If There's a Reason He's Still Alive

treize

Thomas POV (we haven't done that in a while)

When I get back to my office I see a notification on my computer telling me that Alex's medical team is going to meet to discuss his medication, and would I like to attend?

Wonderful.

I email Angelica back, telling her that Alexander's first session of CBT went well today and that I'd love to attend the meeting regarding his medication.

Scrolling through the list of prescriptions Alexander is taking I notice that he's taking medication given to him when he was first admitted. It seems that nobody has bothered to take him off of any medication during his stay here, so he's being prescribed much more than he needs. I note that he seems to be taking four different antidepressants, not to mention that two of them are not recommended for persons exhibiting antisocial personality disorder or similarly classified traits.

This in of itself is evidence that he was ignored by past therapists. While there were no notes regarding his actual diagnosis, his manipulative behavior around those he hasn't formed a connection with is fairly obvious.

After perusing the list for a bit I take note of at least five different pills Alexander should be taken off of entirely and two that should have a lower dosage.

~ Timeskip brought to you by grendae (intentional spelling). ~

I sit down in Angelica's office. Eliza is present, along with two other nurses that I don't know but are supposedly in charge of interacting with Alexander when he needs to be medicated. To my disgust, James is also present.

"Hi guys, today we're discussing the medication for Alexander Hamilton. Thomas, you're new here, but we tend to do this every few weeks, mostly because he takes so much," says Eliza.

"Actually," I say, "That's something I wanted to talk about. I feel like Alexander's taking a lot of medication that is counterproductive to effective treatment of his condition and I'd like to change that."

"Okay," Eliza says, "That's something good to work with. What were you thinking, Thomas?"

"We-" I begin.

James interrupts me. "Look, I know I'm the only person here that's not a doctor but I'm around Alexander a lot and even with this much medication he's still violent and unruly on occasion. I'm surprised you guys want to reduce his medication; I would think you would be all for increasing it."

Oh hell no. "James, that is correct, you are the only non-medical member of this meeting, and you do work with Alexander a lot. However, have you considered that it might be the combination of pills taken by Alexander that might be the cause of some of his behavioral tendencies?"

"No," James argues, "Don't you want him to be non-argumentative? If you drug him more, he'll be a better patient, right?"

I'm about to argue back when Eliza cuts in. "Actually, Thomas is correct in noting that some of the medications he's on, particularly some of these antidepressants, tend to be not used in patients exhibiting some of Alexander's behavioral traits."

"So why didn't you stop giving him them if you think they're a bad idea?" says James, smirking.

"The med team has an input in what meds we give to a patient, but we don't have complete control," says Eliza.

"The decision to medicate a patient lies with the psychiatrist in charge of the case and the head psychiatrist," adds Martha, one of the nurses who interact with Alexander. "We can comment on what we think but we don't see the patient for in-depth psych exams or therapy sessions; we know some about them but the psychiatrist is the only one who really knows enough to make that decision."

Angelica cuts in. "Thomas, what medications were you planning on removing from Alexander's medication list?"

"Well," I begin, "He takes redundant anti-depressants. One was prescribed upon admittance to the hospital, and three of his therapists have also prescribed the ones they believe would work. The one prescribed during processing is marked to not be used with antisocial personality disorder patients, as is the one prescribed five months ago. These, clearly, should be removed. I'm in favor of removing one other antidepressant as it is also noted that it should not be used for patients that are under the age of thirty, Alexander is twenty-one."

"Reasonable," Angelica says with a nod.

"I'm also in favor of reducing the dosage of the remaining one as it can sometimes increase manic behaviors in patients, but aside from that, it fits Alex's needs very well. Let's see... he's also taking a lot of sedatives, too many in my opinion. I can't say for sure but I would assume that the amount of sedatives he takes, although not dangerous, is noticeably affecting him."

"Well what sort of a problem is that?" says James. "We want him to feel calmer."

"I think that it is giving him a noticeable mental fog, meaning that he doesn't feel calmer, he feels like he's being drugged to be sleepy. At that point it's no longer helpful, it's just a power move showing him that we have the capability to knock him out if we wanted to. Actually, the most recently prescribed one, from three months ago, is classified as an Emergency Medical Sedative. That one has to go."

"Well," says James, "I, as I've said before, think it's the wrong idea to reduce the amount of meds taken by Alexander. How's he supposed to 'get better' if he's not being medicated? I mean, take him off the medication all you want, but I'm trying to look out for him like we're supposed to."

What does he think he's playing at?

"Alexander," Angelica says firmly, "can not go home taking all of these meds. It's not stable and we aren't allowed to prescribe that much for out-patient usage. If you want him to 'get better' as you say, you would agree with us on removing these four medications and cutting the dosage of one."

"Fine," says James, sulking.

"Is that all we want to discuss, folks?" says Angelica.

"Actually, I'd like to propose taking him off of this one sedative which tends to interact with the antidepressant Thomas wants to keep, preventing it from accomplishing anything. In other words, it's extra baggage that's just weighing Alexander down," says Eliza.

"Yeah," I say, "I was going to mention that one. We didn't work with it that much in clinical studies when I was getting my degree because it's a rarely used one and tends to do more bad than good, so I wasn't quite sure how it would affect his other medications, but I did know I wanted to remove it. What's your opinion on lowering Alexander's mood stabilizer dosage?"

"I'd say, well I don't know about Eliza, but I'd say that it seems a little too high," says Martha.

"No, I agree with you, Martha, that one has always seemed to be a bit overkill, but again if something doesn't work out Thomas, call a meeting and we'll sort it out from there," says Eliza.

"Okay, well I'm good with that then," I say.

"I'm good with that too," says Angelica.

Martha nods to Eliza. "We feel good about that too," says Eliza.

"I just think you're going about this wrong," argues James.

"James," Angelica says, a stern look on her face, "We can discuss this later if something goes wrong. If nothing happens, however, I would hope you might see it helpful to drop this issue, for it seems you are only pushing it to drug Alexander, which is a violation of our ethics code. Meeting adjourned."

Hooray for Angelica!

With that, I retire to my office, ready to tell Alexander the good news later this afternoon.

Stay safe everybody!

Your dearest author,

Angie

Word Count: 1281