From that night on, she came to me for thought confirmation. At the outset, she did so frequently. I always tried to stop what I was doing and provide my undivided attention. She would say things like, “I was at Jamie’s school today, and her teacher said that Jamie was a ‘real character.’ I think she meant that Jamie is unusual, with her vivid imagination and everything, right?”
“Yes,” I would answer, “that’s what she meant.”
“Okay, good, because for a second I thought she might be implying that Jamie thinks she’s an actual character from one of her books. But that wouldn’t make any sense.”
“Correct, that wouldn’t make any sense.”
We had countless exchanges like this. Mia needed to confirm that she hadn’t interpreted comments too literally, or that she hadn’t misjudged someone’s emotional response to a situation. Texts were especially difficult for her, given that so much could be misunderstood.
The approach worked, and she slowly regained her confidence, one interaction at a time. As the weeks passed, we began to see more of the old Mia. Once she started laughing again, sometime midsummer, I knew that real progress was being made. With her laughter came a thawing of the tension that had gripped our house for months. The kids sensed the change, and Mia’s relationship with them began to heal.
At the same time, without the medication, her body reverted to its natural metabolism, and her appetite no longer raged out of control. The weight she had gained came off steadily throughout the summer, and her mood and energy levels increased. She was back to her normal rest schedule, no longer sleeping eleven or more hours at night and taking naps during the day.
When the kids resumed school in the fall, Mia felt strong enough to go back to work. She didn’t want to return to clinical practice immediately, believing that starting slowly would be less stressful. She had a standing offer to become an instructor in the PA program of a local university. She could work part-time and increase her hours when she felt ready.
By early November, our lives had returned to normal. The kids, now in seventh and fifth grades, were doing well. Will had long since overcome his separation anxiety, and Jamie and Mia weren’t fighting nearly as much. Mia was kind, caring, and cheerful again. From the outside, only those who really knew her could sense the changes that the crisis had imparted. She was a bit more specific with her language, a little slower to laugh, and slightly more anxious overall.
Below the surface, Mia was struggling to accept what had happened, and I was struggling, too. I had gone from feeling like an emergency room doctor to feeling like a nurse to feeling like a therapist. Although the frequency was receding, she continued to come to me for thought confirmation. So I knew that although she could override its initial reaction, her brain suffered lingering effects of the illness.
But it was more than that. My defenses against being hurt remained in place. Prior to the crisis, I had complete faith in Mia and the close connection that we had built. It wasn’t her fault, but that faith had been shattered. We still had our relationship, but I had already grieved its demise. I was wrestling with feelings of love and hope, on the one hand, and not wanting to relive such an incredible loss on the other.
I decided that time would heal the bond between us. It was unrealistic to believe that our relationship could mend itself in a few months, but we had our entire lives to rebuild. The long agony was over; with patience and commitment, the closeness we had cherished would reemerge.
And then, in early December, Mia came to me with fear in her voice. “Pat, I didn’t sleep well last night,” she told me abruptly one morning.
“What do you mean?” I felt like Mark in his clinical mode. “Did you have trouble falling asleep? Did you wake in the middle of the night? Are you worried about something?”
She responded with the precision of an experienced patient. “No, I fell asleep fine. Yes, I woke around 2:30 a.m. and couldn’t fall back to sleep. No, I don’t think anything was worrying me.”
But she was concerned now. Dr. Rojas believed that a lack of sleep had triggered the last crisis, and Mia knew it.
“I’m sure it’s fine, babe,” I lied, not wanting to fuel her anxiety. “Try not to worry about it. I’ll call Dr. Rojas today to see what he thinks.”
“Okay,” she said uncertainly.
Dr. Rojas was surprised and disappointed to hear from me again, but he didn’t seem alarmed. He told me to give Benadryl at bedtime, an antihistamine known for its soporific effect, and to contact him the next day with an update.
That night, Mia took twenty-five milligrams of Benadryl. I couldn’t relax until she was breathing heavily, which happened after about an hour. But when I woke the next morning, she was already up, waiting for me.
“Pat, it happened again,” she said nervously. “I was up at 3:00 a.m., and I wasn’t tired at all. I’ve just been lying here since.”
“Look,” I said as calmly as possible, “Dr. Rojas wasn’t overly concerned, and we shouldn’t be, either. We’re fully on top of the situation. I’ll call him this morning.”
Once again, Dr. Rojas didn’t seem panicked. He instructed me to switch out the Benadryl for Restoril. “She isn’t going to want to start on strong medications again,” he said, “but it’s important that we get her sleeping through the night. The Restoril should ensure a solid night of sleep tonight.”
“She’ll do anything to prevent a relapse,” I assured him.
“Good. Pat, it goes without saying that you should watch for any signs of concrete thinking or centers of reference. Anything that seems out of the ordinary.”
“She has been bouncing her thoughts off me. I’ll know what she’s thinking.”
“Bouncing her thoughts off you?”
“Yes. Sometimes she has thoughts that might be a bit paranoid or confused, but she’s able to see them as such and overrule them. She checks her conclusions with me.”
“Good. Keep me updated. I want to know any changes.”
Mia took fifteen milligrams of Restoril before bed that night. After forty-five minutes, she was asleep, but I couldn’t relax. Planning for the worst, I snuck out and emailed Luke, putting him on standby. After living off the land in Georgia for a few months, he had gone to Mexico. But we communicated frequently; I knew he would return on a moment’s notice.
Mia slept for three and a half hours and then woke around 1:30 a.m., fully energized. I had instructed her to alert me if that happened, which she did at 2:00 a.m.
“I’ve been lying here for a half hour. I’m not going to fall back to sleep; I know it.”
“Yes, you are. You’re taking another fifteen milligrams of Restoril right now.” I rose to fetch the medication.
“Do you think that’s a good idea?”
“I’m sure of it, babe.” We had to get her sleeping again.
After taking the medication, Mia slept another three hours. I didn’t. I crept over to the safe to check our supply of pills, including olanzapine and Ativan. If the war was coming, we’d be ready. Any thought of rebuilding our relationship was forgotten. I was—once again—completely focused on saving Mia.
The next day, Dr. Rojas was startled that the Restoril hadn’t worked as planned. He thoroughly supported my decision to give more in the middle of the night.
“Any thought disorder?” he asked.
“Not that she has shared, and I haven’t noticed anything.”
“Okay, good. Same thing tonight. Restoril before bed and more if she wakes up. Keep me updated.”
When I checked my emails, I saw a response from Luke. “I got your back no matter what, Patricio. I’m in Cabo San Lucas, but there’s nothing I can’t drop in an instant.” It gave me a jolt of courage. Okay, disease, I thought, we’re ready for you this time.
Mia taught on Thursdays, and the kids were already asleep when she arrived home that night. After sneaking in to kiss them good
night, she came into our room.
“Pat, I need to ask you something.”
She was anxious; I gave her my full attention. “What is it?”
“I was testing the students on their clinical interaction tonight, and I think they were videotaping me. Does that seem right to you?”
That familiar feeling of adrenaline hit instantly.
“Hmm, what do you mean?” I asked nonchalantly. “Was someone there taping the students for the exam and you were involved, too, because you were asking the questions?”
“No, I don’t mean that. I mean, I think the school has secret cameras, and they haven’t told me. I’m pretty sure they have them embedded in the walls.”
I didn’t want to startle her. The school might have posted cameras in different places, but the idea that they were hidden in the walls and designed to record her was absurd. She was losing the ability to separate fantasy from reality.
“I wouldn’t worry about it. They may have a security system, but they’re not watching you or anything.”
She put her finger to her chin in that quizzical way that reminded me too much of the early days of her psychosis. “I’m not so sure about that.”
I changed the subject and gave her Restoril. Once she fell asleep, I texted Dr. Rojas. It was past 10:00 p.m., so I was surprised when he responded immediately. He was as concerned as I was with her paranoia. We discussed starting olanzapine, but he remained hopeful that a few nights of fuller sleep might resolve the problem.
Mia woke again in the middle of the night, this time with her thoughts racing. She was focused on work, telling me about the various students she had tested. She kept repeating her questions and the answers that were given, all the time wondering if the school had caught it on tape. It was bordering on psychotic, and I was reminded of that first morning of the crisis, when she became fixated on a patient in her pediatric clinic. I was relieved when she fell asleep for the second time that night.
By this point, I had plenty of experience with disjointed ideas and paranoia. It was disheartening but not creepy. However, I was stunned at how quickly her thought process had veered out of control. Less than twenty-four hours earlier, we had been sharing rational conversations; that seemed impossible now. Lying in the dark, I began mentally preparing myself for the upcoming days, before drifting into my own troubled slumber.
Surprisingly, she seemed much better in the morning. After the kids left for school, I went to my office to gather up work to bring home. I texted Dr. Rojas details of our midnight exchange. His concern was growing, and he asked me to keep him constantly informed.
As I was collecting my things, I received a text from Mia:
A man with a white van is watching me walk Chica
My heart sank as I responded:
What do you mean, watching you?
I was hoping for a rational response; it didn’t come:
He smiled at me but I don’t know him
I don’t think he wanted me to see what he was doing
How does one deal with delusions from afar?
I’m sure he’s just working on the cable or the sprinklers or something
I sat waiting, my pulse increasing.
No, he’s not
I think he’s installing a video camera
It’s where the kids get off the bus
He wants to record them
I took a deep breath, exhaling slowly. The battle had started.
I’m sure it’s fine, babe
I’ll come home and we can talk about it
Soon, I was pulling into the driveway. I found Mia in our room. A brief conversation confirmed the worst: she was fully convinced that the utility worker, whom I saw when I drove into the neighborhood, was plotting to kidnap the kids.
Without hearing from Dr. Rojas, I gave Mia two milligrams of Ativan. Before, I would have been hesitant to make such a decision, but over the past year, I had become well versed in these pharmaceuticals. I didn’t start the olanzapine; I wanted to confer with Dr. Rojas first.
The Ativan calmed Mia down, and I left her in our bedroom on the pretense of doing work. Instead, I began mobilizing the troops. First, I texted Dr. Rojas. Then I sent an email to Luke, asking him to return as soon as possible. I also sent a group email updating both sides of the family. Finally, I contacted one of our closest friends in town. She could help with the kids.
Jamie came home from school first. She immediately knew that something was wrong, and I went into her room to speak with her alone.
“Remember last year when Mommy got sick?” I asked.
“Yes.”
“Well, it’s happening again. But her doctor and I, we’re really prepared this time. We know exactly what to do to help her. But it’s going to take time, so she might be acting a little strange over the next few days.”
Jamie lowered her eyes and her shoulders sagged, but she didn’t say anything.
“So, I wanted to give you a choice. You can stay home tonight, or you can go have a sleepover with Beth.” Beth was our friend’s daughter; she and Jamie were good friends.
Jamie sat for a few seconds, then responded, “I really want to be here for Mommy, but I think it will be easier for me at Beth’s house.”
“That’s okay.” I nodded. “They’ll be over to pick you up in an hour.” Then I gave her a hug, holding her a little longer than usual. “Don’t worry, Mommy is going to be fine.”
Will walked in the door shortly after, and I had a similar conversation with him. Surprisingly, he chose to stay home. “I want to be here for her,” he said. “If she’s sick and scared, maybe I can help.”
I smiled. “I’m sure having you around would be nice for her, but Mom might be acting really strange. I don’t want it to upset you.”
“I can handle it, Dad. Now that I know she’s going to be alright, it isn’t as scary as before.”
Dr. Rojas texted back later that afternoon:
I want to nip this in the bud
Let’s hit her hard with the Zyprexa
5 mg now, 10 mg more before bed
The thought of putting Mia back on olanzapine, or Zyprexa, as Dr. Rojas always referred to it, was depressing, but I knew there was no other choice.
Okay, I agree with that approach
His next text arrived before I even hit send:
Restoril 15 mg before bed
15 mg more if she wakes up
Ativan 2 mg before bed
Zyprexa 5 mg and Ativan 2 mg when she wakes up in the am
Do you have all the medications you need?
I confirmed that no prescriptions were needed.
Good, keep me updated
Don’t hesitate to call
I’m here for you both
With that, Will and I faced the night together with Mia. She wasn’t happy taking the olanzapine, but she could sense that something wasn’t right; she didn’t protest. I made her show me that she had swallowed the pills, then I locked all the medications back in the safe. We were falling too easily into familiar patterns.
I warmed up leftovers, and then we decided to watch a movie together. Will had never seen Father of the Bride, with Steve Martin, and I thought he would enjoy it. The three of us sat together on the couch, with Mia in the middle and Will and me on either side, holding her hands. Both of us went out of our way to act normal and calm.
Mia could sense our relaxed nature, and I think it helped. Her thoughts were obviously racing, but she desperately tried to sit still. About twenty minutes into the movie, she started asking about the characters in peculiar ways that made it clear she wasn’t following the plot. Will patiently and lovingly answered her questions. Before too long, she stopped talking. It might have been drowsiness from the olanzapine kicking in.
In the end, the night was a nonevent. Mia sat quiet
ly during most of the film while Will laughed nonstop. When it came time for bed, Mia and I went through our old ritual. I passed a paper cup full of pills to her, and she swallowed them without hesitation.
I slept lightly throughout the night, waking often to check on her. Every time I did, she was breathing heavily. She woke around 5:30 a.m., having slept over seven hours. It was an incredible victory. At the outset of the first crisis, it had taken much longer to slow down her brain.
She had no energy and wasn’t talkative. Without much interaction, I couldn’t ascertain how she was thinking. But she wasn’t psychotic, and that was reassuring. I gave her the morning medication and texted Dr. Rojas. He replied quickly:
Good. At noon, 5 mg Zyprexa and 2 mg Ativan
Keep me updated
Mia kept to herself, and I passed the time sending email updates to the family. I sent Luke a message letting him know that the crisis might have been averted, but he was already on a plane to Miami.
By 10:00 a.m., Mia had climbed back into bed for a nap. I was dumbfounded when I walked in and found her sleeping. I excitedly texted Dr. Rojas, ready to celebrate our victory. He was encouraged but remained adamant: I was to give her the additional medication at noon, even if I had to wake her to do it.
When the time arrived, I begrudgingly roused Mia from a stupor. I began with several small nudges and progressed to more-aggressive shoulder shakes. “Hey, Mia!” I resorted to shouting. “You need to wake up!”
Finally, I was able to pull her into a seated position; she was so drowsy that she couldn’t open her eyes. “I know you’re tired,” I pleaded, “but Dr. Rojas wants you to take these.” I held out the paper cup, but she wasn’t paying attention.
With much patience and prodding, I managed to give her the pills. She grunted periodically, but she never opened her eyes. She was like someone you might see in a movie who has overdosed on narcotics. It felt like instead of giving her more drugs, I should be pulling out an adrenaline shot. When she finished, I gently guided her head back to the pillow. She fell asleep instantly.
The battle never came. The olanzapine snuffed out any threat of psychosis, and all the medication left Mia blunted, weary, and slow. Luke showed up on Sunday but stayed for only a few days. Although Mia remained more paranoid than usual, she didn’t need someone watching over her. She mostly slept anyway.
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 23
