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

better being better boo november 16th 2022 lindsey goes to the south shore emergency department this is the same hospital that she gets sent to january 24th before she's med flighted okay so november 16th she goes into the emergency department and she's like i have severe insomnia she is prescribed chazadone 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 chazadone 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 lindsey 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 adivan which is a benzodiazepine hydroxycine which is like a prescription antihistamine to replace the benadryl boost bar anxiety medication chrazadone an antidepressant prozac a different ssri ambient a sedative sleep medication and then you have remerin an antidepressant clonopin a benzodiazepine saraquil 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 lindsey's med regimen now i'm not saying they're moving in and out of lindsey's regimen but they're moving in and out of lindsey's regimen 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 lindsey is showing signs of depression her husband patrick takes the stand and there's gonna 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 lindsey like she wasn't talking much she had low energy she was really she showed up um my sister-in-law gave her a big hug and um 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 she said no 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 a plan and she was 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 same one yeah she is so lindsey 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 lindsey to see a woman named julie paul julie paul works at south shore she's a psychiatric mental health nurse and nurse practitioner who can prescribe she is board certified and this alone wait hold on this is so crazy yeah patrick's mom is a delivery nurse labor and delivery nurse and his new wife is also she is in the oh my god she's an rei so there's just like a lot of whoa yeah she must know you know like this is kind of her life dealing with women that's wow dealing with people who give birth yes yeah yeah yeah wow so 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 okay and like there's a whole okay what happened just because nurse practitioners have i would say probably less academic training for prescribing in the field that they are prescribing what's her julie julie paul is a nurse practitioner and she prescribed something 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 health 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 lindsey 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 um i don't know there's just yeah it's like a moving mess right julie paul reaches out to lindsey after sue clancy refers her but i i would say that julie paul is one of the more liked health care professionals november 2022 julie paul starts asking calls lindsey asks about callen'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 lindsey 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 said she was going to take it for two weeks and it was working really well and 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 lindsey on prozac which is an ssri because lindsey 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 she's been taking prozac for two weeks and she's been taking it for two weeks 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 and then she prescribes prozac 10 milligrams for the first four days and then increases it to 20 milligrams if tolerated this is november 22nd that lindsey says she starts prozac she's on prozac and nurse truly 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 lindsey right it's in her tree of life journal why is it called tree of life just didn't yeah it's like a tree of the name is on there 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 lindsey with leticia dukes but the same day that all of this is happening julie gets a message from lindsey on my chart which is how she talks to her it's like a provider to patient communication platform and it reads hi julie this is lindsey clancy i'm sorry to contact you like this but when you have a minute can you please call so lindsey and her talk and lindsey expresses concern about starting the prozac they have a conversation lindsey states to julie that okay fine i will be starting the prozac but a few days later lindsey 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 lindsey 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 work will help with that. 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 benzo compared to Ativan, and it appears that there is, quote, 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 wants to take more Ativan probably. So Klonopin, it has a longer half-life. 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. Ativan 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 the dosage of the Remarin, so not the benzo, the, you know, Remarin, the antidepressant. She's like, would that help with sleep? Because it's an antidepressant with, you know, sedative effects, sedating effects, right? Julie Paul gives her the okay, let's trial and up dosage of Remarin, which does end up helping Lindsay sleep. But she reports that she's felt super disconnected with herself and reality. And this is, again, a very common report for people with Remarin on Reddit that I could find. And she said that it was a very scary feeling. So Lindsay asks after two nights if she can stop the Klonopin, which Paul approves. So next day, we've stopped the Klonopin. Lindsay has a full panic attack. Okay, Julie Paul instructs her take the Ativan. So stop the Klonopin, take the Ativan. And again, Klonopin is prescribed as needed. So these are both benzos, but like, don't take the Klonopin, take the Ativan. And she's like, go for a run, because running always helps Lindsay with regulating her anxiety. Julie also suggests partial hospitalization programs. But she says that Lindsay told her it didn't feel like it was going to work logistically for her and her family. But this is the first time that we see a provider see that Lindsay's situation may need more intensive treatment than just normal outpatient medication appointments and therapy sessions. Then there's Letitia Dukes. Letitia Dukes is a therapist. So she's not a prescriber, which also means I don't think I think she might have been recently added into one of the lawsuits. But she is she's not dealing with the medications. She is aware of the medications. She also works for South Shore. That's why Julie Paul recommended her. She's aware of the medications. But mainly this is talk therapy, cognitive behavior therapy, CBT therapy, right? Dukes says her presenting concerns were anxiety, lack of sleep, depression symptoms, frequent passive SI, thoughts of wanting to no longer exist. You know, at one point, this is where I think like the Commonwealth really is not doing itself a favor. I do think the Commonwealth did a shit job at even preparing these prescribers for testimony. Okay, so they just like, I mean, none of them really know how to answer questions in a way that they don't know how to answer questions. And so I think that's one of the reasons why they don't know how to answer questions in a way that is seems favorable to the jury. It just a lot of people keep saying like the Commonwealth is doing the defense's job. And I would have to agree at certain points, because it's just just their lawyering does not seem that great. At one point, the Commonwealth, this is their witness, okay, a very important witness at that. The Commonwealth asks Letitia Dukes, as far as your role as a social worker, do you often get into the weeds with patients about their medication? Letitia Dukes is like, I'm not a social worker. I'm a mental health counselor. But yes, I typically have an overview of medications, but I don't particularly get into prescribing or how to take medications. And again, this is just another example of like, this is your own witness, you don't seem razor sharp what's happening. And this is what we're only like a week or two into trial. Heading into December, Lindsay reports to Letitia Dukes that she has low mood and feels numb. Dukes notes, she was tearful when discussing her anxiety symptoms. She reported as far as passive thoughts were thoughts of not wanting to be here or no longer wanting to live but no plan. December 5, Letitia Dukes says she reported that over the weekend, she had a difficult weekend having intrusive thoughts about wanting to and she contacted aspire crisis support a hotline. She met with the clinician virtually and was told that she did not meet the criteria for inpatient treatment due to having no SI plan. She reports that she did not see signs of mania or signs of delusion or paranoia and no signs of psychosis. But according to Dukes notes, she also says, feels like she's going to die, but she doesn't care if she dies feels like she's going to die but doesn't care. She then talked about how the meds she's on were not helping her sleep. Yesterday, she took Ativan due to intrusive SI thoughts. She was constantly worried something was going to happen to her children or something bad was going to happen to the baby. She reported she talks about her anxiety all the time with her mom, husband, and mother in law. Dukes says that Lindsay reported being uninterested in topics from friends lack of interest in conversations. Lindsay told Dukes that she just feels numb, lack of attention, confusion. She's only sleeping two to four hours a night, which is very alarming. Dukes notes that Lindsay's facial facial expressions show anxiety, fear, apprehension and sadness. Dukes meets with Lindsay four times in December, but largely nothing explosive comes out of Dukes notes nor her testimony. And while Lindsay is meeting up with Latisha Dukes, Julie Paul transfers Lindsay's care to Rebecca Gelata. Julie Paul is leaving the practice and she's moving to New Hampshire. So she introduces Lindsay to Gelata. And she has been working at Gelata has been working at this clinic for about two years. So this is all South Shore Hospital kind of system. Lindsay's first appointment with Gelata is November 29. And Gelata starts her on Seroquel at 25 milligrams. So the plan originally was to just get Lindsay on there for maybe about four week period for sleep and anxiety. But it turns out that she's not sleeping enough. She's but later gelato starts considering it for longer-term mood stabilization possible bipolar spectrum treatment now side note so far most of the meds lindsey has been prescribed are antidepressants and anxiety medications saraquil is considered an antipsychotic medication used typically to treat schizophrenia bipolar disorder but also major depressive disorder so gelato is saying like when i started on the saraquil it was more so for the major depressive disorder but then i'm like wait i feel like there could be an underlying bipolar disorder and maybe we need to take the saraquil for that instead the bipolar conversation gets big here because gelato straight up says she considers that lindsey was bipolar however she does not meet the diagnosing like the diagnostic criteria interesting so same time she's still seeing the first doctor through telehealth the whole time and are they double prescribing her the the meds are they communicating do they know what's going on with each other gelato and tufts never communicate they do not get each other's records both of them argue that lindsey was self-reporting to both of them what the other was prescribing and they did not feel that there was any overlap in medications is what they're saying now when gelato takes the stand a lot of people online don't like her they don't like her and they don't like tufts those are the two very controversial people tufts gets really defensive later so that's one thing gelato is i think people are kind of off-put by her demeanor she's incredibly smiley almost has a playful energy to her and maybe that could be her high-pitched voice which i can relate to and i'm also someone that likes to smile in very nerve-wracking particularly high-risk situations where you do have to be very professional but i think it's more so her tone and cadence so she's asked like how do you spell your last name for the record and again she is someone she's a nurse practitioner that specializes in helping people who are in dark places in life so perhaps she's accustomed to talking in such a way that comes off super friendly but you know when you are a witness on a murder trial and there are three young children it just comes off maybe a little unsettling how do you spell it spell your last name for the record j-o-l-o-t-t-a what kind of training and education did you do in order to become a psychiatric nurse practitioner i have my bachelor's degree from the university of connecticut in allied health sciences and then i went on to get my master's actually in counseling psychology in 2013 gelada is asked if a patient needs a higher level of care is it common to make referrals for those patients gelada does admit that it is pretty common practice and that is like a huge debate online tufts one and a half months into being a practicing psychiatrist should she have referred lindsey to someone that could provide the care that lindsey probably needed gelada nurse practitioner should she have referred lindsey to someone who could provide the care that she needed because you are also again not just talking about someone who might have an underlying bipolar diagnosis you're talking about someone who is in that very sensitive postpartum time bracket so a lot of things are happening gelada says when lindsey came in she expressed her concern about becoming dependent on benzodiazepines and this is this is like a huge thing okay so the commonwealth they kind of hint at the fact that lindsey was doctor shopping and they think that lindsey was doctor shopping for benzodiazepines we'll get there but as for benzodiazepine dependence gelada says she's concerned about taking benzo um she had mentioned something called rebound anxiety what that is is once the dose wears off your anxiety goes above your baseline once the dose of the benzodiazepine wears off if she's taking it in the middle of the night the next morning she would feel more anxious i was concerned about that she was concerned about getting physically dependent on it because she had needed to take it for a number of nights gelada starts her treatment plan which includes switching out the ativan for valium so we go from ativan julie paul says let's switch to klonopin because it's a longer half-life less you know rebound anxiety then she has a panic attack okay back to ativan now she's transferred to gelada and gelada is like you know what let's stop the ativan and she's like let's go to the ativan and she's like let's go to the ativan and go for valium they're all different types of benzodiazepines they do work differently but they're all benzos she says the idea is valium kind of like the klonopin stays active in the body much longer than ativan so the rebound anxiety would probably be less with valium and again valium and klonopin are different so maybe she would react better to the valium you know now serquil is the huge conversation so again she first prescribes it more as a mood stabilizer for major depression but later gelada says she's concerned about taking ativan and gelada thinks it could be possible bipolar spectrum treatment lindsey does not like the serquil the civil complaint attributes worsening intrusive thoughts and self-exit thoughts and auditory type experiences to the period following serquil now i know a lot of people who think that lindsey does have bipolar disorder too they think it's strange that she did not react well to the serquil but this is also pretty common not every ssri is going to react the same with every patient not everyone with bipolar 2 is going to react to serquil in a certain way but it's i think the fact the conversation is going to be very different and i think it's going to be very different is like did we know that she had an underlying diagnosis or not right is more so the conversation but gelada is asked by the commonwealth what did lindsey clancy express to you as far as serquil did she want to continue with that no did she explain why so she felt like when she took remarin and serquil together she felt weighed down and exhausted but her mind was still awake and alert and she didn't seem to think that there was a benefit of being on it and did she express to you a desire to want to get back to trialing prozac both lindsey and her husband expressed that that was their preference which okay this is where patrick seems to get the most involved with lindsey's treatment he does meet up with gelada and he tells gelada that his wife is not bipolar so that is what gelada reports in court and there is a lot of conversation around that wait patrick tags along once that we know of and tells her that she's not bipolar yes but he also tells her that she's not bipolar and he tells her that she's not bipolar and he also tells her like all these medications well from his account is like all these medications are turning lindsey into a zombie like can we just stop like and start fresh right like stop all these medications and start fresh now i will say to kind of point all aspects of this case for someone that's not in health care that could be a very reasonable request because it's like gosh these are so many prescriptions coming in and out like can we just like please slow down it seems so rushed others are saying well his mother is a nurse and lindsey's a nurse it's you can't really just say everyone stop for how long and then i think more than that though i think people can see both ways for that i think people don't like the fact that he said that my wife is not bipolar so december 6th lindsey comes to see gelada with patrick and the commonwealth asked gelada now when you met with lindsey and patrick on december 6th did she or did they report why patrick was there i don't recall if they indicated why he was there i understood it to mean he was there to provide collateral and support for her collateral being extra information so this is also another huge thing reddington keeps pointing out to the other prescribers especially tufts why didn't you call her husband why didn't you call patrick clancy why didn't you call her mom you knew her mom came to stay with her because she was going through a rough time why didn't you call these people because you need collateral information usually for psychiatric patients that you're concerned about because they might not be reporting to you correctly so it's better to get a third party to report to you because third party perspective to know exactly how they are behaving and what they are going through to add to the treatment now a lot of health care professionals push back saying there's just not time and to insinuate that you need to reach out to an adult's parents is very difficult and unfeasible unless you see some glaring red flags which it does not appear that the clinical presentation in lindsey's case was a glaring red flag that it is a huge argument right i don't know but the commonwealth continues with gelada did you express to miss clancy thoughts that you had about her diagnosis based on your interactions over the last few weeks i did and what was that i discussed with her and her husband the possibility of potentially an underlying bipolar disorder i based this on several factors one of them being that she had such what we call in in activating response to the zoloft it's unusual for somebody to describe taking zoloft and then going 48 hours without sleep and not being tired so that raised my clinical suspicion a bit and i think that's a good thing because i think that's a good thing and she had been i would say having difficulty tolerating other antidepressant medications that we had been trying to have her take since then so again i'm wondering if it's because potentially there might be an underlying what we call a mood disorder bipolar disorder there's bipolar one and bipolar two both have mania symptoms as part of the diagnosis bipolar one is usually more severe in that it's typically a patient might need to be hospitalized or it causes greater functional impairment bipolar two is usually more severe in that it's typically a patient might need to be hospitalized or it causes greater functional impairment and so while you noted that there were some concerns reported did it rise to the level of diagnostic criteria for bipolar disorder not at that time so there wasn't enough to diagnose lindsey with bipolar disorder okay and when you explain this to them your thoughts about her reactions to the medications and these reported prior symptoms did patrick and lindsey seem receptive to your diagnosis i recall patrick saying my wife is not bipolar and i'm not bipolar and i'm not bipolar and i'm not bipolar and i'm lindsey looked at me and she did not say anything were you able to get any more specific information from patrick during that meeting not what he said particularly but did you get additional specific information that kind of helped you assess whether you would change your diagnosis at that point no patrick tells gelada that lindsey keeps waking up with panic symptoms and she describes panic symptoms are racing heart intense fear those are panic symptoms sudden rushes of intense anxiety that seem to come out of nowhere and patrick later reports about her panic symptoms as a result of her panic symptoms as a result of her panic symptoms lindsey's big spiral started she started to lose a lot of weight and she became very depressed and she was having a really hard time he says that this is around the time that she started telling him that she wanted to self-exit patrick says quote it appeared she was affected very negatively and she's reporting that she was getting worse on the saraquil so this is what patrick is saying about the saraquil lindsey doesn't seem to like the saraquil either in her civil suit saraquil seems to be like the tipping factor as well but people have some mixed feelings about patrick being there and saying like my wife is not bipolar so it's just all sorts of conversations but more on the patrick conversation in the next episode okay but this is where it gets weird the day after the conversation with lindsey and patrick about wanting to stop saraquil the exact day after gelada prescribes valium and saraquil trying to ramp up to 400 milligrams so to give you an idea of what's going on lindsey and patrick want to stop the saraquil tells gelada that his wife is not bipolar and gelada's new plan is to stop the saraquil and retry prozac but the next day lindsey reports another awful night of sleep however lindsey tells her that she did not sleep but she does not feel tired so again this is very concerning perhaps and this is maybe where gelada feels the concern that lindsey might be experiencing a mixed manic hypomanic state instead of just anxiety and sleep issues prozac is held saraquil comes back with rapid titration and she's not feeling well and she's not feeling well and she's not feeling towards 400 milligrams so this 24-hour window we stop saraquil retry prozac hold the prozac aggressively increase saraquil this is one of the larger dosage movements in the timeline so lindsey was prescribed saraquil initially november 29 30th at 25 milligrams so now we're ramping up to 400 300 milligrams oh and then also another thing is that it would appear that they're Now, instead of Seroquel lasting four to five hours, it's going to become eight. to 12 hours in Lindsay's system. Gelada says that she increased the Seroquel because I recommended 100 on day one, 200 on day two. So this is like, I don't know on a medical standpoint if this is rapid, but it just felt rapid to me as a lay person who has no medical knowledge. Day two, 200 milligrams. Day three, 300 milligrams. Day four, hitting that target number of 400 milligrams Seroquel. This is, she says, the manufacturer recommendation titration schedule to treat manic symptoms. Because again, I had shared with her, I think this is a mixed manic hypomanic state. So that's what I was targeting. And when asked to describe a mixed manic state, she says, when a patient has symptoms of mania, like poor sleep, no loss of energy, but they can also feel depressed, numb, self-exit thoughts. It's sort of like it's a mixed state. It's a mixture of symptoms. And the presentation is clinically acute. Lindsay expresses wanting to get off Seroquel. Gelada explains to her, as long as you are aware of the risks, I don't think you've been on Seroquel long enough for it to have a positive benefit on your mood or anxiety. But if you have noticed benefits, the risk would be worsening of mood and anxiety upon stopping the medication. We also discussed tapering off the Valium, which I'm fine with. Being off medication might help you see where you are at baseline, but I do think you are experiencing significant and severe symptoms of postpartum depression that need to be treated. Gelada tells her, I acknowledge that medication alone is not always the best option for someone, but often it's part of the process. And I think it's a good thing that she's been on Seroquel. It's part of the puzzle. Other treatments include counseling, support from others, exercise, healthy diet, yoga, relaxation techniques. I know this has been brought to your attention several times, but I strongly recommend a partial hospitalization program so that you can get started utilizing those treatment methods for relief. And Lindsay reports that she's at 200 milligrams Seroquel, but she's still doesn't seem to like it. Now in December, Gelada says that she wants to start seeing Lindsay in person. The Commonwealth asks, why did you recommend in person at that point? This was somebody who was communicating with me every day. And I did feel that she had significant symptoms of depression, some mixed symptoms with mania, anxiety. I felt that her symptoms were severe and significant enough that I wanted to touch base with her weekly. And I wanted to see her in person. Gelada later tells Reddington that sometimes it's better to have face-to-face actual meetings with a patient rather than just on the computer, which Reddington loves that point, right? And I will say that Reddington goes much easier on Julie Paul, as well. And I think that's a good thing. And I think as well as Gelada. For a number of reasons, I think there's a lot of discourse online of why is he going so easy on the nurse practitioners and then going so aggressive on the psychiatrist. A lot of psychiatrists are backing up Tufts. It's a whole back and forth. However, I think with Julie Paul, she was not in Julie Paul's care for a lengthy period of time. And there was not that much medication movement for Julie Paul. And then as for Gelada, I think there is a defense strategy of not going too hard on her. Because the defense is arguing that Lindsay has bipolar disorder. And she was the only provider that was kind of seeing that. She's still named in the malpractice lawsuit, but more so to do with the Seroquil. But I don't think that Reddington is particularly fond of Gelada. A lot of netizens are not fond of Gelada either. At one point, Gelada is testifying. The Commonwealth asks her a question. Reddington objects. The judge overrules Reddington's objection. And Gelada, maybe out of nervousness, she laughs. And Reddington is like, laughter coming from the witness judge. It's just like, it's a mess. So people mostly don't like her mannerism or how she carried herself. Yes. And then there are really a lot of debates. So when you watch the full trial, Lindsay and Gelada do communicate a lot through MyChart. Okay. So there's a lot of back and forth communications. Some people think that Lindsay is the worst patient to have. So annoying. Nonstop, right? Others argue there are times where Gelada is like, yeah, okay, we'll talk on Monday. Here are some resources for the weekend. And it's just like hotlines. And people are like, what the fuck? So there's a lot of like back and forth of is this shit care? Or is this great care? And Lindsay is being unreasonable. I think it really depends on how much you like Lindsay Clancy, right? But there is a lot of debate about the constant benzo prescriptions. Ativan, Klonopin, Morvalium, like it just seems like a lot of benzodiazepines. Now, other than Gelada, none of the other providers state that they believed Lindsay could have been bipolar. But is that because Lindsay is not bipolar? Or is it because they were not looking for those specific signs? During the Commonwealth redirect for Tufts asking about bipolar and Lindsay potentially having bipolar, the Commonwealth is asking Dr. Tufts, right? Because she's the one that prescribed the Zoloft. What are the types of questions you ask a patient to determine if they've experienced an episode of mania? Well, a lot of it is what I can see in a session. I might also ask about some of those symptoms like decreased need for sleep or racing thoughts or increased risk taking activities. But even if they're reporting those things, I would have to really see it for myself to diagnose that. Which a lot of people argue that in her notes, she did say that Lindsay was having racing thoughts. She didn't really need the sleep. She wasn't sleeping. She went 48 hours without sleep. So people are like, are these not the exact things that Lindsay told you? But the Commonwealth asks, and what would you see physically? I might see the person is talking very fast and it's almost impossible to interrupt their rate of speech. It might also be very loud. They might be hyperactive, not able to sit still. They might be yelling and jumping through one thought to another without any linear connection between the thoughts. Yeah, I guess that's probably what I would observe in terms of behaviors. Did you observe any of those behaviors with Lindsay Clancy? No, it was the opposite. What do you mean it was the opposite? The opposite of euphoria is dysphoria or depression. The opposite of hyperactivity is tiredness and fatigue. So in a way, it was the opposite of mania that I observed. Which again, people argue in a mixed manic state, you're going to have both present. But there's a lot of debate about even that. Now, when it comes to gelada, the one that did suspect I was having a panic attack, it was the opposite of mania. It was the opposite of underlying bipolar disorder. She says if you were sure somebody had bipolar disorder, because if you put somebody on just an SSRI like Prozac, like Zoloft, it can create a scenario where people are flipping back and forth between manic symptoms and depressed symptoms, or they're called rapid cycling. It's not that antidepressants or SSRIs are never prescribed in bipolar disorder, but you often would want to have a mood stabilizer on board at the same time. December 7th, 948 AM, Lindsay sends gelada a message. Hi, Rebecca. Rebecca Gelada. Last night did not go well at all. I took the Valium and melatonin and only slept from nine to one. Then around two, I got desperate and took 25 milligrams of Benadryl and only slept about one more hour. What can I do? I really need help. So this is another thing a lot of people have been pointing out. They say that with postpartum depression, a lot of people have pointed out that it's the fact that they are unable to get sleep because they have so many new things to do in caring for a newborn. But this seems more so strongly insomnia. She cannot get sleep even when she has the time to sleep. Gelada says patients can have insomnia because they're anxious or because they're depressed, but typically they're exhausted or they're tired the next day. And it really does affect them. If a patient has an underlying bipolar disorder, they could go on two hours of sleep and not feel tired at all. And that's unusual. So is that one of the signs potentially of a manic episode? Potentially, yes. December 7th, 948 AM, Lindsay sends a message to Gelada. No, the weird thing is I don't feel tired at all. So just Seroquel tonight? I feel like I'm going to panic without a benzo with it. Would I be able to do Valium with Seroquel? Gelada responds, if you're not sleeping well with the Valium alone, there's no need to continue it. And I will prescribe a short tape to get you off benzos altogether. Because if you are not tired at all and had a significant reaction to Zoloft at 50 milligrams, I'm concerned this is an underlying mood and bipolar disorder. So I'm going to give you a short tape to get you off benzos altogether. I know you and your husband do not necessarily agree with that, but I'm going to send along this information to review. She sends Lindsay a list of symptoms of bipolar risk factors so she can refer to it. Reddington asks Gelada, so one of the things with the mania that you refer to and that you talk about is that excessive activity. Is that it? Excessive cleaning sometimes, right? Sometimes. Excessive exercise. Sometimes. Did you know that after Lindsay had Callan, that within a matter of a couple of weeks that she ran out of sleep? No, I did not know that. A lot of people think this is a crazy, like often skipped over conversation. I mean, some people argue they're runners. Others are saying like that is kind of with everything that we know about the case so far feels like maybe she felt because Patrick said she felt great the first 12 weeks. Maybe she was in like a manic state. And usually after a manic state is a very depressive state. And then maybe it was after Zoloft, it was a mixed manic state. With rapid cycling, Reddington says, and nobody wanted her to run the 5k, including Patrick, but she had to get out there and run and did. Did you know that? I did not. Is that something that would be important to know? I mean, as far as whether or not a person is that manic stage where it's post delivery, and that's a significant artifact, if you will, of exercising, right? It would have been something I would have considered. Side note, Lindsay went on a jog the morning she went into labor with Callan. So some people say, again, she's a runner. other people are saying like, it just seems like a lot. reddington asks gelada do you know that she had lost over 15 pounds by that point i was aware that she had lost some weight i was not aware that it was 15 pounds by what point i'm sorry from the beginning of the medication i think um within the time of i think running the 5k but there is a lot of rapid weight weight loss okay okay right after she gave birth yeah side note lindsey civil suit also argues that had the prescribers asked more information about dawson's birth her second child's birth and she had told them more about it those would have been critical indicators that would have quote alerted competent psychiatric providers to the risk of bipolar disorder and the potential for more severe postpartum psychiatric complications according to lindsey civil suit it says quote lindsey demonstrated significant activation in hypomanic behavior including an extensive program of exercise beginning only one week after delivery she woke up every day before the children at 4 a.m ran three miles did spinning for 30 minutes and then on the peloton and then 30 minutes of aerobics yeah yeah her sister allison also observed that lindsey was like buying into this beach body multi-level marketing scheme so she said that lindsey is very sensible but lindsey was like purchasing a ton of products to resell for this beach body program of you know she started making these videos of her exercise routines posting them on facebook encouraging her friends to join so they're saying like this is an option that this is a hypomanic episode after having the third child and combined with her behavior after having dawson this should have immediately suggested to a competent provider that lindsey may have bipolar disorder and the biggest debate of all of this is from tufts notes from october 21st 2021 so this is after zoloft reddington has tufts read her notes no sleep last night falls asleep after 40 minutes heart racing severe anxiety worrying about kids baby sleep yawns but not drowsy not hyper comma pressured speech reddington is like what was that not hyper what not hyper not pressured speech is what i meant i know it doesn't say not but that is exactly what i meant when did you see this that you noticed that it did not say not i don't care what it says i know what it meant well when you wrote this you did not say not pressured speech you said in the medical record pressured speech no does it say that yet the word not is right before not hyper comma pressured speech the two are following but not when you put down in the medical record heart racing severe anxiety worried about kids baby sleep yawns but not drowsy not hyper comma pressured speech that's what you wrote she did not have pressured speech did you write that doctor i wrote that but you're misinterpreting my note am i reading this correctly and the jury will be able to look at it that you put not hyper comma pressured speech did i read that right yes but your interpretation is incorrect as opposed to yours that's all i have dr tufts is super defensive she's practically huffing and puffing on the stand and this pressured speech debate becomes huge pressured speech is rapid frantic uninterrupted way of talking driven by the urgent compulsive need to express racing thoughts when someone has pressured speech it's not even someone that talks quickly and talks a lot it's not a yapper it's some you can't even get a word in you can't even really interrupt them it's like they're on a mission but for tufts her notes she is insisting that she meant not hyper not pressured speech but she wrote not hyper comma pressured speech now one thing to note is that later the commonwealth asks her about this so this is like a whole other debate a lot of dr tufts notes are checklists like the practice gives out these little checklists and little boxes that you just check off for each patients i don't know if that would constitute like a malpractice suit but it seems more so an opinion that netizens have made of like what the fuck is that however i will say october 21st 2022 tufts does label lindsey's speech in the box as appropriate so she does check off the appropriate box oh on the same one yes so it could like i don't know if it's a good thing but i don't know if it's a good thing but i don't know i would i would say that i'm leaning more towards she meant not pressured speech just because that same day she does check off on the box appropriate speech however i don't think that her reaction in front of the jury was great i think it's really shitty note-taking documentation of a patient dangerous too yeah so while i am somewhat inclined to believe dr tufts i also think what the fuck is that note why is that even up for debate and what if this checklist didn't exist yeah but even the checklists are kind of what the fuck in my opinion like why are we doing everything on checklists it's just strange but another person just comments the fact that a doctor said i don't care what it says during a murder trial is crazy to me others are just saying i think that she had pressured speech holy moly like this woman failed her others say she can't recall a question from the prosecution but she recalls what her notes should have said others are like a lot of health care professionals are saying like this is going to be used for the next 50 years to hammer in how important patient documentation is and i think the only takeaway from this pressured speech because i do see it kind of miscommunicated on social media a lot with people forgetting the checklist part because i do think that's a huge part of the story that's very relevant of whether or not lindsey had pressured speech but one thing that i will note is i do find it perhaps a bit uncomfortable that she is listing her interests in the checklist because i think that's a huge part of the story that's been going on and i think that's a huge part of the story that she is listing her interests in the checklist because i think that's a huge part of the story that she is listing her interests in the