“I know,” he said in his calm and measured way, “but Pat, I have never seen anything like this.”
“Alright,” I said, gaining my composure, “but we have to ask ourselves the question, don’t we? Is this schizophrenia?”
Dr. Rojas didn’t hesitate. “Mia asked me that before, and you heard my answer. Schizophrenia doesn’t fit.”
“So, what is it? We need to find an answer!” I was raising my voice without realizing it, like if I demanded it loud enough, the solution might miraculously pop into his head.
“I have been through the DSM over and over again,” he said. “I have spoken to colleagues, conducted my own research. I do not have an answer for you.” He had referenced the DSM, that holy grail for psychiatrists. I had pored through the manual myself for years, all to no avail.
I wasn’t mad at Dr. Rojas, but I was beyond frustrated. In a steady list of psychiatrists, he was the one I trusted most. He had become more than a doctor; he was a friend. He had been with us the longest and had observed Mia through every phase of her trial. If he had reached a dead end, where could we go next?
“Dr. Rojas, there must be something we are missing,” I pleaded.
“You’re right,” he said, “but I can’t identify it. Believe me, Pat, if I had any thoughts, I would be sharing them.”
All I could see was Mia’s sedated face from that morning, her deadened eyes devoid of life. I couldn’t accept it; I couldn’t give up on her. A sudden idea struck me.
“Dr. Rojas,” I said, “if this were your wife, the person you loved most in the world, what would you do?”
He didn’t respond for a few moments. I could almost hear him thinking through the question on the other end of the line. “McLean,” he said finally. “I’d take her to McLean.”
“Okay, McLean it is,” I said, grasping at the confidence in his voice. After a slight pause, I felt silly asking, “What is McLean, exactly?”
“McLean is the mental health hospital affiliated with Harvard, up in Boston. It’s the best in the world. Find someone there who can see her, Pat. This is beyond my experience.”
“Great,” I said, feeling suddenly optimistic. “That’s exactly what we’ll do. But you’re with me on this, right? You’ll help?”
“Of course, anything you two need.”
I hung up with a new sense of hope. Even as the illness ravaged our lives for a third time, we had a new path to follow. I needed to believe a solution could be found; Mia needed me to believe it. And now we would be returning yet again to the place where everything had started.
Harvard had introduced us. Maybe it could save us, too.
19.
The Final Diagnosis
Bob Dylan
“Shelter from the Storm”
0:10–0:27
I was fired five months into my role at the investment firm in Sarasota. I wish that I had walked away of my own volition, but I didn’t.
I hadn’t failed at much before, and certainly not at a job. I was the employee whom people loved, the one they wanted to replicate. I created more value for companies than what they paid me. Firing me was a bad business decision, I always made sure of that. At least, I thought I did.
Although I was shocked while it was happening, I quickly discovered that my termination coincided with the firing of about half the staff. The firm, which I had assumed was healthy and profitable, was actually losing money fast. They had to cut salaries in an attempt to survive. Again, I derided myself for not having done more research on the business beforehand.
Thanks to our sale of internet stock, Mia and I could survive without the income for a while. At nights and on the weekends, I had been developing a few startup ideas. If one of them gained traction, I could slip smoothly into a new position at a company of my own.
Nevertheless, the fact that I was fired was a devastating blow. It threw me into an unusual funk. Naturally optimistic and happy, I became worried and disillusioned.
As the days turned into weeks, I found that not receiving a salary was crippling my self-esteem. Although we had money tucked away, a regular paycheck gave me comfort that I was providing for Mia and the kids. It proved that my hard work was worth something; it proved that I was worth something.
I tried to act confident around the family, pretending to be my normal upbeat self, but Mia knew me too well. Even though she didn’t make a big deal of it, she could tell that I was struggling.
One of my startups required overnight travel to New York City. Not only was I not being paid, but I was shelling out money to cover expenses. I felt guilty every time I went, like I was betraying the family’s trust. My faith was wavering; I was second-guessing my decisions. Was this trip really necessary? I asked myself as I checked into the hotel again.
I unzipped my overnight bag and noticed a little note on top of my clothes. The handwriting was Mia’s:
I love you now more than I ever have.
That was all it said, those nine words. But the weight behind them was extraordinary. By the way she had phrased it, I knew that she believed in me. She was proud that I was betting on myself, trying to make it happen for us.
It was a powerful and much-needed reminder—it didn’t matter if I was fired. It didn’t matter if any of my startup plans panned out. What mattered was that Mia and I had found each other and that we loved each other.
Knowing she had my back during those challenging times meant everything.
***
Shortly after my call with Dr. Rojas, I ran an internet search on McLean Hospital. Although it was affiliated with Harvard Medical School, it wasn’t located near the main Harvard campus. No wonder I wasn’t familiar with it. But the institution had been around for almost two hundred years, and it was known as one of the leading mental health centers in the world.
The McLean website offered pages on each of the major mental illnesses, and I found myself returning to the section on bipolar and schizophrenia. Both involved psychosis, and both had been discussed with Mia’s psychiatrists in the past.
I was already familiar with these diseases, although I knew more about bipolar than schizophrenia. The more I read about schizophrenia on the website, the more concerned I grew. Dr. Rojas was adamant that Mia didn’t suffer from it, but the McLean information had me second-guessing his conclusion. She had periodic bouts of psychotic thought disorder, that was for sure. And during an episode, she was quick to slip into paranoid delusions. Maybe she had a strange form of schizophrenia with only some of the symptoms?
Bipolar was far more common and sounded easier to manage. McLean offered several treatment options for both, including short- and long-term care programs. They were all pricey, even the shorter ones; they ran over $25,000 per week. I tried to put that out of my mind. I would focus on finding a solution and then worry about how to afford it.
My bigger concern was the voluntary nature of the programs. By this point, Mia probably would agree to a residential facility as long as it didn’t take her away from the kids for too long. But if she suffered a relapse during the program, she would definitely leave. Hopefully, McLean had solutions to deal with such contingencies.
I dialed the toll-free number listed on the page for bipolar and schizophrenia. A friendly woman answered, and I summarized our situation as succinctly as possible. She asked many questions about exact symptoms and medications. She found it telling that we had met with several psychiatrists, none of whom suggested schizophrenia as a diagnosis.
“One of the doctors,” she asked, “did mention bipolar as a potential cause, is that correct?”
“That is correct. Dr. Martinez, who spent time with Mia in the crisis center, thought that she showed signs of mania.”
“But she has never shown signs of depression?”
“Well, she did when she was taking the Prozac.”
“Right, you did
say that.” The woman paused. I was impressed with McLean already. I wasn’t sure if the person on the phone was a medical practitioner, but she was certainly investing the time to understand Mia’s illness in detail. “But at this time, with your current psychiatrist, you remain unsure about the proper diagnosis?”
“Yes. Dr. Rojas and I are looking for someone at McLean to offer another perspective.”
“Sir,” she said, as if she had reached a sudden conclusion, “you need to speak with someone at the Pavilion, McLean’s comprehensive diagnostic center. That’s where we direct patients whose symptoms do not tell a clear story. The practitioners there have seen all kinds of cases.”
A few moments later, I was talking with a woman named Cathy McCool. She cheerfully introduced herself as the director of admissions at the Pavilion. After about fifteen minutes of collecting information from me, she began telling me more about the center.
“For the most part, the Pavilion is a two-week residential treatment program. We are also self-pay, meaning that we will not accept insurance.”
“That’s okay,” I said. “I don’t think our insurance would cover it, anyway.”
“That’s unfortunate. Many patients are able to receive reimbursement from their insurance carriers. It is possible that the doctor will agree to consult with your current psychiatrist on an outpatient basis. That has happened before.”
“I want to do whatever will help my wife get better. If it means residential treatment, we’ll figure out how to afford it.”
“I understand, Mr. Dylan. To be clear, Dr. Vuckovic has to agree to take the case.”
“Oh?” I was surprised. “I thought as long as we agreed to the fee, we could be seen.”
“No, it doesn’t work that way,” she explained. “Dr. Vuckovic will only accept patients whom he believes he can help. You will need to send copies of all medical records pertaining to your wife’s illness, including your initial visit to the emergency room in Melbourne. Also, your current psychiatrist should provide a summary of your wife’s case in as much detail as possible.”
“Okay,” I said. Gathering all the materials would take some effort. “May I ask, though, what percent of cases does he accept?”
“I’m not sure I could answer that accurately. But if he thinks he can help, he will see your wife. Once we have received the information, you should hear back from him within two weeks.”
I hung up feeling hopeful and quickly googled Dr. Vuckovic. He was the medical director at the Pavilion and had been in that position for over ten years. He had spent his entire career working in mental health, most of it at McLean. He had a degree from Harvard Medical School, where he maintained a part-time appointment in the psychiatry department.
At that moment, I decided that Mia would see Dr. Vuckovic. I would do whatever it took—I wouldn’t stop until she met with him.
Dr. Rojas was my first call, and he echoed my excitement. He promised to begin working on his write-up immediately. I then started the long process of requesting medical records. It was easier to have them faxed directly to the Pavilion, but I wanted copies, too. This meant that additional forms had to be completed. The whole affair took weeks, given that Mia and I had seen so many doctors when she was sick, including not only multiple psychiatrists but emergency room doctors, primary care physicians, neurologists, gynecologists, and other specialists.
Finally, by the end of October, I had collected the last of Mia’s medical records and sent them off to McLean. I also received a copy of Dr. Rojas’s letter, which he sent directly to the Pavilion. After sending an email to Cathy, confirming that all materials had been delivered, I began waiting for Dr. Vuckovic’s answer.
It was impossible to guess the odds that he would take Mia’s case. I still didn’t know much about McLean, and I had never spoken to him directly. Cathy was as affable and helpful as possible, but what mattered was Dr. Vuckovic’s expertise. I bided my time, thinking up strategies for dealing with rejection.
Fortunately, these weren’t necessary. About a week later, Cathy called to share the good news that our case had been accepted, and the even better news that Dr. Vuckovic was willing to meet with Mia on an outpatient basis. In a long sequence of bad breaks, we finally had something to celebrate.
I still hadn’t broached the idea of going to McLean with Mia. On the phone with Cathy, I had scheduled our visit for early December; it was the closest date available on Dr. Vuckovic’s calendar. But Mia remained on heavy doses of olanzapine, and I wasn’t sure how she would react. Resisting the temptation to delay the discussion, I sat down with her that evening.
Rather than become upset, Mia responded positively. She was grateful that I had gone to the trouble of arranging the visit and, after reviewing the website and Dr. Vuckovic’s background, impressed with the Pavilion’s resources. She wasn’t enthusiastic, but I didn’t expect her to be. She was on too much medication to show excitement.
But I was ecstatic. I wrote my own letter to Dr. Vuckovic, thanking him for taking Mia’s case and providing my perspective of her disease. I focused on summarizing the pattern of the illness as I saw it. Hopefully, the more information he had, the more likely he could accurately diagnose the problem.
On an afternoon in early December, we caught a flight up to Boston. We were in the midst of titrating the olanzapine, but Dr. Rojas and I had agreed not to make any changes to the dose during the days leading up to our trip. Mia lacked energy but her personality was stable.
I had booked a hotel right on the Charles River, close to Harvard’s campus. You could see the red dome of Dunster House silhouetted against the bridges spanning the water. The weather was frigid that night, but I felt warm in the rich memories of the time that we had spent together in Cambridge.
Our appointment wasn’t until after lunch. McLean was a half-hour drive, and we arrived on the campus just before noon. It looked more like a collection of old houses and buildings than a hospital. Set back among barren trees in the dead of winter, the snowy fields probably became tranquil lawns of grass in the spring and summer. I was reminded of a well-endowed preparatory school.
We parked near the Wyman Building, where the Pavilion was located, and tracked through the cold to the central cafeteria. After a quiet lunch, we entered the front doors of the Wyman Building, a two-story brick mansion with white colonnades on the porch. Inside, the house was ancient but well maintained, with dark wood floors and intricate crown molding. The furniture and rugs were old, but the place had a quiet air of dignity. It reminded me of many of Harvard’s timeworn buildings.
Cathy, her kind smile reflecting the friendly voice with which I had become familiar, ushered us into a small waiting room on the second floor. We sat on wooden chairs, listening intently for voices leaking from the surrounding offices.
Soon, one of the doors opened and Dr. Vuckovic stepped out. I recognized him immediately, with his gray hair parted to the side and intelligent-looking glasses. He was wearing a dark suit and tie, and a serious but pleasant smile flashed across his face. “Mia?” he asked, and we stood up. “It is a pleasure to meet you.” He offered her an outstretched hand. “And you must be Pat?”
“Yes, sir,” I said, shaking his hand in turn. “Thank you so much for seeing us.”
“It’s my pleasure. I’d like to meet with Mia alone at first, if that’s okay with both of you?”
I looked at Mia, hoping that she wouldn’t be put off. Thankfully, she didn’t seem fazed. “Yes, of course,” I said.
“Thank you. I’d like you to join us in a while. If you could just wait here?”
“Sure.”
He led Mia into his office and shut the door behind them.
In the silence of that old house that reminded me so much of college, I began reminiscing about how Mia and I had met, about those early years: hearing George beg her for pizza on a Saturday night; catching sight of her dancing
across the room at my house formal; seeing her face light up with a surprised smile when I began my wedding toast in Spanish; watching her read a storybook aloud in our new Florida home, our small children snuggled on her lap.
But then those memories faded, replaced abruptly by different ones: Mia rambling incoherently about prison in the pitch dark of morning; berating a kindhearted nun for standing in a Sunday school classroom; battling the door of our lanai in a frantic attempt to escape; whipping confetti-torn pictures at me with malice etched across her face; crying uncontrollably on our front porch surrounded by first responders, red lights flashing in the background.
I snapped out of my ruminating and glanced around the room. How many other people had waited in my same chair, thinking about how their lives had been shattered by mental illness? Had the Pavilion been able to solve their mysteries, or did they still live with the devastation wreaked by their diseases? I could hear people on the first floor, the upbeat voice of Cathy greeting someone at the front door. It was a normal day at McLean; Mia was just another patient in a long line of suffering.
As much as I tried, I couldn’t hear what Dr. Vuckovic and Mia were discussing. What questions were being asked—the same ones that had been posed a thousand times already? I hoped that she was answering them truthfully, opening up to him the way she did to me. More than anything, I hoped he was uncovering some clue that had been overlooked, some insight that might unlock an answer.
After what seemed like an hour, Dr. Vuckovic opened the door. “Pat, would you care to join us now?”
I walked into his office, with its many bookcases and its large mahogany desk. Mia was seated in front of it, and I took my place in the chair next to her. He sat opposite us. Her medical records were spread out before him.
“I wanted to thank you for your letter, Pat,” Dr. Vuckovic started. “It was incredibly helpful.”
“Thank you,” I said, pleasantly surprised.
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 25
