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As it turns out, overdosing is mighty expensive. It has been 28 days since I overdosed, and the bills have poured in to my insurance company. Here is a breakdown of all the charges, with original cost and insurance-approved cost in parentheses:

AMBULANCE
* ALS1-EMERGENCY ($1,100 -> $400.06)
* GROUND MILEAGE ($112 -> $50.12)
* AMBULANCE O2 LIFE SUSTAINING ($35 -> $0)

EMERGENCY ROOM DOCTOR
* EMERGENCY SERVICES ($506 -> $332.16)
* ELECTROCARDIOGRAM REPORT ($25 -> $17.78)

ICU DOCTOR
* INPATIENT PHYSICIAN SERVICE ($501 -> $233.99)

COUNTY HOSPITAL
* MISCELLANEOUS SERVICES ($42.15 -> $34.14)
* MISCELLANEOUS SERVICES ($58.72 -> $47.56)
* MISCELLANEOUS SERVICES ($8.60 -> $6.97)
* MISCELLANEOUS SERVICES ($47.10 -> $38.15)
* MISCELLANEOUS SERVICES ($67.40 -> $54.59)
* COMPREHEN METABOLIC PANEL ($322.40 -> $261.14)
* ASSAY BLOOD ETHANOL ($105.00 -> $85.05)
* ASSAY URINE ACETAMINOPHEN ($159.60 -> $129.28)
* THERAPEUTIC DRUG ASSAY ($97 -> $78.57)
* DRUG SCRN 1+ CLASS NONCHROMO ($250 -> $202.50)
* AUTOMAT HEMOGRAM-COMPLET DIF ($77.50 -> $62.78)
* AUTOMATED, WITHOUT MICRO ($48.60 -> $39.37)
* CRITICAL CARE FIRST 30-74 MN ($693.20 -> $561.49)
* NONINVAS EAR/PULSE OXIM;SING ($88 -> $71.28)
* ELECTROCARDIOGRAM, TRACING ($207.90 -> $168.40)
* INPATIENT PHYSICIAN SERVICE ($584.70 -> $473.61)
* MEDICAL SERVICES ($75.40 -> $61.07)
* ELECTROCARDIOGRAM REPORT ($26.70 -> $21.63)

ON-CALL THERAPIST
* MEDICAL SERVICES ($82.50 -> $58)

MENTAL HEALTH CENTER INPATIENT UNIT
* MISCELLANEOUS SERVICES ($2,000 -> $1,050)
* MISCELLANEOUS SERVICES ($56.33 -> $0)

PSYCHIATRIC APRN
* INPATIENT PHYSICIAN SERVICE ($85 -> $85)
* INPATIENT PHYSICIAN SERVICE ($75 -> $65)

The grand total was $7,537.80, of which my insurance approved $4,689.69. Fortunately for me, I had already reached my maximum coinsurance for the year and did not have to pay a cent of this. Unfortunately for the purposes of this post, I cannot give an idea of what the out-of-pocket cost would have been.

niagara-river

The real cost of an overdose isn't monetary though. It's the risk of having permanently damaged internal organs. It's the awkward silence when you try to explain what you were thinking, or possibly not thinking. It's the knowledge that everyone is looking at you distrustfully, wondering how long until you try it again. It's the awful realization that you could very well be dead, and after coming that close you understand that you never wanted that to happen. It's the fact that once you've overdosed, it continues sounding like a legitimate solution, no matter how mild your depression may be.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/22/the-cost-of-an-overdose/. Please comment there.
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At the beginning of Thanksgiving week, I got up in the middle of the night, stumbled around my living room, and went crashing to the floor.  I couldn't get up.  I screamed for my mother, who leaped out of bed and came to help.  Then, of course, I refused her help.  I managed to pull myself into a dining room chair, but was shaking too hard to drink the glass of water she brought for me.

After some interrogation she asked if I had taken a bunch of pills.  I denied it.  Then she asked again and I confirmed it.  In total, I had taken somewhere between 40 and 50 Benadryl.  When mom realized she couldn't get me to the hospital on her own, she called 911.

benadryl

Many hours of my life are a blur.  I thought I remembered the presence of "Deputy Wayne" from Celebrating February 14th.  This made no sense, so I assumed I hallucinated.  I remembered ambulance lights and being helped outside to get in it.  I remembered a bedpan.  That's about all until I woke up hours later in the ICU.

Things were not much clearer in the ICU.  From that portion of the day, I remember repeatedly getting out of bed.  I remember trying to yank out my IV needle.  I remember a really sweet nurse who offered to order my meals for me so I wouldn't have to make scary phone calls.  I remember the on-call therapist dropping by to determine whether I should be admitted to inpatient, but I don't remember the slightest thing about what I said to her.  I remember mom visiting and telling me that Deputy Wayne really had been there, but I had to ask her about it all again the next day because I wasn't sure I hadn't also hallucinated the conversation in which she confirmed his presence.

I told many different stories about the overdose - some of them during the time when I was not coherent enough to know what I was saying, and others during the course of the following week when everyone wanted an explanation for what I'd done.  Some of the stories:

"I did it for attention."
"I don't know why I did it."
"I wasn't trying to kill myself."
"I wanted to hurt myself."
"I took a few for sleep and it impaired my judgment so I took more."
"I overdosed on Benadryl."  (no reason given)
"I tried to kill myself."

In the beginning, "I don't know why I did it" was pretty close to the truth.  This was what I told my psych APRN when he came to see me the next morning in inpatient.  He tasked me with figuring out the reason(s) I did it so we could prevent it from happening again.

I told most of my friends that it was an accident.  That I took them for sleep and took a few more when they weren't helping, and took a lot more when my judgment became impaired.  The truth in that was that I did only take a few at first and my judgment really was impaired by the time I took the rest.

I told one close friend that I wanted to hurt myself, but wasn't trying to kill myself.  I did want to hurt myself.  I had wanted to hurt myself for days.  I didn't plan to kill myself, although suicidal thoughts had been stuck in my head just as long.

With a few people, I didn't give them a reason and let them make their own assumptions about what happened.  With one particular person, I needed to impress upon him the severity of the situation, so I said I tried to kill myself.  This is sort of true too...I did try, even if it wasn't entirely intentional.

It took me a while to figure out exactly what happened and why and how to explain it, so here's the truth:

I had been having suicidal and self-injurious thoughts for days.  The kind of thoughts for which I'm expected to call the local mental health center's emergency hotline.  The kind of thoughts I didn't think were that much of an emergency and surely I could handle them myself.  The afternoon of the overdose, a friend confided in me that she had been suicidal the night before, for the first time in her life.  She said the only reason she didn't do it is because she had a "painless and tidy" method in mind but lacked the tools needed to execute it.  I don't blame her for my thoughts, but it did spark something in me.  The idea that I really could do it; that nothing was stopping me.

I didn't really plan on dying.  I didn't make any sort of preparations.  I just knew that I had once taken 10 Benadryl with no lasting effects so maybe this time I could try 15.  I was clearly a chicken about it, because I only took 5 at a time, giving myself the chance to back out.  5 pills every half hour, until I reached 15.  Then 20.  At 20 I still felt fine, if somewhat groggy.  I dumped another huge pile in my hand, tossed them in my mouth, and swallowed.  I knew when I took all those at once that it could kill me, but it's true that my judgment had been impaired.  I didn't have the capacity to make a decision about whether I wanted to die.

I was terrified going into inpatient this time.  I was convinced I would be permanently committed.  In reality, they only held me 2 nights.  I got 5 nights once for lying about having suicidal thoughts, but when I overdosed I only got 2 nights?  This was baffling.  I can only imagine that they were trying to get me home for Thanksgiving.  I didn't argue on being released, not wanting to ruin Thanksgiving, but I was still very depressed the next few days and would have benefited from a longer stay.  I'm still working on learning to put my own needs first.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/09/keeping-the-stories-straight/. Please comment there.
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Your 21-year-old car has looked a little better in its time, but it's still running great as you coast toward a green light on the US highway that cuts through your small Midwestern town.  An oncoming car sits waiting and waiting in the turn lane, waiting through the huge gap between you and the car ahead.  As you reach the intersection, the driver abruptly turns left.  There's a split second that lasts an hour, in which you hold your breath, choking on fear as you slam on the brakes, already knowing that the laws of physics make impact inevitable.  The noise as the two cars crush together is familiar from years of Hollywood's most thrilling action films, but now you are inside the noise, not separated from it by a widescreen and a projection system, and it echoes in your ears long after the sound waves have dissipated.

001_wrecked-dodge-dynasty

The air bag explodes with a cloud of suffocating powder, filling the close confines of the car.  You choke, gasping for air, and somehow find the presence of mind to inch your car out of the intersection and into the driveway of the nearby high school, hoping the cloudy air and your watery eyes don't cause you to hit anything else along the way.  You roll down the window, desperate for oxygen, and in between gulps of fresh air you fumble for your cellphone, feeling like Homer Simpson when you think, "What's the number for 911?"  As you remember the number, you forget how to operate your phone, and as you remember that your fingers forget how to move without shaking uncontrollably.

You have just managed to dial for help when you're interrupted by a voice at your window, spilling out of the lips of a man in a blindingly fluorescent yellow vest.  You wish he would go away, and let you finish doing the responsible thing.  You try to focus on the voice on the other end of the phone, asking for the location of your emergency, and when you name the intersection the voice asks you what city you are in.  The rest of the call is a blur, and after you hang up you are surrounded on all sides by witnesses reassuring you that the accident was totally the other driver's fault and that they are staying to give a statement.

It seems like mere seconds between the end of your phone call and the beginning of sirens, and it may very well be seconds given how tiny this town is.  The fluorescent yellow vest belongs to a man who has identified himself as a volunteer firefighter who happened to witness the accident.  He keeps telling you not to move, and you are incapable of listening, trying to reach for the window handle on the passenger side, reach for the hood release when the official firefighters show up.

You won't realize until days later that you never give a thought to the condition of the other driver, as you sit there filling with panic and trying to focus on the paramedic's instructions, asking you what hurts and whether you can squeeze his fingers.  In the back of your mind, you're convinced that you're okay, but you know what happened a few weeks ago when you thought the same thing after taking a tumble on an icy sidewalk.  You know that even if your body isn't hurt, your fragile emotional state is well on its way there, so you agree to go to the hospital.

This is when things take a turn for the embarrassing.  Out comes the neck brace, which does its job of immobilizing you - perhaps too well, as your chin no longer functions when you try to answer an onslaught of questions.  Out comes the backboard and you are surrounded by dozens of disembodied hands trying to pull you onto it and out of the driver's seat as gently as possible, which is, as it turns out, not that gently.

You lie on the backboard on the stretcher, face to the sky, being pelted by raindrops in Mother Nature's sick game of Chinese water torture.  You reach blindly, unable to open your eyes in this weather, for the wallet tucked into your lunch sack, and successfully present your driver's license and insurance card to the person you have to assume is a police officer.  You seem to lie here in the rain forever, the sky crying tears you are still too shocked to muster, before finally being loaded into an ambulance.

After a series of steps to secure you in place, and the removal of a glaring light that still prevents your eyes from opening, the ambulance takes off, blaring its sirens as you think, "This is not an emergency!"  It is a small town though, low on excitement, and clearly the paramedics will take any opportunity to show off their siren.  You jostle and bump along, then head up a steep hill which gives you the bizarre sensation of lying down and standing at the same time.  You are thankful that your injuries are minor, as this carnival ride would have you shouting in pain otherwise.

Somehow, amid all the noise of the siren and jostling of the stretcher, you are expected to answer a series of questions, to which you can barely remember the answers.  You hesitate when asked for the name of your family doctor before finally remembering that you've seen your new nurse practitioner a whopping two times and she does have a name and it's right on the tip of your tongue...  You are asked to name any medications you currently take, and hesitate again when one of them leads to a blank expression and a "What's that one for?"  "Bipolar disorder," you mumble.

Eventually the ride comes to an end.  It seems to have taken an awfully long time in spite of the aforementioned smallness of the town.  You are rolled out of the ambulance and into the ER, seemingly inches away from the lights zipping by overhead.  You barely notice when the combined 200 lbs of your body and the backboard is transferred from the stretcher to a hospital bed.  Someone comes to get your health insurance card and ask you a million more questions, and by now you're so overwhelmed that you're not going to remember anything that was said.  Except that after again asking for a list of medications, your medical history is repeated back to you as "high blood pressure, depression, anxiety, and bipolar disorder".  Clearly someone is not up-to-date on what "bipolar disorder" means, seeing as how depression is one of the poles.

A woman offers to call your mother for you, if you can't get a cellphone signal.  You barely get a signal, and your mother doesn't answer, so as you are leaving a voicemail the woman has to remind you to let your mother know that you're okay.  You do, but if you were totally okay then you wouldn't be at the hospital, would you?

Your mother arrives in no time, and that's when you start to cry.  You feel awful about the car and are terrified of the process of dealing with insurance companies and hunting for something new to drive.  A sweet young nurse practitioner comes in to inspect your knees and chest, and she orders x-rays of your chest and right knee.  You go off to play the most contorted game of Twister in order to have the x-rays taken.

At some point, a police officer arrives to return your driver's license and insurance card, which is now smeary from the rain.  You think about how you'll need to get it replaced, before remembering it's for a car that you will no longer have.  The officer takes your statement and thankfully remarks that it matches the one given by a witness, so the insurance companies should determine that the other driver was at fault.

The results on your x-rays come back and everything looks fine, so you end up leaving with an ACE bandage on your knee and a naproxen prescription in your hand, but not before grudgingly accepting a tetanus booster.  You know you'll spend days feeling like a bullet ripped through your triceps, but given that you work in a filthy warehouse and are exceedingly accident prone, perhaps the shot is not such a bad idea.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/07/02/life-experiences-that-no-one-needs/. Please comment there.

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