“As you noted, there seems to be a clear pattern associated with Mia’s condition.”
“That’s right.” I took Mia’s hand. She was watching Dr. Vuckovic with interest.
“I have been the head of this diagnostic center for the past eleven years,” Dr. Vuckovic said. “During that time, I have seen well over a thousand cases, all fairly complicated. Prior to my time here, I saw thousands more.” He paused to look up over his glasses. “I am, I fear, older than you two.”
Smiling, he glanced down at Mia’s file again. “All in all, I have probably seen five thousand patients in my career, maybe more. And in all that time, I have seen exactly three that I believe share a condition with Mia.”
I caught my breath. “Three people?”
“Yes, three people. And interestingly enough, two of them were related. A brother and a sister.” He sat back in his chair. “Mia, I believe that you are suffering from unipolar mania.”
She didn’t react.
“Unipolar mania?” I asked. “I’ve never heard of that. It isn’t in the DSM.”
He smiled and chuckled. “Impressive,” he said. “You’ve done your homework, Pat. But not everything is in the DSM. Like I said, I have seen this only three times before. It is not only rare; it is exceedingly rare.”
“Dr. Vuckovic,” Mia interrupted. “What is it? Is it treatable?” Her voice startled me; I hadn’t expected her to say anything.
He turned to her. “Unipolar mania is related to bipolar, Mia, except without the depression. Most people would prefer to experience only the manic phase. It gives you more energy, makes you feel invincible; and, as you know all too well, it requires far fewer hours of sleep. But at its most extreme, and left untreated, mania can lead to psychosis.
“That’s what I believe is happening here. Everyone naturally goes through phases of feeling up and feeling down, controlled by various chemicals in our brains and throughout our bodies. We psychiatrists don’t know as much about this as we’d like, unfortunately. We do know that for those with bipolar disorder, these phases are more extreme.”
He stopped for a moment, apparently thinking about some of his patients, before continuing.
“They are more extreme and more problematic. When someone with bipolar goes through the down phase, they suffer depression. In some cases, their depression can become suicidal, and they become a threat to themselves. But the up phase, the manic phase, can also be dangerous. Sure, people might feel more productive and creative, but mania can become quite destructive. People take too many risks, spend their money in foolish gambles, or cheat on their loved ones. And, as I mentioned, it can turn psychotic.” He paused again.
“I believe you suffer from a form of bipolar that doesn’t include depression. Your condition manifests itself only with periodic mania. But, unfortunately, that mania leads quickly to psychotic mania.”
Silence filled the room. It made complete sense to me. We had always been told that bipolar wasn’t applicable because Mia had never suffered depression. But what if she didn’t need to? Her behavior was manic at the outset, with the troubled sleep and heightened energy levels. And when she finally broke with reality, it took unbelievable amounts of medication to stop her brain from spinning.
Mia’s face was a mixture of acceptance and fear. “Dr. Vuckovic,” I said, weighing my words carefully, “if Mia does present symptoms of unipolar mania, what’s the prognosis? There must be a way to treat this effectively.”
He smiled slightly, nodding his head. “I do have some good news there. The challenge in treating bipolar is that the medication for one phase can swing a person to the other end of the spectrum. And psychotropic drugs affect people in different ways. Determining the optimal balance of medications for a specific individual can be quite difficult. But in your case, Mia, we only need moderate the manic phase. We need to keep you from spilling over into psychosis.”
We were listening closely, hanging on to his every word. “Fortunately, we have a drug that does this quite effectively. It’s called lithium. Lithium is actually a naturally occurring element that happens to be an excellent mood-stabilizing agent. It’s one of those strange things in the world of mental health. We know that lithium works—we’ve been using it effectively for over fifty years—but we don’t know why it works. All I can tell you is that I put the prior three patients with this condition on lithium, and they never suffered these symptoms again.”
“Never again?” I asked eagerly. “That was it?”
“Well, I shouldn’t say ‘never again,’ because I don’t know for certain. But in the time during which they communicated with me, and it was many years, they never became psychotic again. I don’t have a recent update, but I assume they have been fine, or we would have heard from them.”
Mia was suddenly engaged, asking about the possible side effects and long-term consequences of lithium. She was the physician assistant, trying to learn as much as possible from an expert in the field, but I was only partially listening. My mind was reflecting on this new, seemingly miraculous, information.
Ever since my battle with Crohn’s disease, I had been convinced that health problems weren’t solved by seeing the right doctor and taking the right pill. They were addressed by lifestyle changes, eating the right foods, exercising regularly, and avoiding stress. But here at McLean, with this menacing disease that had caused so much suffering, I was hoping that Dr. Vuckovic would prove me wrong.
I did catch some of their conversation, which had turned more pragmatic. Lithium had few short-term consequences. It could lead to weight gain, like all the other psychiatric drugs seemed to do, and could also interfere with thyroid function. But these seemed rare and manageable. Over a longer period of time, lithium could cause permanent kidney damage. This was a more serious risk, but apparently, with careful monitoring it could be avoided.
They were then discussing a treatment plan. Mia would continue working with Dr. Rojas, who would oversee her care, with Dr. Vuckovic consulting as needed. She could start on lithium as soon as she weaned off olanzapine.
Watching Mia, I thought she looked unconvinced. She would try lithium because we were desperate. But we had tried Prozac, too, and that didn’t end well.
Nonetheless, McLean gave me confidence. I was impressed by Dr. Vuckovic. His diagnosis was the most plausible I had heard, and he had successfully treated patients who had exhibited similar symptoms.
On the way back to the airport, Mia and I rehashed our conversation with Dr. Vuckovic and speculated about unipolar mania. She was more upbeat than I anticipated. We called Dr. Rojas once we were through security, and he was fascinated. Although surprised, he put his faith in McLean and was looking forward to working with Dr. Vuckovic.
As we took off over the buildings of Boston, I felt my spirits rising along with the plane. After almost two and a half years of suffering, could we finally put the past behind us? If so, Mia and I could repair the life that we had built together.
I thought that if we could restore Mia’s health, the rest would be easy.
20.
The Christmas Present
Foo Fighters
“Walk”
0:38–1:06
Our first couple of years in Florida were hard for me. Mia had dedicated herself full-time to raising the kids, which we both felt was important. She was planning to work again in a few years, while I was desperately trying to earn a living after becoming unemployed.
Given my past success as an entrepreneur, I assumed that starting a company would be the solution, but it was slow going. Neither Mia nor I came from wealth, and watching our savings dwindle with every bill was demoralizing.
I used to stop at a gas station around the corner from our house. As I was pumping, I couldn’t help but notice the huge, colorful sign in the window of the convenience store: “Florida Lotto” it read, in bright green and white. It always showed the
current prize amount, which usually exceeded $10 million. I knew better than to play, but that sign taunted me—the guy without a real job, the guy who couldn’t provide for his family.
After putting the kids to bed one night, Mia and I began talking about the future. It had been almost two years since we had moved down from Boston. Although she loved living in Florida, Mia was fully supportive of relocating if it wasn’t going to work.
“I don’t know,” I complained, disappointed that I hadn’t been able to gain more traction. “I like it here, but it feels like I’m not getting anywhere.”
“Then let’s move back,” she said. “It’s not worth it if you aren’t happy.”
“I’m happy. It’s just that, well, I can’t fool around forever. We’ve already spent everything we earmarked for this adventure.”
“Okay, then we move.”
I shook my head. I knew that she meant it, but I also knew that she loved the warm weather. And we both treasured being close to our families. “It shouldn’t be this hard,” I said, more to myself than anything. “I should be able to figure this out.”
“Maybe we sell the house?” she suggested. “At least that way we wouldn’t be tied down. It would give us more flexibility.”
“No, if we sold the house, we’d definitely move.”
“Then I don’t know what we’re talking about this for. It’s pretty clear that we should just go.”
She was probably right, but I didn’t want to admit defeat. Leaving would feel like surrender. If only we had more time. Suddenly, the image of that Lotto sign popped into my head. More money would give us more time.
“I wish I could just win the lottery,” I mumbled.
“What?”
“I said, ‘I wish I could win the lottery,’” I answered a bit louder.
Mia took a moment to reply. “Pat,” she said, “you already have.”
She waited, giving her words even more impact. “You were born into a supportive family in a free country. You were blessed with intelligence and ambition. You attended one of the most elite universities in the world—twice.” Her unblinking eyes observed me sternly. “And you’re white.” A second pause. “And you’re a man.”
It was a profound rebuke, made all the more powerful by its truth.
“What more do you want?” she finished sharply.
I was speechless. She was right, of course. I had nothing to complain about. It was the single greatest thing anyone has ever said to me. And I have carried it with me every day since, especially during the troubled times that have been recounted in this story.
After that, I went out of my way to stop at that particular gas station. And every time I looked at that sign, it filled me with gratitude. Because Mia had nailed it: when it came to life, I had already hit the jackpot.
***
Three months into the new year, after having fully weaned her from the olanzapine, Dr. Rojas started Mia on lithium. We began the new medication gradually, warily looking for any side effects. Fortunately, she adapted well to it, and within a few weeks all concerns had dissipated. Soon, her former personality began to resurface. By the beginning of summer, our house once again returned to its previous state, filled with liveliness and harmony.
These were easier months for Mia and me, in terms of managing her health. Once the lithium didn’t show any adverse consequences, we could relax a bit. We both knew that the disease provided periods of recovery; we didn’t expect another relapse for at least six months. And while we continued to monitor her sleep carefully, she had reverted to old patterns. She fell asleep easily and slept at least eight hours every night.
In August, the kids started classes. Will was beginning high school, and Jamie was in seventh grade. Maybe it was the heightened level of activity, or the anxiety that came with the start of the academic year, but the past three falls had seemed to increase Mia’s vulnerability. September and October had been difficult months for us.
I was steadfastly looking out for any signs of trouble. In early September, I noticed that Mia was more energetic than usual. Although she was sleeping fine at night, she was hustling around with a huge list of priorities during the day. I mentioned it after dinner a couple of nights into her high-octane schedule. Will remained at the table doing homework.
“Babe, have you noticed that you have more energy than usual?” I asked.
Without stopping whatever she was doing in the kitchen, she replied, “No, I don’t think so, but I do need to get this done by tomorrow.”
Will looked up from his book. He gave me a slight smile and said, “Mom, you should listen to Dad. I’ve noticed it, too.”
Mia immediately stopped and walked over, her eyes wide. “Really?” she asked.
“Yeah,” he replied, nodding his head.
“Okay, I’ll call Dr. Rojas first thing tomorrow.”
Dr. Rojas increased her lithium dosage immediately, and a remarkable thing happened: the illness didn’t progress. Within a couple of weeks, she no longer felt such high energy. In fact, she found herself becoming lethargic and sleeping in later.
It was an immense triumph for us. Clearly, the higher exposure to lithium helped her body defend itself from another relapse. Although not ready to declare victory, we became cautiously more optimistic.
The other positive result was that Mia took over the relationship with Dr. Rojas. In years prior, given that she was periodically so sick, I had been forced to take the lead. But once they could rely on the medication to maintain her health, Mia and Dr. Rojas learned together how to manage her lithium dosage more effectively. Dr. Vuckovic was available for counsel, but they didn’t need much of his input. He provided the kernel of advice, and then Mia and Dr. Rojas became experts themselves.
Knowing the potential long-term effects on her kidneys, Mia began a schedule of having blood tests performed on a regular basis. She and Dr. Rojas would then carefully review the results, monitoring her body’s lithium levels. But more than anything, they would rely on Mia’s own evaluation of her mood. Over time, she began to realize how much energy was too much.
Given that the crisis had been averted, our family enjoyed its first holiday season in years. We felt whole again, with Mia joining the festivities. As the new year started, and the illness receded more distantly into the past, new memories with the kids began to replace unfortunate moments from prior years.
That summer, I planned a ten-day family vacation that involved renting a car and driving through the English countryside, stopping at small towns, staying at B&Bs, and taking hikes together. I wanted us to be close physically, hoping it might help to recapture the emotional warmth that had characterized our family before.
One night, we were gathered at a crowded restaurant where the locals were encouraged to bring their pets along. As I was walking back to our table from the restroom, I noticed Mia and the kids watching me and giggling.
“Okay, what’s the joke?” I asked, a smile now stretching across my face, too.
“It looks like someone’s in love with you, Pat,” said Mia, nodding her head toward the far corner. When I glanced over, I saw the cutest King Charles spaniel, its eyes glued to me. I stood up, walked back the way I had come, and then retraced my steps to our table. The dog’s intense stare followed my every move.
As I sat back down, Jamie quipped, “Yeah, I think that dog wants to marry you!”
I immediately looked to Mia. Instinctively, I was worried that she might take Jamie’s comment literally. But Mia didn’t miss a beat. “That’s fine with me,” she said. “Then that dog will be the one dealing with Dad’s bad breath in the morning!”
The kids howled, and I couldn’t help but laugh myself. Our old Mia was back, and she was thriving. Without the whiplash of ongoing relapses, her relationship with the kids was as strong as ever.
Indeed, everything was going great. Will
and Jamie were growing up; and, although going through the normal challenges of adolescence, they were flourishing. Scars from Mia’s illness had healed. It didn’t appear that the kids would suffer any lasting effects from the experience. And Mia’s confidence was growing with every month of continued health. Her generous and supportive personality was fully restored, along with her sense of humor. Coming home to a house full of happy and positive people became my daily highlight.
After a year on the lithium with no relapses, Mia and I were enthusiastic. After two years, we were confident in its efficacy. And the years were flying by, as they do when you have two teenagers in the house. By all accounts, our war with the illness was over. Everyone seemed to have moved on, putting the conflict behind them. Everyone, that is, except me.
I suffered recurring nightmares—a lot of them. They ran through similar themes. Mia and I would be locked in our room, and she would be fully psychotic. She would be screaming about going in reverse or quietly revealing a secret theory to me, and my adrenaline would skyrocket. The spooky eeriness of psychosis would overwhelm me, and I’d wake up in a pool of sweat with my heart racing.
Other times, I would dream I was in a dark room. I couldn’t touch them, but I knew that Mia and the kids were nearby. And suddenly a sinister force would begin circling outside, searching for a way in. Protecting them was all that mattered to me, but I couldn’t figure out how to keep them safe. I couldn’t see anything, but I sensed the monster close at hand. Usually, I would wake myself up by screaming at it, an actual shout echoing in our bedroom. I’d frequently wake Mia up, too.
Although disturbing, I didn’t think such dreams were unusual. I had been through a lot, and my brain was still trying to process the ordeal. If it meant dealing with terrors at night, so be it. At least Mia and the kids were safe and healthy in real life.
But other problems continued to plague me. I couldn’t walk through our house without scenes from the ordeal flashing through my mind: our bedroom with all of its psychotic memories, the dinner table with its many uncomfortable conversations, the back room where Luke had wrestled Mia to the floor. The worst was the front porch, where I had watched my wife being handcuffed and taken away; I tried to avoid it.
Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope Page 26