However, I remained highly sensitive to any deterioration in her thought process. I had become an expert in looking for signs of early psychosis. But until I could see any indication of a relapse, I forced myself to let Mia live independently again.
We continued to see Dr. Rojas twice a week. We had a memorable meeting with him in mid-January.
“So, how is Mia today?” he asked. Dr. Rojas had continued greeting Mia the same way, even after she yelled at him for it. He confided in me later that he did it on purpose. Once his patients could ignore his peculiar greeting and move on, he knew they had improved significantly.
“I’m good,” she said, without any frustration.
“Wonderful.” He continued with the regular set of questions. We had heard them dozens of times by now. After several minutes, he moved to broader inquiries about how she was spending her time. Then he sat back in his chair and smiled.
“Okay, here’s what I think happened,” he said. “Mia’s situation at work caused her to begin losing sleep. The lack of sleep increased her anxiety, which led to even more insomnia. Ultimately, this cycle led to her psychotic break in late September.
“Seroquel was not the best medication to treat the psychosis. Whether it was the Seroquel itself or an interaction with another medication, perhaps the migraine drug, the illness wasn’t truly managed until we switched to Zyprexa. All that being said, I continue to believe that this was a case of brief reactive psychosis.”
I had been hoping for this. After my own exhaustive research, I couldn’t find any other diagnosis. “That’s great news,” I said. “So, does that mean this was a onetime event?”
“That’s what I believe, yes.”
I waited for Mia to comment. When she didn’t, I said, “Good. Where do we go from here?”
“As I told you during your initial visit, the brain is a powerful and sensitive organ. It can withstand a lot, but it takes a long time to recover once broken.” He was speaking in his pleasant manner, looking from Mia to me. But then he focused his attention on her. “I know you want to get off the medications as quickly as possible.”
She nodded.
“But that would be a mistake. My number one priority is to keep you from suffering another setback.”
“Yes,” she murmured.
“So, we will titrate the medication very slowly. It might take five months or longer before you are off all the prescriptions, and we will watch things carefully.”
“Okay.”
“Good.” He turned to me. “Pat, it will be imperative to follow my instructions precisely. We will be decreasing doses very slightly. You’ll need smaller pills for everything. Sometimes, we’ll have to cut tablets in half. In those cases, just do your best at guessing amounts.”
“Ah, sure,” I replied hesitantly.
“Good,” he repeated. “We’ll lower doses and then give Mia’s body time to acclimate. Every time we make a change, you should expect mood fluctuations. They’re common.”
“Okay,” I said, even more apprehensively.
Dr. Rojas then outlined the first two weeks. Most of the tapering had to do with the olanzapine. We would be lowering the dose by slight amounts and then seeing if and how Mia reacted to the change. If she was okay after five to seven days, we’d lower it again. If she had a negative reaction, we’d stay at that amount longer. If need be, we could always increase the dose to previous levels.
The first challenge came with our insurance. Mia had a couple of weeks’ worth of olanzapine, all five-milligram pills. Dr. Rojas wrote a prescription for a lower dose, but when I went to fill it, I discovered that olanzapine was heavily regulated. The pharmacy wouldn’t execute a new prescription until the previous one had been completely depleted. I tried having Dr. Rojas call, but he couldn’t do anything to persuade them, either. It was impossible for me to obtain pills in smaller amounts.
In the end, Dr. Rojas told me to chop the five-milligram pills into quarters the best I could. It was painstakingly difficult, and I cursed the pharmacy with every cut. But as infuriating as it was, I would soon discover that dealing with our insurance could be even worse.
When Mia was severely sick, I didn’t have time to consider the ramifications of my decisions. I was reacting rapidly to abrupt changes in her health. Given that we had paid substantial insurance premiums for years, I assumed that the bills would be covered.
The emergency room visit and hospital stay coordinated by Mark at the outset weren’t problematic; I owed a small amount for them. The trouble came with the Gulfshore Treatment Center, which sent me a bill for over $30,000. The insurance company refused to pay any of it.
Shocked, I immediately contacted my insurance agent and spent the next several days on upsetting phone calls. In the end, I learned that although the GTC was the only acute mental health facility in our county, and the only one within a forty-five-minute drive of our house, it wasn’t technically considered a “hospital” by our insurance. Therefore, the company refused to cover any expenses incurred there.
It didn’t matter that the only “hospital” in the county that offered mental health treatment was strictly voluntary and that Mia never would have stayed. It didn’t matter that she was taken to the GTC against her will by the police. Nothing mattered to the insurance company.
I fought for hours on the phone, met with my agent, and wrote letters of protest—all to no avail. With no other choice, I called the GTC to discuss the unpaid bill. After asking for the accounting department, I was connected to a kind-sounding representative. I decided to go with the honest and blunt approach.
“Here’s the deal,” I said. “My wife was so sick that I didn’t have time to research the arcane rules of my insurance company. I was naïve; I thought they’d cover mental illness.”
“Yes, I do understand that, sir,” the representative replied.
“And now I owe you $30,000. But I can’t possibly pay that.”
After a pause, he said, “We do have payment plans, sir. We could put you on a financing plan to make the amount more tenable. We have three- and five-year—”
“No,” I cut him off. “With all due respect, I know how this works. If my insurance were paying this, they would have negotiated reduced rates. They’d probably be paying a third of the retail cost.”
Silence.
“So, that’s what I’m going to do. I am going to write you a check for ten grand. I can afford that. I’m going to send it to you this afternoon, right after we hang up. And then we’re going to be even on this.” I was speaking with authority, hoping it would work. “How does that sound?”
Another pause. I waited patiently with my fingers crossed. “That would be fine, sir. We can agree to that,” he said finally.
I hated shortchanging the GTC. The care that Mia had received there was so important, especially the attention that Dr. Martinez had shown us. But I knew the retail price was marked up compared to what the insurance companies paid, and even the $10,000 was a stretch for us. Yet again, I wondered how people with limited resources survived mental illness.
By the end of February, we had been through several changes to the olanzapine levels, and the pattern had become clear. We would lower Mia’s dose of the psychotropic drug slightly, perhaps as little as one milligram. The next day, she would become even more irascible than usual, lashing out at the most innocuous comment. This would last for two or three days, and then her mood would revert to a less-extreme irritability. It demanded tremendous patience.
Jamie didn’t have it. In the years before her sickness, Mia’s relationship with Jamie had become strained. Mia was raised in a strict home, and sometimes she would revert to ordering the kids around. Will would usually obey quickly and then go back to whatever he was doing. But Jamie would instinctively bristle.
With Mia’s changed personality, the friction intensified. Mia would say somethin
g like, “Jamie, brush your hair.” And even if Jamie was thinking of brushing it, she would immediately refuse on principle. Normally, Mia would have provided alternatives or offered incentives. Instead, with her illness, she resorted to more forceful commands, which only caused Jamie to push back harder.
On an almost daily basis, I would come home to find Will alone at the kitchen table doing his homework. Jamie would be in her room, having slammed the door after a fight. Mia would have retreated to our bedroom. They were like two fighters escaping to the corners of the ring before the next round. “It’s a battle royale today,” Will would mutter. “Best stay clear of it, Dad.”
I enlisted Jamie’s therapist of several months, Dr. Jenkins, to help manage the situation. I still didn’t have much insight into their conversations, but Dr. Jenkins could appreciate the challenge. “Pat, Jamie has the independence of a fifteen-year-old, not a nine-year-old,” she told me, “and you’ll have to treat her like one.”
Together, we negotiated a set of expectations between Mia and Jamie. We created a list of chores that the kids had to complete each week. We included Will in it so that Jamie didn’t feel singled out. It didn’t matter when the obligations were performed—a limited freedom that was important to Jamie. For example, Mia couldn’t insist that she clean her room immediately, but it had to be done by Sunday at 6:00 p.m. each week. It gave Mia the authority she needed as a parent but offered some control to Jamie.
Thankfully, the arrangement calmed the fighting, but it did nothing to repair the relationship. Will’s connection with Mia was also strained. Her cantankerous mindset was so upsetting that we would all avoid her; she was a dark shadow brooding around the house and spreading misery.
And while the kids were avoiding their mom, they were clinging more closely than ever to me. I did my best to remain positive, offering a contrast to the melancholy emanating from Mia. But that only made their detachment from her worse. I was the fun-loving dad they had always known. Why would they choose to spend any time with their mom, who was so frighteningly different? It made me feel awful, but I couldn’t find a better alternative.
I kept telling the kids that Mia’s old personality would return in time, but they were understandably skeptical. It had been almost six months without any improvement. And every week, when we lowered the olanzapine dose, their mom would turn from sour to downright nasty.
My relationship with Mia wasn’t any better. We were still meeting with Dr. Rojas on a weekly basis, and Mia had started seeing a psychologist who worked closely with him. I was hopeful that the therapy might improve her disposition, but it didn’t. The effect of the pharmaceuticals was overpowering.
It was a torture every time I gave Mia her medication. I would carefully assemble the pills into a paper cup and then wordlessly hand them over to her, like the executioner passing the cup of hemlock to Socrates. I knew that without it she could suffer a relapse, but I also knew that it would prevent the woman I loved from resurfacing. I felt more like a nurse than a husband. My resolve never wavered, but my despondency grew.
As the days droned on, I began to examine my own feelings. Since Mia had become so startlingly sick at the end of September, my emotions had run through their own cycle of changes. With shock, I realized that I had been working through the customary phases of grief.
It was an alarming epiphany. With a jolt of horror, I recognized what I was grieving: the death of our relationship. The intimacy we felt for each other, the powerful foundation upon which Mia and I had constructed our lives, was disappearing. The trust, the affection, the closeness—they were slipping away.
And then, with another shudder of disgust, I grasped that I was moving into the last and final phase of grief: acceptance. Living day to day, not thinking about the future, I had stopped hoping that our house would once again become a place of laughter and relaxation. I had stopped longing for a few stolen minutes alone with Mia. I had stopped daydreaming about growing old with my beautiful best friend. I was on the verge of accepting the illness as a permanent part of our lives together.
But that wasn’t right. Maybe my emotional side required a coping mechanism, but my intellectual side had to acknowledge the facts. Mia had suffered a onetime crisis. My research pointed to that. Dr. Patel’s first impression had told him the same. And Dr. Rojas’s expert opinion, formed after countless hours of working with Mia, underscored it.
We had a couple more months to go of titration. It would be tough, dealing with the wild swings in her mood, but we’d get through it. The fall was a nightmare; the winter had been hard; but spring should be a time of hope. By summer, when all the medications had been painstakingly eliminated, Mia would come back to us. And by the fall, our family would be whole again.
The illness would be a thing of the past.
17.
The Relapse
Van Morrison
“Listen to the Lion”
0:19–1:01
When I left business school, I expected to be involved in Sam’s startup for a year. But eleven months later, we took the company public, and leaving became difficult.
Those were the early days of the internet, when little companies with big ideas could attract huge prices in the stock market. Our venture was valued by investors at several billion dollars. It was ridiculous, really, given that we were a tiny organization and far from profitable.
When I joined, I accepted a low salary in exchange for a small ownership stake in the company. Once the company went public, that small stake became extraordinarily valuable, at least on paper. But given various securities laws, we couldn’t sell any stock.
After six months, executives of the company were allowed to sell a small portion of what we held. However, we could sell only on one specific day, and we had to decide how much to sell the night before.
This was right about the time that the internet bubble started to deflate, and public companies like ours began losing value fast. But many people believed the downturn would be temporary. “The stock will rebound,” some of my peers at the company kept saying, “and it’d be foolish to sell anything now.”
These were some of the smartest people I knew, and their attitude started to cloud my thinking. The night before the deadline, Mia provided a much-needed voice of reason.
“Wait,” she said after realizing that I was having doubts. “Let’s make one thing clear, Pat: we are selling at this price. And we are selling as much as we possibly can.”
A month later, the stock had lost over 99 percent of its value—but the cash from our stock sale was in the bank.
Without Mia, I’m not sure what I would have done. Thankfully, I didn’t have to worry about it. We had enough to take a chance on moving to Florida to be close to family.
And we could survive a medical crisis without going bankrupt.
***
Mia took her final dose of olanzapine in May. We had met with Dr. Rojas earlier that week, and he was pleased with her progress. Five months of titration had gone smoothly, without any major setbacks. It was difficult for those of us living with Mia, and it certainly wasn’t easy for her, but Dr. Rojas’s plan had been a success.
“As much as I like you both,” he joked, “I never want to see you again.”
Mia and I laughed, but we remained apprehensive. The medication was our first line of defense. Even though it had ransacked our lives, we knew it protected Mia. Plus, she had been on some type of medication for almost eight months. Stripping away everything felt like walking naked into the future.
I could sense Mia’s trepidation, so I hid mine. Instead, I focused on the promise of leaving the bad memories of the past behind. By this time, her old personality was starting to return, and we could have an honest discussion again.
“I’m scared,” she confided the night she took her last pill. “I don’t want to become psychotic again. Ever.”
“I
don’t want you to, either; but you heard Dr. Rojas, this was a onetime event. Besides, if it ever happens again, we’ll know how to handle it.”
“Pat, I can only imagine how awful this has been for you. But for me it has been . . . I’m not sure how to explain this.” She paused. “It’s surreal even talking about this, but when I was telling you all that crazy stuff, I really believed it.” She shuddered. It was the first time we had discussed her psychotic ideas. “I mean, with the devil and the eyes and all that, I actually believed it.”
“Babe, that was the disease believing it. Your brain wasn’t working correctly.”
“Right, I know, but think about this. What do you trust more than anything in the world?”
I wasn’t sure what she was getting at. “Who do I trust more than anything? I trust you.”
She shook her head. “Not who—what.” She was waiting for me, but I wasn’t following her. “I’ll tell you. More than anything in the world, you trust your own brain. It’s the thing you rely on most.”
I thought about it. “Yes, I can see that.”
“Okay, now imagine if you couldn’t trust your own brain.”
“Oh my God, how terrifying,” I whispered as the truth of Mia’s experience struck me. It was incomprehensible, trying to imagine that voice inside your head lying to you, trying to trick you.
“Exactly. Terrifying. So, I’m going to need your help. I’m going to come to you if I’m having doubts about things. I’m going to be open with you and use you as my sounding board.”
“Of course; you know that I’m always here for you, babe.”
“I know.” She smiled and then became serious again. “But it’s going to be weird. I’m going to let you into my craziest thoughts and hope that you don’t judge me for it.”
“I listened to your craziest thoughts for months, Mia,” I said. “I never judged you for it.”
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