by Steve Lopez
“If I have dinner before I perform, I’ll throw up,” Nathaniel tells him.
Rivera takes that as a yes. And Nathaniel, who has already spent several hours practicing, goes back to work with renewed purpose.
She asks to remain anonymous. As a psychiatrist working for the Los Angeles County Mental Health Department, she says it’s not her place to engage in a public debate about competing philosophies on how to treat mental illness. But she has e-mailed me to say she had a problem with my column about the Village in Long Beach and the “recovery” model used by Dr. Mark Ragins.
A “warm and fuzzy” embrace won’t get the job done, she argues when I call, pooh-poohing the notion that doctors should focus on patients’ lives rather than just treating their symptoms. Chronically mentally ill patients are sick, she says, and sometimes dangerously so. They need psychiatric counseling and medication, not sunshine and hugs. She goes on to say she is horrified by the fact that the Village is a model for California’s Mental Health Services Act. If that’s the direction the state is headed in, she argues, it’s going to pour billions of dollars into a bottomless pit while the sick go untreated.
Does she know what she’s talking about? As a matter of pride, I’d like to think not, having become a believer in Ragins’s program. She’s got me wondering, though, whether I naively bought into the idea that Nathaniel could get better with such a passive approach. Then again, he’s now visiting Lamp a few times a week for meals and showers. I’d be much happier if he used the place as something other than a pit stop, but maybe it’s just a matter of time.
Curiosity, and the need to bang out another column, make for a rare brainstorm. I’ll invite Dr. Ragins and the anonymous psychiatrist to meet Nathaniel at Little Pedro’s. We can all chat, they can watch him perform and the doctors and I can hash out the best treatment plan after the show.
Unfortunately, my plan doesn’t work out. Ragins is out of town and the county psychiatrist is still a little gun-shy. But I don’t give up. In Ragins’s place I manage to recruit Dr. Vera Prchal, a psychiatrist who occasionally works at Lamp and is a practitioner of the so-called recovery model, and in place of the county psychiatrist I get her boss, Dr. Rod Shaner, medical director of the Los Angeles County Mental Health Department.
Now all I have to do is produce the star of the show.
I pull up around 6:30 with a bad case of nerves, worrying that Nathaniel might not show. Don’t sweat it, he said earlier. But I couldn’t find him when I left my office, and even if he’s on his way, the shopping cart will slow him down. Alexis Rivera, meanwhile, is up in the San Francisco Bay Area with a band he manages, so I guess I’m the fallback promoter for the evening.
Little Pedro’s Blue Bongo is a dark and cavernous joint that looks like a Mexican bus station and smells like spilled beer. I find the two doctors inside and we order dinner. Prchal, a svelte woman with blond hair and golden skin, was born and trained in Czechoslovakia. Shaner, with a shaved head and a runner’s body, was chief of the psychiatric emergency room at County-USC Medical Center before a promotion to medical director of the mental health department. Both of them have read about Nathaniel and they’re looking forward to meeting him.
I lay out the inspiration for this gathering, telling the doctors that I’m trying to figure out who’s right about the most effective way to treat people like Nathaniel. Is it Ragins, or is it the Ragins critic?
Shaner thoughtfully considers my question while picking at his dinner. Then, with an expression that says he knows I won’t like the answer, he says: “They’re both right.”
It’s not what I want to hear. I want a clear signal as to how to proceed, so I can quickly pass the responsibility for Nathaniel’s welfare over to someone who knows what they’re doing. Yes, I like the guy immensely, but I just don’t have the time to be his primary caretaker.
Some people need medication to survive, Shaner says. Others don’t respond well to a push and would be better served by a Village or Lamp model. There is no right or wrong, and there are no absolutes. Prchal, unfortunately, sees it the same way. She says patients like Nathaniel, who have been forcibly hospitalized or had negative reactions to medication, often aggressively resist any efforts to help them. They don’t want to hear about a new generation of antipsychotic meds with fewer side effects because they just don’t trust anyone. But no two cases are alike, the doctors tell me, and there is no such thing as a universal model for treating people like Nathaniel. Of course, they’d have to see him to know more, but as the clock strikes seven, he’s still a no-show.
I apologize and order another round of drinks, trying to buy some time, but I’m worried the night will be a disaster. I fill the doctors in on everything I know about Nathaniel, but I’m afraid I’m wasting their time and my own as well. Working nights is part of the job, but the chances for a column from Little Pedro’s are waning, and all the extra time I’m spending on Nathaniel is time I don’t get to spend with my family. I wouldn’t mind it so much if I knew I was making a bigger difference in Nathaniel’s life, but there’s no telling if or when that would ever happen. Meanwhile, I’m hearing about too many little developments in Caroline’s life by phone. She’s stringing more words together, trying more foods and wondering where I am half the time. Alison, a freelance writer whose schedule is more flexible than mine, supports and appreciates what I’m doing with Nathaniel, but both of us are overwhelmed with busy schedules, and she keeps getting stuck with more of the burdens at home because I routinely break promises to be home earlier.
It’s now 7:30 at Little Pedro’s. Dinner is done and I’m running out of things to talk about as the doctors check their watches. Finally, at eight, I tell them I’ll go look for him if they can hold on just a little longer. I pull out of the Little Pedro’s lot and hit the gas, and half a block away I see him coming down the street, the palm fronds sticking up from the shopping cart. The Brahms and Beethoven sticks are crisscrossed through the hubcap, his belongings piled high. It looks like he’s got a small elephant on a leash.
“I thought you forgot,” I say. “Where have you been?”
He’s panting when he pauses to rest.
“I had another engagement,” he says.
Scolding him will do no good. Exasperated and relieved, I tell him to hurry, because time is running out.
He agrees to leave the cart with the parking attendant, and this is a first. I carry the cello inside and he takes care of the two violins. I tell him Shaner and Prchal are friends of mine. There’s no telling what he might do if I say they’re doctors. They say hello, but there’s no time for psychoanalysis. Several people have come over from the bar to sit by the stage in anticipation of his performance. Nathaniel barely acknowledges them as he tunes up, and I can’t tell whether he’s in a bad mood or nervous.
Is this the worst idea I’ve ever had? In my eagerness to get an appraisal from two psychiatrists, and another column to boot, have I done just what Alexis Rivera intended to avoid? Have I exploited Nathaniel? I wanted to believe that Rivera’s recognition of his talent and the offer of a stage would give him new purpose and advance his recovery, but putting a man with mental illness in front of a live audience suddenly seems selfish and cruel. It occurs to me that maybe he likes playing next to a tunnel because of the anonymity it provides, and because the noise drowns out the mistakes.
As the tuning process drags toward 8:30, I walk up and whisper to Nathaniel that it might be time to get things moving, if he’s still up for this. He says he’s okay and picks up the violin from Motter’s, with “Stevie Wonder” scratched into it. I put a reassuring hand on his shoulder and introduce him to his audience.
“This is my friend Nathaniel,” I say, struggling to put him at ease while preparing the audience for an unpolished performance. He’s been working hard, I say, “to rebuild a music career that goes back many years.” I point out that he was trained on string bass and is teaching himself violin and cello.
Nathaniel gives a
nervous nod to quiet applause. I take in the spectators as they eyeball his T-shirt scarf, the doodling on his jeans and the untied sneakers. The bottom of the club he keeps hooked to his belt peeks out from under a sweatshirt tied around his waist.
Nathaniel tentatively fingers his way through a Beethoven-like dirge. There’s nothing remarkable about the music and he seems to be struggling. As it gets worse, he turns away from the audience ever so slowly, as if he can’t bring himself to face the crowd. Shaner has a finger on his chin. Prchal looks morose. I don’t know if they’re feeling sorry for him or shocked at me for subjecting him, and them, to this. I’m tempted to put a stop to it and usher him away, though that would only make it worse. But I know he shouldn’t be here. In a shaky voice, Nathaniel apologizes for not playing better, but the audience is giving him a pass, applauding his effort, and this seems to shore up his confidence a bit. He switches to cello and works on the tuning.
“It’s encouraging,” Dr. Prchal says, “that he’s aware that he isn’t playing well.” He can distinguish between how he once played and how he’s playing now, she reasons. And she makes a point I haven’t considered. Maybe he resists treatment because getting better would mean a return to a life he recalls as unbearable. In a conservatory setting, she says, the pressure is immense, and Nathaniel’s talent might have been matched only by his fragility. It is possible that the pressure is what caused him to snap.
Nathaniel looks and sounds more comfortable on cello. The audience becomes more responsive and his confidence grows, and I relax along with him. It’s still clear, even to an amateur like me, that he’s missing notes, mixing passages from the Bach cello suites with riffs of his own and struggling with pitch. But he has his moments and feels his way through the set, becoming more animated as the sound becomes soulful. He hits a groove, nails a couple of vibratos and closes his eyes in relief, saved by music and cured, once more, by his own hand. Now the applause is real, and I’m clapping harder than anyone, filled with pride.
Shaner says it’s tragic and frightening to think of this man or any other spending his nights on dangerous streets. “I’d like to seduce him into treatment, and he needs seduction,” says Prchal, but she knows it won’t be easy. “People with his IQ, tremendous ambition and achievement don’t like to be ordered around. But this man has to be treated. I will try to meet with him and slowly start some dialogue about the possibility of treatment, and slowly also see if he would want to have his own room.”
When we go out back to load his cart, Nathaniel apologizes, saying it didn’t go well. I tell him he’s wrong. There might have been a couple of rough spots, but he turned it around and ended on a roll.
“You really think so?” he asks.
A couple of days later he hands me a note thanking me for writing about his performance. He says he thinks he could “really start progressing much better” if I could get him a copy of the Bach Cello Suites, a music stand and a new A string for the cello.
He signs it:
Your friend, Nathaniel Anthony Ayers
11
Six months after meeting Nathaniel, my bond with him is deeper and so is my desire to get on with my life. I don’t have any intention of abandoning the relationship, but I don’t have the stamina to serve indefinitely as his keeper, worrying about his safety while trying to be a columnist, husband and father. The Blue Bongo episode fits a pattern that is wearing me out. He frustrates my efforts to help him and has me on the verge of giving up, and then he pulls through at the last minute in a way that gets me even more hooked on him.
But is he really any better off than he was the day I met him?
Somewhat, I suppose. As Stella March told me that day over a cup of coffee, he has someone in his life who cares about him. He has a connection at Lamp if he wants food or safe, familiar surroundings. We’ve been invited to a rehearsal by the L.A. Philharmonic—something that never would have happened if I hadn’t met him—and he’s excited about it.
But the questions people ask me about him are a reminder of how little has been accomplished.
Has he moved inside?
No.
He’s not still living on the street and chasing rats with a stick, is he?
Yes.
Is he on medication?
No.
Does he see a psychiatrist?
No. But I think I need to.
Dr. Prchal’s first attempt to “seduce” him into treatment is a bust. She spots him on the street one day and suggests he come see her, and Nathaniel tells her to go away. Anyone whose name begins with “doctor” is no one he cares to see. Maybe if I spend more time with him I can be persuasive, but where would I get it?
If two-year-olds are supposed to be terrible, so far Alison and I are lucky. Despite the required backseat vomiting disaster on the way to a short vacation on California’s Central Coast, Caroline is easy to travel with and excited about going places. She calls me Daddy-O, has begun to speak in the past tense—“I goed”—and thinks it’s just fine to keep singing “Amazing Grace” without knowing all the words. Fortunately I’ve caught all the big milestones, but the really good stuff is nothing you can write in a journal. It’s an expression that only you can see the changes in, it’s the emergence of a personality unique to the world, it’s the way she comes out of the bath with her hair slicked back and you catch a glimpse of what she might look like when she’s older.
One reason we’ve come to the Central Coast is to see if it’s possible to swing a deal on a condo. If we could buy a place and rent it out to cover the mortgage, we’d have a nice little investment and a place to move to in retirement. From Big Sur to San Luis Obispo and Morro Bay, the spectacular California coast is not yet grossly overdeveloped and the climate is ideal. Alison and I both love the water, the pine-scented air and the plunging coastal cliffs, and Caroline is being trained to share our appreciation. But the places we look at are either too expensive or too shabby, or the rent won’t cover the monthly mortgage. And in the back of my mind, there’s one more issue. If we moved up here and Nathaniel was still in Los Angeles, who would look after him?
The fact that the question occurs tells me something about the way he’s gotten to me. Maybe there’s a bit of guilt involved. I’m here in one of the most beautiful and inspiring places in the world, and he’s in one of the most wretched. The difference between us is luck. I’m a healthy fifty-two-year-old dad whose life has been made new by a two-year-old’s discovery of the world, and he’s a fifty-four-year-old former phenom whose development was stopped dead more than thirty years ago.
One morning we return from the beach and I turn on my cell phone after a couple of days of peace. A message had been left, the night before, by Alexis Rivera at the Blue Bongo. Nathaniel is losing it onstage, Rivera says. He’s going off on the audience, cursing, angry. Rivera doesn’t know what to do. Please call as soon as possible.
“Is he all right?” Alison wants to know.
I have no idea, and Rivera doesn’t answer when I call. I’m naturally worried but also upset with myself for allowing it to happen. What a fool I was to think that he could handle a job like that in his condition.
Finally I get hold of Rivera and the upshot isn’t so bad. It was pretty scary there for a while, he says, but Nathaniel calmed down and left the stage. He went outside and played on the sidewalk for a while, and some of the patrons went out there to watch him.
It’s probably best, I tell Rivera, to put Nathaniel’s return to the stage on hold for now.
When the long-dreaded announcement is finally made, it’s anti-climactic but still feels like a gut shot. John Carroll, the man who hired me, is resigning to avoid one more day of battling the hog butchers in Chicago. Dean Baquet, who came close to walking away with him, has agreed to take over for Carroll on the promise that the company won’t rip the place to shreds for the sake of propping up the stock. In the beaten-down newsroom, there’s grief that Carroll is leaving, relief that Baquet is staying and a gen
eral agreement that the Tribune promise to Baquet is worth less than yesterday’s newspaper. Should I begin looking for work, or at least try to come up with a Plan B? I probably would if I weren’t so busy. But moving out of town would mean leaving Nathaniel on his own, and the number of desirable jobs out there is shrinking fast. I don’t know of a better situation than working for the Times under Baquet, a Pulitzer prize-winning reporter and former New York Times editor who tells us this is no time to act as if our best work is behind us.
As usual, the steady march of breaking news keeps me from dwelling for too long on things that are out of my control. I hear on the radio that two teenagers with baseball bats have gone on a crime spree in downtown Los Angeles, clubbing street people as they lie sleeping.
Police are saying the teens were inspired by a video series called Bumfights, in which promoters pay street people to beat one another, pull teeth with pliers, set their hair on fire and perform other dangerous stunts. Some of the victims are down-and-out Vietnam vets who never got free of the war’s reach. In Los Angeles, one of the victims was beaten in a tunnel and is in critical condition, and I’m certain it’s Nathaniel. He has switched up his routine and started sleeping in the Second Street tunnel rather than on Skid Row, and I can imagine him being awakened by the two cowardly thugs and getting beaten as he defends his cello and two violins. This is my fault, and I’ll never live it down.
He’s probably at County-USC Medical Center, but I’m too afraid to make a phone call. Instead I drive over to the tunnel and find no sign of him, nor do I find any leftover markings of a crime scene. The longer I sit with the possibility that he’s hanging on for his life, the worse I feel about lying back and waiting for him to get help in his own time. Finally I get up the nerve to call the City Desk to see what we know. I’m told that the guy they clubbed on Skid Row made it okay. He’s been treated and released. But the guy beaten in the Third Street tunnel might not live. His name is Ernest Adams.