by Mira T. Lee
She put it away, sighed.
“Do you really need to go?” asked Stefan.
They were eating dinner. Baked chicken with roasted potatoes and cauliflower. They had weekend plans. Tickets to a charity gala, for which he’d already rented a tux. His Grossmuti’s eightieth birthday party on Sunday.
“I’m sorry,” she said. “But if I don’t, I’m afraid they’ll let her out again.” She recalled the incident with Yonah. How he’d interfered. But then that last hospitalization in Westchester when he hadn’t dared, yet still Lucia had failed to be properly stabilized. She would not let it happen this time.
“For how long?” asked Stefan.
“I’m not sure. Maybe just a few days.” The words, escaped, an optimistic puff in the air. She knew already it was a lie.
The next morning, she selected an outfit. Her most flattering jeans. A charmeuse silk blouse. No, the red wool sweater. No, the collarless black blazer. Her cream-colored, double-breasted bouclé coat, pink cashmere scarf, black knee-high leather boots with stiletto heels.
“How do I look?” she asked.
Her husband whistled softly through his teeth. “Pretty hot,” he said.
She frowned. “Hot?”
“Okay, not hot. Stylish. Great. Slim?”
“Keep trying,” she said.
The correct answer: Authoritative. Fierce.
Stefan laughed. “Miranda, here, I almost forgot. . . .” He snapped open his satchel, pulled out two rectangular boxes, neatly wrapped.
“What’s this?” she asked.
“Chocolate. Swiss chocolate. Hospital food is the worst. Believe me, I know.”
“Oh, Stefan. Thank you.”
“I love you.” He brushed her lips with his. “Tell her I say hello, okay?”
She nodded.
She was stuck in the middle. A gangly German to her left. A fat American to her right. The fat American said hello and the “o” smelled like pepperoni. “Want one?” he said, waving two sticks of Slim Jims. She declined. He produced a tin of peppermints from his pocket. “Oh, just take one,” he said. “I’m trying to be polite.” She minded, yes, she did—that blubbery face, his squishy elbow bumping hers. She accepted, out of politeness.
She hated airplanes. Always, since her very first ride. She could still picture him, that pudgy gweilo seated next to Ma, vomiting into a paper bag. The smell, making her queasy, and that terrible sound. She clamped shut her ears, breathed through her mouth, while Ma stared straight ahead, unblinking. Ma had changed since Ba died. Her face seemed wooden, and she rarely showed her teeth when she smiled. Partway through the flight, a spotty brown hand protruded from between the headrests. Xiao hai, ni yao ma? The ayi behind them waved a roast pork bun. Queasy still, but oh, the aroma! Ma, I’m hungry. But Ma maintained her waxy stare. She took Miranda’s hand, placed it over her belly. Shh. Be quiet. Ma, pregnant. Full of Lucia, the size of a winter melon. I miss him, said Miranda. This whispered, meek, because it wasn’t quite the truth, because her father had been too much a mystery, because he worked all the time, because he reported to the government, deployed to strange locales, and when he did appear she never knew what to expect—whether he’d come bearing cherries or wine gums or a gold bracelet for Ma, swing her around and around in circles (higher, Ba! higher!), or grunt and lock himself in the bedroom (don’t bother him, Nu-er, your Ba needs to be alone). The last year, he’d mostly disappeared, and they’d moved from their small city apartment into her grandparents’ house, and Ma and Po-Po had fought all the time. Until the day Ba died. Ma had woken her early in the morning, dressed all in black. A car accident, she said, and no one said more. Ma and Po-Po stopped fighting. They stopped speaking to each other altogether. And now she and Ma were by themselves, riding on an airplane to America.
Still, she thought it was the correct thing to say: Ma, I miss Ba.
Ma turned to her, still rubbing her hand on her belly. Shh, Nu-er, don’t be stupid. That gweilo vomited six more times.
Miranda’s cheeks flushed. She would not refer to her father again, and later, much later, when Lucia asked, the answer was the same: Your father died in a car accident. And Ma’s lips would press into a thin, red line.
Charo Alvarez, social worker, was young, ambitious, new to the unit, determined to prove her worth. She disliked the sister immediately, found her pushy and abrasive. This job was about managing expectations.
“Did you read the notes I faxed over?” asked Miranda.
“We’ve had an extremely busy morning,” said Charo.
Miranda bit her lip. She had been polite last time. With that German doctor, the Ostrich. She’d stepped aside and waited patiently for the updates from the nurses, for Lucia to accept the medication, for the professionals to do their jobs.
“I read them,” said Nurse Bob. He held up the sheaf of papers. Lucia Bok. Three previous hospitalizations. Disparate diagnoses. Schizophrenia. Schizoaffective disorder. Bipolar with psychotic features. The notes were meticulous, included a detailed list of all previous medications as well as explanations of their outcomes. Haldol caused her to shake. Cogentin blurred her vision. Zyprexa, 15 mg, clears her up quickly. Dislikes side effects. Abilify and Seroquel give her migraines. Risperdal, questionable effectiveness.
“I remember you,” said Miranda. “You were around last time when she was in that ward downstairs, with that German doctor. I know you tried to keep her.”
Bob remembered, too. Miranda Bok had inundated Hobart Five with an unprecedented number of messages—phone calls, faxes, e-mails, letters—begging them to keep Lucy until she’d fully stabilized. But Lucy had been released. If a patient posed no immediate threat, they had no choice.
“Are you trying the Zyprexa?” asked Miranda.
“She’s refused it. Says it knocks her out, doesn’t like the weight gain.”
“She’s not entering a beauty pageant, for God’s sake.”
“The treatment team wants to try Abilify,” said Charo.
“Abilify? No. She won’t stay on it. It gives her headaches. It’s in the note I faxed you.” Miranda angled her body to face Nurse Bob. “I’d like to speak with the doctor about filing a medication over objection order. I know it can take awhile.”
“Well, that’s not possible,” said Charo. “Such orders are only used as a last resort.”
“I know that,” said Miranda. “But Lucia is stubborn. And she has a baby now. This time she has a baby.”
“The team makes the decisions,” said Charo. “Dr. O’Hara is aware of the situation with the baby.”
“Then you can tell him that if he lets her out and anything happens to that baby, I’ll sue him and this entire hospital,” said Miranda.
Charo glared at Nurse Bob.
“Well, a court order is a bit premature,” said Bob. “It’s usually best if they come to terms with the meds on their own.”
“Part of managing their own illness,” added Charo. She folded her arms across her chest.
“I’d like to speak with the doctor,” said Miranda.
“Dr. O’Hara is very busy,” said Charo. “He’s only here in the mornings, and then he’s busy seeing patients.”
Busy. Miranda was used to this, socials shielding the docs, running interference. “Nurse Bob, please, my sister is stubborn, but once she’s back on her meds, she’ll be fine. The meds really work for her. She has insight. Properly stabilized, she’ll be fine.” She kept repeating it, as if unaware she spoke the words aloud: She’ll be fine.
“Your sister’s lucky then,” said Nurse Bob.
“Lucky?”
“Sure. For some people, the meds never work.”
“I haven’t been able to get in touch with the husband,” said Charo. She had tried Manuel at the house number several times, but no one answered.
“Boyfriend,” corrected Miranda. �
��I think we should leave him out of it.”
“Why is that? Is he abusive?”
“No, no.”
“Negligent?”
“No.”
“Is he employed?” asked Charo.
“Yes. But he’s . . .” Miranda had no interest in involving Manny. He was young and immature and scared as hell, no doubt. Who wouldn’t be? She fished for the right word. “. . . uneducated. About her condition, that is. He doesn’t know about her illness or her history, and their relationship is . . .”
Charo’s eyebrows arched.
“Delicate. And he’s so busy working, taking care of the baby.” That was true, too. A baby, crying all night, tested the most committed of mothers; what could be expected from a young, single male?
“But surely he should know what’s going on?” said Charo. “She is the mother of his child.”
“I don’t see how it’s necessary to involve him, at least while she’s in here,” said Miranda.
“I suppose so,” said Nurse Bob.
Charo chafed. She didn’t buy Miranda Bok’s sudden sympathy for some young Latino kid. She would make recommendations to the team as she saw fit.
“Maybe when she starts clearing up on the meds,” Bob added.
When, not if. Miranda forced a smile.
Nurse Bob liked Miranda Bok. He liked her energy. He liked that she still had the fight. Too many family members came through the ward already wrung out by the system, slumped in their chairs, panning the room with dull eyes. No opinions, no hope, no fight.
“You sure you’re not hungry?” said Nurse Bob.
Once again, Lucy had flatly refused her morning meds. Now she was refusing her lunch. She’d even refused the chocolates her sister had brought, donated them to the nursing station.
“You need to eat,” said Miranda. “You’re so thin, Lucia.”
“Well, I am hungry. But this is probably drugged.” Two triangles of tuna sandwich sat on Lucy’s tray, untouched. The only food she’d consumed in four days came from sealed packages: three cartons of milk, three fruit cups, one bite of Saltine cracker, which she immediately spat out, claiming it tasted like mushrooms.
“They wouldn’t drug your food,” said Miranda.
“I slept for two days,” said Lucy. “It was Friday, and then, poof . . .” She snapped her fingers. “It was Sunday. Two days disappeared, like that. I was drugged.”
Miranda opened her mouth. Closed it. Recalled the 25 Tips.
6. Listen. Empathize.
“That was the Haldol,” said Nurse Bob. “Administered for your symptoms, and to help you sleep. I gave it to you. It wasn’t in your food.”
“Help me?” said Lucy. “I had a seizure. I went blind.”
“Those were unfortunate side effects. I’m sorry.” Bob felt awful. It had been listed in the notes.
“You see?” Lucy glared at Miranda. “I’m not making it up.”
“Maybe your sister could bring you some food,” said Bob.
“Of course,” said Miranda, who perked up at the thought of being of practical use. “Is there something you’d like?”
“Well . . .” Lucy cocked her head to one side. “I suppose . . . sure. King crab legs. I could eat king crab legs.”
“Crab legs? Did someone say crab legs?” Loco Coco called from her armchair by the wall of windows. She liked sitting near the potted plants—mostly spiders, jades, ficuses in plastic yellow buckets—the extra oxygen helped her asthma. “Who’s got king crab legs?”
“My sister,” said Lucy.
Coco shuffled over, dodging Big Juan Lopez’s swinging paddle. Crote Six’s Ping-Pong champion had just crushed one of the depressives. A new admit was next on the list.
“Sister. You ain’t twins, are you, sister?” Coco snapped her gum.
“No,” said Miranda.
“Me and Lucy here, we’re like twins.”
Lucy twisted her neck from side to side, showing off the pigtails Coco had braided for her.
“And I love Lucy.” Loco Coco cackled. “I Love Lucy. Get it?”
“Yup,” said Lucy.
“And you’re bringing us king crab legs.”
Nurse Bob watched the annoyance brew on Miranda’s face. She exhaled slowly, drained it away. “King crab legs it is,” she said.
“From the Golden Duck,” said Lucy.
“Golden Duck?” called Big Juan. He set down his paddle. “Mu-shu pork, please.”
“Mu-shu pork, got that?” said Lucy.
“Sesame chicken,” said Hulk, the three-hundred-pound addict whose nickname derived from a tendency toward belligerence on the days he wore green.
A small crowd gathered. Scallion pancakes. Hot and sour soup. General Tso’s chicken. Buddha’s delight. Miranda pulled out an old shopping receipt from her leather handbag, flipped it over to jot down notes. Nurse Bob, pleased with the unit’s sudden jovial mood, went to fetch Lucy’s meds from the dispensary.
“The sooner you take this, the sooner we get you out of here.” He offered her the small white pill.
Lucy’s face clouded. She folded her arms, closed her eyes. “My body is my temple,” she said.
“Don’t mess with the temple,” said Loco Coco. She stroked Lucy’s hair.
“But the pills help you,” said Miranda.
Lucy’s eyes snapped open. “You. Don’t you talk to me about pills. You and your Swiss doctor with your Swiss telepathy, putting me in this prison.”
“Oh, Lucia. This isn’t a prison. And I haven’t even been in the country . . .”
“Oh, Lucia. Oh, Lucia. You think I’m crazy? You’re the crazy one. You’re PSYCHO crazy, putting me in here again.”
“I didn’t.”
“What kind of person does that?” Lucy’s voice rose to a squeak. “What kind of person locks up a woman who just GAVE BIRTH?”
“Lucia, please, all I want is for you to get better, so you can take care of . . .”
Nurse Bob found himself holding his breath.
“Esperanza.”
“Es-per-an-za? So you know her name now? Essy is my baby. Not theirs. Not YOURS. YOU ordered it. You put me in prison.”
“I didn’t even know you were here until they . . .”
“They. THEY. You and the military strategists put me in this disgusting lockbox.”
“Hey, come on, let’s calm down,” said Nurse Bob. He placed his hand gently on Lucy’s arm.
“Calm down? Or what? You’re gonna stick me with another needle?”
“Come on, baby,” said Loco Coco. “I’m watching out for you. Everything’s gonna be okay.”
“Lucia, please . . .” said Miranda.
Lucy clamped her hands over her ears, squeezed shut her eyes. “LA-LA-LA-LA-LA-LA-LA,” she belted, like a petulant child. She gestured with her chin in Miranda’s general direction. “HER. GO. AWAY.”
A delusion will not go away by reasoning and therefore needs no discussion.
Coco laughed, her high-pitched laugh.
• • •
“Don’t take it personally,” said Nurse Bob.
“But I don’t understand,” said Miranda. “I just don’t understand why it’s so hard for her to take those fucking pills.”
Bob sighed. It was the million-dollar question. Why? Anosognosia. Impaired awareness of illness, also termed “lack of insight.” Some part of the brain, anatomically damaged, such that it could no longer recognize its own malfunctioning. It wasn’t an easy concept to grasp.
“How about this,” he said. “What if I were to tell you, right now, that you don’t live where you live? That your house isn’t your house. You’d probably laugh and tell me to stop messing around. But then imagine you went home, only to be arrested by the police. The nice people at your address didn’t want to press charge
s, so the police brought you to the ER, where a doctor insisted you take psychiatric drugs for your ‘delusion’ that you live where you know you live. Would you listen? Would you take the meds? Right now?”
Miranda shook her head.
“Of course not. Because you know who you are and where you live.”
“Sure.”
“But so does someone with a psychotic delusion. It’s that real.”
There were other reasons, too. Meds didn’t necessarily revert a person to normalcy, though they might mute the symptoms. Some patients grew attached to their delusions, some ditched the meds as soon as they felt better, and the nasty side effects were for real. Blunted emotions, drowsiness, nausea, tremors, decreased sex drive, high cholesterol and diabetes, and weight gain, which especially devastated young women. “And then there’s the stigma. High-functioning young woman like your sister, whole life ahead of her? She has her pride,” said Nurse Bob. “So denial is understandable, too. Right?”
“But she can’t even function now,” said Miranda.
“That may be our opinion, but what if she doesn’t see it that way?” Bob could see Miranda Bok struggling, still confused.
• • •
That evening, she called her husband in Switzerland.
“She hates me.”
“Schätzli, what’s going on?” It was two in the morning there. She could hear him yawn. “She doesn’t hate you.”
“Oh, yes, she does.”
“She’s just angry.”
“At what?”
“Think about it. Wouldn’t you be?”
It was true, anger and hatred were not the same, but Miranda often had difficulty distinguishing between the two.
“Were you sleeping?”
“I was sleeping.”
“Sorry.”
“It’s okay.”
“What’s been going on? Anything new?” She wanted to listen, to bring her mind to a different place.
“I heard a good joke yesterday. What do testes and prostates have in common?”
“What?”
“Nothing. There’s actually a vas deferens between the two.”
She groaned.