Saving Max

Nothing in the litany gets Danielle’s attention. She has a legal pad in front of her. As Reyes-Moreno talks, she dutifully writes it all down, as if she’s at a deposition getting boring background on an inconsequential witness. As the list of disorders wears on, though, she feels very sad—probably because all she wants to hear is that all the other well-meaning but misguided professionals not only made mistakes about the medications, but also about the autism diagnosis and underlying neurological differences. It would have been wonderful if Max didn’t have to face all of these problems. Well, she thinks, as Reyes-Moreno ticks off the list—obsessive-compulsive disorder, fine motor difficulties, tactile defensiveness—she can deal with all of it.

“We recommend a new protocol of antidepressants to combat Max’s suicidal tendencies,” says Reyes-Moreno.

Danielle goes down a mental list of tricyclic antidepressants, SSRI’s, SNRI’s and their potential side effects, as well as those contained in the black box warnings. “What are you thinking of? Effexor? Cymbalta? Zoloft?”

Reyes-Moreno looks at Danielle, but doesn’t say anything. Danielle turns abruptly and stares at Celia, who starts to say something, but catches a vague signal from Reyes-Moreno and looks away. Danielle’s heart is beating too fast, a wild, caged thing struggling to get out.

Reyes-Moreno rolls her black chair closer, takes Danielle’s hand and squeezes it. Her voice is baby-blanket soft. “There’s more, I’m afraid.”

Danielle pulls back. Reyes-Moreno’s viridian eyes lock on hers. If she smiles at me, it means he’s all right. Danielle smiles first—a small, desperate invitation.

Reyes-Moreno has no smile for her. “I’ll just say it, and then I want you to know that we’re all here for you.”

Danielle has no body now. She is only her eyes, which see Reyes-Moreno and nothing else in the universe.

“Unfortunately, our testing has resulted in the diagnosis of a grave psychiatric illness. Max has an extreme form of psychosis, called schizoaffective disorder.” She pauses. “Fewer than one percent of all psychiatric patients fall into this category.”

Danielle is stunned. “Max is schizophrenic?”

“In part. However, schizophrenia does not have the mood-disorder component that the schizoaffective label carries.” She points to a stack of literature on her desk. “I’ve selected a series of articles that will better help you understand the challenges Max faces. Briefly, the onset of schizoaffective disorder peaks during adolescence and early adulthood. The severe disruptions to Max’s social and emotional development—compounded by Asperger’s—will continue over his lifetime. He will, in all probability, always pose a risk to himself and others, and involuntary hospitalizations will be frequent. Unfortunately, Max displays virtually all of the symptoms under the DSM-IV-TR: delusions, hallucinations, frequently derailed speech, catatonic behavior, anhedonia, avolition—”

Danielle forces herself to breathe. “This is crazy! He’s never had any of the symptoms you’re describing.”

Reyes-Moreno shakes her head. “Perhaps not when he is with you. However, our daily charts clearly reflect Max’s symptoms. You must have seen some of these signs. Parents often live in denial until, as here, the child breaks down completely.”

“I do not live in denial.” Danielle feels her cheeks flare. “Are you sure that these symptoms aren’t a result of the overdose you gave him?”

“No.” Reyes-Moreno shakes her head sadly. “These issues are far more pervasive and long-standing.

“What we don’t know is if there is a history of psychosis or mood disorder in your family or his father’s family.” Reyes-Moreno’s lips keep moving—like one of those Japanese cartoons where the red mouth looks like a real person’s, but the rest of the body is a stiff, poorly drawn animation of a human being and the words come out long after the mouth has stopped. Danielle tries to absorb what Reyes-Moreno is saying, but her thoughts are a silent, deafening scream.

“As I mentioned, Max will require frequent, lengthy hospitalizations over the course of his lifetime due to recurrent psychotic breaks and the extreme incidents of violence we have observed and anticipate. I must tell you that with each successive break, Max’s memory and his ability to assess reality will deteriorate exponentially, which unfortunately will compound the severity of his schizophrenia. It will most likely be impossible for him to hold a job or live independently as a result of these breaks. We must also be ever-vigilant with respect to the possibility of future suicide attempts. Unfortunately, Max is fully aware that his mind is compromised. We believe that this knowledge has driven him to consider suicide as the only option.” She looks at Danielle. There seems to be real sadness in her eyes. “As such, we strongly recommend that Max be remitted to our residential facility for at least a year, probably longer. He will undergo extensive psychotherapy so we can help him accept his condition.”

Danielle struggles to absorb what Reyes-Moreno is telling her, but it’s like trying to process the news that you’ve got terminal cancer. Her mind is frozen, unavailable. She shakes her head.

“Danielle,” Reyes-Moreno says softly, stretching out her hand. “Please let us help you deal with this.”

She jerks back and stares bullets into Reyes-Moreno. “Leave me alone. I don’t believe it. I’ll never believe it.”

Reyes-Moreno’s gentle voice is relentless. “… so hard at first … terribly severe in his case … long-term residential options … some medications … Abilify, Saphris, Seroquel … new electroshock therapies …”

All she can think of is that she has to get out of there. She runs to the door without a backward glance, but can’t find the knob. She needs the knob.

“Danielle, please listen—”

“Not to this, I won’t,” she snaps. She opens the door, strides into the hallway, finds a restroom, and slams the door. She grabs the thick, curled edge of the washbasin and sinks to her knees. The cold porcelain feels white and holy on her forehead. Her mind is in a wild panic. If she believes what they say, then everything black and horrible that has crept into her mind at the bleakest moments—and passionately denied—has come true. If she believes what they say, Max will have no life at all.

For one impossible moment, she lets herself feel that. What flows is a thick rush of hot lava, a keening that roils from her soul, dark and sick. She forces herself to stand up and stare at this woman with black tar under her eyes, this blotched face made ugly by knowledge and fear, this…. mother of a crazy child. Mother of a child with no hope. She curses God for the beautiful blue light He gave her this morning. She curses Him for what He’s done to her boy. Stones, stones—all stones.

“Stop it,” she hisses. She has to think, be clear, find a solution. She splashes cold water on her face and tries to breathe, but psychiatric hospitals are vacuums. You’re not supposed to breathe fresh air or feel the sun on your face. You’re supposed to be in a place where other people aren’t. A place where you can be controlled every minute. Where you can be watched and drugged—kept away from normal people and the entire normal world. In a place that is always painted white. The color of a blank. The wiped slate. A place that reduces you, erases the sick part of you and, along with it, the part that makes you human and precious—the part that permits you to feel joy and give joy in return. A quiet, unchallenging world, hermetically sealed with a thick, black ring around it. A place that doesn’t keep the dangers of the world from you, but your dangers from the world. A place where you can look at yourself in the mirror and see the truth—one that imprisons you for life.

She grasps the cool sink and stares once more into the mirror. She will not give in to this. She can’t. Max needs her.

But the mirror tells her there’s no way back. No way back to the time when she believed that someone could put it all back together and make it right. When she believed that even if everyone in the world told her it could never be made right, she would still find a way. No way back to the perfect, soft skin of his tiny, precious body, or the joy in his eyes when she first held him in her arms; his exquisitely gleeful gum smile; his obvious perfection in innocence—limitless in his possibilities. As the mirror blurs and blackens in front of her, the woman she is and the quintessence of that child disappear. The baby is shattered, splintered in the darkness. Cover the glass with a black shawl.

There’s been a death in the family.

CHAPTER THIRTEEN

Danielle awakens from a deep, useless sleep—the kind that affords no rest and is punctured with grotesque forms and fractured events that have no link or purpose. When she opens her eyes, her heart beats erratically—a bird shot out of the sky. She feels an amorphous panic; wonders dully if someone is chasing her. The panic is quickly replaced with stark terror. They think Max is irretrievably mentally ill. Her first urge yesterday was to run to him and hold him in her arms. But she can’t do that—not yet. If Max sees her eyes, he’ll know what he fears is true—that she, too, thinks he’s crazy. She never, ever, wants him to feel that.

She lay awake much of the night agonizing over every word Reyes-Moreno said. Danielle still doesn’t believe what she told her, particularly the bizarre behaviors they attribute to Max—behaviors she’s never seen. No matter how she slices it, there’s no way Max could be what they say he is. But what if she’s wrong? The right side of her brain tells her that denial is always the first response a parent has to devastating news about a special-needs child. She must do her best to divorce herself from either knee-jerk disbelief or the paralysis of emotionalism. She has to get back into lawyer mode and uncover the core facts they’ve based their diagnosis upon. Once pointed in the right direction, she’s a better fact finder than anyone she knows.

She jumps up and yanks on jeans and an old, gray sweatshirt. For the first time since they came to this dreadful place, she knows exactly where her compass is leading her.

Danielle crouches outside the rear wall of the Fountainview unit and swats mosquitoes from her neck. The night air is heavy, and tall grass forms a green nest around her. The steel back door stares at her, as if it knows of her intention.

She can’t believe she’s doing this. What if she gets caught? Even that begs the more basic question: What kind of a mother crawls around a psychiatric facility on her hands and knees in the pitch dark like some kind of card-carrying pervert? Danielle looks around. It would be just her luck if one of the security guards decides that now is the perfect time to make night rounds. She checks her watch. Ten fifty-two. There is only one night nurse on duty. At eleven, she usually sneaks a smoke in front of the unit until her maintenance man boyfriend arrives and enthusiastically feels her up in a dark corner. If Danielle is lucky, they will disappear into the woods for the fifteen minutes they apparently require to consummate their hot, savage passion. She knows this because she has often crept to Max’s window late at night—just to watch him sleep. It took some of the sting out of the parsimonious visits allotted her by Maitland.

The locked door beckons, but Danielle is paralyzed. This feels like life or death. She can find out about Max or turn around; go back to her room; and never know why Maitland insists that her son is crazy. Yesterday, Danielle demanded—and Reyes-Moreno unequivocally refused to provide—the underlying data upon which they based Max’s diagnosis. She knows that filing a lawsuit will get her nowhere. The hospital legal machine will find ways to hide the precise information Danielle needs. She has seen it happen far too many times. At that point, Danielle decided that she was entirely justified in getting it on her own.

Even so, she falters. She is desperate for information, but does her desperation justify breaking the law? But if she doesn’t find out what they’ve really based Max’s diagnosis on—the nuts and bolts of it—she’ll never know if it has any merit. That is intolerable.

Danielle slips a plastic card with the Maitland logo on it from the back pocket of her jeans. She swiped a spare earlier today from the nurses’ station. She takes a deep breath and inserts it into a shiny black box on the cold, metal door. She hears a distinct click.

She slips through the door like satin ribbon through a needle’s eye. Now that she has crossed the line, what she is doing seems perfectly natural, as if she has been breaking and entering all of her life. The soft, eerie lights, dimmed for the slumbering patients, give her goose bumps. She feels as if she has stumbled into a psychic’s murky parlor in an attempt to contact bodies long cold—a vain search for lost souls. She scans the silent hallway and darts into a small office. The first thing she does is to sidle underneath the security camera in the corner and point it skyward. She then places her flashlight on the computer desk and covers it with her red silk scarf. With a soft click, the flashlight’s wide eye lights the room in a soft rose. Office supplies crowd a corner; textbooks queue up in military formation on metal shelves.

Danielle sits in front of the monitor—her nerves singing—and watches as a large, white M gyrates on the screen. After a few moments, a message box appears. Maitland Psychiatric Hospital. A smaller box forms. Password, please. The cursor stands waiting in the empty box. Danielle enters the system without a glitch. When Marianne had raised the issue of Maitland’s security—she was unhappy with its laxness—Danielle was surprised to learn that the nurses on the Fountainview unit cavalierly scribble the daily password on a Post-it and stick it under the counter at the nurses’ station. Marianne scoffed when she related how Maitland prided themselves on thinking that their security system was ironclad. She said they’d never get away with such carelessness in a big-city hospital.

Danielle smiles grimly as she types in the code. Hospital administrators, she is certain, worry about their employees mishandling the system, not the patients. Surely it had never occurred to them that a patient’s mother would jimmy the system.

She gives the keyboard a few intent taps and tries to ignore the horrific consequences if she is apprehended. She is an officer of the court who is committing criminal acts (a few felonies like trespass and hacking) with full knowledge of the legal ramifications. If her law firm finds out, partnership will be the least of her problems. If she is convicted of a felony, the bar will take away her license. She’ll be finished. There will be no way on earth to fund Max’s care. She shakes off these terrifying thoughts. Her watch warns her that she has only ten minutes to complete her task—assuming the frantic coupling outside is still rattling the trees.

Her nails are castanets on the keys. Prompts flash on the screen in mad succession as she negotiates her way through them like a bayou dweller in the Louisiana backwater. The blue glow of the monitor washes her with a purplish cast, and the small room is now nest-egg warm. The screen before her looks like some kind of daily log. Max’s name, unit and room number are at the top, as are his patient identification number and date of admission. Below are typewritten entries which, she surmises, are transcriptions from the handwritten notes of doctors, nurses and attendants. She makes out the initials of Fastow, Reyes-Moreno and Nurse Kreng. Unfamiliar names flash before her—probably other members of Max’s “team.” Danielle reads the first entry; sits back abruptly; and rubs her eyes. Something is very wrong. She checks the name at the top of the page. Max Parkman. She reads it again. Twice.

Day 6 Pt. violent; agg. w/ staff. Threat. pt. with physical violence; had t/b restrained; continue new med protocol; paranoid delusions; psychosis; 20mg Valium Q.I.D. Focus on Mo-son relatnshp/rage/denial. JRF

Danielle waits until the shock passes. Paranoid delusions? Psychosis? How could they decide that he was psychotic only days into this nightmare? She saw absolutely no evidence of this during her daily visits with Max. And what about “Focus on mother-son relationship”? That Fastow should even suggest something harmful in her relationship with Max is devastating. Her mind races back to the day Max was admitted. How had they acted toward one another? Of course he was angry and anxious with her; of course he lashed out at Dwayne when he was forced to go into the unit. He was scared out of his wits. Surely that’s perfectly normal on admission day. She reads on.

Day 12 Incident in cafeteria. Pt. lost control in serving line. Strikes child; curses server; throws tray. Restrained; taken back to unit; destruction to rm; isolation/heavy sedation Post: Pt. now episodically psychotic; suspect schizoaffective disorder and/or Cotard delusion (due to pt.’s depression and derealization). Episodes occur only late night. Pt. has no recollection following day. Tricyclics/ SSRI’s not effective; consider electroconvulsive therapy. R-M

Danielle gasps. Cotard delusion? Electroconvulsive therapy? No one has said a word to her about any of this—not even Reyes-Moreno when she delivered the death-knell diagnosis. A wild thought flashes through her brain: Are they making these things up? She shakes her head. It’s too crazy. But why hasn’t anyone told her the details of what Max has been going through? How often had they shot him up with sedatives—other than the time they overdosed him? And thrown him into “isolation”? Reyes-Moreno only mentioned the one instance. Danielle sees Max lying on the floor in a padded room bleakly calling her name, his hands and feet bound by white canvas strips—to prevent telltale ligature marks or bruises. This sounds more like a sinister clip straight out of One Flew Over the Cuckoo’s Nest than the modus operandi of the most highly respected psychiatric hospital in the nation.

And why don’t they even mention Asperger’s? Does psychosis now trump autism? Danielle can’t even begin to process the last sentence. Over her dead body will they strap Max down; put a piece of wood in his mouth; and electrify his brain. She shivers. She has to get him out of here—now.

Only a few minutes left. She quickly scrolls down to review a few more entries. Observations from play therapy. Educational and psychiatric testing attempted, but unsuccessfully completed due to soporific effect of sedatives and disordered thinking. Reiterations of Max’s suicidal ideations. She flips to the entry for today.

Team Meeting. Pt. skilled at concealing symptoms fm Mo. Admits has not mentioned psychotic thoughts. Pt.’s violent tendencies real threat to himself/others; Pt. experiencing deep disturbances; auditory/visual/tactile hallucinations. Continues to threaten suicide. Diagnosis: Schizoaffective disorder, psychosis—