“Oh, thank God.” Relief washed over me.
“Yeah, that’s the good news,” he said. “The bad news is that we still don’t know what’s going on. But I’ll admit, Pat, I was worried. If we had found a tumor, it would have been terrible. Then it’s the kids grow up without a mommy.”
“Let’s not think about that now,” I said, changing the subject. “Where do we go from here?”
“We can make our way back to the ER. She’ll have a break before the next round of tests.”
Mia was in the same room where we had left her, lying on the oversize bed, her dark hair spilling across the white pillow. “Hello again, Pat,” said Dr. Adams, who was standing nearby. “Mia and I were just talking. I thought she’d be feeling comfortable by now, but she still seems a bit tense.”
“I feel okay,” said Mia, looking up at us, “but it’s time to leave.”
Dr. Adams glanced down at Mia. “Your wife can be pretty stubborn.”
“Yeah, I learned that a long time ago.” I smiled at Mia. She was clearly not as aggressive as before, but she didn’t seem on the threshold of sleep, either. I took her hand. “Still not feeling tired, babe?”
Before Mia could answer, Mark spoke up. “Hey, guys, I’m going to the office with Dr. Adams. Pat, why don’t you stay here with Mia? We’ll be back soon.”
On their way out, Mark turned down the lights. We were left in the dimly lit room, with only beeps from the various machines to break the silence. My anxiety began to build again, as I waited, alone in Mia’s presence.
“How long do we have to stay here?” Mia asked. She was looking at me, but it was a blank stare.
“Mark wants us to spend the night,” I replied. “He wants to make sure you get some sleep.”
“I don’t want to stay here,” she said. “I’ll sleep at home. We still have to drive home.” Suddenly, her eyes grew wide and she looked frightened. “We have to get the kids home, Pat! Where are the kids?”
“The kids are fine,” I said, stroking her arm. I knew from experience that a light stroke on Mia’s arm could calm her anxiety. “I just talked to them. They’re safe and sound at your parents’ house. Mark wants us both to sleep here tonight.”
I held my breath, but the strategy worked. Mia relaxed and glanced across the room. After a moment she sighed and muttered, “This is so weird. Why is everyone acting so weird?” She seemed to be talking to herself again, so I let the question linger.
Mia was slowly scanning the room; I could tell that her brain didn’t want to slow down. I wondered what she was thinking, but I also wondered how much medication she could tolerate before giving up. Not much had changed when the doctors returned a short while later.
“How are we doing?” inquired Dr. Adams.
“About the same,” I replied. “We’re still pretty awake in here.”
“Looks that way,” said Mark. “Pat, you need dinner. I’ll show you to the cafeteria. Dr. Adams is going to coordinate a few more tests.”
“Oh, you haven’t eaten,” said Mia. “You should get some dinner.” Apparently, the fact that she, too, hadn’t eaten anything since breakfast failed to register.
“Okay,” I said hesitantly, looking from Mia to Mark and back again. I stood up and kissed Mia on the cheek. “I’ll be back soon, babe.”
I felt an uncomfortable mix of relief and then guilt upon leaving the room. Mark ushered me through byzantine corridors as we made our way to the cafeteria. He was busy informing me about the tests they had completed and those they were planning.
So far, Mia had received only a small dose of Ativan. They were waiting to use more until all the tests had been run. Other medications would definitely put her to sleep, but they didn’t want to use them until she had been seen by a psychiatrist. Only a specialist could determine the best drug to combat her psychosis. Mark called these antipsychotic medications “hardcore psychotropic drugs.” I would soon learn much about them.
The eating area was sterile and bleak, with several blurry-eyed workers huddled in scrubs and engaged in quiet conversation. Mark and I talked while we ate, discussing possible reasons for Mia’s disconcerting behavior. Mostly this meant Mark throwing out potential causes and trying to describe complicated medical conditions to someone without adequate training. I followed some of his explanations but got lost in others.
After twenty minutes, Mark received a text. He looked up from his phone. “The other tests are done, and Dr. Patel is on his way. He’s a psychiatrist I know with admitting privileges here. He can prescribe the antipsychotic.”
“He can give Mia the sleeping medication?” I asked.
“Yeah, that’s the plan.”
“Great, let’s get back there,” I said, still believing that she would be okay after getting some sleep. Anything else to me was unfathomable.
4.
The First Diagnosis
Bruce Springsteen
“Waitin’ on a Sunny Day”
2:38–3:11
Although Mia and I were inseparable during the last month of college, we didn’t expect our relationship to last past graduation. I had already committed to an investment banking job in Chicago. Beginning in July, I would be working eighty hours a week in a high-rise near the Board of Trade. I wasn’t thrilled about it, but I was deep in student debt and needed the money.
Mia was in the process of determining her next move, but Chicago wasn’t in her plans. I always thought she would become a doctor, but as we spent time together, it became clear that she was giving more careful thought to her career.
“I’ve been thinking that maybe medical school isn’t right for me,” she said after I questioned her about postcollege ambitions. “I know it’s the thing I’m supposed to do, especially after having gone to Harvard, but I’m not sure.”
“Really?” I asked. It was surprising, given that everyone else on the premed track talked incessantly about medical school.
“Yeah, what I really want is to help people,” she answered, “to provide them with medical care. I have been looking into other career paths that would let me do that sooner rather than later, like becoming a physician assistant.”
I had limited knowledge of the health-care field. “Is that like a doctor’s helper or something?”
“No, not really like that,” she explained with forgiving patience. “A physician assistant can basically do everything a doctor can do, but they have to be supervised by a doctor. They see patients, make diagnoses, and even write prescriptions in most states.”
“Wow, that’s cool. I’ve never heard of that.”
“Yeah, and it’s a two-year master’s program,” said Mia. “I’m just concerned about spending four years in med school, three years in residency, and then having to work for years to pay off all the debt.”
“Wouldn’t it bug you, though, not to have the authority of a doctor?”
“I guess it would depend on the doctor I worked with,” she said. “Everything in life has a trade-off.”
“I guess so,” I agreed, although I hadn’t thought much about trade-offs. My postcollege goal had been to find the highest-paying job.
Graduation came quickly. It was a heartbreaking goodbye, but we were headed in different directions. Mia was going home to New Jersey, having signed up for additional college classes at NYU. She had a few prerequisites to fulfill and would be applying to physician assistant programs in the fall.
We had agreed to keep in touch, but I was surprised when she phoned a week later. “Pat, I’ve been looking into things, and I could actually take these prereq classes at the University of Chicago in the fall.”
“Really?” My heart skipped, my expectations for the future changing in an instant.
“Yeah, I’m pretty sure I could figure it out. But I wanted to talk about it first. We were pretty clear that we’d only date until graduatio
n. I wanted to make sure you’d be okay with it.”
“Okay with it?” I asked. “Are you kidding me? Yes, yes, definitely. Let’s figure it out!”
“I’ve already done some looking. I’ll have to fill out the application immediately . . .” Mia was providing details, but I was only half listening. I sensed a crucial turning point in my life.
Great new opportunities opened in front of me, and I couldn’t have been happier.
***
When Mark and I arrived back in her room, Mia was sitting up in bed and nibbling vacantly at a turkey sandwich. She looked up but didn’t register much emotion. They had given her an extra blanket, and she was wearing a navy sweatshirt I had brought along for her from Mark’s house. Mia was usually cold, but the hospital itself was freezing.
“I see they finally found you some food?” asked Mark.
“Yes,” she mumbled.
Just then Dr. Adams came into the room. “I’m on my way out, but I wanted to wait until you came back. Mark, we’ve completed all the tests. If you have a second, we can review things back in the office?”
“Sounds good,” he said, turning to leave.
“Oh, Pat,” said Dr. Adams, pausing before they left. “We gave Mia some more Ativan, quite a bit more than earlier. She should be feeling fairly comfortable now.” She smiled, looking at Mia, and then they left.
I walked over to a chair next to the bed. Mia sat in silence, looking at her sandwich and taking a couple of small bites once in a while. I could tell that she was losing steam. I made a few comments, she murmured responses, and then we fell silent again. The beeping of machines was our only company.
After a half hour, Mark returned with a new doctor. He was solemn and tall with stern, intelligent eyes.
“Mia, Pat,” introduced Mark, “this is a friend of mine, Dr. Patel.”
I stood up to shake the doctor’s hand. Mia glanced up but didn’t say anything.
“Hello, Mia,” began Dr. Patel in a deep voice. “I understand you haven’t been sleeping much.” He launched into the same questions that Mia had already answered several times that day. By this point, she was muttering short responses with an apathetic look. I jumped in with more complete answers, hoping that accurate details might help with a diagnosis.
After about fifteen minutes of this, Dr. Patel and Mark excused themselves, and our silent waiting continued. It was approaching 11:00 p.m., and the ER was deserted. This, combined with the low light, was making me sleepy, but it had little effect on Mia. She kept scanning the room, having given up on the half-eaten sandwich.
A nurse appeared, waking me from a stupor. “Hi, Mia,” she said. “Dr. Patel prescribed a few more medications. I see you have some water there?”
She handed Mia a tiny paper cup containing three small pills. I had never seen Mia take medication without first knowing what it was. She downed them one by one without a second thought, a sign of her heavy sedation.
Given my conversation with Mark, I knew that at least one of those pills was for sleep. My own exhaustion was gone, and I became focused on watching Mia’s eyes for any sign of drowsiness. She kept glancing around, looking at different areas of the ceiling.
Finally, after what seemed like an eternity, her eyes started to close. Suddenly, one of the machines made a noise, and she jolted awake. After a minute or two her eyelids started to droop again, but then another loud beep sounded.
This process continued for another twenty minutes, when I noticed the door slowly opening. Mark came halfway into the room and motioned for me to follow. Mia hadn’t detected him. I stood up, gave her a light kiss on the forehead, and tiptoed into the hallway.
“Mark, she’s almost asleep!” I whispered.
“Oh absolutely,” he said, not bothering to lower his voice. “She won’t be up much longer with all of that medication. Come on, I want to go over some things while they move her. She’s already been admitted.”
He led me to a small office in the back of the ER. “Most everything came back normal,” he said, sifting through papers. “Mia does have a bit of hypothyroidism. We can give her something for that, but I doubt it is causing the psychosis. She told us she took Relpax a few days ago. Do you know anything about that?”
“Yeah,” I said, “that’s her migraine medicine. She’s been taking it for years.”
“Right, and she’s never had any reaction to it. So it can’t be that, either.”
“You’re the doctor,” I replied. “I just think she needs sleep.”
“You could be right. Dr. Patel isn’t sure, but he mentioned brief reactive psychosis. We’ll have to see how she does tomorrow.”
“What is that?” I asked. “‘Brief reactive psychosis’?”
“People can become psychotic under periods of intense stress and anxiety,” he answered. “It would be exacerbated by a lack of sleep. Their bodies can’t handle the pressure.”
“That’s it!” I declared, smiling. “I’m sure that’s it. How long does it last?”
“It can last up to thirty days, but Dr. Patel said that most cases resolve in twenty-four hours or a few days.”
“Great, that’s the best news I’ve heard in a long time.”
“Let’s hope so,” said Mark. “In the interim, we have given her a small dose of an antipsychotic called Seroquel as well as another mood stabilizer, called Celexa. We’ll also keep the Ativan going as needed, and we’ll give her Restoril at night. That’s the sleeping medication.”
Mark led me to Mia’s room on the hospital’s third floor. She was already there, sound asleep in the darkness, finally looking peaceful. I had never been so happy to see someone sleeping.
He helped me unfold the visitor’s chair into a makeshift bed, brought sheets and a blanket, and then told me that he would return in the morning. I thanked him again for everything and reached out for a handshake. Ignoring it, he gave me a quick hug and left.
Alone again, I plugged in my phone, which had run out of battery, and stood looking at Mia. She had a contented look on her face, and I was confident that her brain was repairing itself.
Turning back to my phone, I saw that my voice mail was filled with entries. The kids had left a message, saying how much they missed us. Mia’s parents had left one a bit later, letting me know that the kids were asleep and everything was fine. My mom and Celia had also left messages.
The last one was from my brother, Brad, saying that he’d be up late. Even though it was past midnight, I tried him. He answered almost immediately. His wife, Jen, joined our conversation. They were two of our closest friends and knew Mia like a sister; the four of us had lived together right out of college. Brad and Jen wanted the full story, and I found it therapeutic to talk through the events of the day.
After the call, I stretched out on my temporary bed, relaxing in the comfort of Mia’s rhythmic breathing. I wasn’t tired yet, so I opened the phone’s browser. I was curious about brief reactive psychosis and started researching it.
Everything I found supported Dr. Patel’s diagnosis. The condition struck unexpectedly and in periods of intense stress, often in middle age. It affected more women than men, and many were the children of immigrants. I was halfway through reading the results of a scientific study when my eyelids finally started to close.
Mia will wake up as her old self, I promised myself, settling into a restless sleep. We’ll never have to deal with something like that again.
The sounds of hospital machines continued to haunt me throughout the night, and the nurses returned regularly to take Mia’s blood pressure. Fortunately, these distractions didn’t bother her, but they kept waking me every hour or so. One time, when I was lying awake after one of these interruptions, she mumbled something in her sleep, but I couldn’t make out what she was saying.
Mia woke shortly after 9:00 a.m. The nurses had gone, and I was the only one
around when she opened her eyes. She sat up and looked around the room in confusion.
“Good morning,” I said, standing to give her a kiss. “How are you feeling, babe?”
“I feel okay,” she said, “a little tired.” Her eyes had more life than the previous day, although she still seemed distant.
“That’s not surprising,” I replied. “Kind of a rough day yesterday.”
“Yeah, I guess.” Her tone was flat.
When Mark arrived, he greeted Mia and started to ask more piercing questions. Was she feeling tense and anxious? Did she think that the police were after her? She responded normally to everything, although she seemed more serious than usual.
I tried to lighten the mood by making a joke about how soundly she had slept, complaining that I had been tortured by machines all night. I also mentioned that she had talked in her sleep.
“What did I say?” asked Mia.
“I couldn’t make it out,” I said, “but it must have been a good dream. You seemed pretty worked up about something.”
A nurse came in with more Ativan, which Mia begrudgingly swallowed. She complained of being groggy and feeling “out of it,” and she didn’t want to take more medication. But Mark implored her to continue, insisting that she had to follow Dr. Patel’s orders.
I was in good spirits. Mia was acting as normal as possible under the circumstances. She was tired, and her personality was blunted given all the medication, but the psychotic ramblings were gone. Being around her wasn’t the spooky, stressful experience that it had been the previous day.
Mia’s parents brought the kids to the hospital shortly before lunch. I met them in the parking lot, and with open arms both Will and Jamie ran to me on the sidewalk. They were so excited, and I scooped them into a group hug.
“It’s so great to see you two!” I gushed. “I’ve missed you so much!”
“Is Mommy all better now?” asked Jamie, not breaking our three-way embrace.
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 4
