“Mia, sweetheart,” I pleaded, “I know you are upset, but this is our little baby, remember? She’s been with us for fourteen years. She’s so sweet. We don’t need to do anything to her.” I was slowly taking our dog into my arms, careful not to look down. Mia seemed relieved. “Now, I am going to take her out of the room, and then you and I can review the plan, okay?”
“Okay,” she said, absently walking over to sit on the bed.
We soon left for Dr. Martinez’s office. As we sat in the waiting area, white noise humming in the background, I thought about the seventy-two hours since we had last seen him. According to the plan, the psychosis might be close to resolving. That seemed unlikely given the events of the morning.
After ushering us into his office, Dr. Martinez asked Mia a few questions. He quickly surmised by her answers and conduct that things hadn’t changed. He turned to me instead. “Pat, how would you describe the last three days with Mia?”
I had to be careful. Although Mia might not be thinking straight, she would be listening. “Well, Doctor,” I began, “she has been fairly agitated. It seems to be getting worse. This morning, she was convinced that the devil had possessed our dog. I assured her that this wasn’t the case, and that we didn’t need to kill Chica. But obviously, Mia is having a lot of trouble relaxing right now. She’s frightened that Satan is hiding somewhere in our house.”
“I see,” replied Dr. Martinez, his eyes widening. “Okay, we are going to change the plan. We have increased her dose to six hundred milligrams of Seroquel. We are now going to move it up to eight hundred milligrams.”
“What?” I choked out, louder than I would have liked. “With all due respect, Dr. Martinez, the increases in medication seem to be aggravating Mia’s anxiety. Might we consider toning it down a little?”
“No, Pat,” he responded. “Mia’s thought disorder is not responding to the smaller dosage. We need to increase the medication and let time do its job.” I gave him an uneasy look. “Trust me on this, Pat, Mia will come around. We need to get the acute phase of this under control. The medication is the way to do that.”
Dr. Martinez stood up after scribbling his new instructions. “Here is the new dosage. Ativan and Restoril stay the same. Seroquel moves up to eight hundred milligrams per day immediately.” He reached out his hand to shake mine. “See my assistant, and let’s set up an appointment for Thursday.”
He began to usher us out of his office. It seemed rushed, but maybe he didn’t want to say a lot in front of Mia. I wondered how much of our exchange she had followed. She walked back into the waiting area, and I was starting to follow when Dr. Martinez pulled me aside.
“Pat,” he said, his face grim, “I work closely with the Gulfshore Treatment Center.” I had heard of the GTC. It was our local mental health facility. “In fact, I am the head psychiatrist for the crisis center there. The staff at the GTC, we have a lot of experience dealing with this kind of thing.”
“I’m sure you do,” I replied. I had never visited the GTC, nor did I know anyone who had been there. All I could think of was Mark’s description of those places, and how determined he had been to keep Mia out of them.
“This is my personal cell phone number,” he said, handing me a slip of paper. “If things get too difficult for you, call or text me. I can get the team at the crisis center ready for Mia and make sure she is safe.”
I stood looking down at his number. “We’ll be fine,” I said, without much conviction.
“I appreciate what you are doing, but if you ever feel that Mia is a danger to herself or to others, you need to get help. What you said here today was very concerning.”
“I know, but it’s only another day or so.”
“Hopefully, but remember, this can sometimes take over a week to work itself out.”
“I don’t want to take her to a mental facility. She’s better off at home.”
“She’s better off safe,” he said firmly, “and so are you, Pat. Please, if you need help, call me.”
All the way home I kept thinking about what he had said, about Mia becoming a danger. It didn’t seem possible, but the whole thing with Chica that morning had been creepy. Maybe he had a point. And it was imperative to keep Mia safe; I did agree with that.
Celia was waiting for us when we walked into the house. I could tell that she was still rattled from the previous night. After getting Mia settled back into our room, I ducked out quickly to speak with Celia alone.
“Could you do me a favor,” I asked, “and help with the kids when they get home from school? I think they could do with a change of pace, and you’re so good with them.”
I could see the relief on Celia’s face. “Yeah, sure, I’d love to spend time with Will and Jamie,” she said. She paused, and then with a frown continued. “It’s so upsetting, seeing Mia like this.”
“I know.”
“If anyone in our family was going to go through something like this, I would have bet on me. Hell, Pat, everyone would have bet on me. But Mia? Never. I still can’t believe this is happening to her.”
“I can’t believe it, either. But we’ll get her back, Celia, I can promise you that.”
But as the day wore on, I knew we weren’t getting her back anytime soon. Mia’s paranoia was as severe as it had been earlier in the day. Our conversation rambled through many of the same disturbing tirades: Mensa, messages from God, the truth, the plan, the devil.
Watching over Mia that night was arduous. She had more energy, and as her energy increased, so did my anxiety levels. Plus, all the talk about the devil had gone from spooky to spine chilling, like she could sense him lurking in the shadows of our room. And her thoughts were racing so dramatically that her mood could turn in an instant.
With reluctance, I began increasing her Seroquel dose yet again. I had mixed feelings about it. Her psychosis was getting worse, that seemed obvious. But according to Dr. Martinez, this was the only way to get it under control.
As soon as Mia fell asleep, I crept to our back room, fatigued and apprehensive. I needed some quiet time before trying to fall asleep.
I opened my email. Along with a slew of work-related messages, I also received a note from my brother, Brad. He was supportive and optimistic, promising that Mia would recover. Smiling tearfully, I agreed, confessing that I couldn’t bear to think otherwise.
Climbing back into bed next to her, for a moment I sat studying Mia. She remained as beautiful as ever, with that serene look on her face that accompanies sleep. For what seemed like the millionth time, I wondered what was happening inside her brain. I downloaded a book on bipolar disorder and started reading, but I stopped after twenty minutes. Dr. Martinez was right; it didn’t fit.
Lying silently in the dark, I reflected on Brad’s positive message. Sooner or later, the medication would start working, and my lovely wife would return. Life had confronted us with a major obstacle, but what mattered was how we responded. I was a fighter, and I knew that Mia was, too.
I fell asleep confident that I could handle whatever the illness threw at me the following day.
8.
The Devil
The Killers
“A Dustland Fairytale”
0:44–0:58
One day during our second winter in Chicago, I came home from work complaining about the frigid temperature. “You know,” Mia pointed out, “there are places we could live where it stays warm all year round.” As much as I loved the Midwest, her comment stuck, and later that spring I accepted a position with a company in Houston.
The timing was right. My investment banking job was a two-year commitment, and it was coming to an end. Mia was finishing her first year in the physician assistant master’s program at the University of North Chicago. Her second year would consist of six-week rotations at various hospitals and doctors’ offices. These internships could be located anywhere acr
oss the country.
Finally, after completing several rotations away, she moved to one of her Houston-based assignments. We were excited to be together again, and she lived in my apartment on the outskirts of the city. Mia worked downtown, though, and the drive was an hour each way. In addition, her rotation was in the emergency room at Ben Taub Hospital. She had twelve-hour shifts in one of the busiest medical centers in Texas. The lack of sleep and long commute were challenges.
If she had the night shift, we wouldn’t see each other until right before I left for work. But one morning, she didn’t return home at her usual time. I waited an extra thirty minutes before finally leaving. Those were the days before cell phones, so I stuck a note on the counter asking her to call as soon as possible.
“Sorry, babe,” she said after I jumped to answer the phone a couple of hours later. “My shift ran over last night, and I was so tired, I couldn’t make the drive home.”
“Are you okay? Where are you now?”
“Yeah, don’t worry, I’m home now,” she said quickly. But I remained concerned as she told me about locking her doors and sleeping in her car. In a poorly lit parking garage. In downtown Houston.
My life as a banker had been sleep deprived, but Mia was managing a far worse schedule than I ever had.
Another issue with the rotation was the stress. Ben Taub was a Level 1 trauma center, which meant that the most extreme cases were sent to its emergency room. Mia saw all kinds of nasty stuff during her time there: homicides, car accidents, drug overdoses. Confident in her ability to save lives, Mia tackled the job with determination and vigor.
Frequently, she would want to talk about the various crises she had faced. Not the specifics of the patients—she couldn’t do that—but what she had seen and learned. But the blood-and-guts stuff didn’t sit well with me. I never wanted to listen, and she knew it.
However, I did hear about one event. She came home from a night shift visibly more shaken than normal. “Do you want to talk about it?” I asked, pulling her close. It was a testament to the seriousness of the situation that she accepted my offer.
“We were so busy last night.” She wasn’t crying; she sounded emotional but composed. “Everyone was running in a million directions.
“A teenager came into the ER. Her parents brought her in. Pat, she had tried to commit suicide. Both of her wrists had been slashed. Her mom was holding towels to her arms, but there was blood everywhere.”
“Good Lord,” I whispered.
“A few car accidents had just come in.” She sounded far away, as if she were reliving the shock from a safe distance. “No one else was free, so she was assigned to me. I didn’t even have a doctor to consult with.”
I didn’t know what to say.
“I stitched up both of her wrists. She just sat there looking down at her arms while I did it.”
My wife could handle extreme stress. One didn’t survive the horror of the Ben Taub emergency room without being able to manage pressure. And she could go without sleep, too. I’d seen her do it for weeks.
So, had stress from her work and a lack of sleep triggered Mia’s psychosis? All the doctors thought so. But why didn’t any issues arise when the sleep deprivation and work trauma were levels of magnitude greater?
***
Tuesday began early. Immediately, it became clear that Mia was as anxious and paranoid as the night before. I resigned myself to the fight, accepting that we wouldn’t be taming the illness on the short end of Dr. Martinez’s range of four to eight days.
Mia had moments of surprising clarity that morning. She would be talking about some disconnected idea and then suddenly switch topics. “Oh my God, Pat!” she would cry. “Something is wrong with me! We have to go backward, or else I’ll have to go to the treatment center!”
She couldn’t have heard Dr. Martinez speaking about it, so she must have known about the GTC through her job. She mentioned it several times. I had no answers when she did. I kept trying to redirect her to the plan, but she had lost all interest in it.
Her mood was vacillating so wildly that it was becoming more difficult to influence her. I resorted to remaining as calm and unexpressive as possible, hoping that my stillness might counteract her high energy.
Marcos and Lucia went to the store midmorning. At about the same time, Mia became focused on leaving the bedroom.
“I need to get out of here,” she kept saying, as if in warning. She was talking to herself, her eyes darting from the windows to the doors. “I can’t stay here.” She revisited the idea every five minutes, looping it around with her other racing thoughts.
She was clearly plotting some kind of escape. She had stopped looking at me when speaking. It started gradually and then became evident. She would turn her head in the other direction or stare at the floor. Even if I addressed her directly, she would avoid my gaze.
Mia never accused me of becoming the devil, but her actions made it clear. She couldn’t look into my eyes because then Satan himself would have a direct link into her brain. She was slowly moving physically farther away from me, too, hoping that I wouldn’t notice. Mia was acting like someone in a murder mystery who has finally solved the crime but doesn’t want the culprit to know.
It must have been terrifying for her. For the past week, I had been the one person she could trust through her fog of paranoia. But then, suddenly, I was compromised, taken over by a demon from her nightmares. Attempting to keep her in our room seemed like an especially bad idea.
Reluctantly, I decided to let her go, knowing that Celia was home and the house was locked. I pretended to use the bathroom and left Mia alone for a few minutes. Sure enough, when I came back, the bedroom door was open and she had gone.
I stood still for a moment, scanning the empty room and thinking about the kids. What would happen if they returned from school to find their mom running away from their dad, screaming that he was possessed by the devil?
Slowly walking into the hallway, I was at a loss for what to do. Celia found me in a dazed kind of stupor, staring blankly ahead. “Is everything okay?” she asked. “Where’s Mia?”
“She’s in the house somewhere,” I whispered. “You know how the devil has been bouncing around recently?”
“Yeah?”
“Well, as of about twenty minutes ago, he bounced into me.”
Her eyebrows flew up over panicked eyes. “Pat, what are we going to do?”
I was already reaching into my pocket for Dr. Martinez’s number. “The psychiatrist told me to call if I needed his advice.” I said it calmly and slowly, trying to keep my emotions in check. “I need it now.”
Dr. Martinez answered quickly. I was explaining how Mia believed me to be possessed, when something started clanging in the backyard.
Celia and I whipped our heads around. Mia was standing at the back of our lanai, a screened-in area surrounding the pool, trying desperately to open the door to the backyard. She was yanking the handle, slamming it repeatedly against the screen enclosure. Without thinking, I raced out to stop her.
“Mia,” I asked, skidding to a halt, “what are you doing?” I tried to sound composed. Refusing to look at me, she frantically continued tugging on the door. It was like a scene from a horror movie, where the victim tries to flee as the monster approaches. It was surreal to feel like the monster. Fortunately, I had bolted the door when Mia’s psychosis had returned, and she’d forgotten it had a lock.
“Babe,” I repeated, “are you going somewhere?”
“Stay away from me, Pat!” she shouted. “I’m going to visit the neighbors! You can’t stop me!”
I had the distinct impression that Mia was not going next door; she was trying to get as far away from me as possible. Fortunately, Celia had followed me out. “But Mia,” I said softly, “your sister is here to visit you. Why don’t you spend time with her?”
; Celia took the cue perfectly. “Yeah, come into the house with me,” she said, moving toward Mia as I stepped to the side. “You get to see your neighbors all the time. Let’s go talk.” She put her arm around Mia and started coaxing her away from the door. Not looking in my direction, Mia moved uncertainly back inside.
I remembered the phone. “Dr. Martinez?”
“Yes, I’m here,” he responded. “Is everything okay?”
“No,” I confessed in fear. “Mia was trying to escape our backyard. I think she was running away.”
I heard him let out a breath. “Look, Pat,” he said, “it’s your decision, but I strongly advise you to bring Mia into the treatment center. I can meet you when you arrive.”
He was right. What would have happened if Mia had run away? “Okay, we’ll leave right away.”
He gave me directions, but I was only half listening. Instead, I was trying to rationalize sending Mia to a mental health facility after Mark had fought so heroically to keep her out.
After shoving a couple of Mia’s sweats and T-shirts into a duffel bag, I grabbed my car keys. I could hear Celia talking to Mia in the living room. “Celia!” I called from the hallway. “Let’s go for a car ride. Bring Mia along. I’ll drive.”
Celia didn’t know where we were headed, but she followed my lead. “Come on,” she said with encouragement, leading Mia to the garage. “It’ll be good to get out of the house.”
Mia appeared hesitant, but she was going along with it. Climbing into the back seat, she abruptly became angry again. “Where are we going, Pat?” she began demanding. “What are you planning to do with us, Pat?!”
I sat in the driver’s seat with the engine running and the air conditioner blasting. I kept my eyes straight ahead and pretended that I was oblivious to Mia’s barrage of questions. My hands were shaking; my only focus was getting to the facility as fast as possible.
We started driving. Mia was speaking to herself loudly, having given up on any response from me. She was trying to determine our destination by the route we were taking. “We’re going to the Gulfshore Treatment Center,” she proclaimed. “I knew it!”
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 9
