A Room with a Darker View

by Claire Phillips

  “See,” he said, heaping her plate with a second helping of rice. “She’s getting better.”

  Her appetite had visibly improved. The complaints about her teeth had significantly subsided. I began to feel hopeful again.

  The Story of Joy

  Mid-June. Under a marine layer offering much-needed protection from the ceaseless sun, I drove my regular route to Park La Brea along Third Street, taking in the reassuring and familiar sites of Hancock Park: the two-story, large fabled homes of early Hollywood celebrities with their leafy trees and bushes, tall imposing walls and now, a preponderance of Orthodox Jewish women attired in expensive fashionable knee-length dresses and high heels, guiding strollers past cafes or glitzy clothing stores. Six weeks after my mother’s release, my mother’s doctor began to reduce the heavy dosage of Seroquel our mother was taking: from the fog-inducing five hundred milligrams to four hundred milligrams. Her improvement was immediate. Less confused and more motivated, my mother began to make requests for specific food items. We became convinced that she was ready to live on her own again.

  With her continued improvement, my interest in her medical history grew. By this time, I had begun openly writing about my mother’s illness after a lifetime of silence. Not having participated in my mother’s healthcare for many years, I asked John to fill me in. We arranged to meet one evening to take our mother to a nearby restaurant. As I recall, it took an especially long time to persuade her to leave the apartment; she seemed both agitated and weary. We drove the short distance, two long city blocks. Struggling to find new and affordable places to take our mother, we knew at least this barbeque house with its 1950s retro furnishings and dark wood paneling would be to her liking.

  My brother ordered my mother a healthy dish of salmon and rice and beans, skillfully thwarting her attempts to order the lowest calorie meal on the menu, a diet-conscious salad. Some argument ensued. Despite this, my mother was successful in eating most of it. She had turned a corner, just as my brother had assured me she would. The plan for this evening was to interview my brother after dinner, but by the time we finished eating, I could feel my energy waning. No longer able to curb my impatience, I slipped into interview mode as my mother headed for the bathroom. Catching me on my laptop upon her return, she soon registered what was happening, tuning in to my brother’s depiction of a prior relapse.

  I expected my mother to recoil angrily, rankled by the open discussion of her illness. Instead she was eager to participate.

  “No,” she corrected my brother’s memory of the ill-fated change in her medication by her doctor those fifteen-odd years ago. “He had me on fifteen milligrams of Haldol, and he reduced it by five milligrams.” I was impressed by her fine recall of facts.

  In the low lighting of this bustling restaurant, our discussion of her multiple hospitalizations continued. My mother participated without rancor or confusion.

  “You’re not writing about me?” she asked, an excited gleam in her eye.

  “No, I’m not,” I dissembled, afraid of my mother’s censure.

  “You are,” she countered with notable relish.

  “Okay, Mom, I admit it,” masking my intent with a heavy dollop of irony. “I’m going to title the book: The Story of Joy,” I said with an extra flourish.

  My brother nudged me. “I like that,” he said in all sincerity.

  “That’s a terrible title,” I groused.

  Across the table from us, despite my heresy, our mother continued to beam.

  Delusion of reference

  Still the delusions persisted. When it came time to pay, she placed her credit card on the table with the following complaint:

  “This card is not my credit card. It has silver patterns on it,” she said, pointing to its identifying hologram. “My card didn’t have patterns.”

  Described in medical terms as “a delusion of reference,” as in the case of her telephone, nothing actually belonged to her anymore. It wasn’t uncommon for her to insist that the phone she was speaking to me on belonged to a mysterious “them.” She continued to insist the newly issued credit card in her wallet was not hers. My brother did his best to make light of her complaints, parodying her distinctive southern-African accent.

  “I don’t like this card,” he mocked in a high-pitched voice, tossing his hands in the air in a display of helpless femininity. “It’s not mine.”

  My mother began to laugh. This was a familiar tack on the part of my brother. Identifying closely with a maddening effect of her disorder, he helped her find some detachment. To laugh at herself and move on. I had never comprehended my brother’s grating parodies of my mother’s accent before. Now I understood this strategy’s power.

  It wasn’t long, however, before she launched into another round of delusions.

  “I can’t eat in my kitchen,” she complained to us as we rose in our seats to leave the restaurant. “There are rats scurrying up and down the walls.” The bright gleam in her eyes told us she knew this was a symptom of her illness.

  “Fine, Mom,” my brother jibed. “We’ll buy you a pet rat if that’s what you want.” Again she giggled, glad to be in on the joke. My brother’s disarming comments worked to curtail the familiar litany of gothic horrors. Once again, I had to wonder why my mother suffered from hallucinations that were strictly terrifying. Why did her mind never manufacture something beneficent or at the very least benign? That night, dropping off our mother at her apartment, she seemed especially sad to see us go.

  July 2013

  Mid-summer with scorching triple-digit temperatures, teaching writing to art students at uc Irvine, I was now commuting along congested freeways under interminably sunny skies. Conscious of the vulnerability of the elderly during heat waves, I became worried about my mother. Would she even know to turn on the air conditioner? She lived on the seventh floor of a tower building. I could only imagine how hot it would get. Stuck in the slow crawl of rush-hour traffic on the freeway, I called from the car.

  “It’s over a hundred degrees today. Turn on your air conditioner,” I insisted. She refused.

  “It’s too loud. I can’t.” I felt confused. I had never noticed the air conditioner in her apartment being loud. I was over sixty miles away. I couldn’t easily reach her.

  At 6 p.m. when I returned home, I noted a cooling ocean breeze had reduced temperatures significantly. I called my mother to suggest she open her windows to get some fresh air.

  “I can’t,” she told me. “They are drilling outside the apartment day and night. From 8 a.m. until 8 p.m.”

  “I didn’t know that,” I responded, unsure what to believe.

  “Any day now, they will come and demolish my building.”

  “I don’t think so,” I countered. It had been years since I had heard this particular fear. She then added a nightmarish confession: “I am the only person living here.”

  I tried reminding her that we saw people getting in and out of both of the towers’s elevators all of the time.

  “No,” she refused my version of reality. Other false beliefs had become more persistent as well. She informed me of a complicated scenario in which electronic signals were being relayed between the downstairs security office and her neighbor’s apartment, and how these signals interfered with the use of her phone and the television. There were references too, to men who purportedly showed up and did things in her apartment that she refused to divulge.

  “Why don’t I ever see one of these men?” I asked.

  “They only come when you’re not here,” she said in full command of her imaginary world. Dismayed that she seemed altogether worse than the week before, I ended the conversation.

  Capgras delusion

  Soon I would be confronted with a familiar accusation.

  Opening her front door to greet me one day, she declared, “I don’t think you are Claire.”

  My brother and I had not heard this delusion in over thirty years. This was a symptom of Capgras delusion or syndrome, a
psychiatric disorder in which a close relative, friend, or even doctor, is deemed an imposter, first described in 1923 by Capgras and Reboul-Lachax. Its reemergence gave me the impression that this illness, left unabated, followed a specific neurological course. Researching this particular syndrome, I found that, according to psychiatrist Dr. Sadgun Bhandari, these “delusions of misidentification are common in late onset delusions both with and without cognitive impairment. A related phenomenon is that of phantom boarder syndrome in which patients believe their home is inhabited by unwelcome guests.”26

  This could explain why she had been insisting for months that her telephone did not belong to her. It was an imposter phone. Just like Phillip K. Dick’s imposter police station in his science fiction classic Do Androids Dream of Electric Sheep?, where bounty hunter Rick Deckard of a future dystopic San Francisco hunts down android escapees of Mars. It also explained why she insisted on the constant presence of invisible intruders.

  This delusion carried some unwholesome effects. For instance, when it came to her healthcare, she refused to see her doctor or make a dental appointment, insisting either: He won’t be there or It won’t be him. If she were to reach her doctor, she was convinced it would only be to speak to an imposter.

  The imposter syndrome signaled to me that her psychosis had been running on for way too long.

  Mother and daughter

  “Why don’t you get your hair done?” I suggested to my mother later that week. She didn’t wash her hair, having relied on professional care as far back as I could remember. These appointments were vital to her personal hygiene.

  “I can’t go because my hair is falling out,” she countered. I wasn’t sure if this was a delusion or an effect of her poor eating over the past several months.

  “Let’s make an appointment,” I would suggest to her.

  “I can’t,” she refused, returning to a litany of former complaints. “They won’t want me there. It’s dirty.”

  Scoping about her apartment, hoping to help, I reminded her to try and start taking her vitamins again. Before her relapse, my mother was markedly disciplined about her health. She took scads of daily vitamins: special supplements for eyes, skin, bones, so many I couldn’t keep up with them all. Now, her vitamins languished in the bottles and the weekly prescription dispensers, her woefully underpaid health aides had filled for her as part of their duties.

  “Mom, take your vitamins,” I begged.

  “I can’t take my vitamins,” she explained in a weakened voice. “They smell bad, and half are missing.”

  I began to fear a recovery might never be possible.

  Caregiving

  Some days were better than others. In a crusade to gain weight, my mother had taken herself to the Cheesecake Factory for a slice of her favorite dessert. The good news ended here.

  “There was blood in my milkshake today,” she confided. “I couldn’t finish it.”

  My heart sank. What chance did my mother have to thrive if she believed her food was contaminated? How could I convince her otherwise? It was impossible. Throughout the night, anxious and sleepless, I sent my brother a slew of panicked emails. “Mom is not getting better. She can’t take care of herself, and I am drowning in course work. She needs to be placed in a home.”

  “A psychiatric home would cost us $9,000 a month,” my brother informed me the following day. We simply didn’t have the money. Her insurance would not cover psychiatric care of this type. My brother insisted he had been through this with her multiple times, watching her undergo dramatic weight loss under the sway of pernicious delusions before responding suddenly to a new medication and recovering. “A home would bankrupt her in a matter of months,” he told me. “She’s improving, Claire. It’s slow. But she is getting better. Her delusions are tapering off. Mom will live another twenty years.”

  “But how can she survive when she thinks there is blood in her food?” I raised the specter of the milkshake story.

  “You need to understand, she’s always lived with delusions. She’s eating entire meals whenever I take her out. She always tells me how hungry she is. She’s taking long walks now. She’s able to put her bills out for me now. Last month she couldn’t even do that. Please.” He tried schooling me in her care. “You need to give her more time.” He advised me to take a break. “A friend once told me, you should always stop taking care of other people if it begins to interfere with your ability to take care of yourself.”

  Promising to see more of her, my brother gave me a reprieve. It was time for me to step away. Get some rest. Mark some papers.

  Early August 2013

  For about two to three days, I stopped calling. It didn’t seem reasonable to call when my attitude was so overtly unsympathetic. I was worried about her though. So, soon afterward I started up again. I wondered how she coped alone at night with all of those alarming delusions. I needed to hear her voice. Contrary to my fears, my mother was perfectly capable of staying out of trouble. She didn’t abandon her apartment for another one, wander naked throughout the halls of her apartment building, or go missing.

  That Friday, having taken my architecture students to a see an exhibit of models and blueprints, renderings, and hand drawings at the Architecture & Design Museum, Never Built L.A. Architecture, and after reviewing several unrealized proposals, including Rem Koolhaas’s irreverent bid to tent LACMA and its disparate stew of buildings, I left, intending to surprise my mother with a quick unannounced visit.

  Her green eyes flickered as she opened the door of her sun-flooded apartment, delighted to see me. I found her busy folding laundry. Apparently, she had convinced my brother that she no longer needed a health aide. She appeared thin but kempt in her white cotton peasant blouse and exercise pants, and surer on her feet. Checking on her progress, I opened the refrigerator. It was almost bare. I became frantic.

  “There’s no food. You’re not eating. You need help,” I implored. I then scanned her kitchen for more proof of her need of part-time help. “Why are there so many unclean dishes in your sink?”

  “A man was here working on the plumbing,” she said in possession of herself. “I am not paying rent until they fix a problem with the plumbing.”

  I was confused. I saw no signs of work, or a man.

  “I don’t believe there was a man,” I chided. How many times over the past several months had I heard about these mysterious “others?” Noting the dingy carpet of her living room, I then asked her how she would get by without any help. “You need a new health aide. You can’t do all of this alone. No one has cleaned these floors in weeks.”

  “I do have help,” Mom boasted happily. “Clara was supposed to be here at noon. But she didn’t come.”

  “Really? Where did you meet Clara?” I asked incredulous.

  “I met her doing laundry. She had a big ring in her nose,” my mother chuckled, gesturing to her face. “She showed me how to get my whites clean.”

  Apparently, Clara was helping another woman in the building with her household chores, and was kind enough to explain to my mother how to separate her clothes in order to keep the whites bright. Wow—for how long had my mother labored without that bit of domestic knowledge? The interaction sounded credible, though I still held some reservations, mainly because Clara’s name was uncannily so close to my own.

  Just then, the doorbell rang. My mother and I exchanged surprised looks. Who could this be? I opened the door to a young woman, Clara, who, as described, sported a hulking septum nose ring. My mother hadn’t dreamed up Clara. Here she was, just two hours late. She was only eighteen. What could we expect? My mother and I shared a laugh over Clara’s late arrival and my recalcitrant disbelief.

  “Do you want to work today?” I asked. Clara answered in the affirmative. As I had done for a number of health aides over the past nine months, I demonstrated for her my mother’s daily regime. Her particular habits about emptying the trash, cleaning the bathroom, the kitchen floor, then negotiated an hourly rate
for her of $12. She seemed amenable to this arrangement. Her timing couldn’t have been better. I handed her the broom and left.

  Driving home, I marveled at my mother’s resourcefulness. She hadn’t waited for my brother to hire someone new. She had found someone on her own, a delightful young woman who was planning on enrolling at El Camino College in the Fall. It felt fated, almost magical.

  Gunned down

  Suddenly, we were back to where we started. My mother had succumbed to yet another debilitating round of diarrhea. For two days, she complained to me about her symptoms over the phone. There had been another Foster Farms chicken salmonella outbreak, I would discover later. Was this the culprit? I wasn’t sure. Not willing to face another hospitalization, I begged her to call her doctor, or call 911, or go directly to the emergency room. She consistently refused. Too paranoid to make the call to her doctor, she insisted that if she did, an imposter would be there in his place.

  “It won’t be him,” she said.

  Luckily my brother was willing to intervene, making the visit to her home, as I madly dashed great distances between colleges in bright, sickening heat. She was legitimately ill, I soon learned, a reality I still struggled to embrace. I had never suffered from food poisoning, or from a bacteria outbreak or food-borne illness. Ensconced in my bubble of wellness, I could not relate. My brother then made a worse discovery. She was now no longer taking her pills.

  “You are not someone who gets to choose whether you take your medication. You must always take your pills,” he tried coaxing her into self-care. My mother could not have been more fortunate in begetting this son who proved to be, more often than not, patient and undaunted in the face of chronic illness and its many demands.

  Just as she had claimed, she had suffered a terrible bout of diarrhea and was in need of care. Her linens were soiled. She needed help with bathing. Not only that, but under the influence of a persistent psychosis, she was convinced that she had been gunned down.