Just In Time

by Joan Lindstedt Jackson

  “Has he been down, lately?”

  “A little out of sorts is all,” Nancy said. “I think he’s been unsettled about the meds.”

  “I really appreciate your help with this. Will you call me in a day or so to let me know if he’s on track again?”

  “I sure will,” Nancy said.

  After they hung up, Nancy went to the dining room where Steve sat with his vials and the large scrawl of his scribbled notes stretching at a diagonal across the page of the legal pad. She suddenly felt sorry for him, his struggle to get through the day, sort through the mixed up, crowded thoughts that must overwhelm him constantly. “How about if I write down the med changes on an index card, Steve? Then you can look at it every time you fill your tray.”

  His forlorn, troubled expression seemed to relax. “Thanks, Nancy.”

  Nancy found several four-by-six index cards in the desk in the family room then she pulled out a chair and sat next to Steve.

  “You’re crowding me,” he said.

  She scooted farther down and started to copy her notes. “Let’s compare what you wrote down with what I have. I want to make sure I didn’t make a mistake.”

  He turned the pad so she could look. He named each medication, the dosage, and when to take them—morning or evening or both. He told her what they were for. “The Resperdahl keeps the voices away, same as the Prolixin, but that’s what Pandi is changing. Lithium keeps my moods stable.” He painstakingly dropped each pill into the slots as he spoke.

  “You sure know all about it!” she said.

  “I guess I do.”

  “Thanks for teaching me,” Nancy said.

  Steve gave her a closed mouth smile. “You’re welcome.”

  After he’d finished, Nancy asked, “How about a brownie? I brought some home from the store.”

  He beamed. “Great!”

  “We deserve a reward for our hard work, don’t you think?”

  “I like rewards,” Steve smiled.

  14

  Steve’s moods were spiraling downward. He avoided eye contact and spent more and more time in his room with his door closed, only coming out to eat and sometimes not even then. Some days, he didn’t leave the house at all. Nancy heard him talking to himself at all hours of the night. He’s like an infant. His days and nights are turned around, she thought. At Sylvia’s request, she’d been checking his med tray every day and leaving him the usual reminder note, to no avail. He missed his morning dose for three days straight and two evening doses still sat in the tray—the flaps were down. Finally, she called Sylvia with a full report.

  “How long has this been going on?”

  “About a week. It’s hard to know exactly,” Nancy said. “He says he doesn’t feel good on his new medication. Maybe that’s why he’s not taking it.”

  Sylvia felt a knot in her stomach—a week? She knew it took at least two weeks to a month for a medication change to be effective. Each person reacted differently, and finding the cocktail brew that worked was hit and miss. Had it been two weeks yet? She chastised herself for not keeping track of the dates, and she was angry that Dr. Pandi wasn’t monitoring him closely. It was the job of his doctor to schedule frequent appointments to check his reaction to the new antipsychotic, or at least to verify that Steve understood how to slowly introduce the new one. He was doing fine before, and he didn’t have hand tremors, which was the reason Pandi said she took him off of Prolixin. Even though Sylvia didn’t trust Pandi to do right by Steve, Dr. Pandi was all they had at the moment.

  “I think he needs to see his psychiatrist right away. I’ll call her office, but I may need you to take him, if you can.”

  “Well, sure,” Nancy agreed, sounding rattled. “Do you think he’ll let me?”

  “I don’t know. Maybe call Dr. Nora as a backup.” Sylvia wondered why Nancy hadn’t called Dr. Nora when Steve was obviously going downhill then realized it was Dr. Rita whom Nancy had met when she first moved in, not Dr. Nora. It was Dr. Rita who’d told Nancy to call for any situation that might arise. She couldn’t expect Nancy to know what to do when even she had a hard time deciding whether to call the psychiatrist or the psychologist. Christ, she was floundering herself. Maybe she should fly to Ohio before November. Or maybe Scott could go. “I’d better talk to Steve first. Would you get him?”

  “He’s not here—he went to Friendly’s,” Nancy said. “Maybe that’s a good sign. First time in a few days.”

  Sylvia said she’d call Dr. Nora rather than have Nancy call her, because she wanted to discuss her recommendation for the new psychiatrist and arrange an appointment. If not right away, in the near future. But first, she’d contact Dr. Pandi.

  “Just let me know what you want me to do,” Nancy said, relief easing her voice. “I’ll stay right by the phone until I hear back from you.”

  Hanging up the phone, Sylvia just wanted to crawl into bed and burrow under the covers, or watch movie after movie and not think anymore. How much could a person take before they really gave up? But she wouldn’t—she couldn’t. Instead, she went into overdrive. She wondered what her parents had done or would have. This wasn’t the first time Steve was off meds, but in past episodes her parents had skimmed over the details. “He won’t get out of bed,” was all she’d gotten from them. What prompted them to commit Steve to a psych ward? How did they know it was time? The only volatile episode she’d witnessed was during a visit with her kids, when he knocked the pill tray out of her dad’s hand and ended up yelling in the driveway at no one in particular. The police came, and Steve went willingly to the local institution to be stabilized. Other than that, she really had no idea what to expect. How paranoid could he get? She wondered if it was true that the most dramatic symptoms taper off with age. Was that just hearsay? Her hunch was that nobody really knew what to expect. Not even the experts, who straddled the fence with, “Each case is unique to the individual.” Sylvia started making the necessary phone calls.

  Dr. Pandi was out of town. Another psychiatrist was on call, and Sylvia left a message. Then she left a message for Dr. Nora. And then she waited. She called Nancy to tell her she was waiting to hear back, and then she waited some more. She tried not to exaggerate the situation. Steve wasn’t ranting and raving in the streets. He wasn’t threatening anyone. He was just reclusive. Sylvia still felt shaky. He couldn’t be off his meds much longer, or he might lose all sense of reality.

  She heard back from Dr. Nora first, who said she’d immediately call another psychiatrist she collaborated with regularly. Dr. Nora was sure the psychiatrist she knew would see Steve, if not that afternoon, then no later than the next day. She said she’d go to Friendly’s or to his home to find him. As long as Steve knew that Sylvia was behind the decision, Dr. Nora said she was certain he’d cooperate. If need be, she’d rearrange her schedule to accompany Steve to the appointment. Sylvia was astounded. To have a professional she could trust, who cared enough to act on Steve’s behalf, seemed to lift her burden physically.

  “Dr. Nora, you’re a godsend to me,” Sylvia said.

  “I can only imagine the emotional load you’re carrying, being so far away,” she responded. “And your father hasn’t been gone even a year yet. You can take a breath, Sylvia. You’re allowed.”

  With Dr. Nora’s heartfelt words, Sylvia’s wall came tumbling down. She cried in relief—to be given permission to breathe, to receive expert advice she trusted. When had she started expecting herself to have all the answers, make all the decisions, fix every problem? When did she start feeling that as soon as one shoe dropped, she had to be ready for the other one? It seemed like forever. Why was she always in charge? The more she took on (or had dumped on her), the more tightly she seemed to hold on, unable to let go. Maybe Steve was the lucky one. He’d probably outlive them all.

  Steve was sitting in his usual spot, hunkered down in the red vinyl booth at Friendly’s. He didn’t need to order his iced tea. The waitresses knew to bring a pitcher and a glass when he walked t
hrough the door. He puffed on one cigarette after another, staring down at the table. The restaurant was crowded, and at the table next to him sat a noisy foursome of twentysomethings with a fussy toddler. Steve scowled and mumbled and gave sidelong, dirty looks. A bunch of rowdies, lowlifes. I hate kids. Crying, whining, shrieking. Who brings kids to a restaurant? There oughta be a law.

  One of the men, a burly tattooed guy with a moustache and an attitude, snarled in Steve’s direction. “Who do you think you’re talking to?” The other three snickered.

  “Just wanna drink my iced tea in peace,” Steve said, sure they were talking about him, making fun of him. He thought he heard the woman call him a loser. Then a retard or a looney. They were laughing at him now.

  “Then shut the fuck up!” the guy said.

  “Fuck you,” Steve said under his breath.

  “What’d you say?”

  “Nothin’,” Steve said, focused on pouring more tea into his glass.

  The guy stood up and hovered over Steve. “What’s your problem?”

  A waitress scuttled away and flagged Woody, the manager.

  “You’re the one with a problem,” Steve said, launching into rambling incoherence about jerks with tattoos jerks with kids jerks allowed in family restaurants jerks who wore T-shirts in public. The whole restaurant seemed to freeze into a wide-eyed hush.

  Woody rushed to the table and, turning his back on Steve, asked the guy to sit down. He spoke quietly, making a circle with his index finger to his head, saying that Steve was, “you know,” and didn’t mean any harm, just ignore him. Grumbling that crazies shouldn’t be allowed to harass people, the guy eased back into the booth.

  Woody turned to Steve and gently placed a hand on his shoulder, but Steve shrugged it off without looking up. “Why don’t you go home and come back later?” Woody suggested.

  “I haven’t finished my iced tea,” Steve said.

  Although Steve had been coming in daily for over fifteen years, and the ice cream restaurant sat on a busy road near the freeway entrance, most of the customers—and even some of the staff—didn’t know Steve or his family. None of them lived in his Silver Lake neighborhood. Steve had never caused any trouble, he always paid his bill, and he left a tip for the waitress, but his odd behavior made Woody leery of him. The days when Steve was downright surly, snapping at the waitress, scowling and mumbling under his breath, unshaven, hair greasy, shirt torn, were the days Woody kept a watchful eye from the back of the restaurant, by the dirty dish bin, where he could appear to be busy. That’s when he steered clear of Steve, just hoping he’d leave. Woody felt sorry for Steve, but worried that he was a loose cannon. Woody wished he knew someone to contact, like the sister Steve talked about, or the woman who was staying with him now that his parents were gone. Shoot, he didn’t even have Steve’s home phone number. “Maybe you’ve had too much iced tea, Steve,” he said hesitantly.

  “Fuck you, Woody.”

  Woody had never seen Steve so obstinate and angry, and he couldn’t risk an altercation in his ice cream parlor. “I think you’d better leave.”

  Steve glared at him. “I told you. I’m not ready to leave.”

  Woody, a scrawny, freckled redhead over the age of fifty, tried to put on a stern posture. “You have to leave or I’m calling the police.”

  Steve scoffed, mocking him, “No way will you call the police. You’re such a joke.” He remained in his seat, sipping from his straw. The people at the adjacent table watched and listened. Humiliated, Woody left the table to make the call. Then he returned to Steve’s table. Shoulders back with an effort to stand tall, he sternly warned Steve, “The police will be here in ten minutes, since you won’t leave willingly. Don’t come back for six months.”

  “What?” Steve was shocked. “What did I do?”

  “Just leave now, Steve. The police are on their way.”

  Steve scooted out of his booth, stuffed his cigarettes in his jacket, and, head down, walked outside. Once on the front sidewalk, he realized he left without paying. What if they think I’m trying to skip on my bill? He went back inside. All eyes were on him. Woody stood behind the cash register with his arms across his chest, about to speak, when Steve held out a few dollars, stammering that he forgot to pay. Woody waved him off saying it was on the house. He almost apologized, but Steve hurried back out the double glass doors. He felt for his keys, then worried he’d left them inside. When they jingled in his pocket, he kept moving. As he stepped into the parking lot, the police cruiser pulled up. Steve shuddered and hoped he could get away before they tried to make him go with them. Two policemen quickly got out, greeting Steve politely by name—the police knew Steve no matter where they were from—asking if the problem was taken care of. Steve took a deep breath and forced a meek smile. “All taken care of, officers. No problem. I’m leaving.”

  Steve was unlocking his car when he heard a woman calling his name. He turned and sighed in relief. “Dr. Nora! What are you doing here?”

  15

  Dr. Nora decided not to tell Steve the real reason she was there. It was better to engage him gradually, or he might dig in his heels. “I thought I’d grab some lunch. Would you like to join me?”

  “Woody kicked me out!” Steve blurted. “He even called the police!”

  She’d seen him talking briefly to the police as she pulled into the lot, but she’d assumed he was just being polite and deferential, out of his underlying paranoia that they might be after him. She was taken completely by surprise. “What happened?”

  Steve looked off beyond the parking lot, his eyes frozen in a stare of sullen disbelief behind his thick-lensed glasses. “This guy—rough, tattoos on his arms—was laughing at me.” Suddenly animated, he thrust his arms outward in innocence, as if pleading, and looked directly at Dr. Nora. “Then he got mad. I didn’t do anything!”

  Dr. Nora felt a familiar anger rise inside at the pervasive ignorance and injustice toward the mentally ill. She would bet money that Steve wasn’t at fault, even if his meds were a little out of whack. To her, his behavior was more civil than most ‘normal’ people and often under more trying circumstances than one could imagine. Day after day, the mentally unbalanced struggled to put one cohesive thought in front of another just to perform a basic task, to live like other people and strive to appear normal to the rest of the world. Very few people had understanding or empathy for a disability that wasn’t physical, one they couldn’t see, even though the physical evidence was widely visible in every city. Homelessness, drug addiction, and violent crime often stemmed from the untreated population—and the prisons were filled with them. Would people ever wake up? she wondered. She couldn’t deny that biographies like Beautiful Mind helped increase awareness of schizophrenia, but in truth, the genius, “beautiful” mind of John Nash—who won a Nobel in Economics and remained for the most part accepted and cloistered in academia—was a rare example. She was frustrated that mental illness still carried a stigma and still seemed to come last on the list for government monies or fundraisers. She’d tried in her small way to help, spearheading programs for the local AMI chapter then running a halfway house until it lost funding. Weary of the futile struggle with the bigger picture, she decided to work one on one, as an advocate for the individual, with the various “Steves” in her own little corner.

  “Do you want me to go in and talk to the manager?” she asked.

  Steve shook his head. “I can’t come here again, and I don’t want to.” A short silence ensued then he pursed his lips and raised his eyebrows. “We could go to Pizza Hut—it’s right next door. Their iced tea isn’t as good, but I love their pizza. Maybe you don’t like pizza.”

  Dr. Nora smiled and said that sounded fine. She loved pizza, too. She had to marvel at his ability to adjust so quickly, though she was not ruling out her arrival time as a factor either. Somehow Steve had what it took to adapt, if even in an innocent, Magoo-like way. Perhaps it was due to his overall willingness and desire to “do the ri
ght thing,” which he probably learned early on from his parents and the tight-knit community he grew up in. Come to think of it, not unlike John Nash, Steve was accepted—or maybe tolerated—and cloistered, too, in a unique way. His situation was also a rarity. Whatever set him apart from other severe schizophrenics, she had hope that, in the long term and along with his siblings’ support, he might eventually be able to live by himself. At the moment though, she had to convince him, cautiously, to go with her to meet a new psychiatrist. The appointment was in an hour, and they needed to stop by his house first to bring all of his medication.

  They drove their respective cars the two hundred feet next door. Dr. Nora took her moment alone to call Sylvia and let her know she’d found Steve and had set up an appointment. She’d call her back when she had more information. Sylvia suggested that if Steve wanted encouragement from her or just a stamp of approval, she’d be available to talk to him.

  Sylvia then called Nancy but there was no answer. She left a message. An hour passed and Nancy called her back. After Sylvia filled her in, she asked Nancy if she wouldn’t mind being on standby until after Steve’s appointment, even though Sylvia couldn’t think of a particular reason why.

  “Um, okay,” Nancy said. There was a pregnant pause. “It’s my day off and I have a few errands, like take Sammy to the groomers and later I was going to meet a few girlfriends to have a drink, but I can wait on that.”

  “I’d really appreciate it, Nancy,” Sylvia said.

  “I’m sure surprised that Dr. Nora is so devoted.”

  “I am, too, but I have no idea what’s above and beyond the call of duty for a therapist.”

  “Believe me, this is way above,” Nancy said. “When Danny lost his leg in the car accident, he needed all kinds of therapy, and I had to push for his rights for proper care through the whole mess. There was no one like Dr. Nora.”