While I have traveled solo in Italy, Austria, Greece, Thailand, and Cambodia, I have never before traveled solo during a pandemic. It presents its own unique set of challenges, especially with regard to heatstroke/heat exhaustion. It’s not as if, for example, one might simply walk into a McDonald’s or a public library and avail themselves of the free WIFI and air conditioning, let alone a chair. This fact was never more true than in late June/early July 2020, when I left typically cool and cloudy Cape Cod to visit nearby Rhode Island on a personal/professional quest to see how area resorts and tourist areas were responding to the challenges of reopening. A professional waiter for the past 14 years, and occasionally lead trainer, I myself was still on furlough.
Unfortunately, as I hinted earlier, the weather on ‘the mainland’ was surprisingly sunny and hot, and I was ill-prepared for the sun’s intensity. I was doing a lot of walking, which is my usual custom in such circumstances, much of it lost in thought as I attempted to work through a complicated screenplay idea that had presented itself to me a week or so earlier, and I figured, why the heck not? (Had I known then that I could be “sectioned,” i.e., committed compulsorily to a psychiatric hospital on a whim, and as a direct result of this one decision, my conscious decision to do so would have undoubtedly been much different.) Caught off guard not only by the heat and the sun’s intensity, but also by the dramatic differences in the way in which not only neighboring states but also neighboring towns were responding to the challenges of the pandemic, and admittedly not hydrating as I should have, I fell victim to heatstroke/heat exhaustion.
Absolutely desperate for shade and a place to sit down, even if only for a moment, I walked into an unknown person’s yard. Unable to find either, and temporarily confused by the sun and heat, I entered the home instead. I sat down for a few minutes, and then wandered around, soon realizing my mistake. I left, only to encounter the home’s owner as I did so, and I can honestly say that I have never felt more embarrassed in my entire life. In an effort to forget and quickly move on from the experience, I resumed walking with the intent of figuring out where I was in relation to my car, with the goal of returning to it and subsequently my hotel, when I was suddenly surrounded by three police cars with sirens blaring.
A health and safety check ensued, which, as far as I know, I passed. Their assessment, from what I was later led to understand, was the same as mine: heatstroke/heat exhaustion. I was then taken to the local ER, where I assumed that I would be given fluids and a long lecture on the importance of drinking water, applying sunscreen while traveling, not stepping in poison ivy, etc…. I’ve always been a bit of a peripatetic walker, especially while traveling. Providence, Rhode Island being an ideal city in which to do so, on account of the architecture, and seeking, while on vacation, to make as much hay as possible while the sun shines, or in this case doesn’t, I do sometimes stay out all night. Especially in areas such as Downtown Providence or resorts such as Walt Disney World, which I believe to be relatively safe, perhaps never more so than during a global pandemic shutdown.
This was not to be the case, however. The ER doctor asked if I would agree to a CAT scan, despite my not having so much as a headache, and I, having long been interested in all things brain, especially split-brain research, and very eager to see a picture of my own, enthusiastically agreed. The doctor returned, telling me that they had found a bleed in my cerebellum, and asked if I would agree to be transported to a nearby hospital for treatment, and I of course said yes. Surprised, however, by the utter lack of symptoms such as headache, nausea, or difficulty thinking or communicating.
I awoke eight or so hours later, surprised to find myself not dead, but instead, trapped inside what I consider to be my worst nightmare: a hospital bed from which I could not get up without setting off an alarm. I’d been put to sleep somehow, during which time (I later learned) I’d been given additional scans. Deprived of food and water (and perhaps most importantly, visitors), but still exhibiting zero symptoms, I began to grow increasingly frightened, especially after having looked up the hospital on my phone (my belongings were nearby) and noting the caliber of reviews posted online. This is not good, I remember thinking to myself, somewhat presciently.
Eleven days passed. Ten of which were spent on a locked ward (the door is not actually, physically locked, but neither can you leave), eight in the Neuro Stroke Unit, and two in a group psych ward. My “bizarre” behavior of wandering around unaccompanied, and having entered the aforementioned home, was here being viewed as indicative of mania, according to the ward psychiatrists.
I am 50, a homeowner, with a $325,000 house, a 10-year record of $1,700-a-month mortgage payments, and two cars (a Honda FIT and a Miata), all of which I’ve been successfully paying for on a single woman’s salary. My highest-risk behavior? Perhaps more often than I ought, I do drink diet root beer. More so, lately. I follow an anti-inflammatory diet, take pharmaceutical-grade fish oil, and every two years, I have my blood tested to ensure that my AA/EPA fatty-acid ratio is within a very narrow range (1.5 and 3). I exercise regularly, I don’t smoke, I rarely drink, and I am so opposed to the use of substances that I personally choose not ingest anything with caffeine, save for the occasional dark chocolate almond or nonpareil. My one “addiction” (if it can even be called that) is to potato chips.
“If I am manic, let alone bipolar,” I later said to a friend upon my eventual release, “then I am the highest-functioning individual with mania/bipolar disorder in all of recorded history.” Also, I have a master’s degree in psychology, and I literally own a copy of the Diagnostic and Statistical Manual of Mental Disorders, as its use was taught in one of the courses I took in graduate school.
Nevertheless, throughout the entire nightmarish ordeal, the doctors on the ward subjected me to every neurological exam (“Touch my finger, then touch my nose.” “Who are you?”) that they could possibly think of. So much so, that there came a time where I could practically take myself through the entire exam unaided, and I swore to myself that next time I traveled, I would remember to pack my name tag. Their inability to find any neurological evidence via these exams, and my lack of any headache, nausea, vomiting, etc., presenting as happy, smiley, and ranking my pain as “0” on the 1-10 scale, quickly approached a level of total and utter ridiculousness.
Throughout, they pressured me to take Zyprexa (an antipsychotic so powerful that it is also used as a first-line treatment for schizophrenia), and Lisinopril, a medication used to treat high blood pressure), which I thought odd as my blood pressure is consistently low. Also an MRI and a lumbar puncture. All four of which I refused, asking to be allowed to return home in order for the issue to be addressed by my primary care physician. My repeated requests were denied. Every morning I would shower and dress in the clothes I wore when I was brought into the hospital, a blue and white dress with a blue pashmina, hoping that this might be the day I successfully negotiated for my release.
Upon discharge on the eleventh day, I returned home to a lawn that hadn’t been mowed (they had taken my phone away from me), and a cat that fortunately was not dead, but only because I have a guest staying with me in my house for the summer. Within days, paperwork and bills began arriving from the hospital, my share totaling almost $4,000. (So much for my trip to the Vesuvius region of Italy, which I had already begun planning! Goodbye ancient cities of Pompeii, Naples, Oplontis, Stabiae, and Herculaneum!)
The diagnosis for which I lost 11 days of my life? A “stable, non-bleeding arteriovenous brain malformation.” So stable, in fact, that upon my return to his office a week-and-a-half later, my doctor advised me that no change was needed to my usual activity level, which often includes two to three 50-mile bike rides a week and at least one, sometimes two, three-to-six-hour kayak trips.
My other diagnosis: Bipolar Disorder: Current episode manic, mild with no psychotic symptoms. Classified in the report as “apparent,” due to the lack of observable symptoms, which were explained in the report as being due to my taking magnesium as a migraine preventative. (Then why the heck prescribe an antipsychotic as powerful as Zyprexa?) But what they didn’t know, of course, never having bothered to ask me such questions, is that I have only been taking magnesium for two of the past 50 years, so the absence of symptoms of bipolar disorder (mania, a major depressive episode) prior to then remains a mystery. (A textbook example of mania: the patient quits their job, and returns from the nearby pet store with a car full of aquariums, having devised a new way for fish to breathe, convinced he will now become a millionaire. And, in order to qualify as mania, an episode cannot be attributable to the physiological effects of a substance or another medical condition.)
What possible explanation is there for this bizarre and completely unexpected turn of events? Especially in a country such as this one, which prides itself on being a place where these sorts of things never happen? The answer is perhaps as simple as money. The parent company of this particular hospital reported a $35-million-dollar loss in 2019. Had the hospital simply treated me for heatstroke/heat exhaustion, they would have made next to nothing. But 11 days in the hospital (10 on a “locked” ward), a CAT scan, an EEG, an EKG, an MRI, a lumbar puncture, a COVID-19 test upon admittance, and prior to discharge, Zyprexa and Lisinopril; well, I’ll let you do the math (it’s about $20,000). Something to consider when planning your next solo vacation during a pandemic, especially if you are thinking of visiting Rhode Island. Caveat viator.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.