Saving Max

by Antoinette van Heugten

  She shrugs. “I told you—he’s fast asleep. But if you insist, please keep your visit brief. We don’t want to upset him.”

  Danielle bites her tongue as Reyes-Moreno disappears down the hallway. “No,” she mutters, “we certainly don’t. A visit from his mother—now, that would upset anyone. But overdosing him is fine, just fine.”

  CHAPTER TWELVE

  Today is the day.

  Apparently the collective has finally arrived at a diagnosis. The last week has passed without incident—at least nothing that anyone saw fit to tell her. Max seems so much better. In so many ways, his sweet nature has returned. There have been no incidents of violence and he has shown no resistance to the completion of the assessment. His behavior has so improved that Reyes-Moreno has been able to complete her testing and conclude the evaluation. Even though he seems, at times, terribly sedated and somewhat disoriented, Danielle’s guess is that Fastow has finally gotten his act together and fine-tuned Max’s medication protocol. Georgia’s background check on him turned up nothing at all. In fact, all she found was further evidence of his excellence and creativity in his field. Although Danielle’s personal dislike of him has not abated, Fastow seems to have done a laudable job of straightening out Max’s medications.

  Danielle follows a path through the maze of white sidewalks to the administrative building. She looks up. The sky is a cobalt paint stroke, a piercing, hypnotic blue. The clear crispness of it slices straight through her. Her heart lifts.

  “Ms. Parkman, will you come with me?” Reyes-Moreno’s secretary, Celia, greets her with a brief handshake. She safeguards her boss like a trained Doberman, never saying whether Reyes-Moreno is there or not when Danielle calls—making it sound like she’s always in the restroom or in session. Psychiatrists must have copyrighted employee-training software. They’re all the same.

  Danielle follows her down the hall that houses the psychiatrists’ offices. Celia looks happy. She wouldn’t be smiling if Danielle were about to get bad news, would she? She leads her into Reyes-Moreno’s sanctum sanctorum. It is smaller than Danielle had imagined, especially with the obligatory couch and swivel chair. Toys are lined up on a series of shelves. Danielle turns one of them over gently in her hands, wondering if each represents something incredibly psychiatrically telling. She wonders what Max has said and done in this room.

  Reyes-Moreno’s diplomas and medical certifications hang in thick, black picture frames. An undergraduate degree from Pasadena, California. What is this? Doesn’t everyone who reaches Mecca springboard from Stanford or Yale? At least UCLA? Her heart beats faster as she peers at the other squares of calligraphy displayed upon the wall. There it is—Harvard Medical School. She is relieved. Not that she has anything against Pasadena, but good God, if you’re paying for top drawer, you damned well want a thoroughbred.

  Danielle settles into one of the two wicker chairs that seem to be reserved specifically for parent consultations. Like her, they feel out of place. She thinks about Tony, wishing she had been able to see him again. After she cancelled their dinner, he left a note at the desk that said he had to go back to Des Moines. He wrote down his cell number, but she hasn’t used it. Her life is far too uncertain right now to add him to the mix. The note is still in her purse, a hopeful talisman. She turns her mind to plane reservations. If they leave early tomorrow, she can get Max back to their apartment and still have time to unpack his things. Even the thought of doing his laundry makes her smile. Maybe Georgia, who has returned to Jonathan, can stop by Danielle’s apartment tonight, open the windows, and get a few groceries in so it won’t seem so deserted. Then maybe Max won’t remember they’ve been gone so long.

  Celia returns and hands her a lukewarm coffee. Reyes-Moreno is running a few minutes late. Probably still meeting with Max’s team, she thinks. They work in packs here. No one shrink, neurologist, or psychiatrist—no one doctor responsible for anything. She takes a sip of the bitter brew. She’ll have to try and square things at the office as soon as she gets home—big-time. She feels a fleeting panic and then pushes it out of her mind. First things first.

  So, what will Reyes-Moreno tell her? She’ll probably confirm all of the old diagnoses, tell her that the other doctors were mistaken, that they had him on the wrong medications. She smiles to herself. Max seems so much better. He looks more like, well, like Max.

  The door opens and Celia comes in. Her eyes don’t quite meet Danielle’s. She is reminded of jurors who don’t look her in the eye when they file back into the courtroom after deliberations. Reyes-Moreno walks in and closes the door. She gives Danielle a broad smile and squeezes her shoulder. The knot of tension Danielle has felt growing somewhere around her neck just as suddenly disappears.

  “Good morning, Danielle.” Her voice is soft and controlled. “How are you today?”

  What appropriate niceties does one exchange with the person who holds your child’s life in her hands? “Fine, Doctor. And you?”

  “Let’s sit, shall we?” She rolls the black swivel chair around until she faces Danielle, Celia slightly behind her. Danielle wonders what Celia is doing there, but doesn’t want to ask. Instead, she crosses her legs and puts her hands on her lap. Ready.

  Reyes-Moreno sits erect in her chair, eyes intent and focused. “Danielle, I know you’ve waited very patiently for us to have this meeting, and I’m happy to report that Max’s team has reached a definite consensus on his diagnoses and treatment protocol.”

  Danielle discovers that she’s been holding her breath. She forces oxygen into her lungs. Reyes-Moreno begins in a singsong voice. “It probably won’t surprise you to learn that we are confirming a number of diagnoses Max has been given over the years.”

  Danielle relaxes back into her chair. Same old stuff.

  Dr. Reyes-Moreno continues, her rhythm unbroken. “We confirm that Max is autistic—Asperger’s—and suffers from an unfortunately wide spectrum of learning disorders and disabilities,” she continues in her soft, melodic voice. “He has both a receptive and expressive communication disorder, an auditory processing disorder…” Her voice drones on.

  Nothing in the litany gets Danielle’s attention. She has a legal pad in front of her. As Reyes-Moreno talks, she dutifully writes it all down, as if she’s at a deposition getting boring background on an inconsequential witness. As the list of disorders wears on, though, she feels very sad—probably because all she wants to hear is that all the other well-meaning but misguided professionals not only made mistakes about the medications, but also about the autism diagnosis and underlying neurological differences. It would have been wonderful if Max didn’t have to face all of these problems. Well, she thinks, as Reyes-Moreno ticks off the list—obsessive-compulsive disorder, fine motor difficulties, tactile defensiveness—she can deal with all of it.

  “We recommend a new protocol of antidepressants to combat Max’s suicidal tendencies,” says Reyes-Moreno.

  Danielle goes down a mental list of tricyclic antidepressants, SSRI’s, SNRI’s and their potential side effects, as well as those contained in the black box warnings. “What are you thinking of? Effexor? Cymbalta? Zoloft?”

  Reyes-Moreno looks at Danielle, but doesn’t say anything. Danielle turns abruptly and stares at Celia, who starts to say something, but catches a vague signal from Reyes-Moreno and looks away. Danielle’s heart is beating too fast, a wild, caged thing struggling to get out.

  Reyes-Moreno rolls her black chair closer, takes Danielle’s hand and squeezes it. Her voice is baby-blanket soft. “There’s more, I’m afraid.”

  Danielle pulls back. Reyes-Moreno’s viridian eyes lock on hers. If she smiles at me, it means he’s all right. Danielle smiles first—a small, desperate invitation.

  Reyes-Moreno has no smile for her. “I’ll just say it, and then I want you to know that we’re all here for you.”

  Danielle has no body now. She is only her eyes, which see Reyes-Moreno and nothing else in the universe.

  “Unfortunately, our
testing has resulted in the diagnosis of a grave psychiatric illness. Max has an extreme form of psychosis, called schizoaffective disorder.” She pauses. “Fewer than one percent of all psychiatric patients fall into this category.”

  Danielle is stunned. “Max is schizophrenic?”

  “In part. However, schizophrenia does not have the mood-disorder component that the schizoaffective label carries.” She points to a stack of literature on her desk. “I’ve selected a series of articles that will better help you understand the challenges Max faces. Briefly, the onset of schizoaffective disorder peaks during adolescence and early adulthood. The severe disruptions to Max’s social and emotional development—compounded by Asperger’s—will continue over his lifetime. He will, in all probability, always pose a risk to himself and others, and involuntary hospitalizations will be frequent. Unfortunately, Max displays virtually all of the symptoms under the DSM-IV-TR: delusions, hallucinations, frequently derailed speech, catatonic behavior, anhedonia, avolition—”

  Danielle forces herself to breathe. “This is crazy! He’s never had any of the symptoms you’re describing.”

  Reyes-Moreno shakes her head. “Perhaps not when he is with you. However, our daily charts clearly reflect Max’s symptoms. You must have seen some of these signs. Parents often live in denial until, as here, the child breaks down completely.”

  “I do not live in denial.” Danielle feels her cheeks flare. “Are you sure that these symptoms aren’t a result of the overdose you gave him?”

  “No.” Reyes-Moreno shakes her head sadly. “These issues are far more pervasive and long-standing.

  “What we don’t know is if there is a history of psychosis or mood disorder in your family or his father’s family.” Reyes-Moreno’s lips keep moving—like one of those Japanese cartoons where the red mouth looks like a real person’s, but the rest of the body is a stiff, poorly drawn animation of a human being and the words come out long after the mouth has stopped. Danielle tries to absorb what Reyes-Moreno is saying, but her thoughts are a silent, deafening scream.

  “As I mentioned, Max will require frequent, lengthy hospitalizations over the course of his lifetime due to recurrent psychotic breaks and the extreme incidents of violence we have observed and anticipate. I must tell you that with each successive break, Max’s memory and his ability to assess reality will deteriorate exponentially, which unfortunately will compound the severity of his schizophrenia. It will most likely be impossible for him to hold a job or live independently as a result of these breaks. We must also be ever-vigilant with respect to the possibility of future suicide attempts. Unfortunately, Max is fully aware that his mind is compromised. We believe that this knowledge has driven him to consider suicide as the only option.” She looks at Danielle. There seems to be real sadness in her eyes. “As such, we strongly recommend that Max be remitted to our residential facility for at least a year, probably longer. He will undergo extensive psychotherapy so we can help him accept his condition.”

  Danielle struggles to absorb what Reyes-Moreno is telling her, but it’s like trying to process the news that you’ve got terminal cancer. Her mind is frozen, unavailable. She shakes her head.

  “Danielle,” Reyes-Moreno says softly, stretching out her hand. “Please let us help you deal with this.”

  She jerks back and stares bullets into Reyes-Moreno. “Leave me alone. I don’t believe it. I’ll never believe it.”

  Reyes-Moreno’s gentle voice is relentless. “…so hard at first…terribly severe in his case…long-term residential options…some medications…Abilify, Saphris, Seroquel…new electroshock therapies…”

  All she can think of is that she has to get out of there. She runs to the door without a backward glance, but can’t find the knob. She needs the knob.

  “Danielle, please listen—”

  “Not to this, I won’t,” she snaps. She opens the door, strides into the hallway, finds a restroom, and slams the door. She grabs the thick, curled edge of the washbasin and sinks to her knees. The cold porcelain feels white and holy on her forehead. Her mind is in a wild panic. If she believes what they say, then everything black and horrible that has crept into her mind at the bleakest moments—and passionately denied—has come true. If she believes what they say, Max will have no life at all.

  For one impossible moment, she lets herself feel that. What flows is a thick rush of hot lava, a keening that roils from her soul, dark and sick. She forces herself to stand up and stare at this woman with black tar under her eyes, this blotched face made ugly by knowledge and fear, this…. mother of a crazy child. Mother of a child with no hope. She curses God for the beautiful blue light He gave her this morning. She curses Him for what He’s done to her boy. Stones, stones—all stones.

  “Stop it,” she hisses. She has to think, be clear, find a solution. She splashes cold water on her face and tries to breathe, but psychiatric hospitals are vacuums. You’re not supposed to breathe fresh air or feel the sun on your face. You’re supposed to be in a place where other people aren’t. A place where you can be controlled every minute. Where you can be watched and drugged—kept away from normal people and the entire normal world. In a place that is always painted white. The color of a blank. The wiped slate. A place that reduces you, erases the sick part of you and, along with it, the part that makes you human and precious—the part that permits you to feel joy and give joy in return. A quiet, unchallenging world, hermetically sealed with a thick, black ring around it. A place that doesn’t keep the dangers of the world from you, but your dangers from the world. A place where you can look at yourself in the mirror and see the truth—one that imprisons you for life.

  She grasps the cool sink and stares once more into the mirror. She will not give in to this. She can’t. Max needs her.

  But the mirror tells her there’s no way back. No way back to the time when she believed that someone could put it all back together and make it right. When she believed that even if everyone in the world told her it could never be made right, she would still find a way. No way back to the perfect, soft skin of his tiny, precious body, or the joy in his eyes when she first held him in her arms; his exquisitely gleeful gum smile; his obvious perfection in innocence—limitless in his possibilities. As the mirror blurs and blackens in front of her, the woman she is and the quintessence of that child disappear. The baby is shattered, splintered in the darkness. Cover the glass with a black shawl.

  There’s been a death in the family.

  CHAPTER THIRTEEN

  Danielle awakens from a deep, useless sleep—the kind that affords no rest and is punctured with grotesque forms and fractured events that have no link or purpose. When she opens her eyes, her heart beats erratically—a bird shot out of the sky. She feels an amorphous panic; wonders dully if someone is chasing her. The panic is quickly replaced with stark terror. They think Max is irretrievably mentally ill. Her first urge yesterday was to run to him and hold him in her arms. But she can’t do that—not yet. If Max sees her eyes, he’ll know what he fears is true—that she, too, thinks he’s crazy. She never, ever, wants him to feel that.

  She lay awake much of the night agonizing over every word Reyes-Moreno said. Danielle still doesn’t believe what she told her, particularly the bizarre behaviors they attribute to Max—behaviors she’s never seen. No matter how she slices it, there’s no way Max could be what they say he is. But what if she’s wrong? The right side of her brain tells her that denial is always the first response a parent has to devastating news about a special-needs child. She must do her best to divorce herself from either knee-jerk disbelief or the paralysis of emotionalism. She has to get back into lawyer mode and uncover the core facts they’ve based their diagnosis upon. Once pointed in the right direction, she’s a better fact finder than anyone she knows.

  She jumps up and yanks on jeans and an old, gray sweatshirt. For the first time since they came to this dreadful place, she knows exactly where her compass is leading her.

  Daniel
le crouches outside the rear wall of the Fountainview unit and swats mosquitoes from her neck. The night air is heavy, and tall grass forms a green nest around her. The steel back door stares at her, as if it knows of her intention.

  She can’t believe she’s doing this. What if she gets caught? Even that begs the more basic question: What kind of a mother crawls around a psychiatric facility on her hands and knees in the pitch dark like some kind of card-carrying pervert? Danielle looks around. It would be just her luck if one of the security guards decides that now is the perfect time to make night rounds. She checks her watch. Ten fifty-two. There is only one night nurse on duty. At eleven, she usually sneaks a smoke in front of the unit until her maintenance man boy friend arrives and enthusiastically feels her up in a dark corner. If Danielle is lucky, they will disappear into the woods for the fifteen minutes they apparently require to consummate their hot, savage passion. She knows this because she has often crept to Max’s window late at night—just to watch him sleep. It took some of the sting out of the parsimonious visits allotted her by Maitland.

  The locked door beckons, but Danielle is paralyzed. This feels like life or death. She can find out about Max or turn around; go back to her room; and never know why Maitland insists that her son is crazy. Yesterday, Danielle demanded—and Reyes-Moreno unequivocally refused to provide—the underlying data upon which they based Max’s diagnosis. She knows that filing a lawsuit will get her nowhere. The hospital legal machine will find ways to hide the precise information Danielle needs. She has seen it happen far too many times. At that point, Danielle decided that she was entirely justified in getting it on her own.

  Even so, she falters. She is desperate for information, but does her desperation justify breaking the law? But if she doesn’t find out what they’ve really based Max’s diagnosis on—the nuts and bolts of it—she’ll never know if it has any merit. That is intolerable.