This Close to Happy

by Daphne Merkin

  The familiar checking-in routines came next: My bags were taken behind the glassed-in nurses’ station and subjected to the usual examination for “sharps.” Cell phones were also forbidden, for reasons that seemed unclear even to the staff but had something to do with their photo-taking capability. In my intake interview, which followed next, I alternated between breaking down in tears and repeating that I wanted to go home, like a woeful child left behind at sleepaway camp. The admitting nurse was pleasant enough in a down-to-earth way but was hardly swept away by gusts of empathy for my bereft state. And yet I wanted to stay in the room and keep talking to her forever, if only to avoid going back out on the unit, with its pitifully slim collection of out-of-date magazines, groupings of ugly wooden furniture covered with teal and plum vinyl, and airless TV rooms—one overrun, the other small and desolate. Anything to avoid being me, feeling numb and desperate at the same time, thrust into a place that felt like the worst combination of raw exposure and obliterating anonymity.

  I got into bed that first night, under a ratty white blanket, and tried to calm myself. I was sharing a small room across from the nurses’ station with a pretty, middle-aged woman who had introduced herself before dinner—the only one to do so—with a remarkable amount of good cheer, as if we were meeting at a cocktail party. She wore Frownies—little patented face patches that were supposed to minimize wrinkles—to bed, which only furthered the impression she conveyed of an ordinary adjustment to what I saw as extraordinary circumstances. Clearly, she had a future in mind, even if I didn’t—one that required her to retain a fetching youthfulness. I hadn’t so much as washed my face for the past few months, but here was someone who understood the importance of keeping up appearances, even on a psychiatric unit.

  The room was lit, like the rest of the place, by overhead fluorescent bulbs that didn’t so much illuminate as bring things glaringly into view. It was furnished with two beds, two night tables, and two chests of drawers. In keeping with the Noah’s-ark design ethos, there was also a pair of enormous trash cans: one stood near the door, casting a bleak plastic pall, and the other took up too much space in the tiny shared bathroom. The shower water came out of a flat horizontal fixture on the wall—the presence of a conventional showerhead, I soon learned, was seen as a potential inducement to hanging yourself—and the weak flow was tepid at best.

  The lack of a reading light added to my growing panic; even if my depression prevented me from losing myself in a book, the absence of a light source by which to read after dark represented the end of civilization as I had known it. (It turned out that you could bring in a battery-powered reading lamp of your own, albeit with the Kafkaesque restriction that it didn’t make use of glass light bulbs.) My mind went round and round the same barrage of questions, like a persistent police inspector: How did I get here? How had I allowed myself to get here? Why didn’t I have the resolve to stay out? Even more to the point, why hadn’t anything changed with the passage of years? It was one thing to be depressed in your twenties or thirties, when the aspect of youth gave it an undeniable poignancy, a certain tattered charm; it was another thing entirely to be depressed in middle age, when you were supposed to have come to terms with life’s failings, as well as your own.

  I plumped the barracks-thin pillow, pulled up the sheet and blanket around me—the entire hospital was air-conditioned to a fine chill—and curled up, inviting sleep. There is nothing to feel so frantic about, I tried to tell myself soothingly. You’re not a prisoner. You can ask to leave tomorrow. I listened to my roommate’s calm, even breathing and wished I were her, wished I were anyone but myself. Mostly, I wished I were a person who wasn’t consumingly depressed.

  I thought of Zoë, at home in her bed, probably absorbed in watching one of the many implausibly plotted series she followed on her laptop, and felt an enormous sense of loss. My complicated, endearing daughter, over on what seemed like the other side of the world, stuck with me as a mother. My chest hurt when I thought of her, the way she had tried to buoy me up as I grew implacably more lost to ordinary communication, suggesting that we go out for walks or to a movie. I wished I were back at home, in my room next to hers. After staring into the darkness for what seemed like hours, I finally got up and put on my robe, having decided that I’d overcome my sense of being a specimen on display—here comes Mental Patient No. 12—and approach the nurses’ station about getting more sleeping meds.

  Outside the room the light seemed blinding. Two psychiatric aides were at the desk, playing some sort of word game on a computer screen. They looked up at me impassively and waited for me to state my case. I explained that I couldn’t fall asleep, my voice sounding furry with anxiety. One of them got up and went into the back to check whether the psychiatric resident who was assigned to me had approved the request for additional sleep medications. She handed me a pill in a little paper cup, and I took it with clammy hands, mumbling something about how nervous I was feeling. “You’ll feel better after you get some sleep,” she said. I nodded and said, “Good night,” feeling dismissed. “Night,” she said, casual as could be. I was no one to her, no one to myself.

  30

  I spent three weeks all told on 4 Center. What I remember most about my time there was the surreal quality of the “fresh air” breaks that patients were allotted four times a day, watched over by a more or less friendly aide. These “fresh air” breaks were also smoking breaks, make of that irony what you will, and they took place in a fenced-off concrete garden bordered by the West Side Highway on one side and Riverside Drive on the other. The garden was planted with patches of green and a few lonely flowers, the whole space cordoned off behind a high mesh fence. In between were two barbecue grills, bags of mulch that seemed never to be opened, empty planters, and clusters of tables and chairs. It reminded me of a picnic area without picnickers—and then, too, of a long-ago scene in the movie Blow-Up, where the glamorous sixties characters mime a tennis game without ball or rackets.

  Toward the end of my stay I had become distantly friendly with R., another patient who was a writer, having just finished a novel before he entered the unit. He would sit by himself on a bench in his unseasonal cashmere polo, puffing on a cigarette and tapping his foot with equal intensity. On either side of him were ragtag groups of people culled from several units of the hospital, including the one I was on, which was devoted primarily to the treatment of patients with depression or eating disorders. (The anorexic girls, whom R. referred to as “the storks,” were in various phases of imperceptible recovery and tended to stick together.) The garden was also home to patients from 4 South, which catered to patients from within the surrounding Washington Heights community, and 5 South, which treated patients with psychotic and substance-abuse disorders.

  By the end of my second week, when I was no longer chained to the unit, one of the male nurses I had become slightly friendly with would invite me for coffee breaks to the little eatery on the sixth floor where the hospital staff repaired for their meals. These outings were always kept short—we never lingered for more than fifteen minutes at a time—and they always brought home to me how paradoxically artificial and yet supremely real the dividing line between 4 Center and the outside world was. One minute you were in the shuttered-down universe of the verifiably unwell, of people who talked about their precarious inner states as if that were all that mattered, and the next you were admitted back into ordinary life, where people were free to roam as they pleased and seemed filled with a sense of larger purpose. It could cause vertigo if you weren’t careful.

  As I cradled my coffee, I looked on at the medical students who flitted in and out, holding their clipboards and notebooks, with a feeling verging on awe. How had they figured out a way to live without getting bogged down in the shadows? From what source did they draw all their energy? I couldn’t imagine ever joining this world again, given how my time had become so aimlessly filled, waiting for calls to come in on the pay phone or sitting in “community meetings,” in wh
ich people made forlorn requests for light-dimmers and hole-punchers and exiting patients tearfully thanked everyone on the unit for their help.

  Although there was more uncharted time than not—great sluggish swaths of white space, creating an undertow of torpor—a weekly schedule was posted that gave the impression that we patients were quite the busy bees, what with therapy sessions, yoga, walks, and creative-writing groups. Friday mornings featured my favorite group, Coffee Klatch. This was run by the same amiable gym-coach-like woman who oversaw our puny efforts at exercise, and it was devoted to board games of the Trivial Pursuit variety. The real draw, though, was the promise of baked goods and freshly brewed coffee. Even with my drastically lowered appetite, I still had a sweet tooth, and I found myself craving food other than what was on offer on the hospital menu. Despite its being summer, there was barely any fresh fruit in sight except for autumnal apples and the occasional banana. There were some culinary bright moments—cream puffs were served on Father’s Day, and one Tuesday the staff set up a barbecue lunch in the patients’ park, where I munched on hot dogs and joined in a charades-like game called Guesstures—but the general standard was fairly low. After a while, I began requesting bottles of Ensure Plus, the liquid nutrition supplement that came in chocolate and vanilla and was a staple of the anorexics’ meal plans; if you closed your eyes it could pass for a milkshake.

  It wasn’t only the anorexics’ Ensure that I coveted. From the very first night, when sounds of conversation and laughter floated over from their group to the gloomy, near-silent table of depressives I had joined, I yearned to be one of them. Unlike our group, where everyone was finished eating within ten or fifteen minutes, they were required to remain at lunch and dinner for a full half hour, which of necessity created a more sociable atmosphere. No matter that one or two of them had been brought to the floor on stretchers, as I was later informed, or that they were victims of a cruel, hard-to-treat disease with sometimes fatal implications; they still struck me as enviable.

  However heartbreakingly scrawny, they were all young (ranging from their twenties to mid-thirties) and expectant; they talked about boyfriends and concerned parents, worked tirelessly on their “journaling” or on art projects when they weren’t participating in activities designed exclusively for them, including workshops on “self-esteem” and “body image.” They were clearly and poignantly victims of a culture that said you were too fat if you weren’t too thin and had taken this message to heart. No one could blame them for their condition or view it as a moral failure, which was what I suspected even the nurses of doing about us depressed patients. In the eyes of the world, they were suffering from a disease, and we were suffering from being intractably and disconsolately—and some might say self-indulgently—ourselves.

  Forging friendships on the unit was a touch-and-go affair because patients came and went and the only real link was one of duress. The other restriction came with the territory: people were either comfortably settled into being on the unit, which was off-putting in one kind of way, or raring to get out, which was off-putting in yet another. I had become attached to my roommate, who was funny and somehow seemed above the fray, and I felt inordinately sad when she left, halfway into my stay, in possession of a new diagnosis and new medication.

  Still, the consuming issue as far as I was concerned—the question that colored my entire stay—was whether I would undergo ECT. It was on my mind from the very beginning, if only because the first patient I had encountered when I entered the unit, pacing up and down the halls, was in the midst of getting a lengthy series of ECT treatments and insisted loudly to anyone who would listen that they were destroying his brain. And indeed, the patients I saw returning from ECT acted dazed and dislocated, as if an essential piece of themselves had been misplaced.

  During the first week or so the subject lay mostly in abeyance as I was weaned off the medications I had come in on and tried to acclimatize to life on 4 Center. I met daily with the pretty young resident I had seen the first evening, mostly to discuss why I shouldn’t leave right away and what other avenues of medication might be explored. She sported a diamond engagement ring and wedding band that my eye always went to first thing: I took them as painful reminders that not everyone was as full of holes as I was, that she had made sparkling choices and might indeed turn out to be one of those put-together young women who had it all—the career, the husband, the children. During our half-hour sessions I tried to borrow from her irrepressibly hopeful outlook, to see myself through her charitable eyes. I reminded myself that people found me interesting even if I had ceased to interest myself, and that the way I felt wasn’t all my fault. But the reprieve was always short-lived, and within an hour of her departure I was back doing battle with the usual furies.

  One day early into my second week, I was called out of a therapy session to meet with a psychiatrist who oversaw the ECT team. I still wonder whether this brief encounter was the defining one, scaring me off forever. This woman might as well have been a prison warden, for all her interpersonal skills; we had barely said two words before she announced that I was showing clear signs of being in a “neurovegetative” condition. She pointed out that I spoke slurringly and that my mind seemed to be crawling along as well, adding that I would never be able to write again if I remained in this state. Her scrutiny was merciless; I felt attacked, as if there were nothing left of me but my illness. Obviously ECT was in order, she briskly concluded. I nodded, afraid to say much lest I sound imbecilic, but in my head the alarms were going off. No, it wasn’t, I thought. Not yet. Back off, lady. I’m not quite the pushover you take me to be. It was the first stirring of positive will on my own behalf in a long time, a delicate green bud that could easily be crushed, but I felt its force.

  The strongest and most benign advocate for ECT was Dr. J., a research psychiatrist at the institute who had treated me three decades earlier—he was the one who had put me on Prozac before it was FDA-approved—and was instrumental in persuading me to come into 4 Center. In his formal but well-meaning way he pointed out that I lived with a level of depression that was unnecessary to endure and that my best shot for real relief was ECT. He came in to make his case once again as I was sitting at dinner on a Friday evening, pretending to nibble at a rubbery piece of chicken. The other patients had gone and my sister Dinny was visiting. I turned to her as the normally contained Dr. J. waxed almost passionate on my account, going on about the horror of my kind of treatment-resistant depression and the glorious benefits of ECT that would surely outweigh any downside. I didn’t believe him, much as I wished to. Help me, I implored my sister without saying a word. I don’t want this. Tears trickled down my cheeks as if I were a mute, wordless but still able to express anguish. My sister spoke for me as if she were an interpreter of silence. It looked like I didn’t want to undergo ECT, she said to the doctor, and my wishes had to be respected.

  31

  As the weeks passed on the unit, instead of growing stronger I felt a kind of further weakening of my psychological muscle. The picayune details of my life—bills, appointments, writing deadlines—had been suspended during my last few months at home, then left behind altogether, and it began to seem inconceivable that I’d ever have the wherewithal to take them on again. The new medication I was on left me exhausted, and I took to going back to sleep after breakfast. I was tired even of being visited during the fiercely regulated visiting hours (5:30 to 8:00 on weekday evenings and 2:00 to 8:00 on weekends), of sitting in the hideous lounge and making conversation, expressing gratitude for the chocolates, smoked salmon, and quarters for the pay phone that people brought. I felt as if I were being wished bon voyage over and over again, perennially about to leave on a trip that never happened.

  In the week leading up to my proposed departure, a date which I had insisted on despite a certain hesitancy on the part of the staff, I was permitted to go out on day passes as a kind of preparation for reentry, none of them particularly successful. On a broiling Saturday a
fternoon Zoë picked me up and we went for a walk to the nearby Starbucks on 168th and Broadway. I felt thick-headed with the new sedating medication I was on and far away from her. When Zoë left me for a few minutes in front of a bank to make a call on her cell phone, I started crying, as if something tragic had happened. I wondered uneasily what effect seeing me in this state was having on her—what she made of my being in the hospital altogether. The only other time she had visited me in a psychiatric hospital she had been too young to take it in. Did she see me as a burden that she would need to shoulder for the rest of her life? Did she view my depression as a pose, something I could shake off if I wanted to? In between we laughed at small, odd things as we always did, and it occurred to me that I wasn’t as much a stranger to her as I was to myself.

  With the staff’s tentative agreement—they didn’t think I was ready to leave but had no real reason to prevent me from doing so—I left 4 Center three weeks to the day after I arrived, my belongings piled up on a trolley for greater mobility through the annex to the exit. I left behind a pillow I had brought from home and a bamboo plant my friend Deborah had brought me that had been confiscated by a staff member for no discernible reason. It was a hot June day similar to the one I had checked in on, the heat pouring off the windows of the parked cars. Everything seemed noisy and magnified. It felt shocking to be outside, knowing I was on a permanent pass this time, that I wouldn’t be returning to the unit.