Sometimes the Meds Work
Accidental Lithium Overdose


In 2001 I showed up at work and couldn't enter my password into the computer right. It was clear something was wrong with me, though I clearly wasn't manic. I took time off sick and went home to get my act together and just got more and more confused. I tried calling my shrink, who I'd been seeing for 7 years, but I misspelled his name. His name began with a 'K' and I misspelled it with a 'C'. So I couldn't find his phone number in my phone list. I drove to his office and he wasn't there. Then I had an accident with my car in the parking lot on the way out.

Eventually I was hallucinating and having conversations with people who weren't there. I called 911 in a state of considerable confusion about something. The dispatcher said "I can't help you with what you want, but I can send some cops to come visit you and check you out." Figuring that I needed psychiatric help any way I could get it, I said that would be a good idea.

The cops came by and talked to me and I don't remember the conversation, but at some point one of them asked me to tell them my address and I couldn't. He said "Look, we can leave you here, or we can take you in to the hospital." I thought about it for awhile, but I decided I needed psychiatric help any way I could get it. If I had decided otherwise I probably would not have survived.

One of the cops drove me to the hospital. I didn't have my wallet with me, so I didn't have my health insurance card.

The woman doing the paperwork to admit me was asking me what illegal drugs I was on, and when I inisted "none" she wouldn't believe me. I did mention that I was on lithium. She wanted to know my social security number and I couldn't remember it, though I was 41 years old. Then I told her where I worked and that she could call their HR department. They'd know my social security number and be able to tell her all about my health insurance. I think that convinced her that I wasn't wigged out on illegal drugs. If that had been the case there's no way I would have wanted her to call my work.

She asked if they could take a blood test. I said sure, and that they might as well take a lithium level while they were at it.

The next thing I remember, I was in a hospital bed and talking with 3 doctors. On one level I knew they were doctors who wanted to help me, but they looked like vampires with fangs and black capes. They said my lithium level was 3.8. I knew that anything above 1.5 is toxic. They said they were going to filter it out of my blood. I asked why not just not take any more for awhile and let my body remove the excess naturally? They said no, this is an emergency, a lithium level that high could cause brain damage.

I have no memory of them filtering my blood.

The next thing I remember was waking up. Then, I noticed that my left hand and right foot were restrained to the corners of the bed. I thought it was funny. I was in a very strange state.

Ever since I had started lithium, I had drank WAY, WAY more water and soft drinks than a normal person. I was always getting in arguments with waiters who didn't want to bring me a pitcher of water. They totally didn't understand that the water was more important than the food. Lithium really makes you thirsty.

The people supervising me in the hospital weren't aware of the distinct need that people taking lithium have for large amounts of water.

So I wanted a drink really bad, and there was a pitcher across the room on the window sill. But I couldn't talk at that point, and I was restrained to the bed. I was trying to free myself, which was totally impossible. A couple of nurses saw me doing that and said "Look at that, he's trying to free himself." with no idea why and I couldn't tell them.

I was still hallucinating. Many years before, one of my scuba buddies had told me a story about these monasteries centuries ago, where they would have commandos being trained. And these commandos did lots and lots of hashish, so they were called "hashishins". Eventually, they would be ordered to go out and kill somebody and then kill themselves. It's where the word "assassin" comes from. So I hallucinated that I was a "hashishin" in a monestery, preparing for my mission, and these "maidens" were feeding me and taking care of me.

I slowly became more and more coherent, and at some point I said (in my mind) "Kill somebody just because I was told to? That's immoral and I'm not going to do it!" Then, the hallucination crumbled and I was in a mental hospital and the "maidens" who had been taking care of me were nurses.

The staff at the hospital really wanted to get in touch with a next of kin to come visit me. I hadn't really designated any friend to be the person to call in these circumstances, not that I had many friends anyway by that point after 13 years of lithium wrecking my career. My father lived 1,000 miles away, but I was not coherent enough to explain how to find him at first. One social worker gently broke it to me that perhaps my father didn't exist.

Eventually I remembered the city and street where my father lived and they were able to reach him and he flew out.

Eventually, I got out of the hospital, but I was walking funny. There had been nerve damage, and probably with it, some brain damage. Dad drove me home. I waited a week until I was walking better before I tried driving.

My dad flew home, and my sister flew in from the other coast to help me out. Then 9/11 happened, and she couldn't fly home for a week.

I felt that I needed an explanation of what on Earth had happened, for my boss. Everybody at work was going to be sure I was on illegal drugs. My shrink refused to write a note, saying that it was his experience that any medical information that he gave to my employer would be used against me.

With my brother's help through email, we composed a letter explaining that I was bipolar, and had had a lithium overdose. It helped that I mentioned that I'd read three books on bipolar, and had been going to support groups, so I was doing a reasonable job of being responsibile and trying to deal with the issue.

The doctors advised that my kidneys had been impaired. Lithium is hard on the kidneys. What had happened was that after 13 years of lithium, my kidneys couldn't take any more and pretty much shut down. Normally when that happens you're supposed to feel very sick. Then, you go to the hospital and they figure out what's wrong with you. But I didn't feel a thing. So I kept taking my lithium like it was supposed to, and the level in my blood just kept increasing.

A shrink later told me that a lithium level of 3.8 is potentially high enough to send you into cardiac arrest.

The process of my kidneys becoming impaired and my lithium levels rising must have taken several weeks, possibly over a month. In the month or two before I went to the hospital, I really wasn't very with it at all, I wasn't doing well at work (in fact I was later told they were planing to fire me). I belonged to a pre-internet dating video dating service called "Great Expectations". There, they interviewed customers on a VHS video, and members would go to the office and watch videos and decide who they wanted to date. And I made a Great Expectations video a few week weeks before the hospitalization. And when I watched the video six months later, I was horrified. I looked really out of it, like I was drunk or on drugs, my eyes half closed, and rocking back and forth and not realizing it. Of course, the interviewer didn't know me, must have thought I was always that way, and had no idea that this was a medical emergency. He probably thought I was just a phenomenal loser.

One thing about the hallucinations was that I had no prior experience with them. Vivid hallucinations like that are not a normal part of bipolar illness. In manic episodes I'd thought I could sense God talking to me though an inner voice. There are many millions of mentally healthy religious believers do that every day, and still function in society just fine. During the lithium overdose, I actually had conversations with a group of people in my apartment who weren't really there. Saw them with my own eyes and heard them with my own ears. The whole time in the hospital thinking that I was a "hashissin" seemed so real. It took a lot of effort, a lot of rational thought, over the next week or two to sort out which memories were real and which were not.

The assumption that everything you see with your own eyes and hear with your own ears is really there is a pretty fundamental assumption that we base our lives on. It really pulls the rug out from under you when that assumption is violated. It must be really tough being a schizophrenic.

By then there were several other new mood stabilizers on the market to try, and there had been considerable permanent damage to my kidneys, so I didn't go back to lithium.

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