Part 2 (1/2)
But Sarah still had cracks. Now and again actual thoughts were getting through, thoughts that had not been placed there by others or rooted out by the training. Her face was frequently strained by the effort of appearing remote, professionally cool.
She wasn't.
Early on, when we were alone for a moment, I asked her something about her manner, about what she was learning to do, and how you could really hope to relate to another person as a person if you were practicing the art of galvanizing your own soul.
A blush spread over her cheeks. Would she learn to repress that later, I wondered, if it came so readily now? What a loss if she did. Sad, because it was such a pleasure to watch her thoughts bloom on her cheeks like hot little pools of appet.i.te. Intellectual appet.i.te. A noticeable idea coming through her ears in waves of sound, landing on her brain as chemical information, a wave becoming a particle, then the information somehow-G.o.d, how?-pouring itself into an emotion, giving rise to a physiological response, and then a color in her face. For me, it was the best part, the miracle of the brain that it could take my question not just as language but as implication and turn it to a rush of blood.
But if Sarah was going to make it in this line, she'd have to learn to check that evidence. Dry up. Cover. Get stupid.
The unit chief was stupid in that way, I thought. Not genuinely stupid. She seemed bright enough. Doctorly stupid, I mean. Stupid because cut off and rendered arrogant by her profession and her position. She was in charge, and she sat in her sovereignty with unnerving ent.i.tlement. But to me, she knew and controlled a lot less than she thought she did. She was catered to, but mistaken, like a fat newborn, thinking her little sphere was all the world and her will the axis it was spinning on.
She wasn't like other doctors I'd known in this respect. It wasn't Baldy's kind of ent.i.tlement, overweening and repugnant. And yet it was of the same strain, because doctors are trained by doctors to be doctors, and part of being a doctor is acting like one. She came off as if her sphincter had been tied shut like a reticule. Baldy was more the type you suspected might have buried people under his house, people like his high school valedictorian, or maybe, from his ubermensch period, a landlady or two.
Who knows. Maybe she was a really nice cuddly lady at home, as tame as they come. But I didn't see her at home. I saw her on the job, and that is how I judged her, by how I saw her doing her job. It wasn't really what she said so much as how little she said. It was clear that she knew exactly just how little she needed to say to exert her influence. She sat heavily, like lead in a boat, pulling all the ballast toward her. The others deferred palpably, unthinkingly, as if by force of gravity or instinct.
Dr. Balkan was a type, too, and does not yield an inspired description, I'm afraid. She wasn't particularly bad or good. Not singular. Just a yeoman, you might say, doing service day in, day out. Showing up. Trying, but knowing the limitations of talk in a place where most people were too delusional to have what the rest of us would think of as a conversation. She was doing her job conscientiously. She was efficient but not officious. Removed but not too proud. She listened, though maybe a tad hurriedly, during our ten-minute consults each day. She cared, you could see that, and she really did want to accommodate my desire for more therapy and fewer drugs, but there was only so much time in the day. And even if there had been a spare hour, she wasn't practiced at the long, slow muse, or probably much inclined toward it.
Anyhow, Sarah was different. She interested me. I almost wanted to save her, cut her free and say, ”Go and be a person. Get out before it's too late.” But then I was hardly a recommendation for that approach, at least in my present condition, or what she perceived to be my present condition.
But what did she or any of them perceive? This was part of the problem. My private conversation with Sarah had begun with me asking her about herself, about the way she handled situations where a patient asked you something about yourself or tried to establish an exchange. She had said that she hadn't quite worked out yet what to do on those occasions. She wasn't sure when and or if she should ever let the patient see her. I admired her for admitting even that much.
The dance with patients could be tricky, I knew. I mean, you wouldn't want someone like me blundering around inside your head. And I suppose there were always people like me who were wanting to do that, either for entertainment or because it was just too hard to have any kind of therapeutic relations.h.i.+p with a cipher.
I had both motivations, as it happened. I wanted to see what she'd do, what any of them would do if you challenged their remove, if you said in effect, ”Be a person with me, will you? I'm not a petri dish.” I wanted to relate to them, to connect as a human being. But I also wanted to get a reaction that wasn't preprogrammed. I wanted to poke an actual working apparatus. Stimulus, response. Action, reaction. Slap and gasp. Spit and grimace. Whatever worked.
This was the cross-purpose of it all, in my view. They saw me as a set of chemicals. They were dealing with my brain as an organ, palpating it with categories, forgetting of course that, unlike its ill.u.s.trious sister discipline, neurology, psychiatry is not just the science of the brain as brain, but brain as organ of thought, seat of incandescent function, impalpable, the only organ in my body that can answer back.
So, talk to me.
But even their names and t.i.tles were too heavy for such intimacies. Doctor. Dr. It gets bigger with abbreviation. Degrees are magical that way. They make G.o.ds. The doctor who tells you what she knows, as if she knew it for certain. Yet, she is a deeply fallible, mostly chimerical being created by us to talk down to us when things are at their worst, because somehow that makes us feel better. In the absence of someone who actually knows what she's talking about, we are just as comforted by someone who sounds like she knows what she's talking about. That is enough. Just say it with conviction and it will make the boogie man go away.
Dr. Balkan suggested Lamictal, a mood stabilizer that I'd tried years before, but had quickly abandoned because of a swelling in my groin. A very small percentage of patients who try Lamictal develop a dangerous rash. According to the docs, it is the only side effect of the drug, but a very serious one. At the time, my groin swelling had made my doc nervous, so she'd advised me to stop the course. As it turned out, the groin swelling had been a side effect of another, nonpsychiatric medication that I had been taking.
”It's worth trying Lamictal again, then?” Dr. Balkan said.
Having done my homework on meds, I was skeptical. I'd read a lot about the undisclosed or unknown dangers and unpleasant side effects of so many of the pills my docs had been prescribing for me over the years, and I'd been appalled to read, first in books, then in newspapers, of how thoroughly corrupt the drug development and approval processes are in this country.
Pharmaceutical companies have their fingers in the pie every step of the way. They fund clinical trials of the drugs for which they hope to obtain FDA approval. They ghostwrite the papers that report the results of those trials. They provide most of the advertising revenue for, and therefore exercise undue editorial influence over, the journals that publish those ghostwritten papers. They pay large sums of money to many of the doctors and ”experts” who advise the FDA, and often vote directly on which drugs to approve.
Their sales representatives call directly on primary-care physicians and psychiatrists, providing free samples of their drugs, as well as reams of so-called informational literature, which is actually carefully crafted promotional literature about those drugs. Often this promotional literature is the only source of information that most docs consult about the drugs they are prescribing and, more alarmingly, the conditions for which they are prescribing them.
The drug companies often go so far as to hire individual doctors as ”consultants,” paying them thousands of dollars and sending them on all-expenses-paid trips to exotic locations where they can attend conferences about the company's star drugs. Finally, the drug companies go directly to the consumer, flooding the airwaves with advertis.e.m.e.nts not only for their products but for the diseases those products are purported to treat. This is one of the major reasons why most people think they know-not just believe, but know-that serotonin deficiencies cause depression, even though there is no real scientific evidence to support this claim. But we know. We know because the drug companies told us so.
So you can see why I wasn't eager to take any more drugs, and why I was, in fact, attempting to wean myself safely off of the 20 milligrams of Prozac that I was already on when I came into Meriwether. (I had been on it for at least a year, sometimes at slightly higher doses, but usually right at 20 mg, where the side effects seemed least intrusive, but the benefits sufficient to keep me afloat.) You can also see why I didn't exactly trust that Dr. Balkan knew-or if she knew, would tell me-what I needed to know about Lamictal.
”What neurotransmitter does that work on?” I asked.
”I'll have to get back to you on that,” she said.
A few hours later she produced something she'd printed off the Web, a typically useless doc.u.ment that betrayed how little anybody knew about what the h.e.l.l this drug was doing or how.
Apparently, Lamictal acts on the neurotransmitter glutamate, blocking its release in the brain. Glutamate is the same neurotransmitter that appears to be activiated by the street drugs ketamine and PCP, or so the paper said. Lamictal was first approved for use as an antiseizure medication for people with epilepsy, and it is still used in this way.
That's all I could glean from the paper, and it wasn't really of any use, except to confirm my worst fears that when it came to understanding these meds and their real effect on our brains, we were all shooting a blunderbuss at a field of daisies in the dark.
I told Dr. Balkan that I wasn't comfortable with the drug routine and thought it might be best to go the therapy route for now.
She was insistent.
”Bipolar disorder is a chemical imbalance that is something like eighty percent inherited.”
The idea was that I was unlikely to get better without meds.
Of course, the theory that there is any such verifiable chemical thing as bipolar disorder is far from proven. Besides, the idea that I had bipolar disorder at all was built on a pretty flimsy foundation, having come about because I had become hypomanic while on antidepressants. Enough people have done this that antidepressant-a.s.sociated hypomania, or bipolar III, though it is not, as yet, listed in the DSM, DSM, is now an unofficially recognized mental disorder. is now an unofficially recognized mental disorder.
The side effect of a medication had become an organic disorder, poof, just like that.
I spent almost the entirety of my first two ten-minute daily therapy sessions going back and forth with Dr. Balkan about the meds. Finally, I succ.u.mbed to the fear that they might keep me longer than I'd planned if I refused to take anything, and said I'd take the dose.
As they are no doubt required to do, the nurses at Meriwether watched you take your meds. They wheeled around a cart full of pills and liquids, stopping in front of every room to dispense them. By the time they started giving me the Lamictal, on my third day up there, I'd figured out that they weren't terribly vigilant about making sure you weren't hiding anything under your tongue, or holding it in your mouth or palm. Besides, I'd requested a multivitamin, which they gave me at the same time as they gave me the Lamictal, so I was able to make it look like I was popping both pills into my mouth, when in fact, I was holding the Lamictal back, lodged between two fingers.
When the nurses left I went into the bathroom and flushed it.
After the triage hole, the ward seemed like a penthouse. It had big wide windows, albeit elaborately gated and locked. But you could still see through them enough to get a sweeping view of the city below. We were on the twentieth floor, and the width of the sky at that level was intoxicating to my trapped mind. Diffuse light pervaded the large rooms for most of the day, though no fresh air made it in, or very little. My bed, one of four in my room, was pushed up lengthwise against one of these windows, and I spent a lot of time, especially late at night when I couldn't sleep, sitting up in bed watching the lights glowing in the windows of skysc.r.a.pers. The seal on my window had a sliver gap in it somewhere near the bottom, and as I sat there, desperate for a lungful of unprocessed oxygen, I'd lean my face against the grating and listen to the slow whistle of the winter wind, feeling the momentary caress of the cold on my cheek.
In that place, where there was so much that you weren't allowed to do, leaning that way felt like stealing, like I'd get busted for breathing wrong when the head nurse, Mrs. Weston, strode into my room, as she periodically did, and searched the slim freestanding closet by my bed. It was more a power play than anything. She usually missed half of the contraband that was in there, that being a few pens I'd asked visitors to bring me, a couple of oranges taken from a box in the dayroom, a plastic bag for dirty clothes (possible suffocation risk), and a pair of pajama bottoms with a string tie (strangulation risk; the Ping-Pong table in the dayroom had no net for the same reason).
We got oranges around eight o'clock, as a snack after dinner, usually along with peanut b.u.t.ter and jelly sandwiches on Wonder bread. You had to eat all this in the dayroom, though, because we weren't supposed to bring food back to our rooms, lest it attract bugs and mice, or worse-that was the official rationale anyway-though that seems appalling in a hospital.
But, like everybody else, I used food as a form of succor, h.o.a.rding it for late-night snacks. It was about the only thing you could do in there that felt good, aside from m.a.s.t.u.r.b.a.t.e, that is, and I don't know what they did with you if they caught you doing that.
The oranges served double duty, as they were especially useful for making what I dubbed prison potpourri. This was the kind of thing you learned to do when you had extremely limited resources and you were faced with the foul odor of the unlockable en suite bathroom that you shared with your three roomies, all of whom were less hygienic than one might have hoped. The odor was mostly of p.i.s.s, strong concentrated p.i.s.s of the kind you get on the floor and walls when you're overmedicated and underhydrated, have bad aim, and are not particularly concerned about flus.h.i.+ng the toilet after use.
A janitor gave the bathroom a cursory going-over most days, often very cursory. That didn't always include mopping the floor, or if it did, it didn't help for long. The stench was overpowering, yeasty, and thick as no p.i.s.s I've ever smelled, such that you had to keep the bathroom door closed at all times. Otherwise the whole room would smell like h.e.l.l's own p.i.s.soir.
To make prison potpourri I'd take my oranges into the bathroom to peel them, standing over the toilet as I did so, thus allowing the pungent oil in the peels to spray the room with what amounted to a home remedy cleanser. For extra effect I'd stand in front of the steel plate mirror (no gla.s.s), hold each piece of peel up to the fluorescent light, and squeeze it as many different ways as I could make it bend, watching the fine spray spurt into the air. Finally, I'd throw the peels in the garbage and let them suffuse the room for as long as they could.
Standing there squirting my orange peels under the light, sometimes holding them right up to my face to get a really good look at the spray, and doing so with the kind of keen attention that other people devote to their taxes, I realized I was doing something that, if you came upon me doing it, big as you please, in my blue issues with their dodgy snap fly open, and my Acti-Tred socks half pulled off like clown shoes, you'd be inclined to think that I was mistaken in believing I needed to be anywhere but exactly where I was.
But all these elaborate bathroom cleansing plans were foiled for the day if Mrs. Weston stalked in. Usually, I was sitting on my bed, leaning into my grated window sipping the air, or writing in my notebook with a pen, propping it against my upbent knees to keep the writing instrument mostly out of sight. When I wasn't using one of my pens, I kept my stash of them safe in the front pouch of my hooded sweats.h.i.+rt. But even in my bed, taking precautions, it was hard not to get caught using one, so my marsupial supply dwindled quickly.
Mrs. Weston had a keen eye for ballpoint pens. She could see them from the hallway, and before she got halfway across the room, she'd put out her hand imperiously to demand the precious item. She'd take it, then proceed with a vigorous search, flipping open my closet, pulling out the oranges she could see, and saying in her loud ward voice, ”No food in the rooms, people. No food in the rooms.”
The plastic bag was a much bigger deal, but she never found that, buried as it was under my underwear and books and papers (these latter items were not considered to be a risk). As I said, she was more interested in the symbolism of the act. She was a tall, imposing black woman in low-heeled boots and a semicasual pantsuit. Her voice was powerful, and she enjoyed using it as if she were herding third graders at recess.
I suppose it made her feel efficient to conduct her searches. It was probably in her job description to at least walk into every room in the mornings, just to be sure no one had died or stuffed someone else into a closet during the night. Still, the searches were intrusive, and always conducted with the same ent.i.tled att.i.tude and condescending air that made me want to rig my closet with a dummy, or a leaning cup of p.i.s.s, just to make Madam Suzerain think twice about where she stuck her nose.