They say I sat in the middle of the floor pouring water on my head but I say they are liars. They say I stole from my mother and threatened my brother. They say I tried to get a passport to go to Rome to get married, but I hate marriage. It makes women prisoners. This hospital is a jail, too, but the wardens keep it a secret. They say we can leave anytime, but the door is only painted on the wall like a mural. There is no real exit. There are only strange angles and deceptive surfaces, like the long table of mirrored glass in the middle of this room they have brought me to. It has corners that could cut someone. I reach out my hand to test an edge for sharpness, but it is not sharp after all. I see my mother, I see my brother at the table. Where is my sister? There she is in the corner, laughing at me, her shoulders going up and down like wings. She’s the angel, I’m the devil.
My mother asks, “Are you feeling better, dear?” She strokes my hair. A fistful of blonde comes away in her hand and she stares at it.
“Why did you have me committed?” I turn from my mother to scream at my brother. Hands clamp down my flailing arms immediately. They will say I lunged at him. “No I didn’t,” I whisper.
“The police had a warrant out for you, even before you sliced up my clothes. Plus you had a gun illegally. I only called them to do what they were going to do anyway. We had to get you into treatment before the rest of your brain burned up.”
My head is hot. He is the one burning it. “You should go back to your own condo so I can come home to look after Mom.” I grab her hand. There will be no separating us.
Now Mother is interrupting. She needs to stay quiet. “No dear,” she says. “You should stay in the hospital and get well.” I gasp. She has stolen my breath. I toss her hand away and run out of the room. I rush headlong down the halls on the slippery linoleum marked by red and green arrows. Wide-eyed people shush me as I go. A woman is wailing but it can’t be me. I am silent and I run until my legs fall away from under me.
Before that, this.
It was the middle of the afternoon on an ordinary Tuesday. I remember thinking about burning buildings against a clear blue sky, the misstep that breaks an old woman’s hip, the surprise attack by a virus charging out of the jungle. Don’t fret so much, my brother and I always told one another. It’s the thing you never think of that finally gets you, so what’s the use of worrying? Nature may abhor a vacuum, but life loves a sucker-punch. And here it was again – that knockout punch. The disaster we all hoped we had outrun was familiar terrain, a country once escaped from, dragging us back into the war zone.
“She’s gone.” My ninety year old mother’s voice shook across the wire.
“Did she say where she was going?”
“She went to see a group.”
“A group of what?”
“I don’t know, but she needed money.”
“Did you give her some?”
“Yes, but she said it wasn’t enough.”
“Did you give it to her from your purse?”
“Maybe. It was quite a bit. One hundred. One thousand.” She put the phone down and snapped open her purse. I could hear her count the bills in her wallet. I waited, one hand clutching the edge of the table, until she picked up the phone again. She was crying.
“I didn’t know what to do. She got in the car and waved. I didn’t know what to do.”
“Don’t worry, Mom. We’ll find her.”
I should do something. What was it, again? I was three hundred fifty miles away from my mother, and who knows how far from my sister, my vulnerable little sister. Possibilities lined up like birds on a branch: maybe Amanda told Mom where she was going and Mom simply hadn’t registered or retained it; or Mom, with her quirky relationship to time, had no real idea about how long her daughter had been gone. There might have been an appointment to keep, a traffic jam to navigate, a flat to fix.
There is a brittle snap, a loss-of-limb sensation that occurs when a sibling is in trouble. I felt it now, in my left arm, the attached hand still holding a phone I could no longer feel. I turned it over, imagined crossed wires explaining next steps. I punched buttons that summoned my brother Eddie’s voice, waded through his electronic message and left my own. Our sister is missing. Call her doctor. Call the police.
Emergency rooms and locked wards are full of mistakes that get fixed, people lost and found every day. We had survived this before, and we could do it again.
My body didn’t believe it, not this time. As I moved across the room in slow motion, sounds came at me from varied points of origin, and there was a loud buzzing in my head. The phone slid out of my hand.
I must have let people know Mandy was missing. Flyers with her picture appeared online and on bulletin boards at the laundromat and grocery stores. The phone rang and rang with questions from police and troopers, both of my brothers, Amanda’s friends.
“No, I don’t know the car license plate number.”
“GPS? I don’t think she has it.”
“How could I possibly know her cell phone company?”
“No, she doesn’t have a credit card. She’s an artist, she doesn’t have much money.”
A few things I did know. I knew the names of her medications and I knew that one had been discontinued and another reduced. I did not know where she was driving and I doubted that she did either.
“It might be easier to find her if we file the case as a stolen vehicle,” the detective on the phone was saying.
“She’s not a thief! She’s the most honest person I know!” That was beside the point, apparently. Categorizing her as a thief was just a means to a quicker end.
“Maybe she went to see you,” my brother Steven said, and suddenly it seemed like a possibility. I visualized her behind the wheel of a three thousand pound car on a high-speed, congested road sandwiched between trucks and SUVs. With her brain blistering and her hands shaking, would construction on the road confuse her? Did she even know how to fill the gas tank herself?
I looked out the window at the falling snow burying the grass. Did she have an ice scraper in the car? I imagined her at my door, dragging her grey suitcase behind her, smiling her wry little smile. I twisted the knob and looked out onto the porch — hoping, losing hope. “Come on, Mandy. Just come home,” I whispered. Watching the stream of headlights climb the walls and fall away again, I stood at the window for hours.
The trouble with hope is that it’s so fragile anything can kill it—a cold night, the smoking chimney far off in the distance, a medical mistake. The night my sister was hospitalized the first time was a night I could finally sleep through. Sometimes, like a fisted bud, hope can ride out even the snow that bends bough to ground.
At last, I climbed the stairs to bed, but not before I had turned on every light in the apartment. What I didn’t know was that my mother and brother were doing the same thing in our family home, lighting up the dark across the rolling winter hills from three hundred fifty miles away, a beacon for my shipwrecked sister.
Over the next few days a picture emerged in pieces, some sense out of the senseless, from Mom’s bursts of aborted sentences. She had argued with Amanda.
Where did she want to go?
Actually, it was three banks. A trip to one of them showed unusual activity in Mother’s account, and a loss of four thousand dollars. A scrap of paper wedged in behind a cushion in the car revealed itself to be a half-finished passport application (destination Rome). A note on the dresser said: My friend Antonin and I are going to Florida to get married. I’ll be back in two weeks, after the honeymoon.
“Antonin, is it? Antonin Artaud, the writer?” I had asked her the day before she disappeared, when she told me she had given “Antonin” a ride to the ER. He had a gash on his head and needed stitches, she said. I thought of her art, all those wounded heads. My art is always autobiographical.
“No! He’s real.” She was ready to argue about it, although she rarely argued with me about anything.
“Oh? So tell me about him.”
“He’s an endocrinologist I met in the hospital,” she said, a smile warming her voice. She fell in love so easily, whether the objects of her desire were real or not. When I love somebody, I want to crawl right under his skin.
Usually, her hallucinations were manifestations of friends, family, and rock stars. She either knew them or knew enough about them to imagine a personal relationship. They’d appear on a screen in her mind and she would watch them like television. When the latest crop of hallucinations broke through, they’d spilled out of Mandy’s mind into her bedroom, clinging to her green curtain, following her into the living room where she liked to dance. “Dancing makes me feel better,” she told me. “I just wish these guys would quit nagging me to go put on a bra.”
So the hallucinations were demanding and sexist? In real life, she wouldn’t put up with that. She knew how to stick up for herself. She always had, even as a small child. Once, Dad brought home a doll for me and she promptly sent him back to the store to buy one for her. And there was the time one of her little friends came to church dressed in a dress identical to the one she was wearing. Copycat! she’d shouted, slapping the surprised little girl.
“Have you tried your trick of pushing the hallucinations away with your hand?” She was often able to stop them from rushing at her by visualizing a white light around her upraised hand.
“They fall back, but they get up again.”
I reminded her of John Nash’s trick of turning away from the hallucinations, simply not acknowledging them. It was no use, she said. “They’re too compelling. This batch makes me talk to them.”
“Aren’t you scared of them? These seem so much worse than the ones you’ve had before.” Different, too—like the group of beings gathered around the kitchen table commenting on everything Little Amanda did.
“I mostly get annoyed when they give me insomnia.”
She’d been short on sleep since her twenties, and had endured several bouts of addiction to, and withdrawal from medications for it. I thought of the row of amber pill bottles lined up on her dresser, more and more added every year.
A person can learn to live with anything.
Amanda promised that she would give her doctor more details about the nature of the new hallucinations the next time she saw him, and report back to me. She’d always been good about calling after each doctor visit or hospitalization. We’d always analyzed everything to death, as our mother put it. It was our thing.
Amanda did not call. Not the doctor, not me. She stopped calling. The silence was heavy and felt final. She had turned her cell phone off. She probably hasn’t called because she’s sleeping, I reasoned. Her doctor likely increased her drugs and the new dosage knocked her out.
The bitter truth sneaked up slowly: she hadn’t called because she didn’t intend to answer to me anymore. I dialed her doctor’s number. It went to voice mail. I left a panicked message and waited for a call back.
It was Amanda, not the doctor, who called, two days later. In a brittle harried voice, she asked if I knew anything about an organization in New York for people like her.
“What do you mean—artists?”
“No, no. The other thing. Psychics.”
She thought she was psychic? Psychotic, more like. “What’s the group’s name?”
“Just a minute,” she said. I could hear her asking people who weren’t there for the name. “It’s Ghana Corporation, and I’m leaving for New York tonight.”
“What do you mean? You’re in the middle of a relapse! You can’t go to New York!”
“I’m going, I’m going!” she yelled, and clicked the phone off.
Shaking, I dialed the number of the household landline, hoping that Eddie would answer. When I heard his voice, I probably cut into his first words, I don’t know. “Eddie, the hallucinations are worse and she’s talking about leaving for NYC!”
An inattentive doctor, a missed connection—Amanda had stepped off a cliff and nothing could break her fall.
That night, the moon shone on the driveway like a spotlight on a stage. Our sister stood in its circle, ready to be taken away by strangers to a new, exciting future. The garage door opened and Eddie appeared instead. “You forgot your hat,” he said. “Let’s go inside and I’ll help you find it.” He steered her back inside the house, handed her a stack of winter caps to fumble through while he called 911. In the somber, familiar ceremony, he held her hand in the ambulance and helped her into the hospital.
When he called to check on her the next morning, the nurse said, “She eyes the exits constantly. She’s pacing along the red arrows on the floor, back and forth like an animal, right now. She claims there’s nothing wrong with her and she’s not hallucinating.” We didn’t realize that our sister had learned to say what the staff needed to hear to let her go. “She’s very clever,” the nurse observed, like it was a bad thing. “We can’t keep her very long, but she knows that if she keeps going off her meds, her next stop will be a state facility.” It sounded like punishment. So, what was her crime? The idea of my sister in one of those places froze the blood in my veins.
Eddie was able to convince the doctor to keep Amanda over Christmas, which coincided with the anniversary of our father’s death, and was always a hard period for Mandy. I didn’t bring up the date during our phone calls, but only asked what I should get her as a Christmas gift.
“A pea-coat,” she said without hesitation. I ordered a beautiful one in black and sent it on. It was the coat she was wearing in the Missing Person flyers.
Two days after Amanda was released, she disappeared again. This time she abandoned the car after it had run out of gas, and continued on in a taxi. Eddie somehow found the car, and the name of the cab company she used. The driver said he drove her all over Ohio, from Akron to Sandusky, finally depositing her at a Holiday Inn in Ripley, West Virginia. Sure, she looked out of it, he admitted, but she had lots of money, bills falling out of her purse, in fact, so he kept driving her wherever she wanted. He had never had a thousand dollar fare before.
Ready with the hotel’s address, Eddie called the police. Paramedics were sent to the hotel to examine our sister. Good. Anyone would realize that a mental patient in the throes of a relapse needed help. I pushed dire warnings from my friend Karen, a mental health worker, out of my mind. “It’s legal to go nuts alone in your room if you’re not a danger to yourself or others. The authorities won’t necessarily intervene.”
Now my brother was echoing her, his voice tight as a fist. “They say she’s not agitated, suicidal, or homicidal, or any kind of threat. They say they will arrest me if I come down to get her and she resists, which of course she will. They will charge me with kidnapping.”
“Are you kidding me? They know she’s a mental patient just out of the hospital!”
“She doesn’t have a weapon, that’s all they care about.”
“So we’re just supposed to watch her from afar and hope she can figure out how to get home?” She would need our help even with that basic task. When she was younger and rescuing her was easier, she would gladly catch a lifeline thrown by any one of us. No more. She couldn’t get away from the people who loved her fast or far enough.
“Let me talk to the desk clerk,” Eddie said. “Maybe he’ll have an idea. At the very least he can tell us where she goes next.” Matt the desk clerk understood. He had a schizophrenic sister who had needed to be rescued from time to time. He promised to call us if there was any news, and to call the cops again if necessary. He would also call us when Amanda checked out.
In the long meantime, we all tried to reach her. Our brother Steven got through. He told me that she happily prattled on about how “we” were going to Boston or Philadelphia or Baltimore to get married, that she had money, that she was wearing her warm coat. Steven gave her his toll-free number, “in case you need anything,” doing what he could, then letting go.
Matt was also true to his word. The phone rang twenty-four hours after Eddie last spoke to him. “She looks really out of it now,” he said. He called to say Amanda was back after checking out and wandering in the snow all day. “She’s calling herself Rose Westinghouse. She says it’s a pen name and she’s here incognito.”
Our streets are full of people who look like she must have just then, talking to the air, waving their arms to ward off demons from cardboard-box shelters. Reduced to that, what rescue could they hope for? Karen told me about one of her clients, who after being saved by her family once again, refused to go home. She had found a kind of happiness living in a tunnel, with people like herself. They formed a community below the bustling city. These people are my real friends, she said. I belong here.
Eddie asked Matt what had happened with his own sister. “We finally had to let her go,” he said.
A few hours later Mandy came downstairs to ask Matt to call 911. “My husband has a cut on his head,” she said. The authorities came quickly this time, and trooped into Amanda’s room. The TV was playing the same boxing match Matt had been watching at his post behind the desk. The camera zoomed in on a fighter, lip swollen, a cut bleeding into his eye, as Amanda tried to make herself understood. “It’s my husband. He’s standing right behind you! Don’t you see his swollen lip? The cut over his eye is bleeding. He needs stitches!” This time, they took her to the local ER, where she proved too much for them. She was transported to the PICU at Chestnut Ridge Hospital.
It was New Year’s Day.
“I was so scared for you, Mandy!” It was the first time we had spoken since she entered the PICU and I wanted to tell her everything, fill her in on her great adventure. She would want to know the details. She would be amazed.
“Why? How long was I gone anyways?”
“For days. We had the police and everyone looking for you.”
“They didn’t catch me though, did they.” The satisfaction in her voice disoriented and chilled me. Her response was a warning that she had been turned inside-out, and that I was dealing with a different person now, made of dark opposites. How was it possible?
What had this impostor done with my sister?
“You need to get me out of here. I’m only stuck here because the devil tried to give me an aneurysm.”
In the near-whisper she used when she was hallucinating, she continued, “The doctors found AIDs in my blood.” As if she had been caught delivering information to the enemy, she slammed down the phone. I called back.
“We were disconnected,” I said, giving her a way to save face and a chance to revise her message.
“I was telling you they plan to do a spinal fusion on me.”
“No they won’t, honey. They only take care of the head there. They’re not equipped to do those kinds of procedures.”
“Oh. Do you know what a warlock is?”
“It’s the male counterpart to witches in myths and folklore.”
“They are not myths. They’re real! I knew you wouldn’t believe me.”
“It’s not a question of belief, Amanda. You’re hallucinating.”
“I am not, not hardly at all! You’ll find out when they discover my body eaten by warlocks.”
“Now you listen to me. You know that people are taking videos of everything that happens in the world these days. If there were carnivorous warlocks around, don’t you think someone would have discovered a chewed up body somewhere and put it on the news?” It wasn’t much, but it was the best I could come up with on the spot.
“Maybe you’re right,” she said, giving in a little. “But the doctors still want to do a colonoscopy on me here.”
“They can’t do that either. I’m your power-of-attorney and they have to clear any procedures with me.”
“Don’t let them do things to me. Promise.”
It was an easy promise to make. No one would touch a hair on her head without good reason, if I had anything to say about it.
We hung up and I looked at her pictures on my walls. I looked for clues to her thinking, the graphic preoccupations I must have missed, some pattern to her disintegration. It was an impossible task, since the point of her style was to exaggerate the features to bring out the emotional truth of an image. As I grappled with the fact of her relapse, I saw how, despite the illness, she had raised the workings of her unquiet mind to express high art. I thought of the old Japanese artist who created art in a mental institution, her home for the duration of her entire adulthood. Somehow gallerists had appeared, exploiting her talent, imagining they understood it, and she developed an international reputation with her mad bright circles. Was there any comfort for my sister in her story? Was there the chance that, although there was no cure for her disease, her colors could persist?
The doctor had an explanation for the severity of Mandy’s breakdown. “Sometimes when the particular drug she was on is discontinued, there is a bounce-back effect that results in major psychosis,” he said. “Do you know why she stopped taking it?”
I did. “It was all the side effects. Her psychiatrist tried several times to get her dosage below the threshold where hallucinations would break through, and he was successful last spring. Amanda’s head became clearer, she got back her concentration, and she was able to juggle the household chores and her art. She produced more than one hundred pieces of art last year.”
“And that’s better than usual?”
“Yes, although she’s always been productive, despite the anxiety attacks that strike randomly and can last six hours at a time.”
He made a sympathetic noise. “Tell me about those.”
“They have been the bane of her existence for years.” A mental picture of Amanda, suffering, came to and through me, and left me wrecked. My sister, on her bed, face turned toward the clock, stroking one foot along the opposite leg to quiet the spasms. “The attacks will come nearly every day sometimes. She charts them in ledgers but she’s never uncovered a real pattern of what precipitates them.”
“The side effects indicate she was over-medicated,” the doctor said,” but now she needs to go back on a low dose of the same drug. It is the most effective drug for these types of conditions. There is clozapine, then there’s everything else. Will you please encourage her to accept our recommendation? We’re meeting with resistance.”
“We’ve all tried, every day, to get her to accept the medication,” a nurse told me later. “If she doesn’t, there will be other breakdowns and she’ll have no future. She’ll have to be in a protected environment.” It took me a minute before I realized she meant a long-term facility, an asylum. “Each breakdown damages the brain, and it’s a terrible shame when the patient is so smart. The organs break down, too, and she’ll age faster.” The nurse sounded as if she might cry. “I really care about Amanda! She is so sweet, and sick as she is, she’s always polite. I hate to think of what will happen to her without clozapine.”
If I hadn’t fully understood before, I did now.
I went to work on Mandy. “Why are you refusing treatment?”
“There’s nothing wrong with me.”
“Uh-huh. That must be why you’re in the hospital. Ever notice how other patients leave after a few days and you’re still there?”
No answer, so I answered my own question. “It’s because they take their drugs. They let their doctors treat them. They don’t tell them how to do their jobs. When did you get a medical degree? Daddy would be so ashamed of your arrogance.”
“Just take the pills!” I snapped. “Deal with the side effects, if you get them, once they’ve pulled you out of your psychosis.”
She brushed me aside in a torrent of words. “I am not psychotic! For seven years, I slept twelve hours a day, I had no concentration, I couldn’t do anything. It took me years to work up to two hours of painting a day. That stupid drug gave me anxiety attacks, made me twitch and not be able to breathe. It’s the worst thing that ever happened to me. Is that what you want for me? I’d rather have a breakdown now and then than ever live like that again!”
“But they say that this drug is the only thing that will protect your brain function from more breakdowns! Every episode atrophies your brain more and more. How much art do you think you’ll get done if this keeps up? You’ll have nothing left to think with!”
“There’s nothing really wrong with me! I haven’t hallucinated in months. I’m only in here because I saw a warlock in my hotel.”
“No, you’ve been fixated on a man you named Antonin, and you’re always on your honeymoon. When did this fantasy guy turn into the warlock?”
She fumbled a few words for a minute, and then tore on ahead. “I don’t need drugs, anyways. Besides, they’ve got me on two other anti-psychotics.”
“You’ve been on those same ones for two months and you just keep getting worse.”
“I didn’t get better at St. Thomas because I was spitting out my meds!”
“I’m telling you the truth now. I didn’t take my drugs.”
I couldn’t believe it. I struggled to make sense of it, but the fact wouldn’t fit. It stuck like a key in a rusted lock, breaking off truth from theory, impulse from forethought, the bad days from worse nights. It was the one possibility that had flitted across the surface, but never fully lodged in my mind. Amanda had always been a good patient, and taken her medicines without complaint. She saw what happened to patients who did not.
“Have you had any success getting your sister to accept our recommendation?” the doctor asked me the following day.
“She won’t do it. I brought out the big guns—brain damage and risking her ability to do art. No dice.”
“That’s that, then.”
“Wait! What about the fact that I have my sister’s power-of attorney? It should be good for authorizing the use of a particular drug, shouldn’t it?”
“We could try that. It is the kind of situation it’s designed for.” The doctor sounded so unsure that I wondered who he was trying to convince.
“Has she started the medicine?” I asked the next day, and again the day after. My mind darted away from the image of Amanda physically fighting off the injection.
“The doctor decided against it. She is adamant against it, and patients do have rights. We’re concerned that even if we give her the drug here, she won’t take it at home.”
“I’ll mash it in her ice cream!”
“We have no control over what the family does once the patient is home,” the case manager said primly. “But it would be unethical for us to force her here. You can try to get guardianship of her when she comes home. You could call her a Vulnerable Adult who is only competent some of the time.”
“If you gave her the drug, it would normalize her thinking, and she would no longer object to it.”
“She objects now, and we must respect that.”
One of the other nurses told me, “We’re praying for a miracle.”
The day after they gave up on her, they released Amanda. During the discharge process I participated in a conference call with her and Steven, who had come to pick her up, despite his worry that she might lose complete control of her senses, grab the wheel and kill them both. Over the phone I heard the gleeful reunion of my younger siblings. The audible affection between them had texture and pulse and for a moment I believed in happy endings.
That didn’t last very long. When I heard Amanda say, “Eddie did this to me!” and begin to heckle our absent brother manically, goose-bumps rose up along my arms.
Steven asked the caseworker for “a note or something, to make Eddie knock off whatever he’s doing to bother Mandy.”
With back-up from Steven, Amanda told the caseworker she wanted Eddie out of Mom’s house within two weeks. After having ordered the doctors around for so long, she seemed to think she had muscles to flex.
“You can’t really tell your brother, thanks for the help, now get out, can you?” Vicki said. She was there to negotiate a smooth transition, so she tried a compromise on for size. “Maybe he should stay for a few more weeks. We want everything to remain in place so that you have no duties to resume.”
I told her that Eddie had hired an aide to look after Mom while he was at work, but he was the one tending to Mom throughout the night, when she woke up disoriented or in tears. He administered medication, made breakfast, called her from work twice a day, brought her dinner, sorted the mail, paid the bills, did the laundry, took her to the doctor, made sure she had her bath. Did Amanda really expect that he could move out of the house but still perform those services? There’s a law in physics that says it can’t be done.
“He’s violent!” Amanda was pulling out all the stops. She wasn’t used to losing.
“Violent in what way?” Vicki’s voice sharpened to a point.
“He used to be a bouncer.”
I had to laugh. “Sure, decades ago, when he was full of testosterone and beer!”
“He’s still violent! He got into a bar fight a few years ago. Some guy was beating up the barmaid and Eddie threw himself across the counter and beat up the guy.”
Oh, so he rescued a woman, I could imagine Vicki thinking. She tapped her pencil on the papers several times before plunging back into clichés and formulas. She was done with Amanda.
“You have to promise two things, Amanda,” she said, switching the subject. “First, not to run away again. It upsets your family.” She’s a runner, one of the nurses had said. They never stop running.
“I won’t,” my sister promised, exactly the way she’d promised the staff at St. Thomas the month before, when they threatened her with an extended stay in the state hospital if she threw out her pills and ran away again.
“And you must take your medication.”
“I will, I will. I don’t ever want to be in a hospital again.”
“Also, we would request the family not hover too much.” That was meant for me, and I wondered what grievances my sister had manufactured against me, what rumors she had spread.
I said, “Since those are exactly the same amounts of the same drugs she’s been taking for three months with no improvement, what symptoms should we look for when she really begins to decompensate?”
Amanda broke in, volume turned up high. “I TOLD you I haven’t taken any of those medicines since September.”
Now it was September? I was shocked all over again. She clearly believed it. It might have been true.
On the other hand, the sister who never lied could now do nothing but.
Standard of Care by Cheryl Snell