Friday, December 7, 2007

FAQ: Why did you keep having children?

I have gotten this question a lot from people, and it is a fair question given what has been reported in the media.

Let me start by clarifying a couple of things. First, many people picture Andrea as a helpless woman who slowly deteriorated through the years as a result of being overwhelmed with more and more children. This is simply not true. Andrea is a very smart, conscientious person. She was valedictorian of her high school class, she was captain of her high school swim team, and she practiced as a registered nurse at MD Anderson Cancer Center for eight years.

Before we married, Andrea decided that she would stop working as a nurse when our first child was born, and we decided that we would have as many children as we were blessed to receive. When Noah was born, Andrea left nursing to become a stay-at-home mother. She absolutely enjoyed her role as a mother. Of course, things were busy with five children. At the same time, we were all very happy.

Also, Andrea only exhibited signs of depression after our last two children were born. She seemed very much herself after our first three children were born. In fact, I did not notice any changes in her appearance or functioning, and no one ever mentioned to me that she seemed depressed in any way. Andrea has told me several times that she felt fine after Noah, John, and Paul were born.

After Luke (our fourth child) was born in 1999, Andrea became very depressed. The depression started a month after Luke was born, and it gradually worsened over three months, until Andrea tried to commit suicide and needed to be hospitalized - twice. During this time, she slowly changed from a vibrant woman to a catatonic zombie. This was not a subtle change. She was a different person.

While she was sick, Andrea would only respond in 1-2 word statements. She walked around nervously. She seemed disorganized and confused. She scratched her head. Her leg shook uncontrollably. She carried Luke around on her hip and would not feed him even when he cried. She was unkempt. She would stare blankly into space for extended periods. At her sickest, she would not eat or drink, and she could barely walk.

Andrea was hospitalized in an intensive-care psychiatric unit. One day, I spent two hours pleading with her to start taking an antipsychotic medication that her doctor, Dr. Starbranch, had prescribed. Andrea said less than 10 words the entire visit. She was a zombie. After our visit, I spoke with Dr. Starbranch about Andrea's condition. Dr. Starbranch decided that it was an emergency situation and decided to give Andrea an injection.

The injection was a cocktail that included, among other things, Haldol, a very powerful antipsychotic medication, and Ativan, an anti-anxiety medication.

After Andrea received the injection, an amazing thing happened. Within 24 hours, she was on her feet. She was walking. She was talking. She was eating. To this day, I am utterly amazed by how much and how quickly she improved! It took a while to find a medication that worked for Andrea. Her family and I had started to lose hope that she would ever be herself again. Then suddenly, within one day, she was mostly back! There was hope!

After the injection, Dr. Starbranch continued to give Andrea Haldol. She also started to give her Wellbutrin, an antidepressant with some mood-stabilizing effects. Andrea did very well on both medications and recovered quickly. Dr. Starbranch discontinued the Haldol after Andrea had been stable for a couple of months. Andrea discontinued the Wellbutrin herself. For all of 2000, Andrea seemed well.

This had been an exhausting experience. Finally, things started to seem normal again.

Andrea and I discussed the possibility of having more children. We both love children, and we would have loved to have more.

Some of the biggest challenges in 1999 were: recognizing the symptoms of Andrea's depression, seeking prompt treatment, and determining which medications worked for her. Dr. Starbranch and her staff told us that if we had more children, then there would be a 50 percent chance that Andrea would become depressed again, and that if she did become depressed again, then she would have the same symptoms and require the same treatment.

Given these things, Andrea and I decided to have more children. If Andrea did become depressed again, then we would quickly recognize her symptoms and take her to a doctor; and her doctor would give her the same medications that had worked before. Therefore, we (in hind sight naively) thought that her symptoms would not be severe, nor last for long, because she would be treated quickly and effectively.

Here is an analogy: Suppose you could receive a beautiful new car in exchange for enduring the flu for two weeks. Would you do it? A child is much more valuable than a car. Also, two weeks with the flu is worse than what we expected. We had no idea that having another child could lead to such a tragedy. To us, it was a good trade.

Now, about our conversations with Dr. Starbranch. It is true that Dr. Starbranch recommended that we not have any more children, because Andrea could become sick again. When we told her that we wanted to have more children, she said that she wanted to put Andrea on medications during and after the pregnancy, and Andrea refused, because she was concerned that the medications could harm the baby.

During the course of Andrea's treatment, Dr. Starbranch never explained to me that Andrea had been psychotic and was potentially harmful to our children. She did explain that Andrea was depressed and was potentially harmful to herself. This is a key point. Apparently, Dr. Starbranch also wrote a comment in Andrea's medical record that Andrea could become psychotic again if she had more children.

I suspect that Dr. Starbranch withheld this critical information from me, because she has a duty to Andrea to maintain doctor-patient confidentiality. At the same time, she had a duty to Andrea and me to warn us if our children could possibly be in danger. On the whole, I believe that she is a competent psychiatrist. However, if she did believe that our children could be in danger, then she should have explicitly warned us.

To be complete, during the course of Andrea's treatment and through a lot of discussion, Dr. Starbranch did mention to me that it is possible for a woman to become psychotic and harm her children. However, she never warned me that Andrea herself was psychotic, nor did she describe the symptoms of psychosis to me. I did not know that Andrea was psychotic and posed a threat to our children in 1999 and 2001 until after the tragedy.

So what mistakes did we make? What could we have done differently?

Well, first, I do believe that Andrea and I treated her illness too lightly. We believed that Andrea had a routine case of postpartum depression, while in fact, Andrea had a very severe case of postpartum psychosis. Similarly, we expected that if Andrea became depressed again, then the progression would be slow as in 1999. However, what took 2-3 months to develop in 1999 took 2-3 weeks to develop in 2001.

Second, we naively believed that any psychiatrist could treat Andrea effectively. Dr. Starbranch did treat Andrea effectively; Dr. Saeed did not. While Dr. Starbranch found a combination of medications that worked for Andrea and fought our insurance company to keep her in the hospital until she was well, Dr. Saeed gave Andrea medications that exacerbated her condition and discharged her while she was still the sickest patient in the hospital.

If we had known these things at the time, then I think we would have decided to count our blessings and stop having children. At the same time, I feel blessed to have known Mary for the short six months of her life. She was a beautiful little girl.

14 comments:

Mary said...

Hey Mr. Yates, I'm replying to your comment. Some of which you pointed out I recall reading in Are You There Alone but I distinctly remember reading that Andrea's doctor warned you to the danger of that fact that she had psychosis and if she became pregnant again it would reoccur. But I've also read that you waited until March 31 of 2001, three weeks after the death of Andrea's father Andrew to get her help. I dont mean to be a jerk but its what I've read and a quite few of my friends have read as well. I'm just curious if this is the case then why did you wait three weeks to get her the medical help she so desperately needed. And on second thought, when you knew your mother-in-law's concerns about Andrea being alone with the kids, why did you leave alone anyway? I understand it was Dr. Seed's understanding that there was someone there at the house all the time. Yeah, Dr. Seed did several things wrong, but generally since he is from the middle east they generally have biased against american woman, and dont know a whole lot on PPD or PPP. I dont understand why you didnt check into this dude's background and why didnt you go back to Andrea's orginally doctor?

Ann said...

To Mary:

I highly doubt Dr. Saeed had a bias against women because of where his family is ethnically from. That is just flat out ignorant to say. My husband is from the Middle East and my psychiatrist is from the Indian subcontinent and never have I felt that he wasn't treating me adequately or that he had something against me because I was a woman who happened to be from the US. My doctor as well as myself (due to my professional background) know a lot about postpartum mental health issues.

While after the fact everyone wants to blame someone, it is a natural reaction. Sometimes there are really very little warning signs. You can't base something on nothing. Most women who have PPD do not go into PPP and to assume that they would automatically is wrong. No one could of predicted this so they couldn't be aware of every single symptom. People in general do not want to think the worst, and remain optimistic. It is a huge tragedy and I genuinely can sympathize with the entire Yates family. When I heard the story on the news I thought was that this woman sadly lost her mind. I could tell she adored her family.

Addy said...

I don't have too much to add just that it is easy for people to judge others. Our job is not to judge.
I can understand having more children. Children are precious. This was a tragedy and there is no blame. A woman was extremely sick and this happened as a result of that. Sometimes we look back and ask what could I have done differently, but after the fact there is no use beating one's self up over it. Nothing was intentional here and that is the most important thing to remember. I'm sure Andrea and Rusty would give their lives to turn back the clock, but we know that isn't possible so the most positive route is to learn from what happened, grieve and try and heal and make a difference in this world and something meaningful with the rest of their lives.

Anonymous said...

My heart breaks for this family. I've been in the situation of trying desperately to get mental health care for a loved one. It was a dangerous situation for me and my 2 children as their father was out of control. He was a good man, became a different person, was in terrible mental pain. The legal profession failed us "they didn't get involved in domestic issues" at that time. The medical profession also did not inform me as to the danger I was in trying to get him help. I was of the false notion that he would never hurt me. I, like you, found the entire situation exhausting, trying to raise my children, work full time, and trying to get help for their father that I also had no legal authority over since we divorced during that time period.

There should be a law that the doctors are required to notify the care taker/supporter of the danger they and others might be in. Doctors obviously know when a patient is incompetent to make their own decisions, including the patient/doctor confidential relationship.

Congrats on going on with Life Rusty, and with your new baby son. I wish you nothing but happines with Laura.

Alicia Rogers said...

Mr. Yates,

I just found this site, and I can't tell you how much everything you've written about Andrea and her journey through mental illness almost echoes my own journey after the birth of my son.

I too became depressed after my son was born in June, 2006. At first my husband and I thought it was simple postpartum depression, so our family doctor (not a psychiatrist) put me on Lexapro. It made me too spacy, so I quit taking it and as a result I spiraled down again. Then I was put on Zoloft and felt great! By my son's first birthday I felt so good that I stopped taking the Zoloft, and I thought I would be fine.

I was wrong.

I spiraled down again, this time worst than before. I barely had any energy, any motivation, any happiness or joy in life. I used up what little energy I had to care for my son, but I couldn't be the mom or wife I truly wanted to be. I would swing back and forth between extreme depression and extreme agitation and anger. I thought I was the worst person in the world and that my son would be so much better without me in his life.

I was in a very dark place. Eventually I gained the courage to go to my husband and I started to see a psychiatric nurse. I thank God for her! She immediately diagnosed me as having Bipolar II Disorder (a result of my pregnancy) and I was put on Effexor XR.

Through taking this and going to therapy I feel like myself again! I feel human again! And my husband and I are talking about having another child. Like Andrea's psychiatrist spoke to both of you about the possible risk of a relapse, so too has mine. I am scared that it could happen. I am scared it could be worse. I am scared to completely stop taking the Effexor since I know how fast my descent could be.

All we can do is what you and Andrea did and hope. So I completely understand what you said in your blog post about deciding to have little Mary. Andrea was herself again and feeling good. You both had hope that she would continue to be fine.

I think that anyone who has never had a mental illness (or had a loved one suffer from one) could understand how quickly and easily a person can go from being fine to falling down again. Within the span of a day things can go from great to very bad. I wish those without experience with such illnesses would not judge those who do, but that's the state of the world unfortunately.

Anyway, I guess my whole point is my heart aches for your and Andrea's losses. I can't imagine the pain you feel, nor the pain she has experienced as she's been treated and come out of her darkness. I, back when I was naieve, was like many who thought Andrea was so horrible of a person. Now, due to growing up and living through a postpartum mental illness myself, I know better. She was a good and loving mother who merely got caught up in the dark abyss of mental illness. I rejoiced the day her new verdict was given since she doesn't deserve to be in prison.

As one mother to another, as one woman to another, I wish I could give Andrea a big hug of understanding and empathy. I wish I could tell her she is not alone in dealing with a mental illness. I wish I could tell her how my heart aches so much for her. My heart truly goes out to her.

All the best to you, Mr. Yates, and to Andrea, and to your wife and baby boy. I think you all deserve whatever happiness life brings to you all. And thank you for writing these blogs. I can only hope they can help some people understand instead of judge.

Anonymous said...

Why did you choose to have another baby when you knew Andrea had already twice tried to commit suicide? Why did you leave a depressed mother with a history of suicide home alone with your 5children? When you said you would nip Andrea's illness in the bud next time, was it worth it to you to delay Starbranch's urging to bring her in right away so you could make your driving distance more convenient to your schedule? Don't you have any remorse for any of these decisions? Don't you see how these decisions played a major role in the outcome of the tragedy?

Theresa Cutino said...

I agree to what Mary is saying, I have been meaning to look up Andrea's case info. I remember the day it happened and the way I responded about it!!! I felt stupid after hearing more details of her and how she got to that point.....how horrible it was of me to be biased by the act she committed, to only find that like in every situation or scenerio there is much more to find out and understand before coming to a conclusion.

After watching American Justice and anything about Andrea, I found myself so angrry at Rusty Yates and his strange mother figure. Thier portrail of Andrea was rediculous and the way they made themselves seem to be so caring and intuitive to Andear's condition and state of mind at that point!!!! Now Rusty is some how gaining notarioty and financial wealth from this horrific tragedy, that is just absurd.

Andrea gave herself completely, even to the rediculous request to follow that religous nut case.....not to mention the purchase of his humble abode for the Yates family (what the hell kind of normal man does that to his family!!) anyway I am rambling and just wanted to show my support for Andrea in hopes that she will find peace and serenity in her life......of course I hope that she has rid herself of Rusty and his mother!!!

Anonymous said...

Dear Rusty,


My name is Mary. And This is what I want to say. I understand that she tried to Andrea the help she so deserved but found none. But I still don't understand why you didn't go back to her original doctor, and stayed with Seed. I'm not a biased person but I believe that Dr. Seed did not really understand the situation of Andrea's case. But I do understand that someone told Noah that his mother had tried to hurt herself in the bathroom of Grandma Kennedy's house. Who in their right mind would tell a seven year old that their mother tried to commit suicide. Not me. God bless Noah John Paul Luke and Mary.

ana said...

Hey Rusty, nice website you have for your young children. But I don't understand a couple of things. I read in "Are You There Alone" that Dr. Stanchbranch said that if Andra had more children it would cause her to become pyschotic again. I also read that she told you the children could be in danger. IS any of this true?

Anonymous said...

i have a question for you mr. yates and it might be a little graphic but to me it seems like ur fine with that!...im not trying to be mean but i am very angry i sat here crying one day when i ran upon what was said by your oldest son noah.. when he ran into the bathroom and seen that evil women with mary in the tub and he ran then andrea caught him his last words were sorry... that evil women made ur poor child b4 he died scared to death and say sorry for something he had no control of i lost it after that and i know my god has that sweet boy in his care noW along with the other 4 children... i am sorry that andrea has ever become a mother it was a bad idea from the jump...i myself have dealt with depression and had suicide thoughts and such but i have 5 nieces and nephews total and i would never ever think of or even want to and i dont think anything in this world could make me hurt any child for that matter i dont think u can be that "sick" and "depressed" to drown a kid and even hear them plead that their sorry ... god bless them kids... may their poor souls now be at peace... sorry to be so mean but it angers me and i dont even see how u moved on so fast when thoes were your children thats just me tho i guess i have a bigger heart than most people do.... R.I.P YATES KIDS??....WRONG R.I.P GODS KIDS!

ana said...

who ever said that. Right on girlfriend. I mean come on. People knew she was sick. But I don't really blame Rusty. I blame the medical staff and stuff.

Valerie said...

Dear Mr. Yates,
I am glad you have done this blog. I am doing a school report for my senior english class on Andrea and I am trying to see both sides of the story as i write my essay. This blog is helping me see your side and I also enjoyed looking at the yateskids.org page. I almost feel a connection to your children as if i knew them because of it. I understand now that you are not the only one who wanted more children and I don't think you should have to take the blame for what your wife did and the condition she was in. Thank you for keeping this blog again.
Valerie

Anonymous said...

I think you're amazing for educating people about your life and these issues. I hope you've found peace <3

Anonymous said...

i am only 15, i do not remember the case when it happened as i was only 5 and i live in scotland, so it was never really in the public eye over here. when i was visiting america in the summer of 2006, i read about it in a magazine in a coffee shop. since then i have looked up the case, and i am awfully sorry. i think you are a very brave man :)