by Mark Lukach
Giulia was in the acute section of the psych ward.
The two sections were divided by a glass door. Giulia’s side felt more like a hospital. There was a large central room surrounded by single-occupancy bedrooms for the patients. The lounge was more cluttered, there were IVs on wheels around the perimeter. But even this side had a door out to a patio garden that was open all day long. Giulia’s bedroom window offered views of trees and flowers. There were no bars on the windows.
Visiting hours were set: seven to eight thirty on weeknights, with the addition of twelve to one p.m. on the weekends, just like the first hospital. But I never had to follow those rules. When I first called and explained our situation—hour-long drive, young baby at home—the staff made a note in Giulia’s file that gave me the freedom to visit whenever I wanted.
When I was allowed through the second set of doors, the ones that led to the acute section, I encountered Giulia with a nurse. “Mark, they’re trying to kill me again with these medications. Why do they always try to kill me when I’m in the hospital?”
“They’re not trying to kill you, honey,” I said. “These medicines will help you, just like they helped you before.”
The nurse smiled as Giulia introduced me. “You must be Mark,” she said. “And I’m sure that Jonas is at home in good hands,” she added for Giulia’s benefit. “Giulia has been talking about you both nonstop since she arrived.”
I saw over the nurse’s shoulder the familiar whiteboard where patients were assigned to nurses. Giulia’s name was on the board, along with another patient’s, under the name of one of the nurses. Only two patients. At her past hospital, her nurses were often responsible for ten patients at a time.
Giulia shrugged in agreement at what her nurse said but then returned to her worry about the medicine. “Mark, please, you know how this medicine makes me fat and lazy and sluggish. They are trying to kill me. Please, I don’t want to take it.”
We were back. It was terrifying, exasperating, and overwhelming, but it was also familiar. I was flooded with a sense of purpose that I knew well. While Giulia’s year of psychosis and depression had been miserable, we had rarely fought during that period. We were so focused on survival that the only option was to make it through the crisis. And now we were back, and it felt unexpectedly meaningful to face the challenge of being her protector again.
“What happens if she doesn’t take the medicine?” I asked the nurse.
“Oh, well, we’ll just come back in a little bit and see if she’s ready then,” the nurse said back. “We understand she doesn’t like the medication, but it’s going to be so critical to help her get back home to you guys, and so I’ll just keep checking back in until she’s finally ready.”
She didn’t admit that since Giulia was on a 5150, she had seventy-two hours to reject all medicine. That would come up later, only if it needed to, but I was focused solely on getting her to take the medication. It had been only four days of difficult sleep for Giulia. Another three days of unmedicated sleeplessness felt like a lifetime lost to deeper psychosis.
I stayed with Giulia, and helped her settle in, and talked to her, and patiently coaxed her into taking her medicine. It took almost two hours. But she took both the Risperdal and the lithium. She was now back on the magic combination that had worked the first time.
I stayed for a few hours, much longer than I had anticipated. It was after dark by the time I got in my car to drive home and almost eleven p.m. when I arrived at Jaimal’s house an hour later. I hadn’t eaten anything since the night before. He and his wife were already asleep. They had left the door unlocked for me and some food on the table. I scarfed down my first meal of the day and then delicately lifted Jonas out of the pack’n play they had put him in. Gently, slowly, trying not to wake him, I took him down to the car, into his car seat, and home to his own bed.
Giulia’s doctor, Dr. Franklin, was accessible and willing to spend a lot of time on the phone with me. On the first day she had a long conversation with Giulia’s IOP doctor, who then called me after their consultation. The two agreed that lithium and Risperdal had good potential to stop Giulia’s slide.
But the psychosis didn’t fade. Instead, it deepened.
Even on a strong dose of Risperdal, Giulia somehow slipped further and further into her delusions, which became increasingly troubling. She continued to say endlessly that “heaven is a place on earth,” but it was no longer reassuring to her. It left her disoriented as to who was alive and who was dead.
Her mantra littered the psych ward. The erasable whiteboard was covered with it, every available blank spot filled in with the phrase. The nurse told me it took her hours each day to fill out the whiteboard. She wrote it on all of her art projects from the group therapy art sessions.
For the first few days when I visited, Giulia took me outside to the garden patio as soon as I arrived. She lay on her back and stroked the grass with her arms, as if to reassure herself that steady ground was still beneath her. She was calm and thoughtful but profoundly confused, with questions that she rarely voiced but desperately wanted answers to. We didn’t speak much. She knew that I couldn’t give her the answers she needed.
She gathered leaves from the garden and scattered them throughout her room. When I walked in, they crunched underfoot. Giulia also piled leaves on the few flat surfaces in her room—her bed, her one shelf for clothes, her one small bedside chest for storage. She’d often scoop up a pile of the leaves and inhale, as if the smell might anchor her thoughts against floating away.
I brought Giulia’s breast pump to the hospital under doctor’s orders, and Giulia began the slow process of weaning herself off producing milk. She had to pump and dump, since her milk was no longer suitable for Jonas, but she never said a word about it to me. She also rarely asked about Jonas when I visited. He was all I wanted to talk about, but Giulia wasn’t interested when I tried.
Of the many improvements of this hospital, one that left me puzzled was that the acute section of the psych ward had a computer, with Internet access. On Giulia’s first night she logged in to her work e-mail and wrote an e-mail to her boss, telling her boss how much she loved her and to not worry, heaven was a place on earth. Giulia’s boss promptly retrieved my e-mail address from Giulia’s emergency contact card and forwarded it to me, along with a litany of her own questions.
Giulia still resented how I had quit her job for her three years earlier, so I called Giulia’s social worker when her boss forwarded me the note. The social worker said she would handle all communication with Giulia’s work to ensure that Giulia’s privacy was protected and that she would be supported by her company. It would also take me out of the equation of dealing with work. The hospital, the doctor, and now the social worker—they all gave me a glimmer of hope that this time around would be so much different.
Suoc arrived on Giulia’s third day in the hospital, and my mom arrived the day after. We spent a week in the house, all four of us—two grandmothers sharing the master bedroom, while I slept in Jonas’s room on the guest bed. They watched him together as I made my daily pilgrimage to the hospital, but I insisted on sleeping in his room at night so that when he woke up crying for his nighttime feeding, I could be the one providing it to him.
After a week of all of us in the house, we finalized a schedule where the moms would rotate living at our house for a week, while the other returned back home. Suoc wouldn’t fly all the way back to Italy but would instead go to New York. My mom would be commuting weekly between San Francisco and Japan. These were big requests, expensive requests, but they both were up for it.
I discovered a fantastic playground only a few blocks from the hospital in Mountain View, so I began to bring Jonas and whichever mom was in town down to the hospital. I was desperate for Giulia to see Jonas. We scheduled the drives around his nap times. If Giulia wasn’t up for the visit, he could go to the park with Grandma. It became our daily outing—a long drive down to I-280 while Jonas had his m
idmorning nap, a few hours down in the sun at the playground with a packed lunch, and then the drive back for the early afternoon nap.
Giulia knew that Jonas was only a few blocks away at a park and that he would love to see her, but she always said no. She didn’t explain why. It crushed me. Jonas needed his mom, and she needed him. That felt obvious to me. I even hoped a reunion might jump-start her ascent out of psychosis.
After a week in the hospital, her doctor intervened. She believed Giulia was suffering from postpartum psychosis, and Giulia and Jonas needed to see each other as a part of Giulia’s recovery.
The plan to get Giulia and Jonas in the same room was baroque in its complexity. Children were not allowed in the acute section of the psych ward; Giulia was not allowed out of the acute section of the psych ward. There was a small office space that connected through the back of the nurses’ station that was technically in both sides of the psych ward, since it had doors that opened to both. Giulia’s doctor reserved that room for our visit so that no rules were broken but mother and child could still be together.
I went into the hospital first, to make sure that everything was in place and that Giulia was still okay with the idea. She paced in her room and smiled at me briefly. She had a few leaves in her left hand and in her right hand a collage of family pictures, which she had cut up from a stack that I had printed out and brought to her a few days into her stay. I texted Suoc, who was waiting in the car with Jonas.
Then, along with Giulia, two nurses, the doctor, and a burly orderly in case things somehow got out of hand, I waited. There was nowhere to sit. After a few minutes, Suoc knocked and then slowly rolled Jonas into the room in his stroller.
I stood next to Giulia and watched Jonas’s face light up to see his mom. He reached out to her and smiled as she walked across the room to meet him. She dropped her leaves and collage, reached into the stroller to unlock his straps, and then lifted him into her arms. She had tears in her eyes—everyone did.
Jonas didn’t know where we were. He didn’t know that anything was wrong with Giulia. He simply knew that he was back with his mom, where he wanted to be, and I felt so relieved.
Giulia squatted down to pick up the collage she had made for Jonas—several of his pictures, along with a brightly colored portrait of our family that Giulia had drawn—and gave it to him.
“I love you, Jonas,” she told him. “I’ll be home soon. I’m being strong in here, and I’ll be home soon.” He cooed in response. It was the saddest happy moment of my life.
I felt an immense burden lifted to see Giulia and Jonas together, but it lasted barely a minute. Giulia looked back at me with panic in her face. She held Jonas out, offering him back to my care, but I didn’t want this to end yet. It was too quick. I hesitated, to prolong the reunion. If we had to be in the psych ward, let us at least be there together. But Giulia held Jonas even farther out. Now I felt panic, too, so I scooped Jonas back into my own arms, where he comfortably settled in.
“That’s enough for now,” Giulia said, and she picked up her leaves and then walked out. The visit was over.
At our first family meeting, there was no uncertainty around Giulia’s diagnosis. “Bipolar disorder,” her doctor declared. “It’s clear. That’s why the lithium worked. She’s probably going to have to stay on lithium for the rest of her life.”
Bipolar disorder I, to be more specific, is characterized by soaring highs and crippling lows. Giulia somehow experienced both as negatives. Her highs were not the freewheeling spending and partying that many encounter in mania. Her mania fast-tracked directly into psychosis, with its paranoia and delusions.
The one advantage to Giulia’s unpleasant mania was that it made the prognosis of caring for the disease more manageable. Those who experience mania as euphoric are loath to treat it. Yes, they hate the depression, but they often stop their own medication because they miss the highs of the mania. But Giulia’s mania was terrifying, which made both manifestations of her bipolar undesirable. Dr. Franklin suspected it wouldn’t be hard to convince Giulia that she would need to stay on her medication to avoid her highs and her lows.
The medical team suspected that Giulia’s relapse into mania was amplified by Prozac. When she was on lithium, the Prozac was a godsend. Without lithium, Prozac probably sped up the onset of the mania.
This time around, the doctors resorted to a more traditional antipsychotic medication called Haldol, a drug far less gentle than Risperdal but also one that is especially effective in treating postpartum psychosis. The medical team wanted to clear up Giulia’s psychosis as quickly as possible so she could get home to Jonas, so they brought out the big guns of Haldol.
Our second family meeting was on Halloween. Dr. Franklin was dressed up like a sock-hop girl from the movie Grease, which reminded me that I didn’t have any plans for what to do that night for Jonas. Sure, he was six months old and wouldn’t have any idea what was going on, but it was his first Halloween, and I wasn’t going to miss taking him to his first trick or treat. I met Dr. Franklin in the same small conference room where Giulia had seen Jonas, and we waited for a nurse to retrieve Giulia.
When Giulia shuffled into the room, I was shocked. Her eyes were barely open. Her mouth hung agape, drool pouring out of the sides.
I reached out for her hand and she slowly turned to face me. “Good to see you, Giulia.” I smiled, reverting back to my rehearsed mode for visiting her in the psych ward. She didn’t say anything in response.
She settled slowly into the chair. This was awful. Inhumane, even. Giulia was barely aware. Dr. Franklin asked her questions; Giulia didn’t respond. Her eyes didn’t blink or search. She stayed in the room for five minutes and then got up to leave. I followed her as she stumbled to her room and lay down in her bed. Then I returned to the meeting, fuming.
“What the fuck is going on?” I said. “Giulia looks terrible. Is this the fucking Haldol?”
“Uh, maybe,” the doctor said, squirming. She appeared shocked and even a bit embarrassed, like when you have to introduce your child to strangers and they pick that moment to throw a tantrum. She clearly hadn’t seen Giulia yet today and had no idea that she would be in this condition. “I think she’s on too big of a dose. We’ll back off the dosage immediately. But I still think this is a good drug for the situation.”
“Are you sure? She looked horrible.”
“I’m sure.”
I returned to Giulia’s room to say good-bye. She was asleep on the bed. I sat next to her and watched her breathe. I wanted to go home but wanted to stay, too. When I was with Jonas, I worried about Giulia. When I was in the hospital, I worried about Jonas. I didn’t know who I was anymore—a husband or a father? The two roles pulled me in separate directions, and I didn’t know how to go in both places without being torn in half.
We repeated our policy that if Giulia wanted me to visit, she would call and invite me. On a Saturday morning, she called and said she didn’t want any visitors that day.
“Are you sure?” I asked.
“Yes, I’m sure,” she said.
“Positive?” I asked again. I hadn’t missed a day yet.
“Yes, I’m sure, Mark. I don’t want you to visit today.”
I listened to her. It was a clear fall Saturday morning, and the whole day lay ahead of us, the first day in over two weeks that wouldn’t revolve around visiting Giulia. I called up Cas and Leslie and asked if we could come and visit for an overnight. They dropped everything and said absolutely. My mom was in town, and it would be her first time sleeping over at their house.
We arrived at their house in Point Reyes and went first to the chickens, as always, which Jonas loved, and futzed around in their garden for a bit, and then we stuffed our feet into knee-high wader boots for a walk in the swampy marsh behind their house. I strapped Jonas to my chest in the BabyBjörn, and we waded through the high grass. For the first time since Giulia had been admitted to the hospital, I focused on what was right in front of me: J
onas, my mom, my best friends, the natural world. With each step, I felt my mind slowing and untangling.
And then my phone rang. It was Giulia.
“Mark, can you please come visit me? I really need to see you,” she said.
“Uh, I thought you didn’t want me to visit today?” I said nervously.
“No, I really need to see you today, Mark,” she said. “Please, I need to see you.”
I stopped walking, and everyone else stopped to hear my side of the conversation. “But Giulia, you said that you didn’t want me to visit,” I repeated. Point Reyes was ninety minutes north of the city, and the hospital was an hour south of it. I was two and a half hours away from the hospital.
“Please, Mark, please come visit,” she begged. “Please visit today.”
I immediately began to think of possible ways to get down there. Maybe I could leave Jonas and my mom here to spend the day with Cas and Leslie. I could drive down to see Giulia and then drive back and be in Point Reyes by dinner, sleep over as planned, and then head back in the morning.
Cas stopped next to me. He could see in my face that I was trying to come up with a plan to go and visit Giulia, even if it meant I was going to spend upward of five hours in the car.
“No,” he mouthed. “No.”
Leslie did the same. My mom was more forceful. “You need a break,” she whispered. “She said no visitors. You listened to her.” I looked back at them, ashamed. I was so embarrassed, even though it was my own mom and my closest friends, for them to see our family like this.
“Giulia, I’m sorry, but I can’t come and visit today.” I didn’t want to tell her that we were in Point Reyes, one of our favorite places to go together, while she was locked up in the psych world. “You told me not to, so I’ve already made playdates for Jonas,” I lied. “I can’t change the schedule.”