by Marin Sardy
It was a sign of Dad’s bewilderment that one day, unexpectedly, he wrote and asked me for advice: “Has all of your study given you any new ideas regarding Tom?” I sat for a few moments before responding, trying to conjure some better answer than the one I had to give: No, it had not. It almost stung, the question, forcing me to acknowledge what I had preferred to deny. There was something painful, too, in Dad’s phrasing. All of your study. The grasping, the sense of totality. All the king’s horses, all the king’s men.
* * *
—
In February, something finally gave way. The Brother Francis Shelter changed an important rule about when and for how long a person could sleep on one of its cots. It had been the shelter’s policy that after sleeping there for thirty nights straight, you had to spend one night away before returning for up to thirty more consecutive nights. Then, in the deepest part of winter, the policy changed: Now a person had to spend a full thirty nights away before returning for another month. And that year, as was typical, a mid-February cold snap brought temperatures down to single digits for several days. Suddenly stuck out in the cold, Tom overstayed his welcome somewhere and was asked to leave. When he refused, the cops came and arrested him for trespassing. It was Valentine’s Day—a day I celebrated that year with Will at an expensive French restaurant. Tom spent it back in jail.
For the next month he was held in the correctional facility’s mental health unit and was, records say, very fearful of everyone. His symptoms were as bad as they had ever been—“chronic responding to internal stimuli, both auditory and visual hallucinations, pacing, and some symptoms of mania, including not sleeping for periods up to 24 hours.” His physical condition had deteriorated as well, and he had a rash caused by either scabies or bedbugs.
To be rendered competent for his coming court appearances, he was given risperidone, but he kept cheeking the pills, so the doctors had to switch him to a liquid form. By mid-March, the antipsychotic was having its effect. He was for the first time making eye contact, and in general was far less afraid of others—though he could still be, the doctor noted, “quite fearful if challenged.” He was still hallucinating too, and when he spoke, in a low stream of rapid and unceasing speech, he seemed genuinely unable to stop midsentence to answer questions. Deemed still not competent to stand trial, he was transferred to API for his third and final stay there.
The exchanges in Tom’s last intake interview, when I read them now, feel at once bizarre and familiar, funny and sad—full of images that, depending on my mood, strike me as either profound or absurd. When asked if he had ever had a head injury, Tom said, “I’ve been hit in the head more than anyone who’s ever been.”
FORENSIC ADMIT EVALUATION
Admission Date: Mar 14, 2014
MENTAL STATUS EXAMINATION: The patient is unable to state why he is being admitted to API. He announced that he believes himself to have Downs’ Syndrome and referenced this condition several times during the admission interview. However, he clearly presented as far more intelligent than this condition would predict. Much of what he said was inaudible and, when understandable, was often nonsensical. He was clearly responding to auditory and visual hallucinations and reported that the “spirit” of the [psychiatric nursing assistant] was alternately sitting and standing next to the PNA. He seemed to be carrying on conversations with other beings in the room at times, possibly checking in with them before answering questions. He had difficulty providing personal history or focusing his attention for any length of time. His judgment and insight are poor. His memory appeared to be negatively impacted by his active psychosis. It was not possible to directly measure his general fund of knowledge. He does not exhibit understanding of his legal status.
* * *
—
By the time Tom contacted Dad, that May, his condition had improved significantly. He was taking lorazepam for anxiety, melatonin for insomnia, and risperidone for psychosis, as well as benztropine, which reduces agitation. His previous diagnosis of undifferentiated schizophrenia had been called into question by his manic symptoms, and now the report included notes on his manic state and the need to rule out “bipolar disorder with psychotic features.” Dad began visiting Tom regularly in API’s locked ward and, at some point, was told that Tom had been diagnosed with schizoaffective disorder—the same illness I had long suspected Mom had.
Tom clearly didn’t want to spend another winter outside, but he believed his only solution was to go to prison. He said he was preparing himself for that eventuality, as it seemed unavoidable. Dad countered by explaining that if he cooperated with the system that existed to help him, he would never have to go back to jail. Tom was slated to leave API in mid-June, at which time he would have his court hearing and would likely be released for time served. His treatment team seemed to be doing their best for him, hustling to find him transitional housing, and we heard that they liked him, found him kind and polite. But with the chronic shortage of both staff and beds at API, they needed to get him out of their care as quickly and efficiently as possible. So Dad focused on talking to him about what would come next, speaking positively, being optimistic, trying to empower Tom to work with the people who could help him.
It wasn’t clear if the message was sinking in, but Dad stayed at it. Wanting to remind Tom of how much awaited him if he got well, he brought photos of my sisters and their children, and of my wedding day. He also asked me if he could tell Tom about my depressions, and asked Adrienne if he could share that she had for a while taken the mood stabilizer lamotrigine, thinking this would help him feel less alone. Tom was surprised to know that we had had our own struggles with mental health, and I hoped he found it encouraging.
* * *
—
In June, Tom gave permission for us to call him. It had been at least seven years since we had last talked on the phone, and two since we last stood face-to-face. It felt surreal to simply dial a number from my house in Tucson and ask for him. So bafflingly easy. And just as baffling, just as easy, was the way he said in his gentle voice that he loved me, he missed me, he was glad to talk to me. It was clear right away that he was far, far more coherent than when I had seen him last. But I could also feel the schizophrenia still in his speech, tightening and stilting his thoughts. His sentences, short and direct, phrases repeated too often, the wording always identical. Flattened. Stereotyped. Words in toneless bursts. Long pauses after I spoke, as if he struggled to process my statements.
I called him four times in as many weeks, each call building on the last, but each one also strangely redundant. Thinking about his circumstances, trying to sort out how to move forward, he told me more about his life in that one month than in the entire previous decade. But his mind was still muddled. When I asked him questions, trying to draw out his concerns so that I could address them, it was hard to tell how much of it was landing. And although he seemed to quite like API, saying it was nice and that the people there were helpful, it was clear that his trust—in us, in the system, in everything—was tenuous. On our first call he announced, in a heavy tone, that he wanted me to know that after he left API he believed he was going to have to end up in jail. When I assured him that this could be avoided, and that everyone was going to do their best to make sure it would be, he said simply, “Thank you for saying that.” And though it was a kind reply, it flustered me. I didn’t quite know how to read it—if it meant he believed me and felt better, or if it was a way to say he appreciated my concern but didn’t think it would amount to much.
He told me he was reading The Great Gatsby. Surprised, I asked how much of it he had read. I felt hopeful, but unsure whether this meant he was reading or just that he thought he was reading. “The first couple of chapters,” he answered. “It’s pretty good.”
“What do you like about it?” I asked.
“I like the scenes with the people just sitting around enjoying each other’s compa
ny,” he said. “Drinking beverages and talking to each other. And there’s one part where they all go for a ride in a car.”
Suddenly sad, I said, “That sounds really pleasant.”
“It would be nice to do things like that,” he continued. “It kind of reminds me of our grandfather.” To my mind’s eye came Grandpa in his vintage convertible Cadillac—pale cream, with brown leather seats and round, smooth fifties curves. He sat wearing his white Stetson, one hand on the wheel, the other beckoning us all to hop in for a ride down the narrow ranch roads to the creek. I could see Tom, nine years old, sitting on the seat back, perched high as we passed through the orchards and fields. Tom had wanted to be like Grandpa. I remembered him standing by the creek in the too-big, weather-softened Stetson Grandpa gave him. His old eagerness, his wide grin.
I had a feeling that Tom understood, as I did, that even if he did everything he could to get well, nothing was ever going to bring him all the way back to his former self. Then I was thinking, with a shock, what a luxury it is to sit with a drink among friends, to go for a ride in a car. I was thinking about the characters in Gatsby—their ease, their wit, their grace. “You can do that,” I said, forcing myself. “You can have all those things.”
“I don’t know,” he said. “I don’t know if I can.”
“Sure you can,” I insisted. “Why can’t you?”
He paused. “I don’t know if I can support myself—if I’ll be able to support myself.” A little bit stunned, by both his fear and his honesty, I asked if anything else was worrying him. He said, “I don’t know what’s going to happen to me when Dad dies.”
It was almost with a sense of being outside myself that I replied, “You have Adrienne and me, and Alicia, and we’ll always make sure you get what you need after Dad is gone.”
Again came his refrain: “Thank you for saying that.”
* * *
—
I have been haunted by Tom’s final weeks—what I did and didn’t do, what was said and not said. Adrienne and I both thought of flying home, but it was a bad time. She had a newborn and I was about to fly to New York to teach a four-week class. Tom asked Dad if he could move back in with him, but Dad said he didn’t think it was a good idea. Instead he promised to help him apply for housing. I winced when I heard this, but said nothing.
We were bolstered, however, when he was deemed competent to attend his hearing and when, afterward, his release date was pushed back to late July, giving him more time to improve before having to take the next step. To help prepare him mentally, Dad brought him a new pair of boots and they talked about what clothes to bring for his release. They talked about Tom visiting the house again. They played checkers in a game that dragged on and on until they had to call it a draw. “I can tell you whatever part of Tom’s brain deals with checkers is still in great shape,” Dad wrote. “I was doing my best to beat him.” He added, “I am not sure how all of this is happening???” For a moment, I allowed myself to feel elated.
I tried to discern progress week by week, but I could not. Each time I called Tom, I asked if he would like me to call again. He always said yes, so I promised I would. Yet when I did, he sounded surprised, as if he either had forgotten the previous week’s promise or hadn’t believed it. He did, however, seem on track to succeed after his discharge from API. He told me outright that he had been diagnosed with schizophrenia—a stunning admission—although he believed it was a mistake. He had decided to just let the doctors say he had schizophrenia since that was necessary to qualify for housing and disability benefits. Confused, I asked how he felt about his medications. And to my relief he said that they made him feel better and the side effects did not bother him, so he was content to keep taking them.
It seemed that we had finally arrived somewhere. He would not need to believe he had schizophrenia so long as doctors and social workers kept working around it as they apparently had been. I saw then how this could work out for him.
But his fear for his future was deeper than I realized. It plagued him. And it was still so strange to me that he feared for his future at all that I never registered the fear’s sudden extremity. He was determined not to return to the street, and most days he was stuck sitting around without much to do besides stew in his worries, as API lacked the resources to provide many therapeutic activities. I learned later that as his release date approached, he kept checking in with his case manager, popping into her office every day, asking if she was sure that his housing application would go through, wondering if she had gotten a reply yet. Each day she told him not to worry, half calming him and half brushing him off.
In subsequent calls, I asked again what worried him, hoping to help him feel more confident. He replied with more questions, specific enough that it was clear he had been mulling things over. What if he ran out of medication while living at the halfway house? And he couldn’t get more? What if the pharmacy was too far to walk to? What if the pharmacy was closed? Would they kick him out of the halfway house? This made sense of his belief that going to jail was the only solution: It was the only form of housing he could envision working out for him.
I tried to sound assured, always, telling Tom he could ask Dad for help, saying we would have a plan to deal with those issues. He would press on, unsatisfied, considering every potential problem, believing each one could undo him. Not knowing what else to say, I told him I would personally help him deal with whatever came up. At the end, always, came his cryptic reply. “Thank you for saying that.”
Five days later, he failed to turn up at lunch. No one noticed—he must have known they wouldn’t—until the meal was over, and when staff went looking for him, they found that he had locked himself in a bathroom. Inside he lay dead.
Slide
I remember winter as it once was, in childhood—absent of terror, no sort of metaphor, only beautiful and nothing more. Alyeska, our mountain, the flanks on which we learned to ski. Days when clouds banked the terrain so thick that the sky and slopes fused, erasing contours so you had only the flex in your knees and your amber goggles to know the shape of the land. Charging through dense snow, skis pulled at by heavy chunks, eating shit as often as not. On easy runs, pointing downhill and going straight to the bottom in as few turns as possible. The ecstasy of speed.
Bodily memories overwhelm me sometimes: lying in Dad’s cabin in early-morning darkness, awakened by the sound of bombs on Alyeska while the town of Girdwood slept beneath it. I would listen to the muffled boom, boom, easing out of sleep and letting the distant noise lull me, knowing it meant there had been a dump of overnight snow, that the runs were thick with powder and ski patrol was bringing down avalanches, making the mountain safe for skiing. Sometimes I would reach up and pull back the curtain from the small window above the big loft bed, a sister or friend asleep beside me, and look to see if the sky was clear. And in the half sleep that followed I could already feel the mountain beneath my skis. My edges cutting the heavy coastal snow. My body floating up and sinking through the turns.
The dangers of nature are something Alaskan teenagers survive first and understand later. I was home on winter break from college one year when the bombs failed us. A high cornice between Alyeska and adjacent Max’s Mountain broke off and released a slide onto Max’s while the main part of the ski area, on Alyeska, was open. I stood watching from the cafeteria, a wide building at the base with a wall of windows facing the slopes where the two mountains joined. I paused, holding my chili, and stood agape as half of Max’s Mountain came away. A white sheet, unzipped and falling. For a moment I wondered if all those tons of snow would slide right into the cafeteria. If I should run. And then it was easy to gauge that running would do no good.
Luckily the slopes of Max’s—outer areas not regularly used—were closed to skiers at the time. Nobody was hurt. But I watched as the slide carried a bright yellow snowcat down into the creek gorge. The cat was parked o
n a track halfway up the mountain when the avalanche plucked it up and rolled it until it came to a halt, half buried, nearly at the bottom. I thought of those children’s construction toys, picked up like nothing by small careless fingers.
A few years later I got a job as a lift operator, checking tickets and helping skiers onto the chairs and shoveling snow off the platforms. One day the Glacier Bowl above Alyeska gave way and a slide crossed into the boundaries of the ski area. Ski patrol evacuated the runs, shut down all the lifts, and gave us long, thin poles, ordering us to probe the mountainside in a disciplined line, searching for buried bodies. Poke, up, step, and on. “Strike!” someone would say, followed by a rush of digging until somebody said, “Rock!” And then we would breathe again and keep going.
Should I continue—on into the sadder memories? Of my friend Johnny, blond and beautiful, who was up in the Alaska Range somewhere near Denali when he rounded a corner and vanished forever. Presumably carried by a small avalanche into a crevasse. Or of that woman Michelle, who died in the backcountry two days after I met her, when above her a young snowboarder let loose a slide that tossed her over a cliff.
* * *
—
A therapist friend, who knew schizophrenia well—she told me, “It is a miracle your brother lived as long as he did.”
Break My Body
