Dr. Rojas tried a couple of times to get her on track, but it was no use. “Okay, Mia,” said Dr. Rojas, interrupting her, “could you please wait here in my office? I have some samples of a new medication we might like to try.” Turning to me, he said, “Pat, could you come with me? I’ll need some help.”
“Um, sure,” I said. Dr. Rojas held the door, closing it as he followed me through.
“Pat, my God!” he exclaimed. “What happened? She’s so much worse than last week!”
“I don’t know. Things changed so quickly, that’s why I thought it might have something to do with the Relpax.”
“No, no, the Relpax couldn’t have caused this reaction.”
We were right outside his office. I wondered if Mia might be able to hear us.
“Are you sure she has been taking the Seroquel?” he asked.
“I don’t have any reason to believe that she hasn’t. I’m usually there when she takes it.” This was true, although I hadn’t made a point of studying her closely while she did.
“I’ve never seen anything like this,” admitted Dr. Rojas after a pause, “such a dramatic change when on such high doses of Seroquel for so long. It shouldn’t be happening.” He paused again, his mouth folding down into a slight frown. “Pat, if I were treating this from the beginning, I would have put Mia on Zyprexa.”
“Zyprexa?”
“It’s a much older drug than Seroquel, used to treat bipolar and schizophrenia. We have much more data on its effectiveness. I’ve had very good success with it when dealing with psychosis.”
“Will it be a problem if she takes it with the Seroquel?”
“It shouldn’t cause an adverse reaction, but she will be heavily medicated.” I could tell he was thinking it through as we talked.
“She’s already heavily medicated,” I sighed.
“I can’t bring down the Seroquel too quickly, that could cause problems, but it doesn’t seem to be the right drug for her. People respond to these medications in all different ways.”
“You have way more experience with this stuff than I do,” I said. “But I would agree with you, the Seroquel doesn’t seem to be working. I’m okay with making a change if you think we should.”
Dr. Rojas looked at me. “Thank you for your trust, Pat,” he said evenly. “We are going to wean Mia off Seroquel and start her on Zyprexa. Come with me.”
I followed him down the hallway. He opened a closet, and I saw boxes of medications piled high. “These are Zyprexa samples.” He opened a plastic bag and threw little purple packets inside. “They won’t approve the Zyprexa prescription until the Seroquel runs out. These samples will allow us to start on it immediately.”
He handed me the bag. “I’ll write down specific instructions on how to administer the medications. It’s going to be very important that you follow my directions exactly.”
“Okay,” I said nervously. We were mixing strong, brain-altering pharmaceuticals. What kind of effect would that have on Mia?
“Good,” said Dr. Rojas, his eyes steady. “And Pat, you have to make sure that Mia takes the medication. Watch her take it, every single time.”
When we arrived home, I had carefully detailed instructions on how to manage Mia’s medications. Dr. Rojas wanted to precisely titrate the Zyprexa and Seroquel, increasing the first while slowly decreasing the second. With pills everywhere, the counter of my dresser looked like a pharmacy.
Mia took her first dose of Zyprexa immediately. I gave it to her reluctantly, apprehensive about loading up on so many psychotropic drugs. But I trusted Dr. Rojas, and the Seroquel was clearly failing.
Luke and I took turns watching Mia the rest of the day. I stayed with her initially, making sure that she didn’t become worse with the new medication. Then he took a shift so I could make dinner and help the kids with homework. When I checked back in with Luke, he and Mia were secluded in our bedroom.
She was in the bathroom, but he looked up from the bed. He was lying down and fiddling with his phone. Although he wouldn’t sleep on a mattress, he didn’t mind relaxing on one.
“Yo, Patricio,” he said, “she’s been good for the past ten minutes or so.”
“Really?”
“Yeah, bro. Before that, nah, she was all confused . . . pa pa pa, pe pe pe . . . rambling here and there. But then she became more coherent.”
“Thanks, Cubano. I’ll manage things from here.”
I took his spot on the bed. Closing my eyes, I tried to enjoy the brief silence, but it wasn’t possible. My body was taut, prepared for battle. After a couple of minutes, Mia came out of the bathroom.
“Hi, Pat,” she said. I opened my eyes; she sounded normal.
“Hi,” I replied. “How are you doing?”
She let out a big sigh, then sat on the bed next to me. “What is going on?” she asked wearily. “None of this feels right.”
“No, it doesn’t,” I admitted.
“Why have I been treating you so badly? I’ve been so mean to you.”
I didn’t answer.
“I’m so sorry, babe.” She put her hand on my leg. “This must be horrible for you.”
I couldn’t believe it—Mia seemed suddenly cured! I sat up quickly.
“Um, yeah, it hasn’t been great,” I replied, “but it’s okay.”
With sincere tenderness in her voice, she said, “I’m so sorry.”
We sat looking at each other for a moment. “Mia, is that . . . is that really you?” I asked, staring into her eyes. And I saw it; I saw that connection I had been craving for so long.
“Yeah, Pat, it’s me.”
I kissed her and wrapped her in an eager hug. She reciprocated the embrace. I tried desperately to enjoy the moment, but my mind was racing. Could the Zyprexa have worked so quickly? It didn’t seem possible.
“What are we going to do?” she asked, trying to pull away.
“I don’t know, whatever we have to do,” I responded, unwilling to let her go. Could she be better? Was the nightmare over?
“What about the kids? Are they okay?”
“They’re okay,” I promised, finally releasing her.
She sat back, smiling weakly. I still had her hands in mine, holding them in my lap. I didn’t want her to move, didn’t want the moment to end. But less than a minute later, she stood up and walked across the room.
“There’s got to be some reason for it,” she said.
No, no, don’t go looking for reasons, I begged silently.
“If we can figure out the reason, we can find a solution.”
No, don’t worry about that now. Stay with me!
“Maybe if we just go backward . . .” And then it was over, as quickly as it had started. She was trapped again in psychosis, swirling through disjointed ideas.
At the time, it was absolute torture. But in days to come, that exchange became a source of inspiration. I knew that my Mia was somewhere in there, ensnared inside a spiraling brain.
After she fell sleep, I received a text from her cousin Alex. I hadn’t spoken to him in over a week, but I knew that Mark was keeping him updated. Rather than text back, I called.
“It’s been tough, Alex,” I said after he answered. “She did have a brief moment of clarity tonight, but it didn’t last long.”
“Dude, I guarantee you she stopped taking the Seroquel,” he blurted out. “There’s no other way she could be psychotic again.”
“That’s what her psychiatrist thought, too,” I said, “but I don’t see how that could be possible. Either I’ve been there or Luke has been there every time we’ve given it to her.”
“You don’t see it because you haven’t dealt with mentally ill patients before. They hate the way the medication makes them feel. They get really good at faking it.”
“Faking it?”
�
�They put the pills in their mouth and pretend to swallow them, but then, when you aren’t looking, they spit them out.”
“I don’t know about that,” I replied. “She took Relpax for her migraine on Sunday. Isn’t it possible that it triggered some kind of relapse?”
I could hear him looking up the details in his reference guide.
“No, that shouldn’t have caused it,” he said. “Pat, trust me on this. You need to go buy a safe. You need to do it tonight.”
“A safe? What are you talking about?”
“Here’s the next phase of this; I’ve seen it a million times. If you leave the medication on the counter, you’ll go to give her a dose and she’ll say, ‘It’s okay, I’ve already taken it.’ And you won’t know if she has or not. You’ll be scared to give her too much, so you’ll let it go.”
“You mean, I should lock up the medication so I know exactly when it has been accessed?”
“Exactly,” he agreed. “Even small changes to the dose can set things off. You can’t let that happen. You have to know for sure that she has taken it. And you have to know exactly how much she has taken and when. Another thing, when you give her the medication, watch her take it. Make her open her mouth afterward and show you that the pills are gone.”
“Jesus, man, that will really make her mad.”
“Who cares if she’s mad? The only thing that matters is that she takes the medication. Takes it at the right dose.”
“Yeah, I guess so. You’re right.”
“I’m definitely right,” he said. “There’s no way that little Mia could be psychotic again on that much Seroquel. No way.”
A half hour later, I was standing in a brightly lit aisle of Walmart, evaluating the various options for safes. I chose a medium-size one, big enough to hold the plastic bottles but small enough to fit next to my dresser. Back home, I programmed the lock and arranged the medicine inside. I showed it to Luke, too, bringing him up to speed on Alex’s advice.
I stayed home from work the next day. After she woke, I gave Mia the day’s first round of medication. She didn’t notice the safe, but she was not pleased when I asked to see that she had swallowed the pills. She finally complied when I said it was her cousin Alex’s idea: opening her mouth, sticking out her tongue, and casting a withering stare afterward.
Her psychosis continued all day, but the pattern was different. She had dramatic swings in behavior. She would be fairly reserved for a while, never quite approaching the clarity of the previous night but acting almost normal. This might last twenty minutes or so. And then abruptly she’d be raving again.
Luke and I continued swapping out responsibility. Keeping her contained to the bedroom became impossible. She refused to stay in one spot and wasn’t easily distracted. But she didn’t try to run away, and she didn’t feel threatened, either.
I left in the afternoon to take Will to another session with his counselor. I picked Jamie up at the bus stop along the way, wanting to keep her out of the house. Neither of the kids knew that Mia had relapsed, and I wasn’t sure how to break the news.
Will met with Matthew while Jamie and I read together in the waiting room. Once we were all in the car, I decided it couldn’t wait any longer.
“Guys,” I said, turning down the radio, “I wanted to talk to you about Mom again.”
They didn’t reply, so I continued. “I know her illness has been really hard on everyone.”
I waited a second; they were listening.
“And, as we have learned, her illness comes and goes. Sometimes she acts really weird, and that’s when the sickness is messing with her thoughts. She can’t think straight. And other times she acts mean, not like her usual self. And that’s because of her medication. Remember when we talked about that?”
“Yes,” said Will in a low voice.
“Yes,” echoed Jamie.
“Okay, well, I wanted to let you know that Mom is acting really weird again,” I said. “It started yesterday. But even though she might be acting funny, she’s still the same Mom inside. It’s her sickness that we’re seeing, not Mom. We just need to remember that and try to be as patient as we can. Think you can do that?”
“Yes,” whispered Will again.
“Yes,” repeated Jamie, just as quietly.
“Thanks,” I said, “and if things get too uncomfortable, you can always excuse yourself and go to your room. Or you can come to me or Uncle Luke if you want to talk.”
“Okay,” they both said, barely audible.
“Hey, you two!” I said with false cheer. “Mom isn’t dying! She’s going to get better. I know it is taking longer than any of us thought, but she’s going to get better.”
They both kind of nodded their heads like they agreed, and I decided to stop there. I turned the radio back up, but a sense of anticipation filled the air. None of us knew what to expect when we arrived home.
Mia was out by the pool with Luke when we walked in, so Will and Jamie retreated to their rooms. When dinner was ready, everyone came into the kitchen to get their food, and it looked like we might have a normal meal—until Mia appeared.
She was clearly agitated and in her own world. Mumbling under her breath, she made her way to the table and then started walking around it, studying the plates and silverware.
“No, this isn’t right,” she said, grabbing Luke’s plate. He sat looking at Mia while she continued circling the table, holding his food. The rest of us had paused and were watching her now, too.
Mia put Luke’s dish down at a different spot and stood looking at it. “No, no,” she muttered, picking it up again. Then she looked over at Will. “You sit here,” she ordered, pointing down at a chair. “Right here.”
Will glanced over at me; I shrugged.
“Come on,” Mia said. “Don’t be afraid. This is your place.”
Will sat. Mia continued to circle, finally putting Luke’s plate down and instructing him to switch chairs. This went on for five minutes, with Mia concentrating hard to unravel the correct arrangement of seats.
Then she began to rearrange the silverware. She was picking up people’s forks, believing they had to be paired with certain plates. I finally stepped in.
“Okay, that’s all, babe,” I said, taking the silverware out of her hands. “You don’t need to worry about any of this right now.” The kids had seen their mom acting bizarrely enough.
Mia stared at me, a nervous glaze to her eyes. I was keenly aware of my actions and my tone; I knew the kids were watching.
“C’mon,” I said tenderly, “let’s get you some food.” I put my arms around her shoulders and led her over to the kitchen, hoping that she wouldn’t react negatively.
Once she had her food to focus on, Mia was better. She sat silently for a while, but I could tell that she was frustrated. The kids were talking about school, but she wasn’t able to follow the conversation. I suggested that she and I return to the bedroom.
For the rest of the night, the illness displayed a pattern similar to the one we had seen during the day. At times, she was calm and almost coherent, but then she would become extremely confused and paranoid. One common thread ran through it all: she became upset every time we forced her to show us that she had swallowed the medication.
On Thursday morning, Luke offered to watch Mia for the day and update me as needed, but I decided to stay home again from work. I wanted a firsthand view of her condition.
As the day progressed, her psychosis became more belligerent; she was especially quick-tempered with me. At this point, she was losing her phone every twenty minutes. Mia asked us to help her look for it at least fifteen times that day. After we found it, she would usually accuse us of stealing it. “If we had stolen it, why would we help you find it?” I asked the first time it happened, hoping to defuse the situation. Unfortunately, she thought I was teasing her. All it did was wid
en the divide between us.
And even though the devil hadn’t shown up again, Mia was exhibiting signs of intense religiousness. This was not like her; she had never been preachy. Now, she was listening nonstop to Christian radio at high volumes, usually turning it up even louder when I walked into the room.
In the afternoon, Mia continued cycling through degrees of psychosis, becoming more hostile during the worst phases. I was worried about the crescendo; my gut told me that we were headed toward an untenable situation. Alarmed, I texted Dr. Rojas. He instructed me to slow the rate of increase of Zyprexa.
Luke and I kept Mia away from the kids that night; she was too unpredictable and antagonistic. Finally, I was on the last shift of the night with her. She was talking with her mom on the phone, in our bedroom. It was during one of her lucid phases, and their conversation sounded quasi-normal. Not realizing that Mia was watching, I went over to the safe to assemble her last dose of medication for the day.
“Wow, look at this!” I heard Mia say to Lucia. “Pat has a safe here, Mom. A safe!”
I glanced back at Mia.
“What’s the safe for, Pat?”
“It’s just so I can keep track of the medication,” I answered, trying to remain calm.
“Keep track of the medication? What are you going to do, lose it?” she sneered.
I was kneeling on the floor by the safe, not sure how to respond.
“I think he’s taking the medication now, too,” she said to Lucia. “He’s guarding it for himself. That’s smart, Pat. It’s about time you started taking the medication. You need it!”
“It’s another one of Alex’s suggestions,” I explained, ignoring her accusation.
“Oh, Alex has a lot of great suggestions!” thundered Mia. “He’s the reason you and Luke don’t trust me to take the pills by myself.”
“He said it was important that you take them as instructed.” My heart was beating faster.
“Haven’t I been doing that, Pat?” she screamed, pulling the phone away from her cheek. “Haven’t I been taking the medication for weeks now?”
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 16