“Bro! Know! Grow! Show!” Target clanged.
“Would you go with me, Ho?”
“Where do you want to go, Brewster?”
“To see my therapist. Levi.”
“Why would you want me to do this?” I asked, wondering if Brewster was hallucinating. Why would he be on a first-name basis with a therapist?
“Levi says I have to stay on my meds, too. So I can get my check. It’s the same place Ranger goes, but they don’t make him take meds. If you went with me, maybe Levi would tell me why.”
“Has he not told you?”
“Yeah. But … but you’re different, Ho. He’d talk to you different, too. I know he would.”
“When do you next see your therapist?”
“I can go anytime I want.”
This, too, sounded bizarre to me. I imagined one would require an appointment. And again wondered if Brewster had slipped forever into a world of his own creation. But I had no choice. My debt was not to Brewster; it was to our … unit.
“I will go with you tomorrow morning,” I said. “But only if you give your word that you will not go off your medications again.”
“If you believe Levi, I’ll believe you, Ho.”
“That is deliberately evasive,” I said, bluntly. “I am not going to bargain with you. I will not substitute my judgment for that of a trained professional. This cannot be decided by what I believe. Or even what you believe, Brewster. Either you must make the commitment, on your honor, or you will undertake the mission without me.” I paused, and looked around the circle. “Lamont and Target have already spoken as well.”
“Your number’s been called, kid,” Ranger told him. “You either stand up with us, or go sit someplace else.”
“I gave back my winnings,” Michael told him, conveniently overlooking how he had come by them.
“Ho?” Brewster pleaded.
“I said I would go with you tomorrow, Brewster. And I will. That is what a man of honor does. He keeps his word. We are, all of us, damaged in some way. But a man whose word is worthless is a worthless man.”
“Now! Now! Now! Now!” Target shouted. No interpretation was required.
“I swear I won’t ever go off my meds again,” Brewster said. The young man broke into sobs.
Lamont passed around paper plates from our stack as if he were dealing from a deck of cards, concentrating on his task.
88
“What is an ACT Team?” I asked, as Brewster and I entered a storefront with “Community Outreach Service Center” neatly lettered on its blacked-out front glass.
“That’s where Levi is,” he said, as if he had just provided a detailed explanation.
The receptionist was a shapely mixed-race woman whose appearance was clearly of great importance to her. She favored Brewster with a dazzling smile. When she picked up her telephone without asking Brewster’s name, I assumed he was a well-known client.
I made for the chairs on the far wall, expecting a long wait, but Brewster tugged at my coat sleeve, silently bidding me to stay where we were.
Almost immediately thereafter, a powerfully built black man with a shaved head came over to us. He looked like those who are placed on guard outside exclusive clubs, but instead of a menacing scowl, he presented a cheerful, welcoming countenance. “Brewster. My man! Come on. Levi’s wrapping up something; he’ll be with you in a few.”
As I began to follow Brewster, the large man turned and blocked my path, his tone and posture transforming him from Brewster’s friend to his guardian. “Something you want?”
“I am with Brewster.”
“This is Ho, Earl,” Brewster said. “I asked him to come with me today.”
The black man immediately offered his hand. I took it, noting his grip was intended to convey a comforting strength, not a demonstration of power.
We passed a young Latina with large, luminous eyes. She smiled at Brewster, exchanged what was meant to be a covert look with Earl. “Welcome,” she said to me. I bowed, hiding my surprise. I always fancied myself as a man not given to assumptions, but recognizing my own surprise at being greeted formally was proof that my self-assessment had been inflated.
Brewster seemed to take great pride in his intimacy with those we encountered. “Hi, Joanne!” he called out to a blond, blue-eyed woman, who responded with “Good to see you, Brewster.”
A smallish woman walked over to us, her movements supple and self-assured. “Who’s this?” she asked Earl.
“Name’s Ho,” Earl replied. “He’s with Brewster, Glo.”
When that response appeared to satisfy her, Brewster took this as affirmation of his own status. I could feel his presence expand with the assurance that he was known, a person, not a “case.” I understood that the exchange between Gloria and Earl was a technique of some sort, but a technique beyond my experience.
I was introduced to Hiram, a pensive young man who wore his hair in two thick braids, as if to emphasize his Native American heritage. He was far more formal in his greeting, as if to tell me that his heritage was no mere costume—I was, after all, quite obviously his elder.
Next I met Wendy, who looked like some of the women I had seen at a poetry reading Lamont had taken me to at the public library the year before.
“That was Adanna,” Brewster told me as an African woman in a tan sweater flew past, obviously too busy to exchange even a word.
“And that’s Dr. B.,” he confided, as we passed the office of a red-haired woman so deep in reviewing papers on her desk that she did not look up as we walked by.
The noise level varied from room to room, from silence to shouting.
“Open for business,” Earl said, indicating an open door. He rapped on the jamb, and called out, “Brewster’s here to see you, boss. And he brought a friend, too.”
The man who must be Levi stood up. He was moderately tall, well muscled, with close-cropped blond hair and the high cheekbones and blue eyes I associate with Slavic antecedents, wearing an unbuttoned denim shirt over a thin black jersey.
He offered his hand. I responded, wondering if there was some special grip all those of his profession had to learn—his was precisely the same as Earl’s had been.
Brewster sat down without being invited. I thought this impolite, but accepted that I was a guest of another culture, and must be respectful of its rules.
“When did you go off your meds?” Levi immediately asked, in a conversational tone which implied that Brewster had already disclosed his lapse—that such was a fact, not a topic for discussion.
“Five days ago,” Brewster replied. “And I feel okay.”
“Uh-huh. Is that why you brought a friend with you today?”
“No, Levi. This is Ho. He … he understands things. I thought you would, like, explain to him how come I have to take the meds. Then he could, you know, explain it to me.”
“Like an interpreter, huh?”
“Yeah!” Brewster said, with genuine enthusiasm.
“Brewster,” Levi said, without inflection of any kind, “you know all about confidentiality. You know I can’t discuss your case with anyone unless you give permission.”
“But that’s why I brought him. I mean, I brought Ho. Isn’t that the same as giving permission?”
“Sure,” Levi agreed. As he spoke, I heard a distinct whistling sound through his nose—it had been broken at least once. This did not fit my imagined picture of “therapist.” Nor did his style of dress, and the way he spoke to Brewster more like a friend than a patient. “But you know Mr. Ho, Brewster. I don’t. So I have to ask him to sign a paper that says anything he hears in this room can’t be repeated. Okay?”
Not knowing to whom Levi had addressed his question, I said, “I will sign your paper.”
I stared at the page long enough to allow my other senses to explore the immediate environment, then deliberately scrawled some undecipherable “signature” at the bottom.
“How do you want to do this?” Levi asked Bre
wster.
“Couldn’t you just, like, tell him?”
Levi turned slightly to connect his eyes with mine. “Brewster is schizophrenic,” he said, using the word as though he were saying Brewster had brown hair—a description, not a judgment. “He hears voices. The voices aren’t his friends. They try to make Brewster do things he doesn’t want to do. Sometimes, they succeed. That’s when Brewster ends up arrested, and we have to go and get him. That’s how Brewster came to us in the first place: a referral from Rikers.”
I knew Rikers was a jail or prison of some kind. But I had also thought Brewster had never been arrested. So all I said was “Yes?”
“Schizophrenia is incurable. But it is manageable, with the right combination of medication and therapy. It’s our job to make sure Brewster gets both.”
“Brewster says he does not need this medication.”
Levi studied my face for a moment. “But you already know that’s not true,” he said.
“Yes,” I admitted, noting again Levi’s habit of asking questions that assumed facts—I was impressed that he could so quickly intuit the truth. “But is there no alternative? Brewster says the medication makes him feel … strange.”
“Tardive dyskinesia,” Levi said, nodding his head. “Those uncontrollable movements you see, like jerking his arms for no reason, or when he rolls his tongue outside his mouth—it’s a known side effect of any medication that controls … or even eliminates … the voices. Brewster’s schizophrenia is what we call ‘Undifferentiated.’ He’s not paranoid, he’s not disorganized, and he’s never had a catatonic episode. So Brewster has a real shot at functioning in the community. But he’s got to achieve and maintain a consistent blood-level of his medications before he can participate in our skill-building program.”
“What skills are taught?” I asked, genuinely curious.
“That depends on where we start. For some, it could be as basic as personal hygiene. Brewster actually has a relatively high GAF—” Seeing my obvious confusion, he explained: “Global Assessment of Functioning. The higher the better. Brewster could already handle a wide variety of clerical jobs, for example.”
Sensing that Brewster did not resent being spoken of in this manner—indeed, he seemed to regard the information I was being given as praise—I asked, “Who would hire—?”
“That’s another skill we teach,” Levi said. “Job-finding. Handling the interview. How you keep a job. We do the same thing with housing, transportation … anything that gives the client a realistic shot at self-maintenance. Truth is, Brewster could have been on his own a long time ago, if he put some effort into it.”
I looked at Brewster.
“I don’t want a job,” the young man finally admitted, blushing furiously. “I just want to work on my library.”
“But you have to come here to get your check,” Levi said. His voice was neutral, not accusatory. “So you show up and go through the motions.”
“I come to every—”
“Yeah. You never miss a session,” Levi said, his voice hardening slightly. “But you never participate in them, either.”
“If it wasn’t for my sister’s husband—”
“You’d move in with her,” Levi finished. “But what would that change? You still wouldn’t be taking care of yourself, Brewster; you’d just be changing caretakers.”
“The meds make me all … fuzzy. I can’t think straight. How could I ever hold a job?” Brewster said.
“I’m not saying it’d be easy,” Levi told him. “I never said that, did I?”
“No …” Brewster replied, his attempt to divert the conversation away from his own lack of interest in what Levi had called self-maintenance having failed.
I waited a few moments, then I spoke into the silence: “Can you … can you tell me why Brewster might, most sincerely, believe he does not need this medication?”
“When a schizophrenic goes off medication, there’s a honeymoon period,” Levi told me. “His mood elevates, the kinetic tics occur less frequently, or even stop altogether. Off the meds, he gets all manic. Expansive, grandiose, absolutely convinced he’s in total control of himself. Then comes the … episode.”
“Always?”
“Always. No different than taking a diabetic off insulin and putting him on a diet of hot-fudge sundaes. We try to build in every option possible, and we’re always adding new ones. But the medication, that one’s nonnegotiable.”
“You will reject Brewster if he does not—?”
“It’s not personal,” Levi cut me short. “Everybody here likes Brewster, and he knows it. But he also knows that ACT is all about helping folks change their lives, and, for some of our people, they can’t even get started unless they commit to taking their medication. This isn’t a Welfare office. Brewster’s got himself a nice, certified diagnosis. He knows he can stop taking his meds and he’ll still keep right on getting his Disability check. But he won’t be picking it up here.”
I shifted my posture so that I could triangulate Levi and Brewster, although I addressed my words only to Levi. “So Brewster has chosen to be in a program where more is required of him than he is willing to give?”
“Yeah,” Levi said, leaning on his forearms. “I wonder about that myself.”
“I like talking to Levi,” Brewster said.
It was as if theater curtains were lifted, and the play was the revelation of a secret. I then understood the true reason why Brewster had asked me to accompany him that day. Despite his claims, some part of him did want to self-maintain. He attended the various programs at this place not because that was the only way to get his government stipend, but because it was his only channel to Levi.
“You are a young man to have acquired so much wisdom,” I said to the therapist.
“I’m a good listener,” he said, flashing a quick, thin smile.
“Ranger doesn’t have to …” Brewster muttered sullenly.
Before I could act to protect Ranger’s privacy, Levi had already stepped on Brewster’s childish sulkiness: “The ACT Team works with the most high-need cases, but that’s the only thing our clients have in common. You want to be treated as an individual, right, Brewster?”
“Sure. I mean—”
“I don’t want to hear anything like that again, okay?”
“Levi,” Brewster pleaded, “I didn’t mean to—”
“Sure,” Levi said. “Just let it go. Any decisions you make, you make them about you, okay?”
“Okay.”
“Your expectations, they, too, vary with the individual?” I asked, sensing Brewster’s anxiety at having trespassed across a known barrier.
“Right,” Levi answered, his voice back to neutral, the very sound soothing to Brewster. “Let’s say, hypothetically, there was a man with PTSD—Post-Traumatic Stress Disorder—as a result of a long period during which he was fighting for his own survival … like a soldier in combat. If his problem was due to military service, he’d be entitled to treatment at the VA. But we see a lot of guys who blame the government for whatever’s going on in their heads. They end up here, because you couldn’t ask for a less military outfit than this one.”
How Levi assumed I knew Ranger, I did not know. But it was clear he was offering me the “hypothetical” information for a purpose. I immediately seized the opportunity to test the limits of my access.
“And if a person had, say, an addiction to gambling?”
“If that was his real problem, we’d probably never see him,” Levi said. “Depending on his resources, he could get anything from celebrity spa ‘rehab’ to a bed in a detox facility, only it wouldn’t be dope they were trying to get out of his system. Most of them end up in one of the self-help programs. Like AA.”
“That contract you had me sign …?”
“Yeah?”
“Could not Brewster sign one as well?”
“I’m not a lawyer,” Levi said.
“Ah. Forgive my poor English,” I said. “What I m
eant was, you said each individual has a different level of … functioning, is it?”
“Uh-huh.”
“And Brewster’s is quite high?”
“It is.”
“So I am not asking you a question about whether he could sign a contract to buy a house. My question is: Could Brewster sign the contract every man signs when he gives his word? Is he … functioning enough to do that?”
Levi gave me a hard, searching look. Then he said, “I wasn’t lying when I told you I was a good listener.”
I bowed.
He quickly turned to Brewster. “How many days, Brewster? No games. How many?”
“Five,” the young man repeated, without hesitation.
“Counting today’s?”
“Yes. But, Levi—”
“Which means we can cut that down to four. Understand? You come here to get your meds from now on, Brewster. Every day. We’ll trust you over the weekends, give you three days’ worth on Fridays. Same day you let us draw some blood.”
“That’s not—”
“Yeah, it’s fair,” Levi said. I could now detect a vein of well-controlled anger in his voice. “This is a place where we help people help themselves, Brewster. We’re a therapeutic team, not a fucking pharmacy, got it?”
“I never said—”
“Your behavior said it for you. So that’s the deal. You give us one solid month without missing a day, we go back to giving you a week’s supply at a time. You come to the programs and you do more than just sit there, understand? That’s our contract. You want to be a man, stand up and we’ll shake on it. You don’t, there’s plenty of other places where you can go and pick up your check.”
None of us moved for a long minute. Then Brewster stood up. He stuck out his hand. “I promise, Levi,” he said.
“Good enough for me,” Levi told him. He hit a button on his desk. “How can I—?” came through the telephone speaker.
“Pull one day’s med package for Brewster,” Levi said. “He’ll be in once a day from now on, until I tell you different.”
“Dr. Pkhafatsh’s orders—”
“He doesn’t work here, okay? He’s just a rubber stamp,” Levi interrupted. “If he’s got a problem, he knows where to find me.”
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