My Lovely Wife in the Psych Ward

by Mark Lukach

  Each agreement was a small victory, a genuine step in the right direction in a world where such steps are rare. The conversations typically got tense, but we powered through. We resolved many unknowns, but there were still other questions to address. We had to figure out what type of help to accept from our parents. There was still the question of having more children. We both wanted more, but the idea evoked any number of disastrous scenarios.

  But we stuck to our commitment to come up with a plan, even though setting aside time to work on that plan felt like we were scheduling time to fight. The subtext underlying these tense conversations was that we were making progress. When we sat down to discuss medication doses, or a timeline for getting pregnant, or the risks of taking lithium during pregnancy, we were essentially saying “I love you.” My exact words might have been “I think you’re rushing things,” but the subtext was “I want you to be healthy and fulfilled, and I want to spend my life with you. I want to hear how much you disagree with me, about something that is as personal as it gets, so that we can be together.” And Giulia might have said “Give me my space,” but in her heart, it was “I value what you’ve done for me, and appreciate how hard you’re trying to be open and flexible in your support, and let’s make this work.”

  eleven

  October 2014

  In the midst of all of this was Jonas, growing steadily and proudly and always the anchor that made us stick to searching for a way to make the best of what we had. After his first steps in our front yard, Jonas was off and running through life. He hit his first Wiffle ball off the tee a month later and was hitting underhand pitches at eighteen months old. Football, soccer, anything that allowed him to throw, kick, or catch, and he was hooked, especially if he could wrestle someone in the process. He loved nothing more than to run the bases and slide into home plate. I loved to watch how much he explored his world through his body, much as I did through my running and surfing.

  I marveled at his physicality, but beyond his size was the sheer power of his positivity. He laughed and smiled all the time, even when things were most challenging with Giulia. He loved to crawl in our laps and cuddle through story time, and after moving into his big-boy bed, he still found his way into our room at some point almost every night so we could all wake up a tangled mess together in the morning. Our Man in Motion earned a new nickname from us: Sweet Sauce.

  The truth is I needed Jonas as much as he needed me. I turned to Jonas more than anyone else for joy and comfort, even though I knew I was placing an unfair burden on the shoulders of a toddler. He was my escape while Giulia was lost to her depression.

  His pediatrician assured me that young children can adapt to challenges facing their parents as long as one of the parents can continue to show reliable love and affection, and I took that charge seriously. I adored him and wanted him to adore me back, for both our sakes.

  As Jonas learned to talk, he mostly asked for “Daddy.” I noticed, and I know that Giulia noticed, too. We didn’t speak about it with each other, but it lingered uncomfortably between us. Neither of us knew how to handle it. Giulia wished she were more in Jonas’s spotlight, and I didn’t blame her for it. I cherished my special relationship with Jonas, but I didn’t want to flaunt it. So we didn’t talk about it and instead held our breath whenever Jonas said “Daddy” and not “Mommy” and hoped for the best.

  One day—he must have been around two and a half—we asked him to describe our bulldog, Goose. “What’s Goose like, Jonas?”

  Jonas looked quizzically at Goose and then proudly answered, “Handsome!”

  We all laughed.

  “What’s Mommy like, Jonas?” Giulia followed up.

  He turned his attention to her, studying her closely. I was nervous as he took a while. No one had never asked him so directly to describe Giulia.

  “Gorgeous!” He beamed, elated. Phew. We laughed again.

  “What about me, Jonas? What’s Daddy like?”

  “Happy!” Jonas answered immediately. We laughed a third time.

  “All right, Jonas, last question.” He looked at me eagerly. “What is Jonas like?”

  He chewed on his finger as he thought about his answer. Then his face lit up.

  “I’m happy, too. Just like Daddy.”

  It was a wonderful fall. We picked pumpkins and brainstormed Halloween costumes. Jonas wanted to be either a baseball player or an elephant. The Giants were in the playoffs, fighting for a thoroughly unexpected third World Series win in five years. School was going great. Giulia’s job was going great. Nobody could really believe it.

  And then on a Monday night, Giulia couldn’t sleep. She couldn’t explain why—she didn’t have anything in particular keeping her awake. But on 900 mg of lithium, which had worked solidly for two years, she couldn’t sleep.

  I lay awake with her through the long, quiet hours of the night, fighting my heavy eyelids. I frequently faded off and awoke with a startle. I listened to her breathing and for the sounds of rustling that would give clues to whether she was awake or not.

  We had our plan, which had felt so solid in the abstract, but now that it was time to enact it, I was afraid—afraid to say something that might anger Giulia or, even worse, wake her up if she had fallen asleep. I waited until three a.m. to suggest maybe it was time to take 1 mg of Risperdal. Giulia resisted. She wanted to go to work the next day, and if she took the pill now, at three a.m., she would have a hard time waking up when the alarm went off at seven thirty.

  So she stayed awake, and in the eerie quiet she e-mailed her doctor and her therapist to see what they thought she should do. The e-mailing put her at ease, and she fell asleep soon after putting down her phone. I woke up to my work alarm at five forty-five and rushed through my morning of getting Jonas and myself ready. Giulia slept through it all. I decided to let her sleep and to take Jonas to day care myself, even though that was usually Giulia’s favorite part of the day. Before we left, we tiptoed in to kiss her good-bye. I asked her how she was feeling. She mumbled a nonresponse from under the covers and was back asleep before we left the room.

  She woke up to her seven thirty alarm and had e-mail responses from her therapist and doctor, who both said that tonight we should stick with the plan: 1 mg Risperdal at midnight, 2 mg more by two a.m. She set up an appointment for the next day with her psychiatrist, who encouraged her to stay in daily contact. Then she otherwise pulled herself together and went to work.

  I checked my phone throughout the day for updates from Giulia, but none arrived. I texted her a few times and got bland responses: “I’m ok.” “I’m tired.” Midafternoon, I picked up Jonas as usual and took him and Goose to our nearby park, checking the time every few minutes, eager for Giulia to get home.

  We gently embraced when she walked through the door. She looked fine, just tired. I was on high alert for signs of psychosis—pacing; weight shifting from one foot to the other; nervous, twitchy eyes—but I couldn’t let her see that I was watching her.

  With nothing else to do, we turned on the baseball playoffs. It was an odd combination—Giulia’s sleepless night and the Giants against the Cardinals in the National League Championship Series, the winner going to the World Series—and I felt torn in two directions. On the one hand, I wanted to care for Giulia and go through all the meditations, massages, and relaxation techniques we had acquired over the years. Whatever it took. On the other hand, I was a Giants fan, and so was my son. There were certain rituals of fatherhood that I was committed to—the tousling of hair, the serious talks, the camping trips—and watching your home team in the playoffs was one of them. I wanted it for my sake as well as his, so someday Jonas could say that he and his dad had watched the games together in 2014, when the Giants surprised everyone and made it deep into the postseason.

  Besides, Giulia and I had our plan. The main reason to have a plan was to allow us to continue with our lives and to keep psychosis from destroying everything like a wrecking ball. Watching baseball was continuing
with our lives. The plan gave Giulia space to be in charge of her experience, without me breathing down her neck.

  Jonas cheered when we finished dinner and I told him we were going to watch the Giants game. I flipped on the TV and kicked my feet up on the couch. Jonas loved the rare times we watched baseball together. He settled into my lap but bubbled with questions, asking for the names of every player and explanations for what was happening with each play. He quickly became impatient with being only a spectator. It took only a few outs for him to scramble off to find his own glove somewhere in the mess of the garage. A few minutes later he came back with his glove and a Wiffle ball, and he spent the next hour throwing the ball around the room and diving on it, passionately narrating a game that he was playing out in his mind, full of home runs, and megahits, and really fast pitches.

  Giulia sat next to me, and I massaged her neck, and scratched her head, and rubbed her earlobes. She seemed settled at first, but as the game progressed and the sky darkened, I could feel her body tense up next to mine.

  With only two innings left, she abruptly stood up. “I’m gonna go walk outside,” she said. Her body was tense. She couldn’t keep her feet settled beneath her or her eyes focused on one thing.

  “Where are you gonna go?” I didn’t like the idea of her walking around by herself. “Why don’t we come with you?” I said, an obviously halfhearted offer.

  “No, it’s okay,” said. “You and Jonas watch the game. I won’t go anywhere if it makes you nervous. I’ll just walk around in the backyard. I won’t go anywhere.”

  Giulia walked out and began to pace in the backyard, back and forth across our modest patch of grass. I went out with her, but she assured me that she was fine and just needed some space for herself. So I returned to the living room, with Jonas and the game and the fun of the postseason. Between innings, I went back outside to check on her. She was taking big, deliberate breaths as she walked, her shoulders rising and falling with her inhales and exhales. Her hands were all over the place—behind her back, holding each other against her chest, pressed up against her face.

  My throat tightened each time I walked out to check on her. Inside, in the living room, Jonas and I were continuing with life as normal. The Giants were losing, but it was a great night of baseball. Outside, barefoot in our backyard, Giulia was trying, and failing, to stay calm as she approached her bedtime.

  “Giulia, it’s getting dark, and cold,” I said gently. “Why don’t you go and take a bath? Jonas already had his, that might feel nice.”

  “That’s a good idea,” she said, nodding. “I’ll start my bath, and maybe you can handle bedtime until I’m done. I’ll come in after I’m done.”

  “Sounds good.”

  I went back to the game, which was wrapping up. Jonas smiled at me at the indulgence of watching TV on a school night. He whined when the game ended with a Giants loss, and I carried him off to his bed.

  Bedtimes with Jonas lasted forever. He loved books and fought against his exhaustion to stay awake through the endless stories that I read. I stole glances as I flipped the pages to see if his eyelids sagged and fluttered. But if I stopped reading for more than a few seconds, he roused himself to insist, “Keep reading, Daddy.”

  I was deliberately slow to switch from one book to the next, so I could listen to the sound of jostling water from down the hallway, to assure myself that Giulia was still in the bath. I kept reading, and Giulia stayed in the bath. When Jonas fell asleep, Giulia was still in the tub.

  I stuck my head through the door. “He’s asleep. Sorry you didn’t get to come in and say good night.”

  “Oh, I’m sorry, too,” she answered. She was submerged as much as she could be in the tub without the water going into her eyes, the waterline drawing a tight circle around her face. She seemed to be finally calming down. “Thanks, honey. This bath feels good. I think I’m not going to wait until midnight tonight. I think I’m just going to take Risperdal. I want to get some sleep. I’m tired from not sleeping last night.”

  “That sounds like a great plan, Giulia. I’m proud of how you’re being so responsive to this.”

  I stepped over the pile of towels on the floor and sat on the edge of the tub. I searched through the warm, bubbly water and found her hand and held it.

  “Thanks, honey,” she said quietly. We were being so tender with each other. We knew we were walking on a narrow tightrope. Any slip could be consequential.

  I lay in bed, at a distance, as Giulia took the Risperdal in the bathroom. She flashed me a quick look of fake optimism and kissed a quick good night before we turned on her favorite playlist and flicked off the lights. We lay in bed together, quietly waiting for sleep. So much of my life had become about the threshold between sleep and awake and the fragile waltz back and forth across the two.

  Giulia didn’t sleep. She took more Risperdal.

  She still couldn’t sleep.

  The next morning, we cleared our work schedules and were at Dr. Stefania’s office for her first appointment of the day.

  “We need to get you a blood test, first and foremost,” the doctor said. Giulia had been on an uninterrupted regimen of 900 mg of lithium for almost two years, but it had been at least a year since her lithium levels were measured. “There’s the chance that Giulia’s body has started to metabolize the medication differently, and she might not be on the therapeutic levels that she needs.” She typed an order into the computer, requesting the blood work.

  “Now, let’s talk about what’s going on,” she said.

  “Well, it’s now been two days and I’m having trouble sleeping,” Giulia explained.

  “Are you getting any sleep at all?”

  “Yes, a little bit,” Giulia said. “I guess I fall asleep around four or five in the morning. But then I have to get up and go to work a few hours later.”

  “Are you having any delusions? Any of the religious fixations that you have had in the past when you couldn’t sleep?”

  “No, none of that,” Giulia said.

  “Has anything big happened at work?”

  “No.” Giulia had recently celebrated completing her first year at her job, something she hadn’t done in three years. One down, four more to go to hit her goal.

  “Are you sure you’re taking your medicine? You haven’t stopped it in secret or anything, have you?”

  “No,” Giulia said, offended by the question.

  “I have to ask,” Dr. Stefania said, backpedaling. “I’m not accusing, I just have to make sure. Because this is coming out of nowhere.”

  “I agree,” I chimed in. I had finally stopped mansplaining during Giulia’s appointments, but it didn’t mean I sat in silence. “She’s taking her nine hundred milligrams of lithium. She’s doing everything right. What’s going on?”

  “I don’t know,” the doctor responded. “But I’m going to prescribe a sleep medication on top of the Risperdal. Giulia, stay on one pill of Risperdal, and take one sleep pill tonight. Take both at bedtime. If you’re still not asleep four hours later, take a second sleep pill.”

  “What if I’m still not asleep after that?” Giulia asked.

  “Then you should take a second Risperdal.” Giulia’s eyes widened in response. “But I doubt you’ll still be awake,” Dr. Stefania added hastily. “That’s a lot of medication to take.”

  “What about work? I really don’t want to lose my job. Mark and I have a plan in place, and we have a lot of goals we’ve agreed upon. The two biggest ones are that I don’t want to go to the hospital, and I don’t want to lose my job. This is the first job I’ve been able to hold down for a while, and I really like it.” Giulia was getting herself worked up. I leaned across from my chair and held her hand.

  “Those are my goals, too,” the doctor affirmed. “But if you’re taking all these drugs, you probably shouldn’t go to work. Can you take some time off?”

  “Yeah, I guess. I mean, I took the morning to be here today, and I haven’t ever taken a sick day,
so I definitely have some of those saved up.” Giulia shrugged.

  “Why not take tomorrow off, too? When you do fall asleep, this will allow you to sleep in, and you won’t have to worry about your alarm. Then, after a good night’s sleep, you should already be feeling better. If you can get two good nights in, then we can pull back off the meds. It’s Tuesday now, we can hopefully have this wrapped up by the weekend.”

  “I was going to go to New York City this weekend. My brother just got engaged, I want to celebrate with him,” Giulia said. “Mark and Jonas are going camping. They already have a campsite reserved.”

  “Well, let’s see how you feel. Going to New York might not be a good idea. Let’s check in about that on Thursday.”

  We left her shiny office, hand in hand. We had been to so many appointments before, but this felt much different. We were in charge. No, Giulia was in charge. I was supporting her decisions because we had already talked through the contingencies before. This was going to be different. It was going to be fine. We went back to work, ate dinner, put Jonas to sleep. All felt encouraging.

  Except that Giulia didn’t sleep that night.

  The Giants continued their march through the playoffs, and Giulia continued to not sleep. I watched the next game on TV as Jonas played around in the room with me, Giulia paced barefoot in the backyard, and I tried to wrap my head around why this was happening.

  Her two prior psychotic episodes had such similar origins. I figured that work was the main culprit in both cases, a new job with unexpected demands. But nothing was tumultuous at work right now; in fact, it was the exact opposite. Work was going great. And she was on lithium, which she hadn’t been taking for the previous two episodes. She should not be sleepless. None of this should be happening. It disrupted the pattern. It made no sense.

  The only constant was the time of year. In 2009, she was hospitalized in September; in 2012, it was in November; now, in 2014, we were smack in the middle of October.