Death Grip

by Matt Samet

  This is way hardcore.

  I cannot tell you how much Rik’s story frightens me, because it so resembles my own. I’m not paradoxical like Rik, but like him I am weak in a way I never imagined possible. Even during my most fearful moments in the mountains, those ill-advised free solos or sprinting from a raging lightning storm above treeline, I’ve never felt so close to death. Right now, a falling leaf could fell me. On bad days, I wish one would. I’m so low that I want to die. My brain is winding down like an old pocket watch; I’ve passed that threshold at which life itself becomes worse than dying, at which the urge to suicide becomes the only clear and logical choice. More than once I’ve begged my father to “let me go” so I can wander off quietly to end it. But another part of me, the small, impenetrable kernel that represents my will to live, slogs along on autopilot. So I keep peeling away the drugs in hopes of someday returning to my true self.

  Within two weeks I’m off Paxil and have halved my Ativan. Paxil is a terrible antidepressant to withdraw from, leaving you with tremors, hot flashes, nightmares, rebound depression, and strange, electric “brain zaps.” I pass my days on the duplex floor while Kasey is at work, kicking, sobbing, howling, and clutching Clyde. He’s a lively Plott hound puppy, but manifests in this burgeoning psychosis as loose skin draped over greening bones. All is corruption; all is death. To break up the hours, Clyde and I take short walks under pig-iron skies. We shamble through late-autumn sleet and sheets of grauple blown by a stern north wind, the tarmac oily-wet beneath our feet, the corn-flake smell of decaying leaves rising from the gutters. The days dawn bleak and drear and lightless, each worse than the last. One day I end up at Dr. Porridge’s office, and I tell him about the “Ashton Manual.” His response? One word: “Huh.” He expresses no interest in reading it, no interest in trying a switchover to Valium. Instead, he says that I’m at great risk now because I no longer have an antidepressant on board and that we must quickly find a solution. One drug he’s mentioned in the past is Remeron (mirtazapine), and I’ve found a forum post somewhere in which a man mentioned successfully using Remeron to get off Klonopin. I bring it up, and we agree to try yet another pill.

  Another good benzo site, bcnc.org.uk, didn’t exist in 2005, but if it had I might have found this tidbit from one author about adding in antidepressants during withdrawal: “From a personal point of view the only antidepressant that I would advise against is mirtazapine … I have noticed many people having horrendous symptoms, which seem to last an extremely long time after discontinuation of this drug.” For me, Remeron is the last straw: I lose what few moorings remain. I call my parents daily, hourly, but can only groan, sob, and plead into the phone in subverbal snippets. More floor time, more clutching at Clyde. “Desperate” does not even begin to describe the situation. I return after two days to the psychiatrist’s office, where he diagnoses more “mixed states” and urges me not to give up on this new drug, adding that perhaps we need to increase the Depakote. I am unable to form an opinion one way or the other. I simply can’t think. I can’t stand to be around anybody; I can’t stand to be alone. Kasey gives up: I’ve worn her out. She will break up with me over the phone two weeks later, and I can’t say I blame her. Finally my father flies out to collect me and bring me back to Johns Hopkins for my third and final hospitalization since September.

  CHAPTER 10

  Mountain men aren’t supposed to dwell on adornments, on minutiae: the cartoon tablecloth pilgrims, the grinning tom turkeys on Dixie plates, the orange fork-and-spoon sets, the chocolate-brown napkins. But mountain men do not spend Thanksgiving locked in psychiatric wards either. They should be in the Utah desert climbing red sandstone spires or parallel-sided fissures up blank panes of rock. They should be down at Hueco Tanks, auguring in on razor crimps, heel-hooking above their heads, hucking dynos for distant potholes. They should be in Las Vegas, climbing two-thousand-foot flying buttresses of Aztec sandstone. But not here at Johns Hopkins, not in some airless big-city hospital with nary a rock in sight, unless it’s been quarried for flagstone cladding.

  I look down at tablecloth pilgrims, push mashed potatoes around the plate, weep openly before the other patients. No one notices. No one says anything. No one cares. This is par for the course on a ward. Tears, bags under the eyes, screaming fits, aimless shuffling, manic bromides, panic attacks, muteness—business as usual on the fourth-floor “Affective Disorders” unit in Meyer Building at Hopkins. It is sundown, when my symptoms are strongest. My father and his girlfriend came by during visiting hours but then had a proper Thanksgiving dinner elsewhere to attend. They came; they saw; they went. I eat with my fellow mentals. I’m thirty-four, a mountain man given to long days solo above treeline, on granite aiguilles raked by wind and grauple. To ascending ropeless up thousand-foot inclines of sandstone, racing my stopwatch as sweat pours into my eyes with each ragged pant. To clinging to the overhanging underbellies of limestone caves, swarming toward daylight. I’m a “tough guy” with twenty-two years in the mountains, bawling over cartoon turkeys. The fake turkey on the plate is a not-alive turkey; he wears a pilgrim hat and smiles even as he holds the musket that will be used to kill him. He’s so cute, so happy and carefree, but he will soon be dead within his own cartoon universe. The turkey in my mouth is a dead turkey. A real dead turkey. Yanked from the coop, shipped off, and beheaded at some factory. Moist and easy to chew, but dead. I have killed them both. I have killed everyone. I have destroyed everything. I feel bottomless pity for myself and for anyone who’s ever known me. I am the world’s biggest fuckup.

  Another patient’s parents brought the feast in. I wipe away my tears and come back around long enough to thank them. Their son is Mark, a thin young man with dark hair: diagnosis, major depression. Mark sits rigidly in a plastic chair, adrift in a bizarre, sparkle-eyed catatonia while his mother tries to interest him in a flake of turkey. She gets it into his mouth; he chews automatically. When he speaks, which is rare, it’s in a disconnected robot voice. Anemic Maryland sleet spatters the hospital’s sealed, tinted, double-paned windows, dimming bruise hued with the day’s end. We’re in the dining area fifty feet—one-quarter of a ropelength—above the enclosed courtyard where the patients go to smoke. There’s a lot of that on wards: smokers. Nervous, aimless, idle, compulsive, yellow-toothed smokers. The fluorescents buzz overhead. Their harsh glare separates me even more from reality. It will be this way for years: Fluorescent-lit industrial spaces, grocery stores, gyms, and offices will foment going-over-the-waterfall feelings of derealization (the sense that your surroundings aren’t real; the world compressing into two dimensions and receding) and depersonalization (the feeling that you yourself aren’t real). When DP/DR comes on, I will have to grab a fold of skin and pinch hard to confirm my very existence.

  I cannot picture climbing again, I’m so amped with withdrawal and scared of just … being. The fear is with me—it is me—but outside me too. It often feels like some inchoate astral presence hurtles toward Earth, and all I can do is sit shivering, awaiting its arrival. It’s worse when I sit still, when I’m not distracted by group therapy or a nurse taking my blood pressure or conversation with other patients about our diagnoses, our meds, about what led to this point. There’s not much else to talk about on a psych ward, so you find this common ground. If I stop moving for more than five seconds the fear comes crashing down again. The worst thing is that it will never arrive; it is always traveling but never arriving, suspended in the air like that moment in a horror flick when the coed poises to pull back the shower curtain, looking for the killer.

  At Hopkins, we comprise a unit of twenty patients. The ward is shaped like a rectangular racetrack, the day area and nurses’ station at the center, the rooms leading off the halls. My first morning there, a psychiatry intern pulled a chair up to my bed and sat before me with his pen and notepad. I slumped against the wall, retelling my history. It took three hours. He and other staff then talked to my father, phoned my mother, my stepmother (my father’s ex-
wife), and my girlfriend to investigate any history of mania. I will give them that—Hopkins at least sorted out that I wasn’t bipolar. No one among my inner circle could recall a manic episode or even such tendencies. Soon they have a med plan: The Depakote will be replaced by lithium. Once I begin asking around, I’ll learn that almost everyone on the ward has been placed on lithium; it’s like the leis with which you’re garlanded at the Honolulu airport. A naturally occurring salt, lithium is an old-school, first-line treatment for bipolar disorder. It flattens you, neutralizes you, neuters your moods—it’s a chemical straitjacket, an agent of control to keep the inmates fat and docile, all in the same whatever-the-fuck-happens-is-fine mood. The pill makes me feel heavy-limbed and spacey, swaying to and fro with mal de débarquement, my hands fluttering with the shakes. I will taper it as soon as I’m back in Colorado. You can become toxic on lithium; dehydration or an increased dose can elevate your blood levels and land you in a coma, or worse. And climbers can’t always carry enough water with them up the rock. Later, my father and I will have a discharge meeting with the doctors and a social worker, and I’ll point out that I don’t want to be on lithium—that I can’t risk becoming toxic in the mountains.

  They push back, these Chesapeake flatlanders with no concept of anything higher than the Alleghenies. “Okay, Matt,” says the social worker. “Fair enough. You don’t want to be on lithium. But I don’t think you need to worry about toxicity if you can’t get out of bed in the first place.” I bite my tongue. I’ve gotten good at that. Another part of the plan is to taper me directly off Ativan, substituting the epilepsy drug Neurontin as an anxiolytic, slowly increasing the dosage as the benzo wanes. This will take about two weeks. Neurontin is the second drug I will shed back in Boulder, and its withdrawal will be horrendous. I will augur in, grit my teeth, and taper off 2,100 milligrams amidst three weeks of pain, horror, and ghastly hallucinations. Such will be my resolve. Neurontin’s generic name is gabapentin and, like Zyprexa, it has been the focus of prosecution for aggressive, illegal off-label marketing, in this case by Warner-Lambert, a division of Pfizer. The molecule, a GABA analog, is structurally similar to GABA, having been formulated to mimic the neurotransmitter, though it’s unclear if it works directly on GABA receptors. Neurontin will take the edge off, but also makes me dizzy and bleary, and I don’t like the 100-milligram capsules that float at the back of my throat and the 600-milligram horse pills that stick going down. I’ve never, believe it or not, cared for swallowing pills—at least not the physical act of it.

  The doctors also add the tricyclic antidepressant nortriptyline, which, they tell me, is useful in treating anxiety. “It has been very well studied,” one psychiatrist barks at me when I dare to question his selection. He’s younger than I am, in his late twenties, with a vaguely unctuous demeanor to match his outthrust jawline. Studies; doctors love their studies. Studies upon studies; studies that reverse earlier studies; studies in which the data is later shown to be flawed or manipulated; studies sponsored by drug companies; studies run by KOL doctors on the Big Pharma take; studies conducted with an outcome already in mind, in which the data and sampling are tailored to fit the predetermined conclusion; and studies that cite other, previous and possibly flawed studies, a mad game of research telephone. Studies: Turn on the news and there’s another damnable study telling you what to do with your life, and which pill to take for it. Doctors love studies, often more than they love actual patients. At Hopkins, outside five minutes each morning during rounds, I won’t speak with the doctors more than twice, and neither are there any therapists or psychologists to meet with individually. On the Affective Disorders unit, everything is treated as a chemical malfunction of the brain, the organ, and not a crisis of the mind, emotions, or soul. The doctors rush to and fro in their white coats devising chemical cocktails, but never stop to chat in the halls. Sad people, you can tell, make them uneasy. Messy, snotty, smelly, teary, gray-skinned sad people are, in corporeal form, best left to the nurses. Perhaps this brisk veneer of officialdom is necessary to lend their whole drug-and-shock circus medical legitimacy, to somehow elevate the black art of psychiatry from its ignominious roots of basement asylums, lobotomies, imprisonment, and torture. The contradiction is highlighted during morning rounds, when a half-dozen doctors, residents, and interns come to hover over my bed in a hyenas’ killing circle. Some look like they’re barely out of high school with their pink, newly minted skin. They ask me to rate my moods—anxiety, depression—on a scale from one to ten, as if I am telling them how badly a broken ankle hurts. I spit out numbers, lie still on my crinkly plastic mattress, and try to project a smile through my caul of pain, fear, and disorientation, undignified in my boxers and with my wan, winter torso bared to the assemblage.

  Each night as darkness descends over the Meyer Building, a cloak of smoggy, river-cooled air drapes the city and I enter the blackest hours—the insensate, cave-newt doll coiled unblinking at the matryoshka core. The hospital lights paint the other patients’ skin in cadaver green-whites; I shake as I push food around my dinner tray. When they glance at me, their eyes retract snail-like into bottoming sockets. Voices clamor and clash, a shambles of sound. Security guards saunter by, putting on their best swagger for the pretty nurses, blue blazer tails swaying, trailing a wake of testosterone. I’m eating starch, starch, starch, and my wastes smell like the cafeteria food. I am becoming the hospital, stale roll by stale roll, rubbery broccoli spear by rubbery broccoli spear. My dad brings in some items, gourmet crackers and chocolates. I share them with the other patients. The soap—even the shower soap—comes from wall dispensers, with a cloying odor of bleach and cotton candy. This viscous pink hand soap starts to seep into my skin, to merge with my cells and turn me into gelatin. Some nights the smog morphs into a lowering bank of halogen orange and a light snow spits, so I crack my window the prescribed half-centimeter, inhale the moisture, and recall that I was once alive in a meaningful way. That I was “a climber.”

  My father has lent me a digital radio and I listen to that. When it is off, I set it on the window ledge by photos of Kasey and Clyde, by my stuffed frog Smeech. I call Kasey each night but she doesn’t always answer, or when she does is usually walking somewhere, huffing into the phone, distracted, out with friends or leaving work, her boot heels clicking over the pavement. On a good night, I’ll get three hours of sleep. You don’t really sleep in a hospital—there’s always some to-do out in the hallway, nurses rushing about, cleaning people bantering, floor-waxers thrumming, lights eternally on, someone coming around to pester you about something. Because they’re monitoring my progress off Ativan via pulse rate and blood pressure, the nurses awaken me twice a night for vitals. This is a “medically safe” taper: As long as I’m not having seizures, then everything is hunky-dory. Sometimes a nurse will come in and find me hugging myself in bed, saying, “I love you, Matt. I love you,” because these are still words that a person needs to hear.

  Night terrors begin to penetrate my sleep, like when I was a child of ten. I wake up one night in a room red-orange with reflected street light and stand wordless before the blur of metal mirror in some primordial epoch when the earth shook with the tantrums of the gods. I do not recognize the man looking back. I can register only shock and disappointment smeared across his features, veins of white threading his hair, eyes burning like embers. My final dose of Ativan comes on December 4, 2005—almost seven years ago at the time of this writing. Two nights before that an ancient fear kicked me out of bed. I ran down the hall barefoot, groaning, wringing my hands. By the time I completed a half-lap around the ward I realized who and where I was, and slowed to a halt at the nurse’s station to ask for warm milk. The doctors will learn of the incident, will hold me an extra few days to “make sure you’re not running down the halls screaming anymore!” as the lead doctor says in a jokey tone. As if I amuse her, as if the fear that has destroyed my life is somehow funny to this woman.

  I pass the days shuffling to groups, obs
erving, cataloguing as a distraction to take my eyes off the clock where I must mark the hours until the next crumb of Ativan. There are the major-depressives, stents lewdly adangle from their arms and resembling bovine aortas, lined up on stretchers before the elevators as they await morning electroshock. Then the eating-disorder patients, IV machines their constant companions, curled into themselves in the dayroom chairs, downy-limbed, ethereal, dozing. One girl hugs a teddy bear, and you can tell that she’d be stunning if she gained forty pounds, or sixty. I’m starting to forget the words for things—at art therapy, I can’t distinguish a hammer from a saw on the pegboard. The doctors worry about me being “snowed under” by Neurontin, but I tell them to keep it coming because I’m apprehensive about how much worse I’d be without it. I feel the terror coiling in my gut like a snake. I always feel like I need to shit, whether that’s the case or not. They move us around in elevators, using a key to activate the lift, ascending and descending through the throat of the colossus. We go to the first floor twice a day for art therapy and cognitive-behavioral therapy. I construct a wooden key holder from a kit for my father and present it to him during visiting hours. He and his girlfriend are moving into a new house next to Patterson Park, and I hope they appreciate my gift. I can’t really tell; they do a good job of pretending. In exchange for however many thousands of dollars he’s paying, I can offer my father a key holder. One day another patient, a frail, waif-like woman, erupts during cognitive therapy. She has been receiving ECT, been hospitalized and shocked before, relapsed, whispers like a mouse, and rarely makes eye contact. The poor, poor woman: Her depression radiates off her like a fierce, almost holy aura. The psychologist, up there before the blackboard confident in her white Hopkins lab coat, is trying to goad the woman into answering some pointless question when the woman starts slamming her fists down on the table screaming, “It’s hopeless, hopeless, HOPELESS!” We always have cognitive therapy after lunch, at 1:00 P.M. At that time of day my hands go numb and the veins retreat into my arms, obscuring the roadmap of vasculature cultivated through years of climbing.