Thursday, January 10, 2013

My Ugly Bipolar Day

Crazy pill count:
AM .5 Ativan, 30 Cymbalta
afternoon .5 Ativan, 60 Cymbalta
PM .5 Ativan, 10 Zyprexa

I was not exactly my best self yesterday. I have been "off" for a long time. I miss my old friend, Lamictal. In Lamital's absence, the sky is greyer, the days drearier, and it is more and more difficult to find reasons to get out of my pajamas. In contrast, my moods are sharper, more erratic, and as fierce as a rattled beehive.

That has become the daily question when I awaken.
Especially yesterday morning - my "not exactly my best self" day.

Before you read, please know I am not proud of my behavior. I am actually very embarrassed. But I am sharing it with you to show you exactly how ugly those bipolar, mixed episode, irrational, emotional outbursts can be. I am embarrassed to share it with you, but I have always promised to give you "a not so gentle look into a bipolar mind," and a lot of it isn't shiny and pretty. And it certainly isn't always gentle.

I had a lengthy phone conversation with my health insurance company in which I used many bad words, I raised my voice, and eventually hung up - but not before screaming, "fuck you." This is what I meant when I said I wasn't exactly my best self yesterday.

And so as the not shiny and pretty story goes...(get ready it's a long, wordy one)

I went to the pharmacy to fill my Zyprexa prescription. I can no longer tolerate the generic, and therefore need to take the brand medication. Apparently my insurance company has decided it is too expensive. If I insist on the brand, it will cost me $3000 to fill my prescription because I am denying less expensive options that are available to me.

I explained to the Care First Blue Choice phone guy the generic for Zyprexa is available to the general public, yes, but it is not available to me, specifically, because it makes me ill. I asked him if he wanted me to be ill. He said he didn't. I asked him if Care First Blue Choice wanted me to be ill. Again, he said no. So I asked him if he could please explain to me how there is a less expensive option available to me.

He replied that since I can not tolerate generic Zyprexa, I can take a different medication with an available generic formula, and that I can refer to the Care First Blue Choice website for "similar" medications and ask my doctor which one he would recommend for me.

I told him that wouldn't be necessary because my doctor already has recommended a medication for me and it's called Zyprexa.

He said Zyprexa is not a choice, and that I need to try something else.

I told him I have already tried something else. I have tried twenty-four "something else" psychiatric medications over the last fourteen years and Zyprexa is the medication that my doctor and I have determined works best for me. I have been taking Zyprexa for seven and a half years. I have tried many other less expensive drugs throughout those seven and a half years, but Zyprexa is the drug that works best for me.

I told him:
Another drug is not an option.
Generic Zyprexa is not an option.
And paying $3000 for it is not an option.

He said:
Care First Blue Choice can recommend another drug.

This is about the time I lost my cool.

This is not me. 
I'm not a cartoon character,
 and I'm not wearing a newspaper hat, 
but this is basicly what happened to me:

I asked him if he went to medical school. He said no. I asked him if he was a pharmacologist. He said no. I asked the same about Care First Blue Choice. Again, his answer was no and no.

I replied that it is very fascinating because my doctor did go to medical school and is a pharmacologist. Fancy that, I told him. I also asked him how long we have known each other because my doctor, who has prescribed me brand Zyprexa, has known me and monitored me closely for seven and a half years. I asked him who he thought would have a better understanding of what drug to recommend for me? Him, or my doctor who has been monitoring me for seven and a half years?

At this point he started getting rude. Can you blame the poor guy? I was being an absolute ass. It's not his fault. It's not up to him. His job is just to talk to crazies on the phone, and I was being a crazy.

To clarify I said,
"You will not cover brand Zyprexa for less than $3000 out of my pocket expense."
And he said,

I flew off the handle.

Remember this guy?
Times his rage by a million:

Crazy Me:
Guess what? The joke's on you, asshole.

Excuse me?

Do you know what's a lot more expensive than Zyprexa? The hospital. Which is where I'll be going because I couldn't take my medication. Because you wouldn't give it to me. Would you like me to be in the hospital?


Crazy Me:
Would Care First Blue Choice like to pay for me to be in the hospital?


Crazy Me:
Hey asshole, guess what else is expensive? Suicide attempts. Do you know who attempts suicide? People who don't take their medication. Do you know who doesn't take their medication? People who can't afford it. Guess what else. When Care First Blue Choice is paying for me to be in the hospital because of my suicide attempt, do you know what else they will be paying for? Zyprexa. That's right, asshole, Zyprexa. Because that's the drug they'll be giving me. Because that's the drug that works for me.

I understand you are upset.

Crazy Me:
Yeah, I am upset. I sound pretty crazy right now, too, don't I?


Crazy Me:
Do you know why I sound crazy? Because I'm trying to fill my prescription for Zyprexa and I can't. This is what I'm like without Zyprexa. I'm fucking crazy.

No one is saying you don't need Zyprexa. We are simply saying Zyprexa is too expensive.

Crazy Me:
Now you're putting a price on my life? You want me to live like this? You want me to be fucking crazy?

I'm sorry, Zyprexa is too expensive.

Crazy Me:
Let's see...I have a couple of ideas for a solution. You can cover the cost of my Zyprexa minus a $30 copay like you did last year, you can give me $3000 to pay for it, because I sure as hell don't have $3000, or I can not take my medication because you are denying it to me at a reasonable cost, and I will remain fucking crazy and probably commit suicide. What would Care First Blue Choice prefer because those seem to be the likely options here. Would Care First Blue Choice like to be a contributor to my suicide? Would you feel good about that?

I'm sorry, Zyprexa is too expensive and you can choose an alternate treatment.

Crazy Me:
Hey, asshole, Zyprexa is my treatment. Thanks for denying me the treatment that has given me my sanity and my life back. Without Zyprexa, I'm not me anymore. I'm just some crazy bitch. You are robbing me of sanity and a normal life. That's on your hands, asshole. You're hands. Sleep well knowing that. Fuck you.

And then I hung up.

Geeze...that was awful. So awful. It is such a perfect example of when I have explained the phenomenon of having emotions that don't fit the situation.

It does make sense to be upset. It would fit to be angry about being denied coverage of an important part of your treatment plan. Even experiencing fear would be appropriate. What will happen to me if I can't take Zyprexa? I do have that fear.

But that? That display? Blaming him, the poor phone guy, for a potential future suicide attempt? Well, that's just ridiculous. And very cruel.

But bipolar disorder is not always kind, shiny, pretty, or gentle.

The rage of a mixed episode can be really scary. During that conversation, I didn't even recognize myself. And now, when I recount it, I am horrified - absolutely horrified and physically cringing that I am capable of being that person who was on the phone.

But remember that acceptance we've been talking about? This is still part of it - accepting bipolar disorder is accepting, at times, we're not exactly going to be our best selves.

Sometimes the best we can do is take our pills (at least the ones we can afford), take a deep breath...and apologize. What's done is done. I can't take back my words, but I can forgive myself for being an asshole, and apologize to the poor man who was not being asshole but merely doing his job.

We win some, we lose some. I know sometimes, it feels like we lose a lot.
But it's all part of that not so gentle look into our bipolar minds.

Don't be afraid to look, friends. I know it's not always shiny and pretty in there, but it doesn't mean we are ugly. It means we have an illness that can be pretty damn ugly at times; we just have to keep doing the best we can. And apologize. Sometimes we need to do a heck of a lot of apologizing. At least I do today.

Until next time...


  1. I SO understand your "display" of emotions. I have been trying to explain this and the fact that people can't get their medications or therapy covered to people for so long and all I get back is "The drug companies say they will help you." or"They have medicaid or medicare." Bullshit!! I'd love to share your story on my blog (She's Mental). If you want?? I would direct them all to your blog too. Think about it. ♥

    1. Feel free to link if you like. :)

  2. Sweet friend,

    I am not bipolar but I have had similar experiences due to other circumstances. No, it isn't pretty. It isn't nice and it doesn't feel very good to be reactive. And without medication it is difficult to keep these episodes at bay.

    However, it is a fact that you are being screwed by the insurance company. We all are and unless we speak up nothing will change. I agree that speaking up in the way you did is not appropriate, but I have nothing but deep respect and empathy for what you are going through.

    xo, Joan

    1. Thanks for your support and kind words. It means a lot considering how ashamed I am of my behavior!

  3. Sending you a hug and wishing I could post some sense to the insurance companies that act this way or at least shake them in the hope they might see some sense themselves. We complain an awful lot about the NHS here but I know that I am lucky that while it is a struggle to find the prescription fee for the latest crazy pill experiment, it will still be there should I not be able to pay anymore. I hope that there is a way around it so that you get what you need to keep things on an even keel.
    Take care lovely

  4. Sucky sucky suckity suck suck.
    I am glad you are already on your way to forgiving yourself for the bipolar asshole behavior. That forgiveness behaviour comes from the strong, beautiful, loving Bacon-girl you are, in spite of this crappy crappy illness.
    Praying for a good solution to come out of all this.
    And sending hugs to all the parts of you.
    Love ya !

    1. "hugs to all the parts of you..."
      Oh my, what a gift. Thank you for your kind words, encouragement, and acceptance of that bipolar asshole who showed up. ;)

  5. Now, call me crazy, but your behavior didn't seem totally uncalled for. Sure, he's just the poor customer service guy. It is bullshit, though, that you're denied the meds that make you feel better. I'd be pissed, irate, rageful, too. I've gotten like that with the cable company. Cable. Sometimes it just feels good to argue, and they're usually a safe target, especially when they're the front lines of the insurance company (or any other company screwing us). And that situation wasn't like a cable company. You can't say, "Well, if this doesn't happen I'm switching." It's the other way around. Talk about feeling controlled and helpless, when you were already feeling that to begin with. I feel pissed off for you.

  6. TOTALLY do NOT think you were out of line! But, I have bipolar too, and had a similar situation with my insurance and Seroquel. I think your argument made perfect sense, and I don't think it was that horrible except for maybe the "fuck you" part.

  7. Yes, the f-word is never a good choice!!

    1. Becky,
      I think that you were fully justified in being so angry. This is happening to all of us in different ways. I am wondering how we can address this issue. I never see mention of it in the NYTimes or anywhere else. Why?
      Your conversation was outsized but not crazy. The system of the insurance companies and pharma is crazy. The US charges much more for drugs. Maybe we need to all move to Canada or, better yet, find a way to address the robber baron companies.

    2. Thank you for this comment, Ms. Szabowhite! You have brought up a very good point. Why is it never mentioned anywhere?! Perhaps WE need to mention it?!