Partial Hospitalization Program Rescue Jet

After I bombed at regular middle school, the partial hospitalization program was like a rescue jet to take me to safety. Originally I had gone to the local private Jewish Day School, but they had really small classes.  Plus all the other kids had been together since kindergarten.  I had just moved to Massachusetts so I didn’t fit into the giant clique that only left out one other girl who didn’t care because she always had her nose in a book and was oblivious to the world around her.

Sixth Grade Bullies and Gastroparesis

I had gone to most of the sixth grade but bailed toward the end of the year when I couldn’t take the bullying anymore. The partial hospitalization program probably would have been a good idea then.  Instead,  I went back for the beginning of seventh grade, but again, didn’t last long. My gastroparesis flared up which stressed out my parents, who, big surprise! Tried to blame it on psychological causes, even though I’d had extensive testing done at the hospital when I was ten showing that I have one of the most severe forms of gastroparesis possible.

The Crisis Center Recommended The Partial Hospitalization Program

No matter what I did, my GI confirmed that it would be impossible for me to eat and drink normally. The combination of my gastroparesis acting up and the bullying at school had kind of pushed me over the edge and I’d had a meltdown one day in the middle of October of seventh grade. My mom brought me to the crisis center for an evaluation because I just couldn’t calm down.

While I was crying in the car, I felt so upset and out of control emotionally it brought back wisps of memories of the hospital in New York City where they had locked me in that awful Quiet Room and took all my toys, clothes, art supplies, phone calls, and visitors away, while I was on the Klonopin. That awful anti-anxiety medication that I’d had an opposite reaction to.

Luckily, the crisis worker helped me calm down by talking to me and doing some breathing exercises with me. She got me all set up to do something called a Children’s Partial Hospitalization Program.

The Partial Hospitalization Program even helped with my gastroparesis issues because they explained to my parents that it was something purely physical.

How The Partial Hospitalization Program Caused a Flashback

On my first day, I was super nervous, especially because when we got to the unit’s door it was locked.  A memory of being wheeled to St. Vincent’s child psych unit doors and asking my mom if she also had a key to these locked doors burned through my mind.  I remembered my mom turning pale and whispering that only the nurses had keys to these doors.  Then the door clicked open and an angry unfriendly nurse basically dumped me out of the wheelchair and commanded me to walk.  It had been weeks since I’d walked. 

When my wobbly logs gave out on me, the nurse hauled me to my feet.

“Stop playing games, your chart says you can walk,” the nurse told me.

“She’s done nothing but lay in bed for weeks, her muscles might not support her yet,” my mom tried to explain.

“Yeah, she’s pretty deconditioned,” explained my nurse from the medical floor.

“I think it’s time for you two to leave.  You can come back at visiting hours, we’ll take things from here,” the nurse had told my mom and the nurse.  I grabbed for my mom, but the grumpy psych nurse pulled me away.  Then I began crying hysterically and she just left me there until she came back to ask me if I needed more meds.  I was just feeling the sting of the needles in my butt again when a nurse slid a card key through the lock and opened the door to the partial hospitalization program.

Learning What a Flashback is at The Partial Hospitalization Program

“What’s wrong?” she asked me.

“The lock made me feel like I was back at St. Vincent’s being admitted to the psych unit for the very first hospital stay again,” I explained through my tears as my dad rubbed my back, finally understanding the cause of my hysterics and meltdown.

“Oh, you had a flashback.” The nurse whose name was Nancy suddenly understood.

“What’s a flashback?” I asked.  Unaware of the lingo at the partial hospitalization program.

“A flashback is when someone who has Post Traumatic Stress Disorder (PTSD) gets stuck in a terrible memory of their trauma.  It’s like they’re reliving it.”

“Yeah that’s what just happened to me,” I told her.

“We don’t use this lock to lock people in,” Nancy the nurse explained to me.  We just use this lock to lock people out.  If some random person came wandering into our partial hospitalization unit and stole one of you kids, your parents wouldn’t be really happy.”

“That is true,” agreed my dad with a smile.

Getting My Morning Search

“Here try to open the door from the inside, it should open for you,” Nancy told me.

I gave the door a push and it was heavy but it opened.

“We ask all the kids to never leave by themselves, but you’re not locked in like on an inpatient unit,” Nancy promised me.  I nodded.  My dad handed her my backpack and bottle of Pediasure.. 

Nancy brought me back to an area with cubbies and had me empty out my pockets. 

“Okay, now I just need you to take off your socks and shoes.  Once they are both off can you turn your socks inside out?”

This all seemed a bit overkill, but I followed her directions.  She examined them.

“Okay now put down your teddy bear and stand with your arms out like a tree,” she instructed me.  Then she scanned me with one of those scanners they use to scan for weapons at airports if you can’t walk through the X-ray machine.  After that, she scanned my bear Haley.  Finally, she was satisfied that I wasn’t packing heat and let me put my socks and shoes back on and take Haley back.

Explaining My Gastroparesis To The Other Kids

We headed into the kitchen where everyone was eating breakfast.  All the other kids at the partial hospitalization program asked me why I wasn’t eating.  At first, I was scared to talk to them.   All the bullying at school had made me scared of other kids. 

“It’s okay, you can explain your gastroparesis to them.” Nancy the nurse assured me.  She had followed me into the kitchen and was hovering nearby.

“I have a disease,” I explained to a girl with a long red braid who introduced herself as Rachel.  It makes my stomach stop working.  I used to have a tube that went from my nose into my intestines to feed me, now I just do my best to sip on drinks called Pediasure and Pedialyte, but my best guess is that they are going to have to put the tube back in me again, because it’s getting way too hard to even drink those drinks again.”

“Is that why you’re so skinny?” Rachel asked.

I nodded.

The other kids were listening in.

Just then one of the adults spoke up.  It’s time for a community meeting.  Teenagers head into the school room, younger kids stay in here.

There was a flurry of activity and only about seven kids remained behind counting myself.

Community Meeting at the Partial Hospitalization Program

“Who wants to start off our community meeting?” asked a partial hospitalization unit staff.

“I do,” said Rachel.

“Okay Rachel, take it away, that same staff said.

“I am feeling ok, I listened to my mom the first time and put away my PlayStation and went to bed when she told me to, so I achieved my goal. My goal for today is to use my fidget objects during talking groups to help me pay attention better.”

One of the adults at the table grabbed a sheet from the middle of the table.

“That’s a great goal, Rachel, I will write it on your point sheet.  I think another great goal would be to try and raise your hand in groups instead of interrupting,” she told her.  Rachel nodded.

Other kids went over goals from the night before and whether they’d achieved them.  Then they created new goals for the day.  The adult sitting at the head of the table, who I learned was a mental health counselor named Deanna, kept grabbing new point sheets from the middle of the table.  Each kid got their own point sheet and she would write their goals on it.

My Turn at Community Meeting

When it got to be my turn she explained that since it was my first day my goal would be “get to know staff and rules”.

“Every time you go to a group you give your point sheet to the group leader at the beginning of the group, then at the end of the group they rate you on how well you behaved and how well you met your goals.  The more points you get the higher level you can earn.  If you earn a higher level you have the opportunity to earn more points.”

“Why are points so good?” I asked.

“Well, at the end of the week, we open up the store and you can buy stuff with your points, all the best stuff costs the most points.”

The Groups at the Partial Hospitalization Program

“Oh I get it,” I said.

The groups we went to were talk therapy, art therapy, occupational therapy, medication education, and activity groups.  We also had school classes every day. At the end of the first week, I used my points to get a beanie baby, Hello Kitty socks, a package of colorful gel pens and a black notebook to doodle with them in or journal in, and build-a-bear clothes for my babies like Haley, Softia, Vanilla, and Bearemy.

During my time at the Partial hospitalization program, I did a lot of talking about my time in the hospital. The counselor at the crisis center had explained that I needed to process it, and the psychiatrist at Partial agreed.  It took a lot of guts, but on my first day, I spoke a little bit about it in group therapy. 

Other Kids Identified With My Traumatic Hospital Experiences

The other kids immediately latched onto the conversations.  They voiced their experiences with getting shots in the butt.  Hospitals called it forced sedation.  The other kids also related to me about getting taken down in restraints.  They also knew the anger felt after getting privileges taken away.  We discussed our anger over how we had been treated.  We spoke about our anger at how we had been treated.

The main feelings that came up for all of us out of this discussion were the wild feelings of loss of control we had felt.  Then there were the lingering feelings of fear of the same loss of control that we were terrified would return if we started letting our emotions get too strong.

“My worry is always in the back of my head.  The worry is that I will breathe wrong and then suddenly I will be dumped off at a pair of double-locked doors.  I will have a nurse pull me in and I will start getting shots in the butt.  People will start tackling me to the floor and holding me there with so much snot pouring out my nose that when they move me, it leaves a thick trail. 

Other Kids Identified With Locked Doors, Shots, and Restraints

Then there will be that net-like device tying me down to the bed.  There will be people yelling at me, all my clothes and toys getting wrenched from me.  My parents and connections to everything I know and love will be torn away from me.

It feels like all that is seconds away from me. It’s always in the back of my head that I breathe wrong that here comes the double-locked doors, the shots in the butt, the getting tackled to the floor and held there with so much snot pouring out of my nose it leaves a thick trail, the straps tying me down to the bed, people yelling at me, my possessions and parents and connections to everything I know and love being torn away from me.  It feels like it’s all seconds away from happening again.” I explained to the other kids and the counselors and psychiatrist. They all seemed to get it.

Swallowing One Pill Had Turned Me Into a Psych Patient

I had gone from being in the hospital because I couldn’t eat, took this one pill that they said would help me feel better, and then bam I had turned into this crazy out-of-control psych patient.  

I didn’t know why I felt so volatile. It had been a completely chemically created feeling.   No matter how hard anyone tried to emotionally, or mentally understand that feeling, it would have been impossible, unless they’d been through it.

The Psychiatrist at the Partial Hospitalization Program Understood Me

“Everyone at the hospital understood and treated you as a behavior problem. They acted like you were just being bad on purpose to get attention.” the psychiatrist at the partial hospitalization program explained to me.  “They understood and treated you as a behavior problem. Even if you had been just a behavior problem, you don’t leave a ten-year-old child in restraints for 2 hours. That’s just not okay.”

“When I couldn’t eat my meals they would say, ‘Well I guess you’re here till you turn 18 and we ship you to the state hospital then,’” I told the psychiatrist.   “Every time I think about that hospital stay my heart gets really fast, I get really anxious and I can’t think about anything else.  Then I start to cry and can’t stop, no matter how hard I try.

We Practiced Building Up Safe Place Imagery in my Head

The psychiatrist had me work on building up different places in my head.  She would ask me what they looked like, sounded like, smelled like, and felt like.  Then we would practice going to those places.

The first place I chose was my room at home with my mom reading me a chapter from a book while stroking my back. and getting me ready for bed. Newcomb Hollow Beach in Wellfleet, Cape Cod was my second place. I was picturing myself lying on the shore on a towel in the sun after I just got out of boogie boarding in the ocean.

Places far away from any hospital.

“Every time your brain takes you away from that safe place, I want you to just notice that. Don’t beat yourself up for leaving your place. Don’t judge yourself at all. Just notice you left and bring yourself back.  I want you to say to yourself. ‘Oh, I left my place.’ Then I want you to go back to your place again.  

Go back to the details. Notice your mom’s hand on your back. Smell the mild scent of the Dove Fresh deodorant she uses, and feel the soft pink Hello Kitty blanket covering you.  See the stuffed animals lined up all around the room like little soldiers gearing up to protect you from harm’s way back.” The psychiatrist told me.

The Psychiatrist Made Both Thinking and Medication Adjustments

The psychiatrist had me practice going to one of my places every morning when I woke up for a few minutes and every night before I went to bed for a few minutes.  She explained to me that if I practiced going to these comforting places when I was doing okay then it would be easier going to these places to help me relax and stay calm when it was one of those times that I was getting caught up and stuck in bad hospital memories.  Sure enough, thinking of my safe places helped my heart get less racy and the memories less intense. It didn’t make them go away, but it cut down on the crying jags and I was able to stop pulling out my hair from the intensity of it all.

The psychiatrist also gave me a medication called Trazodone to take at night to help me sleep.  I had been waking up so many times a night that I’d only been sleeping about a total of four to four and a half hours a sleep a night.  She also switched my antidepressant to one that would work better on kids with anxiety.

In OT The Progressive Relaxation Video Relaxed Me So Much I Fell Asleep

In the sensory group, we learned about progressive relaxation techniques.  The occupational therapist brought mats in and had each of us kids grab a colorful, sticky, yoga mat and lay down on it.  Then she turned on some soothing music and had us clench up our muscles and then relax them starting from our forehead, then our eyes, then our nose, then mouth, then chin, then neck, then shoulders, all the way down to our toes.  I fell asleep before we finished.

The occupational therapist woke me up, I was so embarrassed but none of the other kids were staring at me or laughing at me.  A couple of other kids were asleep as well. Some were goofing off and talking to each other.

“How did doing this progressive relaxation make you feel?” the OT (occupational therapist) asked me.

“Super relaxed, so relaxed that I fell asleep,” I smiled sheepishly.

“How would you like it if I gave your mom a YouTube link where it walks you through a bunch of different progressive relaxations to listen to either when you’re in crisis or to help you fall asleep?”  She asked me.

“I’d like that a lot,” I told her.

We Had an Emotional Group Therapy Session at The Partial Hospitalization Program

In a group therapy that one of the psychologists led, one of the other girls in the partial hospitalization program was talking a lot about cutting and being suicidal.

“I really want to just stop cutting, but then I’ll just be so overwhelmed plus I don’t know what else to do to get rid of the need.  The urge comes on so strong and I just can’t fight it.” She explained.

After a long discussion about coping strategies and skills, we ended up making lists of all of our best coping skills.  I wrote down:

1. writing
2. talking to my two best friends Corah and Samantha who lived on my street,
3. drawing,
4. painting,
5. reading,
6. craft projects,
7. going to the mall,
8. watching movies and TV,
9. coloring,
10. Playing with my stuffed animals

11. taking hot or cold showers,
12. doing deep breathing exercises,
13. going to my places in my head,
14. the progressive muscle relaxation exercises,
15. taking pictures with my camera phone,
16. if I have flashbacks to the hospital, naming three things in the room at the present time that weren’t there when I was in the hospital.

Impressing The Psychologist at The Partial Hospitalization Program

The psychologist was very impressed with my list.  

“You’ve done a lot of hard work at learning skills, understanding yourself, and dealing with your emotions.  I think you’re almost ready to graduate from Partial.”

I was a little scared when he told me that because I didn’t want to go back to school.  No matter how many skills I had picked up, I wasn’t ready to face Natasha and her cohorts. There was no way to prepare myself for the way everyone at school laughed at me, made up stories about me, made gagging noises as I walked by, and refused to sit anywhere near me.  

The “Me” before partial would have been afraid to express herself in words and would have let the emotions of fear and anxiety get packed in deeper and deeper.

The “Me” before partial probably would have gone to the next group which was school and then would have done something extreme as the emotions finally imploded and I would have bit myself and pulled out my own hair or something crazy like that because I felt so completely out of control on the outside.

Using My Coping Skills To Express My Needs

However, that was the older version of me.  The new, more skilled version was now in operating condition.

“I’m scared to leave partial because I don’t want to go back to my old school where they all bully me and make me feel bad,” I told the psychologist in private after group therapy, right before I went to the school group.

We went to “school” in the afternoon where we do all the work our teachers from our regular school sent us so that we didn’t fall behind while we were at the partial hospitalization program.

Getting Set Up To Finish Middle School At Home

I never had any trouble at school. They got my work from Sinai Academy and I would finish all of it way early and then just journal, read, or do extra algebra problems that the teacher came up with. Because there was no worry about me falling behind in school, the psychologist and I had a long meeting where I described the extent of the bullying.  The psychologist assured me that we would come up with a solution that would work for everyone.

I left the meeting reassured, but not completely. After all, the adults in my life up to that point hadn’t exactly been that reliable. But this time we had a discharge meeting with my parents, the psychologist, the psychiatrist, the occupational therapist, and the nurse, They all sang my praises, and it was decided that it would probably be better for me if I were just homeschooled. With my mom having a master’s in education and my dad being a dean and professor of a well-known university, they were both more than qualified to teach me at home.