need Mom,” he adds, “she’s down at the Tanaka’s house.”

The Tanakas were close friends in Palisades; their house was a likely place to find Mom during a conflict or crisis. All week, Dad has been worried about her periodic disappearance. At least now he believes she’s in a safe place.

Dad looks more peaceful. His eyelids close.

“Good night, Dad. Pleasant dreams.”

“Good night, Denise.”

Shortly afterward, fifty minutes after Dad awoke confused and agitated, the nurse returns with his Risperdal.

I indicate that he’s sleeping and tell her the medication is unnecessary.

Later, my father would suffer from chronic akathisia, a horrific adverse effect of the psychiatric cocktail he was prescribed in the hospital and afterwards. After 11 days in the hospital, he would never again shower, shave, or dress independently. He would never return home. He would never delight in publishing another chapter of his memoirs, or experience the satisfaction of completing them

We would watch helplessly as my father relentlessly paced in a nursing home with a halting and precarious Parkinsonian gait and an anguished facial expression –excruciating hours, days, weeks, and months for the remaining year that he lived, even after the medications were discontinued, until he broke his hip and died as he was treated for pain.

Later, I would learn that Risperdal and his other psychiatric drugs are potent neurotoxins to which older adults are particularly vulnerable, that they don’t specifically prevent hallucinations or delusions but instead silence victims by impairing the emotional regions of the brain. Later, I would recognize the extrapyramidal effects of these drugs, and feel viscerally why survivors routinely liken these effects to torture.

But on this particular night, when my father’s Risperdal was temporarily unavailable, we had a window into an alternative response to an elderly person’s desperate cries for reassurance in a moment of pain and fear. While doctors had diagnosed my father with a neurodegenerative illness and prescribed medicine, I sensed that he was experiencing a crisis of the soul—one that could be healed with love.

 

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