“My Wife Is Not Bipolar” Nurse Testifies & All The Signs of Possible Hypomania Discussed in Court

Rotten Mango

This episode examines the complex psychiatric history and medical testimony surrounding Lindsay Clancy's treatment prior to the tragic events

Key takeaways

• Dr. Tufts' medical notes were a point of contention due to ambiguous punctuation regarding 'pressured speech.'
• Nurse practitioner Julie Paul recommended Prozac, which Lindsay later reported caused issues with sleep and dissociation.

Main topics

• Postpartum psychiatric care
• Medication titration and dependency

Notable quotes

My wife is not bipolar.

Conclusion

The episode provides a deep dive into the clinical complexities and po

Transcript preview

Speaker 4 (0:01) Badabing badaboo. Speaker 2 (0:02) November 16th, 2022. Lindsay goes to the South Shore Emergency Department. This is the same hospital that she gets sent to January 24th before she's med flighted. Speaker 4 (0:13) Okay. So Speaker 2 (0:14) November 16th, she goes into the emergency department and she's like, I have severe insomnia. She is prescribed chazodone at 50 milligrams for sleep. She... Takes it home. She doesn't stay. She's not like inpatient. She just goes to the emergency room. She gets a prescription and she later reports to Dr. Tufts that she went to the emergency room, got trazodone, and it had very minimal effects on her. Two days after this emergency room visit, November 18th, she writes in her journal, Tree of Life Journal. It's like I'm so desperate to get a mental break from taking care of everyone that my mind is trying to make something physically wrong with me. My mind never shuts off. It's constantly thinking of the next thing someone needs. I can't shut it off. I desperately want to go back to work, but now I don't know how to function and it worries me. Now that we're in the month of November, the medication switching gets really fast. And from there, December does not get any better, at least in my opinion. It would appear that November and December, Lindsay is going through a very active, rapidly changing psychiatric treatment period. So from September 15th, 2022 to January 23rd, there are approximately 35 prescription dosage changes, taper or treatment plan events that involve 13 core psychiatric medications. So it's like 13 medicine and then they're like, okay, well, let's ramp it up. Let's decrease the dosage. Let's swap. And it's 35 different plans. So you have Zoloft SSRI, you have Ativan, which is a benzodiazepine, hydroxycine, which is like a prescription antihistamine to replace the Benadryl, Boost Bar, anxiety medication, Trazodone, an antidepressant, Prozac, a different SSRI, Ambien, a sedative sleep medication, Remarin, an antidepressant, Klonopin, a benzodiazepine, Seroquel, antipsychotic, Valium, another benzodiazepine, Lamictal, an anticonvulsant, and mood stabilizer. as well as Elavil, which is an antidepressant. We literally have a cocktail of antidepressants, benzodiazepines, sleep medications, antipsychotic mood medication, and a mood stabilizer moving in and out of Lindsay's med regimen. Now, I'm not saying they're moving in and out of Lindsay, but it's a constant up and down increase, decrease with the dosage, and she's clearly not getting better. Thanksgiving 2022, two months before the Clancy children are killed, Lindsay is showing signs of depression. Her husband, Patrick, takes the stand. And there's going to be a lot more on Thanksgiving in the next part because there's a lot on Thanksgiving. But he's being asked about Thanksgiving. What was Lindsay like? Speaker 3 (2:51) She wasn't talking much. She had low energy. She was really depressed. I just remember when she showed up, my sister-in-law gave her a big hug. Speaker 1 (3:01) And she was able to get through dinner, eat dinner with everyone? Yeah. And when she told you she was suicidal, did you ask her if she had a plan on how to kill herself? Yes. And what was her response? Speaker 3 (3:16) She said no. Speaker 2 (3:18) And at some point in time, did she tell you that this was the first time she was having these thoughts? I don't know if she mentioned it was her first time or not. I just remember her saying she had them. Patrick's mom, Sue Clancy, more on her later as well, is also a nurse. She works at South Shore Hospital. So this is, again, the same hospital. The same Speaker 4 (3:36) one? Speaker 2 (3:37) Yeah, she is. So Lindsay is, well, she was a nurse, a labor and delivery nurse at Mass General, but she gets taken to South Shore. And Sue Clancy works at South Shore in labor and delivery. And she recommends Lindsay to see a woman named Julie Paul. Julie Paul works at South Shore. She's a psychiatric mental health nurse practitioner who can prescribe. She is board certified. And this alone. Wait, hold on. This is Speaker 4 (4:01) so crazy. Speaker 2 (4:02) Yeah. Speaker 4 (4:03) Patrick's mom is a delivery nurse? Speaker 2 (4:06) Labor and delivery nurse. And his new wife is also, she is in the, she's an REI. So there's just like a lot of. Speaker 4 (4:13) Whoa. Yeah. She must know, you know, like this is. kind of her life dealing with women that's wow dealing Speaker 2 (4:20) with people who give birth yes yeah Speaker 4 (4:22) yeah wow so Speaker 2 (4:24) she recommends her to see julie paul and she is a board certified nurse practitioner this has spawned a new debate like i'm telling you every single fucking thing that we talk about is a freaking debate online and it's it's just so heated there's now a whole debate on nurse practitioners should they be allowed to prescribe Speaker 4 (4:46) Okay. And Speaker 2 (4:47) like there's a whole... Okay, Speaker 4 (4:49) what happened? Speaker 2 (4:50) Just because nurse practitioners have, I would say, probably less academic training for prescribing in the field that they are prescribing. Speaker 4 (5:00) What's her name? Julie? Julie Speaker 2 (5:02) Paul is a nurse practitioner, yes. Speaker 4 (5:03) And she prescribed something. Speaker 2 (5:05) Yes, but... More so later, there's another nurse practitioner that enters the conversation. And so now there's a whole debate on Reddit forums of, you know, MDs, doctors saying like, we should never let nurse practitioners fucking prescribe shit. And then nurse practitioners be like, yeah, well, we should. And then there's. Who cares more about the patient? And that itself is a huge beast of a conversation that, again, I'm not in health care. I've never worked a day in health care in my life, so I really have no say. But, you know, but I'm just saying it's out there. That conversation is out there. So she's like, maybe you should see Julie Paul. Julie Paul is the director of the Perinatal Behavioral Health Program at South Shore, which specializes in pregnancy and postpartum. Now, Julie Paul is. Well, she was, and this is a misconception out there, she was one of the few providers not being named in the lawsuit by Lindsay or Patrick, but I believe she is now listed as a defendant in one of the civil suits. So there was a lot of, I think, praise for Julie Paul during her testimony, knowing that she was not being sued by either of the Clancy's, but I don't know. Speaker 1 (6:12) There's just, yeah, Speaker 2 (6:13) it's like a moving mess, right? Julie Paul reaches out to Lindsay after Sue Clancy refers her. But I Speaker 1 (6:20) would say that Julie Paul is one of the more liked healthcare Speaker 2 (6:25) professionals. November 2022, Julie Paul starts asking. Calls Lindsay, asks about Callan's birth, and Julie testifies. She said that she did really well for the first 12 weeks. She was excited, really happy. And then Patrick went back to work, and she said she started to struggle with some anxiety. Lindsay expresses to Julie that she was concerned about Ativan and Benadryl. Julie says she'd been taking it for two weeks, and it was working really well, the Ativan, the Benzo. But she was getting concerned about dependence, so she self-weaned herself off of that. She reports to Julie feeling overwhelmed now having three children, but she experienced this to some extent with her second pregnancy with Dawson and nurse Julie wants to put Lindsay on Prozac, which is an SSRI. Because Lindsay had told her that way back in nursing school she had actually taken Prozac before and she didn't really have any crazy symptoms or side effects from Prozac other than sexual side effects, but You know, that's not the biggest problem right now, right? So she's like, instead of just trying other SSRIs, let's try Prozac. Like this is a known medication to you. Rather than taking shots in the dark, this is a good start. Now, Prozac is, again, another SSRI that we are prescribing to someone who may have an underlying bipolar disorder that is not counteracted with any other mood stabilizer or anything else. Just straight Prozac, just like it was straight Zoloft. So she prescribes Prozac, 10 milligrams for the first four days, and then increase it to 20 milligrams if tolerated. This is November 22nd that Lindsay says she starts Prozac. She's on Prozac. And Nurse Julie also still says you can take the Ativan when you have severe anxiety. But the plan is let's still taper off the Ativan, right? And let's move towards something like Boost Bar, which is not a benzo. It's anti-anxiety medication, much safer. Well, I don't want to say safer, but... Much less risk of dependency. That same day, November 22nd, 2022, Lindsay writes in her Tree of Life journal. Speaker 4 (8:27) Why is it called Tree of Life? Just didn't... Yeah, it's like a tree of life. The name is on there? Speaker 2 (8:32) Affirmations. I am calm. I will remain calm today. There is nothing that needs to be on my mind. The weight is lifted from my mind. I will sleep tonight. Julie also sets up talk therapy with Lindsay with Letitia Dukes. But the same day that all of this is happening, Julie gets a message from Lindsay on MyChart, which is how she talks to her. It's like a provider to patient communication platform. And it reads, Hi, Julie, this is Lindsay Clancy. I'm sorry to contact you like this, but when you have a minute, can you please call? So Lindsay and her talk and Lindsay expresses concern about starting the Prozac. They have a conversation. Lindsay states to Julie that, okay, fine, I will be starting the Prozac. But a few days later, Lindsay tells her that she doesn't like the Prozac. Julie testifies she wasn't tolerating the Prozac. So we had a conversation about stopping the Prozac. She was having a really hard time sleeping. So I gave her a one-time dose of Ambien. Ambien is a very strong sedative. for usually very severe cases of insomnia, but this is a one-time dose. But I think a lot of people just see Ambien on a list of medications and are like, oh my god, Ambien on top of the benzos, it's a lot. And I'm not saying that her list of medications is not a lot, but it is a one-time dose. The next day, November 23rd, 2022, Lindsay journals, I slept well last night. I will sleep again tonight. Today will be a great day. I will go back to work on Sunday. I will thrive. I can feel like myself again. I'm grateful for Sue, Patrick's mom, who is always listening and trying her best to help me. Kids are sleeping great for Pat. Pat is handling nighttime stuff. I'm grateful for Julie for making a plan for me. A big thing is I feel disconnected with myself, time, reality. I think going back to Speaker 1 (10:19) work will help with that. Speaker 2 (10:22) After Lindsay stops Prozac, after reporting to feel, quote, disconnected, out of it, spacey, Julie Paul prescribes Remarin, which is an antidepressant with very significant sedating effects. So it more so can help with sleep and anxiety. A lot of people report getting deep sleep with Remarin, though a side effect is feeling a bit groggier in the mornings. But Julie Paul also prescribes Klonopin. Klonopin is another benzodiazepine, but it's a much longer acting Speaker 1 (10:52) benzo compared to Ativan. And Speaker 2 (10:54) it appears that there is kind of like a less risk of dependence there. This is where people think it starts getting reckless. So when you have a benzodiazepine prescription and you get another one to replace it, you're not turning in your previous benzos. You still have them. You're supposed to have compliance. The patient has to show compliance of like, okay, I'm just going to switch, right? But they think there's too many benzodiazepine prescriptions going out nonstop. And this is just one of the many that's going to continue. Just different forms of benzodiazepines. So we're switching from Ativan to Klonopin. Now, Julie Paul does argue that she wanted to switch to Klonopin because Ativan was giving Lindsay rebound anxiety. So when it wears off, the anxiety comes back tenfold, which makes her want to switch. to take more Ativan probably. So Klonopin, it has a longer half-life. It's a, you know, you're not going to feel as much of that rebound anxiety as what people report. So she wants to replace the Ativan with Klonopin. Lindsay reports that with the Remarin and Klonopin together, she did sleep on and off until about 3.45 a.m., which isn't great, but it seems like this is better than what she's been dealing with. Lindsay asked Julie Paul if maybe she should up