Following her directions, we enter a brightly painted wing, strips of yellow crepe paper strung across the ceiling, Berenstain Bears cavorting on the walls. Pediatric ER.
We find an examination room and sit tight, Sally curled up on the padded table, her head in Pat’s lap, as if trying to endure the fibrillation of her brain without imploding. Afraid. Frayed. Why are you so a-frayed? she keeps asking. I repeatedly tell her I’m not afraid. Then the logic of her insistence dawns on me: she wants me to be afraid for her. I am custodian for the terror that the hollow exuberance of her mania won’t allow her to feel. This exuberance, I begin to understand, is the opposite of the truth. She is beleaguered by certitude because she is certain of nothing. She thinks she’s eloquent, when she can’t put together a coherent sentence. She demands control because, in some interstice of her psyche, she knows she is hurtling out of control.
This realization brings me closer to her. I can’t witness her disintegrations without somehow taking part in them, and, closing my eyes, I feel myself racing too, as if her flutter has lodged inside me. “I feel like I’m traveling and traveling with nowhere to go back to,” she says in an almost casual whisper. Pat whispers something in return, gently stroking her hair. The gesture seems to soothe the agitated solitariness that, it’s increasingly clear, is her chief terror. Sally’s need to feel understood is like one’s need for air. (Isn’t this everyone’s struggle? To recruit others to our version of reality? To persuade? To be seen for what we think we are?) I envy Pat’s ability to make her temporarily believe she has penetrated her mind, but I couldn’t do it myself. I don’t want to enter her world, I want to yank her back into mine.
A very young doctor peeks in, talks with us for about fifteen seconds, and rushes off. “I’ve paged the psychiatric resident. She’s on her way over.”
Another forty minutes drag by. Pasty light pours down from long tubes in the ceiling. The protective paper on the examination table is shredded from Sally’s tossing.
The psychiatric resident arrives: short, early thirties, her eyeglasses held together with tape. She politely asks us to leave so she can interview Sally in private.
After five minutes she emerges and leads me to a tiny windowless room, a supply closet really, crammed with IV bags, exam gloves, sterile pads, soap refills…We sit facing each other on folding chairs, our knees almost touching.
When did I first notice Sally was acting strangely? I tell her about her recent insomniac nights, her poem about “the great breath of hell,” and the kicked garbage can yesterday morning. “She wasn’t incoherent yet, you understand.” And then, uncomfortably aware of how unobservant I must sound: “I have a high tolerance for aberrant behavior, I suppose.” I immediately regret that statement too. My every utterance, I fear, will incriminate me further. But for what crime exactly?
“It’s not unusual,” says the resident, “for this kind of illness to break very suddenly into the open like a fever. When it happens, it’s shocking, I can imagine how you must feel.” I give her a grateful look, but our physical proximity makes eye contact awkward. “Sally’s condition has probably been building for a while, gathering strength until it just overwhelmed her.”
When I ask what this “condition” is, she gives a pallid smile. “What we call Sally’s disease is not what’s important right now. Certainly many of the criteria for bipolar 1 are here. But fifteen is relatively early for fulminating mania to present itself. What I do know is your daughter is very ill. I strongly recommend she be admitted so she can get the treatment she needs.”
“To the psych ward?”
She nods curtly and I immediately feel myself balking. Despite mounting evidence to the contrary, I’ve had my heart set on a last-minute reprieve. My first line of defense, drugs, has crumbled, but why not a rare metabolic disorder, like King George’s porphyria, that could be routed by a strict dietary regime? Or a glandular imbalance, the chaos of conversion that marks a girl’s fifteenth year? To hear the actual verdict is crushing. But how final is it? How can she accurately make such a judgment about Sally in the space of five minutes, as if she were diagnosing a case of strep throat or bronchitis?
The resident excuses herself and returns a few seconds later with a sheaf of photocopied papers, which she hands to me.
“Since your daughter is under eighteen we’ll need your consent to admit her.”
She unclips a pen from her side pocket—“Risperdal” it says, the latest antipsychotic medication—and hands that to me too.
Each page is marked with an X where I am to sign my name. But if I do what will it mean? I can’t conceive of Sally as a mental patient; my mind refuses to accept it. I have an idea of the treatment she’ll undergo—a powerful narcoleptic cocktail, chemotherapy of the brain. I’ve seen the result of this cocktail, we all have. I can’t imagine Sally being blunted like that: staring at the world from behind a scratched shield of plastic, the bulletproof kind you see in liquor stores and cabs.
“Give me a minute, Doctor.”
“Take all the time you need.”
I return to the examination room to talk it over with Pat, still hoping to figure out a way to take Sally home. A nurse is drawing her blood. When she removes the needle a single drop falls on Sally’s dress: an oblong crimson stain. “Look what you’ve done! Clean this up! Clean it off me! Now!” She pushes the hem of her dress under the nurse’s nose, evidence of her heinous crime. Her expression is homicidal, as if this blood were a smear of shit corrupting everything she’s been crusading for, her purity, her vision, instantly defiled. She is trembling wildly. What Sally has been experiencing, I realize, is a fragile and horrendous triumph over doubt, and this stain somehow has brought this “triumph” into question. It’s the crash to come, the worm in her rose, threatening her florid bloom. And Sally won’t have it.
“Get it off me!” she cries as if her life depends on it.
“Clean it yourself, sweetheart,” says the nurse. Unfazed, she drops a tube of Sally’s blood in her pocket and walks out the door.
Pat removes a paper towel from the metal dispenser on the wall, wets it, and rubs at the stain, thickening it into a pale watery blob.
Sally continues screaming.
I snap at her to shut up.
Pat raises her head, questioning, frazzled. What do we do now?
Sally looks at me for a split second as if she doesn’t know who I am. Then, without warning, her voice goes soft and operatically tragic. With broad, exaggerated strokes she caresses my cheek with the back of her hand. “Poor, poor Father. Trying to get back your lost genius. When all you had to do was come to me. It was right here, under your nose.” And she bursts into tears.
Accepting the truth, I complete the consent forms and thank the resident for bearing with me. No problem, she says. Just give the administrator your insurance card.
My insurance card. In the upheavals of the day I had avoided thinking about this detail: Pat recently left her teaching job and our insurance has lapsed. With no apparent catastrophe on the horizon (didn’t we know catastrophe is always on the horizon?), we have been shopping for a provider for months. On a shelf in our apartment a pile of benefit booklets is gathering dust.
“No coverage? Nothing?” asks the administrator.
I turn to the resident. “Whatever the bill comes to, I’ll pay it. I give you my word.”
“Apparently your word is all you can give me.”
She half turns from me, shivers slightly, and confers with another resident: male, also young. I feel like a fish wrapped in yesterday’s want ads as he looks me over. I repeat my vow—I’ll pay every penny—with stentorian sincerity this time. I hold their eyes: I’m a stand-up guy, a good father who happened to get caught in a temporary insurance gap…
She snaps the Risperdal pen, signs the forms, and, with an audible intake of breath, walks briskly away.
The ambulance is waiting, an unnecessary extravagance. Pat and I could easily take Sally in a cab to the psychi
atric clinic ten blocks away. Now that she is officially a patient, however, standard procedure kicks in. (Add five hundred bucks to my tab.)
While the paramedics strap her to the gurney, Sally races on about her epiphanies, the piercing nature of light, the lightness of light, the genius in us all…
The medics lift the gurney into the ambulance and lock it down. Mummy-strapped, staring at the roof of the van, she is festive and reassured. Pat and I climb in after her. It’s 2:14 A.M. The street is so still I can hear the East River, about a hundred feet away, rushing against the concrete embankment. The doors swing shut.
We glide cozily over the deserted East Side streets, no siren, no traffic laws, a thick moonless night. The ambulance pulls up at an undistinguished white brick building, squeezed between two similar 1960s eyesores. The building jogs my memory: I have the odd sense that I’ve been here before, but I can’t place when or why.
On the fifth floor we’re passed through two solid steel doors, each with a tiny rectangular eye slit. A double-locked ward.
A skeletal night crew is on duty, all female, a tight cabal. Ignoring Pat and me, they instantly take possession of Sally. They have the drill down to the minutest detail. Physical contact: minimal. Tone: brusque, commanding, but not unkind. Any authority I may have had is annulled; she belongs to them now. If the resident’s tendency was to exonerate us for Sally’s illness on biomedical grounds, the nurses seem to view us as vectors of instability: parental failures at best, at worst suspects for mental illness ourselves. My anxious, competing claim over Sally clearly annoys them. As far as they’re concerned, the sooner we get out of their ward, the better they’ll be able to do their job.
They usher Sally into a tiny shoebox of a room. A gated window, disproportionately large, looms over a narrow bed: a surrealist painting in which the dream is enormous, the dreamer inconsequentially small. I start to follow them into the room, when one of the nurses bars me with an unequivocal gesture and shuts the door. I am reminded of my stint, some years ago, as a Spanish–English interpreter at Manhattan Criminal Court. When the officers took custody of a remanded defendant, they did so with a peculiar solicitude very much like that of these nurses: careful not to damage what they have no particular feeling for.
Pat and I wait uselessly in the hallway. The place is quiet, dozens of patients sleeping their medicated sleep behind rows of beige doors. On the wall near the nurse’s station hangs an erasable white board with patients’ privileges posted on it. D can go out to smoke (Level 3). R can eat at a restaurant with a visiting relative (Level 5). M is under twenty-four-hour surveillance. The video tomorrow will be A Fish Called Wanda.
Sally emerges from her room in a thin hospital gown, snap buttons, no laces or ties. She suddenly looks ageless. The only other time I’ve seen her in a hospital was the night she was born. By that point in our marriage her mother and I were like two people drinking alone in a bar. Not hostile, just miles apart. Yet when Sally appeared a huge optimism came over us, a physical optimism, primitive and momentarily blind. She was her own truth, complete to herself, so beautifully formed that the jaded maternity nurses marveled at what perfection had just slid into the world.
Though she has never set foot in a psychiatric hospital, there is the tacit sense from Sally that these women understand her, she is where she belongs. She acts as if a great burden has been lifted from her. At the same time she is more elevated than ever: feral, glitter-eyed. In 1855 a friend of Robert Schumann observed him at the piano in an asylum near Bonn: “like a machine whose springs are broken, but which still tries to work, jerking convulsively.” Sally appears to be heading toward this maimed point of perpetual motion. Her sole concern is to get her pen back, which has been confiscated with most of her other belongings—belt, matches, shoelaces, keys, anything with glass, and her comb with half its teeth snapped off by her potent hair. She initiates an agitated negotiation with the nurses which immediately threatens to boil over into a serious scene. The nurses confer like referees after a disputed call. Then they grant her a felt-tip marker and march her back to her room.
With assurances that we’ll be permitted to visit her tomorrow, they give us the bum’s rush through the double-locked doors.
In the lobby, I again experience the sensation of having been in this building before, but the memory squirts away before I can grasp it.
Back at Bank Street the air conditioner won’t work: I forgot to buy fuses. Pat undresses, lies down on our bed. I lie down beside her, close my eyes, then immediately sit up, my blood pounding.
Wide awake, I go into the living room. The apartment feels like the shadow of a home, provisional, funky, bearing the merest imprint of our lives. The windows are rotted; last winter one of the panes fell out like a bad tooth, narrowly missing a man who was dropping his clothes off at the laundromat five flights below. After discovering the wood was too decrepit to accept glazing putty, I reinforced each pane with duct tape. The place is literally bandaged.
Our tenancy is just as precarious. In exchange for my below-market rent, I fulfill various duties for the building’s owner, such as keeping an eye out for boiler breakdowns and appearing at city agencies in response to code violations or overdue tax bills. I am forbidden to substantially improve the apartment or even to introduce a few new sticks of furniture—the owner’s theory being that to do so might cause us to start thinking of it as our permanent home. He’s a friend from high school, the owner, and our Byzantine housing arrangement is the kind that New York is famous for—antiregulatory in spirit rather than outright illegal. The price of my freelancer’s ticket. But at what price to Sally? I have done a poor job of concealing my anxieties, living at the whim of a man who can, by our own agreement, evict us tomorrow.
Surely she has internalized this instability at the very center of our lives.
I keep picturing her in the hospital, in that gown, gripping the felt-tip pen she fought for. The resident was right, we didn’t have a choice. Yet I can’t stop thinking of her as a prisoner on that locked ward, where I put her.
James Joyce’s daughter Lucia once told him that the reason she was mentally ill was that he had given her no morale. “How can I give you something I don’t have myself?” was Joyce’s mournful reply. Lucia had been variously diagnosed with schizophrenia and rapid cycling mania, but Joyce insisted that her mental distortions were nothing more than the growing pains of a gifted girl. With a gullibility that may be interpreted as an attempt to protect them both from the truth, he accepted whatever she told him at face value, once going so far as to ban every male visitor from his home because Lucia accused them—all of them—of trying to seduce her.
One day at the Gare du Nord in Paris it became impossible to continue ignoring that something was seriously wrong. With their bags already loaded onto the train, Lucia launched into an unprovoked tantrum, screaming at the top of her lungs for forty-five minutes while her parents looked helplessly on. Shortly after, at a party in her honor, she collapsed on a sofa, where she remained for days, open-eyed and catatonic. She threw furniture at her mother, Nora, the main recipient of her wrath. She sent telegrams to dead people, lit her room on fire, and would disappear into the streets for days.
Joyce was merciless in blaming himself for her troubles. Lucia, he believed, was the victim of his monomaniacal existence. He had dragged her around Europe, living in a succession of tiny apartments and hotels, turning her into a woman without language or settled home—a rootless, polyglot soul. A feature of her psychosis was a penchant for speaking in neologisms and puns that added up to an incomprehensible, almost infantile babble. No one could understand what she said. Except Joyce. He listened to her attentively, responding with the utmost seriousness and respect, seeming to enter the garbled workings of her mind with an intuitive sympathy that often left others bewildered and embarrassed.
An irresistible notion took hold of him: that his work on Finnegans Wake had infiltrated his daughter’s brain and deranged her. He had co
nceived Finnegans Wake as a novel of the unconscious night (as opposed to the day of Ulysses), a novel of nocturnal wordplay and associations that might come as close as literature can to the sealed world of psychosis, without itself being insane. Surely this had precipitated Lucia’s cryptic utterances. “Whatever spark of gift I possess,” he said bitterly, “has been transmitted to her and has kindled a fire in her brain.”
His superstition was rooted in the almost telepathic empathy between them. He instinctively understood the scorched loneliness of Lucia’s condition. Madness wrenches us from the common language of life, the language that Joyce too had departed from, or surpassed. We all fear at some point that “our” world and “the” world are hopelessly estranged. Psychosis is the fulfillment of that fear. One is reminded of the manic patient in a lie detector test who was asked if he was Napoleon. “No,” he replied. The lie detector recorded that he was lying. Joyce’s immersion in the workings of Lucia’s mind was an attempt to rescue her from that double lie, an attempt to show her that he too spoke her language. If he spoke it then how could she be insane, or alone?
Guiltily, Joyce reversed the equation of their relationship, turning Lucia into the superior one. “Her intuitions are amazing,” he remarked, though he alone was capable of deciphering them. She was “a vessel of election,” an innovator, foreshadowing a new literature.
It was his last line of defense against hopelessness. In 1936, when Lucia was twenty-nine, she was carried away in a straitjacket. Joyce visited her at the hospital every Sunday, trying to cheer her up with presents and Latin phrases. But his heart was broken. His drinking increased beyond his habitual wine in the evening; now it was Pernod in the afternoon. On several occasions his wife Nora walked out on him. He begged her to stay, weeping. “I feel like an animal who has received four thunderous mallet strokes on the top of the skull,” he said. “There are moments and hours when I have nothing in my heart but rage and despair, a blind man’s rage and despair.”
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