“Tell me one more time?” I asked. I didn’t want him to go. He stayed on the phone with me a long time. When we said goodbye, I dialed Regan, and said, “I’m going to have ECT.”
“You are?”
I told Regan about David’s sudden appearance, about his story, and the sound of his voice, his encouragement; and then, after Regan and I hung up, I went looking for my doctor; and a day or two later, early in the morning, a nurse came to my door. She had my medical charts. She gave me a hospital gown. I put on my socks, pants, and the gown, and we walked through the ward. The nurse unlocked the main door, and we went to a room down the hall. It was an operating room—lots of medical equipment, but also computers and electronics.
You lie in your gown and your socks on the table. You’re looking up at the white ceiling. The ECT nurse glues electrodes to your head, chest, arms, and legs. Wires run from the electrodes, across your body. You nod to the anesthesiologist—they’re usually pretty friendly—who sticks you with a needle, beginning the IV. Maybe you speak to the administering physician, the team leader. This doctor stands behind you, behind your head, programming the shock. You look up at the doctor’s face. The ECT nurse fits an oxygen meter over your index finger, and then binds your ankle with a blood pressure cuff. The cuff will remain inflated throughout the procedure. It blocks the paralytic, succinylcholine, from entering your foot. This allows your toes to twitch, visible evidence of convulsion. Vital-signs monitors beep. You are having right unilateral ECT. The convulsion should last half a minute. If other patients are doing ECT, your buddies on the ward, then you might glimpse one or two asleep on gurneys in the recovery area. You feel something like fellowship, as if you were all at war together, or had been in the same dreadful accident. You ask the ECT nurse to hold your hand, and you squeeze hard. The anesthesiologist says, “Atropine.” You are crying. You’ve been in tears the whole time. Atropine keeps the heart beating. You tell the doctors that you want to get better. You’ve only ever wanted to get better. There is a bite plate on the metal table beside the anesthesiologist. The nurse fits the oxygen mask over your face. The anesthesiologist inserts a syringe into the pipette connected to the needle in your arm. The anesthetic trickles down the tube. You can smell it. It has a sweet smell. You count backwards, one hundred, ninety-nine, ninety-eight, and then the anesthetic reaches your blood, and a second passes, and you feel that you are falling—and then blackness. The succinylcholine goes in, and you no longer breathe on your own; you are on life-support, and your body will not shudder or shake. And now you are awake—did anything happen? Are we ready to begin? A voice asks you where you are, and you reply to the voice that you are in the General Clinical Research Unit, on the fifth floor of the New York State Psychiatric Institute, at 1051 Riverside Drive, in Manhattan. You are behind a curtain, recovering in bed. Your mouth is dry. You feel like you could sleep. You have had general anesthesia. Your friends in treatment have already woken and been returned to the ward; and, in fact, you are done; it is over.
“How are you feeling?”
It was the nurse, the one who earlier that morning had knocked on my bedroom door and brought me to the ECT room. She held my arm, steadied me while I stood, and we walked back to the ward, where there was breakfast. I sat alone in the dining room. I had oatmeal, and drank milk and coffee. It was midmorning. I ate my oatmeal, and then the nurse helped me down the hall. ECT patients could go to their rooms after treatment. I lay in bed and wondered if I felt better. Had anything changed? Maybe I slept. I looked forward to feeling well. I couldn’t recall feeling well, or imagine what that might be like.
Our parents’ marriage went into crisis for the first time when Terry was five and I was six. We were living in Gainesville, Florida, where my father was finishing graduate school, at the University of Florida. We lived in a small, wood-frame house at the top of a dead-end road. Spanish moss hung from the trees, and there were always kids out playing. My friends and I went on expeditions to a pond at the end of the road. The pond seemed far from home, a trek, though it was only a few backyards away. Algae on top made the pond bright green. The water beneath was murky and smelly. Trees lined the far perimeter, and fallen branches, partly submerged, looked like alligators. Dragonflies hovered, and little fish surfaced and then went back underwater. I had a toy pistol that shot paper caps. I collected tadpoles in jars and took them home. They always died. There was a girl who lived across from us. She was about twelve. She babysat Terry and me. I had a crush on her, and imagined scenes in which she was in peril, and I was able to rescue her. My parents threw parties, and my sister and I couldn’t sleep, and in the morning we found their graduate school friends passed out on chairs and the living room floor. Twenty years later, after she got sober, after she stopped blacking out, my mother told me about my father’s affair. His lover was an assistant professor in the French Department at the university, a poet who, according to my mother, later married a man who abused her. My mother told me that before she and my father separated, I’d again and again pressed my face against the floor, and then rubbed my nose and forehead into the carpet until I had sores. How miserable I must have been. I was five. I’ll never forget my parents’ violent fights. My mother told me that her parents had been drunks when she’d been a child, and that her mother threw water in her face to stop her crying, and put bourbon in her baby formula, dosing her to sleep. Bourbon was my mother’s drink. She drank Jim Beam, or, sometimes, Kentucky Gentleman.
Shock treatment for suicide wasn’t always induced electrically, not until the early 1940s. Electroshock therapy proceeded from insulin, camphor, and Metrazol shock therapies, a line of hormonal and chemical treatments that sometimes showed positive results, but that caused anxiety and discomfort, both for patients and for their administering doctors, who worried that the therapy might kill, which, though rarely, it did. Insulin shock was developed and promoted by Manfred Sakel, an Austrian. It went into use in the early 1930s. The patient was given increasing doses of insulin, reducing blood sugar and producing coma and seizures. Old film reels show insulin shock patients trembling and quivering. Many treatments were required, and Sakel’s patients undertook it daily, which must have been grueling. Sakel proclaimed insulin shock therapy as a cure for schizophrenia and other historically intractable psychotic illnesses, and even drug addictions. Sakel was unrealistic; nonetheless, insulin shock was used in Europe and America until the 1950s, when it gave way to electroshock therapy, a safer and, as it were, cleaner, more effective procedure. Electroshock was introduced in 1941 by the Italian neurologist Ugo Cerletti, after animal experimentation.
ECT was administered three mornings a week, Monday, Wednesday, and Friday. Would it work? And if not, then what came next? The doctors added lithium to my drug load. Lithium slows metabolism. My weight increased, and my movement and speech slowed. I searched for words, even the answers to simple questions. “Uh, uh, uh,” I would say before beginning sentences. A week went by, and then two, and then three: one treatment, and then two treatments, and then three, four, five. I had ten rounds of ECT, or maybe eleven. The anesthesiologist told me that the doctors wouldn’t give up. “We’ll take care of you,” he said, and then told me that he had once been averse to electroconvulsive therapy, thinking it barbaric, but had been persuaded to come across the skywalk from neurosurgery and observe. He said that he’d watched patients improve and go home. The ECT doctor recalibrated the shock. We kept going. Patients discharged, and new patients arrived on the ward. John came one morning in a wheelchair. John was my age. He’d been transferred from another hospital. He looked sick and wretched in his gown. He wasn’t registering much. Dawn came late at night. She was on a gurney, tranquilized, breathing slowly, her stiletto heels piled on top of the sheet covering her.
For her first days, Dawn did not leave the quiet room. She wore her hospital gown, and did not speak. She was thirty, and had been an artist, and had acted in experimental theater. She’d grown up in New York, and was an only chi
ld. She described herself as manic-depressive, bipolar, and said that she’d been in a manic turn when they brought her in. I never learned what had happened. She and I sat in the common room with John, whose beard grew down his neck. He’d swallowed Klonopin tablets that he’d sorted out of his monthly prescriptions. It had taken him months to save enough. I saw in his life what I feared for my own. He’d been married, but there were no children. His father had been a doctor, and John said that such close proximity to childhood images added to his difficulty on the ward. This wasn’t his first hospitalization. There was no family, or maybe there was a sister. He was a banker, but out of work. On weekends, he drove out to Long Island, where he was building a house that he couldn’t complete. He saw only sitting in his house on Long Island Sound, all by himself.
And there was Helen. Helen came to the Institute in late July. She was eighty, or older, catatonic, stooped over from the pain in her muscles and joints. She pressed her arms against her sides, and her hands and fingers were clenched. She couldn’t look up, or eat much, and she barely spoke. She moved very little, but she did not seem still. She began ECT immediately after admitting. Sometimes, before bedtime, Dawn and I huddled on the sofa. We sat close, though not so close that a nurse might see and then stop us. Sometimes we touched hands. The television blared. Dawn and I whispered about other patients, about our families and our childhoods, about what we did on the outside. Her parents came to visit, and I met them.
I met my stepmother the first time at the airport. It must’ve been 1983. I was living on the Upper East Side. My mother had been two or maybe three times at Mercy Hospital, in Coral Gables, for alcohol poisoning. She would stop drinking or die, the doctors told her, and my father picked up and left. They were getting divorced again. Not long after my father left my mother, he called from Miami and told me he and his new wife were flying to Italy for their honeymoon. New wife? How did he suddenly have a new wife? He said that they had a layover in New York, and an hour or so free at the terminal. Would I like to take the subway out to Kennedy to meet?
I rode the train to the airport, and then took the shuttle to the terminal. It was late in the day. My father, my stepmother, and I sat at a concourse bar. My father drank a martini. Maybe my stepmother had a glass of wine. Travelers and flight crews hurried past. My stepmother told me that she wanted me to think of her as a second mother. My real mother was close to dying. I told my stepmother that I would do my best. Then it was time for them to board their plane. It was a long time before I saw them again.
The paralysis of suicide is not apathy or stillness. We may feel encased, restrained somehow. Our bodies might break, or something outside us will break. What will break? We may stop opening mail, and drop contact with people. We might stop bathing or brushing our teeth, and we neither leave nor clean the house, and the dirty dishes and the dirty clothes and the week’s trash and garbage might make piles that we walk around. We may feel as if we are burning, as if our cells have caught fire. We might get only a few hours of medicated sleep, or we may sleep and wake throughout the day, and that can be mistaken for resignation or apathy, but it is sickness. We picture taking the canoe out to the middle of the lake, rowing slowly over the water, and then slipping in, careful not to tip the canoe; or we pick up the pistol, the one in the cabinet, and hold it for a moment, and that helps—the bullet will be there when we need it—and we can then place the gun back in the drawer; or we run upstairs to the roof and hang from the fire escape, but without letting go, not this time. We are burdens to our caretakers; we know this, no matter what you say to soothe us, no matter that you love us. If we are agitated, pacing, smoking, then we might seem to be fleeing demons, or even to be one, crazed, possessed. If we are alone in the house, we may become desperate. We watch television, into the night. Or we turn out the lights and sit, as if waiting. Is this the paralysis that we feel when threatened with violence or death? Is this our so-called fight-or-flight response? Tomorrow we will walk alone to the lake, or pull the trigger, or drop from the roof.
Why did he do it? Why did she? Why did they? What didn’t we see? Is it our fault? What more could we have done? We ask ourselves versions of these questions again and again. Was it the pain? Was she unable to bear the pain? Had he become exhausted with life, and did he finally give in to despair? Wasn’t she always unstable, oversensitive, crazy? Does it run in the family? Is suicide hereditary? Is it genetic? Was there a note?
One day in August, I took a walk with Nurse D. It was dinnertime. The sun was in the west, and the hallway to the dining room was bright with light from the windows facing the Hudson. I’d had five weeks of ECT. I felt stable on my feet, and felt easier talking. I asked Nurse D whether she had noticed anything—anything about me that might be different. She said that she had seen changes, they all had. The changes were audible in my voice, and I looked more relaxed. She told me that the doctors and nurses see health before the patient feels it.
“You see?”
Nurse D told me that I was getting well. It happens over time. The muscles in my neck and face loosened and relaxed, and my breathing got easier. I took steady breaths. My voice grew deeper, and I wasn’t clumsy, only nicely depleted from treatment. I realized that I had not destroyed my life by writing about my mother. My life was not done. I could stand straight when I walked down the halls, and visitors and friends on the phone told me that I sounded better. People could stand to listen to me! The decline in psychotic certainty can be heard as the opening of new frequencies in the voice, an indication of reduced muscular tension in the chest and the face. I went to a cooking class—it was a Friday—and picked up implements, and held them, and contributed. We made hamburgers.
In the evenings, after we’d had our meds and sat beside each other on the couch, Dawn and I strolled down the hall to our bedrooms. We walked through the open doorway to the dorms, and stopped in front of her room. Dawn had a roommate named Charlotte. We were all friends. I wished Dawn and Charlotte good sleep and sweet dreams, and hoped that they’d feel better soon. I felt safe with Dawn, safer than I’d felt at any time at the Institute. I cared so much about her and the other patients—I mean that I liked them, and felt for all of us.
We describe feeling in touch. We say that we feel in touch with the world, with people, with our feelings. Was I in touch? The daylight through the common-room windows seemed clear, somehow gentle. The sky was deep blue, going orange in the west, and the trees along the Hudson looked bright with color. I no longer minded the sound of the television. My friend Jon brought me a tiny music player, something that fit in my pocket, and Nurse D let me keep it, and I walked the halls, listening to the beat, grooving, tuned in and in touch, greeting people, chatting. My weight went up and up from the medications, and I could barely get my pants on, but I didn’t care. I was alive; it was mid-August; I’d been in the hospital almost four months; I did not feel burning in my gut; my legs didn’t tingle or shake; and I no longer woke in terror at three in the morning. Maybe I hadn’t ruined my life, and would not spend it in institutions. Dr. A congratulated me on my recovery, on working hard and persevering. We were standing in the hallway beside the nurses’ desk. He wore his white coat, and a yellow shirt with a tie. I told him that I’d had nothing to do with it, that he and his team had got me better, but he objected, repeating his praise. A day or two later, he invited me for coffee and a Danish. He unlocked the big steel door, and we left the ward. I felt uncertain at first. My doctor and I walked down the hall to the commissary. I looked out the window at the day. I felt free, not from the hospital, not from illness, just free. It felt good to be in the commissary, away from the ward, holding a cup.
I never wanted to die. Have you wanted to die? Do you now? At what stage in sickness do these desires come? Are they even desires? We might say that we are ruminating, death-obsessed, consumed. We may refer to our obsessions as intrusive thoughts, or as ideations, as if we are having ideas about dying, when in fact we have certainties. When were you firs
t aware of your own death? Would you feel relieved to leave people and the world? Were you afraid that they would never understand your dying? When did you first picture your death? Can you name the day, the hour? What did you see?
My pictures began in the winter, in the months before hospitalizing. I was lying in bed. Regan slept beside me. I was sweating, and the sheets smelled like cigarettes. I went to the living room and turned on a light. It was better to sit in the light than to lie in darkness. I couldn’t bear music, and movies and television shows, even comedies, scared me. I sat shivering, waiting for the sun to rise, the time when I could take another Klonopin. Why was I thinking about knives? Why couldn’t I stop? Surely it would pass. I stayed quiet about it, though. Death is our burden and our comfort. No one can know.
If they know, they will worry or be scared, or threaten us with the hospital. They’ll tell us that life is good; that we have only one, and that it is worth living. It is not right to die this way.
Try not to lose hope, they say. Try to stay optimistic. Keep faith. Losing us, they say, will be the end for them.
But hope to the suicide is a death sentence. The suicide cannot feel or live on hope. Our hope is gone.
I went home from the Institute by myself. I’d been there almost four months. It seemed much longer than that, though. Regan wanted me to go away with her after discharge. She said that she wanted to go somewhere quiet. I think that she wanted to celebrate, if that’s the right word, my recovery. But I didn’t think that I could do it. “I’m not strong enough,” I told Regan, and I wasn’t. Life in the world—what would that be like? What if I couldn’t make it? Would I need to come back to the hospital? Would Regan and I get along? Would we have peace? Would I be a disappointment? I thought of my own quiet place, my apartment. Regan had helped me, but I felt at risk. I was afraid to resume life as it had been before the hospital.
One Friday in April Page 6