A Room with a Darker View

by Claire Phillips

  911

  My mother returned to New Jersey, apparently under the care of her psychiatrist, who would somehow get her back on track. I could only assume this to be the case, as I certainly avoided checking on her condition. Accustomed to distancing myself from my mother’s medical needs, I disassociated myself from the problem, answering her calls on occasion, periodically fantasizing about an unlikely recovery. Shortly before Christmas, I called my mother to discover she was no longer answering her phone. My mother always answered her phone. If she happened to be out, on her daily walk or running an errand, she would always call back promptly.

  Immediately I called my brother. This was how I learned that she had been committed to a nearby hospital. On my mother’s behalf, as he had done several times before, he had dialed 911. Whisked away by perfect strangers in the midst of a terrifying winter storm, my mother was once again confined to a psychiatric ward, alone, thousands of miles from her family, struggling in the face of a progressive illness without the comfort of a trusted doctor or a familiar face. Without family or close friends advocating on her behalf, I was not too sure she would come through this on her own.

  Cardiac unit

  Stunned, I began calling the distant hospital hoping to speak to her. What I discovered was alarming. No longer a psychiatric patient, after falling and hitting her head against hospital equipment, she was now a patient of the cardiac ward. Even worse, a doctor had yet to sign off on her medications. Two days without the right medication, and my mother was considerably worse. When I spoke to her, she was no longer sure of her whereabouts; it was clear how deeply confused she was. The Northeastern seaboard was blanketed by heavy snow that weekend: no doctor appeared to be on duty, ever, or at least was not reachable by phone. Voicemail messages were ignored. Several phone calls and two days later, I found someone willing to listen and take concerns about my mother’s medication seriously.

  A male nurse in the cardiac unit was willing to take on the arduous task of procuring a doctor’s approval for the correct dosage of my mother’s medication. I felt ashamed to be so far away. I wondered if my mother’s psychiatrist also felt ashamed for having botched her medical care. Is this why she had failed to call?

  When I finally reached my brother and asked him why he didn’t tell me where my mother was, he reacted: “Just let the system do its work.”

  Hospitals that begin with the letter “R”

  In a few days it was determined that my mother would need to be moved to another psychiatric facility. Either the hospital did not take psychiatric patients for long, or they did not accept her insurance. Whatever the reason, my mother would be sent to Ramapo Ridge, a private psychiatric hospital. My brother and I had no idea what to expect. We had not been asked our opinion on the matter and had no recourse. This was presumably the best nearby facility with a bed.

  It turned out to be a better facility than I could have hoped for. Overlooking tree-lined Sicomac Avenue, perched on several rolling acres, the small psychiatric facility was located in Wycoff, New Jersey, a wealthy suburb twenty miles outside of Manhattan. This was a Christian-run facility with both general adult and geriatric psychiatric care programs housed in one of several plain red brick buildings. A day after my mother had been deposited here, I arrived in the aftermath of an historic Mid-Atlantic Nor’easter that had blanketed the entire region in twenty inches of snow. The timing of this—the start of a new semester—couldn’t have been worse, personally. Teaching part-time at two art colleges while maintaining another position at a community college, I had little time to prepare for the new Cultural Studies course on the science fictional grotesque that I had proposed the semester before. I felt, however, that if I did not show up for my mother it was unlikely that she would receive adequate care. After arriving at Newark, I took a cab straight to the psychiatric facility, where I found my mother in her room strangely slumped on one of two twin beds. She had lost a considerable amount of weight already. Her hair was no longer brown but patchy and grey. Her facial features, once commanding, exotic even, were now stern and drawn.

  Though I suffer from an inordinate fear of medical facilities of most any kind, to my relief, the red brick facility was almost cheery. The walls painted in agreeable earth tones, the furnishings clean and new looking. Her room did not evince the tiny, cell-like room similar to where she was first committed when I was a young college student. However, like the psychiatric ward at UCLA, monitored doors and security locks prohibited patients from leaving at will, but at least the surrounding hallways and rooms were spacious and inviting.

  My mother’s main trouble at this point, beyond her psychosis, was the high blood pressure associated with the increased dosage of Seroquel.

  On the bed, curled up in a tight fetal position, my mother appeared either depressed or catatonic. Immediately, I worked to get her up and into a seated position. After being bed-ridden for the past week or two, she was fairly wobbly on her feet. But in a short time, she was able to take short walks with me throughout the ward. Being in my company seemed to help. In just a few hours, she had pulled out of a withdrawn and listless state.

  Dining room

  One of the first effects of a prolonged relapse is the loss of appetite. Before returning to the hotel that evening, I escorted my mother to the dining room, hoping to hustle up support for her among the young uniformed staff. Having spent time with her once, however briefly, during a stint in assisted living, I knew she would eat soft, white foods. I tried to inform a few of the staff members of my mother’s preferences when unwell: basically, gooey white substances like ice cream and oatmeal. Throughout the meal, I watched the staff’s interest in other patients take the form of small plastic bottles of orange juice or short cartons of chocolate milk, while my mother seemed to vanish inside the large institutional room. We take for granted being able to “put on a face,” how much a simple smile or clean brightly-colored sweater might afford us in our daily interactions. Withdrawal and apathy, symptoms of my mother’s illness, caused her to disappear in a hospital environment.

  At this one meal, I purposefully seated us at a table with two young women in their early twenties as much for my mother’s sake as for my own. The young college-aged women were friendly and unabashed about being in my company. This automatically dispelled some of my discomfort, the prejudice I had unwittingly developed about those who suffered from neurological disruptions. My mother, on the other hand, was not capable of much interaction. Before going to the dining room, she had confided in me a fear of being shunned.

  “They won’t want me there,” she said in a hushed voice. Numb to my mother’s lifelong challenges, I wasn’t entirely sympathetic, insisting she go anyway.

  “This place is really nice,” I ventured, making small talk.

  “Oh yes,” one of the college-aged girls wearing her hair in short braids, brightened, nibbling at a hamburger. “Compared to where we just came from, it’s a four-star hotel.”

  “I think it’s nicer than my apartment,” I confided ruefully of my dilapidated, 1920s bohemian courtyard apartment that I was desperate to jettison.

  The pair then launched into terrifying stories about a nearby state facility, where they had been confined before coming to Ramapo Ridge.

  “It was terrible,” the older of the two shuddered. “We were strapped down, and they yelled at us. There were no windows.”

  I had no reason to discount their story. This recently acquainted pair had just touched upon an unspoken fear of mine: that one day, my mother would end up in such a place, living out her final days in an environment of unmitigated filth and unbridled abuse.

  A difficult decision

  On the second day of my visit, my mother’s doctor arranged for a conference call with my brother to devise a strategy for my mother’s care. At 10 a.m. in a small room of the hospital, my mother, her psychiatrist, and I sat together at a large table, peering at a corporate multi-line phone on the table. Once my brother’s voice sounded from the
conference phone, the meeting began.

  “I think we should first try electroconvulsive therapy,” the doctor suggested. “We are getting very good results with ECT, and it won’t negatively affect your mother’s blood pressure like Seroquel.” As the doctor spoke, my mother lowered her gaze to the institutional blue sock-like slippers with the nonslip adhesive strips that she had been advised to wear.

  “That sounds like a good idea,” I chimed in. She continued to gaze downward, and shook her head no.

  I was baffled. “It’s much better than it used to be,” I tried to explain.

  “Yes,” her doctor said, speaking up for the improved use of this procedure substantially modified through the use of a brief pulse device.

  “No,” my mother refused. “I won’t.” I was crushed.

  Unfortunately she had developed a prejudice against ECT. This was understandable. Notoriously overpowering in the 1940s and 1950s when it first gained popularity in psychiatry, it has been portrayed as causing severe convulsions, fracture or displacement of bones in some cases, and memory loss and confusion. Its portrayal in the media as largely torturous, unnecessary, and barbaric, most memorably with the “shock shop” of Ken Kesey’s One Flew Over the Cuckoo’s Nest, along with the advent of pharmaceutical solutions, contributed to its waning use.14 My mother also perhaps retained a memory of its stigmatizing use when she had her first psychotic break in the late 1950s while studying for her college final exams. Today, electroconvulsive treatment (ECT) is touted as very much improved with far fewer side effects. I have heard stories of its positive use. A friend whose brother has suffered from severe bipolar disorder, often going off his meds with terrifying results—crashing his car into the side of a building, putting tens of thousands of dollars of debt on family credit cards—became stable only after undergoing ECT.

  That morning at Ramapo Ridge there was not much time for debate. Her fears or prejudices against this treatment ran too deep, so we moved on.

  Her doctor’s next suggestion was to try Zyprexa, “the latest antipsychotic.” Later I had to wonder what he meant by this, when he said it was a new drug, since the second-generation antipsychotic had been widely available since 1996.15 Was its newness the form of its dispensation?

  “This is a very easy drug to take,” he advised, producing a dissolvable, translucent blue strip similar in appearance to newfangled breath mints or mini Post-its.

  While my brother in Los Angeles listened in, the doctor demonstrated for my mother how to take Zyprexa.

  “Joy, you just place it on your tongue and let it dissolve.” Again my mother vetoed his suggestion.

  I felt let down by my mother’s behavior. Why was she so obdurate? I felt equally disturbed by her doctor’s suggestion that my mother place an unfamiliar blue object on her tongue. Was this the right tack to take with someone suffering from paranoid delusions? A few moments passed before my brother and the doctor agreed: the first course of action would be the Zyprexa. I felt utterly confused. Hadn’t my mother just said “no”?

  New to the vagaries of my mother’s healthcare, I kept silent. Later, when I talked with my brother privately, he explained the importance of establishing respect for the doctor’s decisions.

  “We don’t really have a choice,” he clarified. “Ultimately her healthcare is up to him, not us.”

  The patriarchy

  The next morning I awoke to news heralding another major New England blizzard, one on par with the Nor’easter that had paralyzed the entire metropolitan area just the previous week. This made finding a taxi to take me from my hotel to my mother’s hospital nearly impossible. From the moment the stout Russian cab driver ducked into the lobby of the Woodcliff Lake Hilton and trundled up to the front desk, half-covered in snow, I knew I was in trouble.

  “I’m not going back out there,” he announced gruffly to his friend behind the front desk. “Nothing will make me do it.”

  After a number of calls to several other car services, the front desk clerk finally found someone willing to drive me the short distance. Arriving late to the hospital that morning, I was just in time to discover that my mother had refused the new medication. Crestfallen, I did not display much patience.

  “Please, I’ve come all this way to help you,” I beseeched her to follow the doctor’s orders. “Do it for me. Just try it.”

  My mother’s pleasure in defying her doctor was undeniable. Her grin told me as much. This behavior took me back to my childhood when we lived together under the same roof in the suburbs of New Jersey, to a time when my mother would take regular pleasure in defying the simple household rules set by my father during the Carter years, when energy efficiency was a national objective. Joy, he would complain. Who put the heating up? She would lie about her wasteful energy use, I didn’t put up the heating—Claire did it, placing the blame on her twelve-year-old daughter, when we all knew she raised the thermostat by several degrees whenever she got out of the bath and felt cold.

  “He’s not a good doctor,” she complained to me about the Ramapo Ridge psychiatrist after refusing to take her morning Zyprexa. “He’s not as smart as he thinks he is.”

  “Great. Don’t listen to your doctor,” I chided unhappily. “Stay here in this hospital for the rest of time.”

  Yes, I knew that paranoia was a feature of my mother’s illness yet I couldn’t help but question her underlying motives. What precipitated her sense of superiority? Was her rebellion racially motivated? Did she lack respect for her doctor because he was Indian and not Jewish or Anglo like her previous doctors? Or was this a subconscious jab at her long-since-deceased father? Was she thumbing her nose at her doctor as a means for asserting herself against the patriarchy? Getting back at the world for her many terrifying losses? Or was she simply protecting herself from another inefficacious treatment?

  Increased dosage

  At this juncture, her doctor had no choice but to administer to her a sizeable dose of Seroquel: six hundred milligrams. To counterbalance my fears of a bad reaction, I spent the day shepherding my mother on short walks throughout the small hospital. Looking for distraction, we spent time in the community rooms. In the large sitting room, where windows opened out upon a wintry scene of snow-blanketed hills and mature oaks, there was an abundance of daylight. We sat together on a large couch stationed across from a huge flat-screen television. The loud TV—which was set to unsettling fare of unsolved true-crime murder mysteries—soon got on my nerves. A second community room, smaller and adjacent to the nursing station, attracted a more sophisticated set. The bright winter light was softer here, mitigated by white gauze curtains. On this quieter television, 1970s dramas starring Robert Redford played throughout the day.

  The room that held the most horror, we were to soon discover, was windowless and located at the far end of the ward. Somnambulant, prone geriatric patients were splayed in strange positions in long metal mobile contraptions. I warned my mother to steer clear of this particular room. I feared the private institution would keep her here, ad infinitum, thereby enriching themselves and draining her of the last of her precious Medicare days. We did not have long-term care insurance and were afraid the officials might deem this necessary for our mother should she not improve.

  During these short walks between wards and community rooms, I noticed my mother’s diminished physicality and concerning lack of balance. Her elastic-waist sweat pants, size “small,” were alarmingly baggy. Another fall was all but inevitable. This worried me, but no one I spoke with seemed too concerned. That day, I approached my mother’s social worker sitting behind the front central desk in the geriatric ward.

  “Can you get my mother some sort of help? She’s going to fall again if a nurse or someone doesn’t help her. I’m leaving for California tomorrow, and I won’t be able to return for another few weeks. She has no family here in New Jersey.”

  Carol, my mother’s social worker, assured me she would get a nurse’s aide to watch over my mother. Despite her cheerf
ul and affecting tone, I did not feel hopeful.

  That afternoon, wearied by the situation, I left several hours ahead of my scheduled flight. My excuse: the imminent monster snowstorm. The same brave man of Haitian descent who had shuttled me from the hotel to Ramapo Ridge earlier that day waited for me in his shiny black Cadillac in the short circular drive of the brick building. The storm had scaled down considerably. I was lucky. There were just snow flurries now on the highways as we drove a slow, cautious journey to Newark airport. Through the fogged-up window, I took note of the bridges, old foundries, the tall and abandoned brick tenements on the outskirts of Newark, mesmerized by the relics of America’s earlier industrialization, glad to be headed home.

  Brothel

  No sooner did I arrive in California, with its severe ongoing drought and unfathomably high temperatures, than my mother had a significant fall. I was beside myself. I had failed to prevent it. Whisked away to a nearby medical hospital, she was alone once again with no one to monitor her surroundings. According to her social worker, the high dosage of Seroquel she had been taking had caused her blood pressure to skyrocket, just as we feared. Lightheaded and dizzy, she had fallen down on the way to breakfast. After a discussion with my brother, who had already contacted the administration of Ramapo Ridge in order to get them to consider her condition more seriously, I called the hospital to speak to her.

  “Mom, are you okay?” I asked once I got through.

  “Yes. I think I am in a bottle.” Her voice was slurred. She almost sounded drunk.

  “What?” I could not follow. I tried to picture what might be happening. Had she just returned from an MRI? Was this what she meant? “You’re in a bottle?” I repeated back her words.

  “No,” she corrected me. “I’m in a brothel.”