Danielle is breathless after her frantic drive back from the Des Moines airport to Maitland. The flight from New York had begun boarding when she received a hysterical call from the Fountainview night nurse, who told her of a crisis with Max. She said that Dr. Reyes-Moreno would meet Danielle at the hospital but that she was not at liberty to divulge any additional information. Danielle was terrified during the entire flight. When she finally lands in Des Moines, she drives as fast as she can to Plano; jams the car into a handicapped space; and dashes into the unit.
She catches sight of Reyes-Moreno in the hallway. She is in deep conversation with Fastow. He towers over her, his stick neck bent to catch her words. His black, frizzy hair is shot through with gray. They stop talking as soon as she reaches them. “What’s wrong with Max?” she demands.
“Danielle,” says Reyes-Moreno. “You remember Dr. Fastow. He is—”
“I know who he is,” she interrupts. “Where’s Max?”
Reyes-Moreno takes her arm and steers her into an empty office. Ichabod trails behind. “I’m afraid that Max seems to be dissociating,” she says. “His behavior today—while not suicidal—has been highly erratic and disturbing.”
Danielle tries to keep the panic out of her voice. “What do you mean, ‘dissociating’?”
“He is losing touch with reality.” Her olive eyes are rueful.
“It could be the result of extreme anxiety, but we feel it needs to be addressed immediately. In addition to Max’s continued perseveration upon suicidal ideations, he has had another…episode.”
“What does that mean?”
Reyes-Moreno’s eyes slide past Fastow before they fix on Danielle. “Max attacked Jonas. As you know, it isn’t the first time.”
Danielle’s heart races. She flashes back to that horrible day when Max assaulted Jonas—the blood on his head and Marianne’s stricken face. “Why didn’t you tell me this? Did he…hurt him?”
“Unfortunately, we had to keep Jonas under observation all day yesterday.” She touches Danielle’s arm lightly. “He’ll be fine. The fact remains, however, that Max punched Jonas in the nose, and the boy bled profusely. It also seems that Jonas has a cracked rib.”
Danielle is shocked. “Where is Max now?”
“We put him in the quiet room—”
“How dare you?” Danielle has seen that room. It’s solitary—that’s what it is. A big white box with canvas padding all around and a slit of a window to shove food through. She stalks toward the door. Reyes-Moreno grasps her arm.
“Danielle—he isn’t in there,” she says. “We’ve had a bit of a…situation arise. Please, let’s sit.” Reyes-Moreno closes the door and continues. “As you know, we put Dr. Fastow on Max’s team at the outset of his assessment. He has done a stellar job with Max’s medications and is confident that he has found the right—”
“Cocktail,” snaps Danielle. “What does that have to do with—”
“There simply isn’t any other way to explain it, except to admit that an error has been made,” says Fastow. “We are un
certain precisely how it happened, or who is responsible, but it appears that Max received a far higher dose of his current medications—”
“Oh, God,” she says. “Is he all right?”
Fastow regards her calmly. “Of course.”
Reyes-Moreno takes Danielle’s trembling hands into her firm ones. “Max is resting comfortably in his room. He’ll weather the overdose and be back to normal very soon.”
Danielle yanks her arm free. “
Normal?
You think overdosing him is
normal?
I want to see him.”
“There’s nothing to see right now, Danielle.” Reyes-Moreno’s voice is salve on a burn. “He’s asleep. I assure you that we’ll call you the moment he wakes up.”
Danielle stands rooted to the floor. It is all suddenly unbearable—her relinquishment of Max to this place; his terrifying displays of violence; the unspoken presumption that her insistence that she remain here with her own child is injurious to his treatment; and the even stronger undercurrent that somehow her son’s very presence here must be her fault. The implication is that she, as his mother, should have seen the “signs” of the severity of Max’s problems long before he wound up at Maitland. Her fear galvanizes into anger. “I’ve had about all of this I can stand. Why don’t you tell me how such a thing could happen? You people are supposed to be running the foremost psychiatric hospital in the country—according to the pundits of your profession—and the minute I’m gone, you overdose my child!” She jerks her head toward Fastow. “And now we have his medicating physician, the famous psychopharmacologist, who has screwed up in colossal fashion—”
“Ms. Parkman, I must object to your accusations.” Fastow’s flat, liverish eyes fasten on hers. He leans forward in his chair, head and arms in praying-mantis pose. “This is very disturb
ing for you, I’m sure, but this was a staff error, not a prescribing error.”
All of her pent-up frustration, fear and anger burst to the surface. “I don’t care who fucked up—and that’s the only word for it—but it’s my boy in there. Who knows what an overdose like that will do to him?” She shakes her head when Fastow tries to respond. “Look—both of you—I’ve been more than patient and cooperative since we got here. When I tell you I want to stay here with my son, you tell me to go home. Then you put me on supervised visitation like I’m some kind of axe murderer. And now you tell me that Max has attacked a patient. It’s absurd!”
Fastow folds his arms across his chest and stares at her, unperturbed. Reyes-Moreno’s emerald eyes are kind. There is that pat on the arm again. Danielle fights the urge to shake it off. “Danielle,” she says softly, “you have to keep in mind that we are dealing with a young man with serious issues—one who is obviously suicidal; who now appears to be having psychotic episodes; and who is becoming alarmingly violent. These things take time, which is why we don’t like to meet with parents before we can give a true assessment.”
Danielle feels the fury in her subside. Now she’s just worried out of her mind. What is really wrong with Max? Is it possible that because he’s been stripped of the old medications, this “psychotic” behavior—whatever it is—is the true Max coming out? She sighs. But this isn’t a courtroom where she can use righteous indignation, however justified, to her advantage. She reminds herself that Maitland—and its doctors—are the very best in the country. It doesn’t matter if she chafes at Fastow’s arrogance. It’s Max that matters. And if Max is exhibiting violent, psychotic behavior, he desperately needs their help, and she has to let them do their job. She turns to Fastow, her voice quivering as it always does when
her anger gives way to fear. “I want a list of every medication Max is on—the milligrams, dose frequency and any known side effects.”
Fastow gives her a bland look. “Of course. I’m sure most of the medications are known to you, although the combinations may be different.”
An idea forms in her mind. She stares at him. “You don’t have him on any experimental drugs, do you?”
Fastow’s eyebrows—fat, ugly caterpillars—form upside-down U’s and stay there. “Absolutely not. Surely you do not question my ethics—”
Reyes-Moreno steps between them, her voice poured oil. “When we have a collective diagnosis, I will schedule a meeting immediately.”
“I’ll be there.” Danielle turns to Fastow. “Will you?”
He and Reyes-Moreno look at each other. Fastow uncoils his lean frame from the chair, a supercilious smile on his face. “I’m sure we’ll have an opportunity to converse should Dr. Reyes-Moreno’s explanation prove inadequate to address your concerns.” He extends a bony hand to her, snake dry to the touch.
“I’ll hold you to that.”
Fastow gives her his hubristic stare and stalks out. Danielle wants to yank him back into the room and tell him what an arrogant son of a bitch he is, but doesn’t. He isn’t the first ego-maniac in the medical profession who believes—no, knows—that he is God. Telling a deity that he is mortal is pointless. She starts to stand, when she has a revelation. Maybe she detests Fastow because she wants him to be the enemy. If he’s giving Max some crazy medication—or overdosing him—then Reyes-Moreno’s claim that Max is having psychotic episodes simply isn’t true. Danielle knows enough about psychotropic
medications to know that the risk of drug-drug interactions can be devastating. But if Fastow is on the up-and-up…
Danielle fights the black ice that grips her heart. Max can’t be crazy. A slim hope surges in her. Maybe the hospital doesn’t know all it should about Fastow, even if they think they did a good job screening him. She’ll ask Georgia to run a background check on him. What could it hurt? She turns to Reyes-Moreno. “May I see Max?”
She shrugs. “I told you—he’s fast asleep. But if you insist, please keep your visit brief. We don’t want to upset him.”
Danielle bites her tongue as Reyes-Moreno disappears down the hallway. “No,” she mutters, “we certainly don’t. A visit from his mother—now, that would upset anyone. But overdosing him is fine, just fine.”
Today is the day.
Apparently the collective has finally arrived at a diagnosis. The last week has passed without incident—at least nothing that anyone saw fit to tell her. Max seems so much better. In so many ways, his sweet nature has returned. There have been no incidents of violence and he has shown no resistance to the completion of the assessment. His behavior has so improved that Reyes-Moreno has been able to complete her testing and conclude the evaluation. Even though he seems, at times, terribly sedated and somewhat disoriented, Danielle’s guess is that Fastow has finally gotten his act together and fine-tuned Max’s medication protocol. Georgia’s background check on him turned up nothing at all. In fact, all she found was further evidence of his excellence and creativity in his field. Although Danielle’s personal dislike of him has not abated, Fastow seems to have done a laudable job of straightening out Max’s medications.
Danielle follows a path through the maze of white sidewalks to the administrative building. She looks up. The sky is a cobalt paint stroke, a piercing, hypnotic blue. The clear crispness of it slices straight through her. Her heart lifts.
“Ms. Parkman, will you come with me?” Reyes-Moreno’s secretary, Celia, greets her with a brief handshake. She safeguards her boss like a trained Doberman, never saying whether Reyes-Moreno is there or not when Danielle calls—making
it sound like she’s always in the restroom or in session. Psychiatrists must have copyrighted employee-training software. They’re all the same.
Danielle follows her down the hall that houses the psychiatrists’ offices. Celia looks happy. She wouldn’t be smiling if Danielle were about to get bad news, would she? She leads her into Reyes-Moreno’s
sanctum sanctorum.
It is smaller than Danielle had imagined, especially with the obligatory couch and swivel chair. Toys are lined up on a series of shelves. Danielle turns one of them over gently in her hands, wondering if each represents something incredibly psychiatrically telling. She wonders what Max has said and done in this room.
Reyes-Moreno’s diplomas and medical certifications hang in thick, black picture frames. An undergraduate degree from Pasadena, California. What is this? Doesn’t everyone who reaches Mecca springboard from Stanford or Yale? At least UCLA? Her heart beats faster as she peers at the other squares of calligraphy displayed upon the wall. There it is—Harvard Medical School. She is relieved. Not that she has anything against Pasadena, but good God, if you’re paying for top drawer, you damned well want a thoroughbred.
Danielle settles into one of the two wicker chairs that seem to be reserved specifically for parent consultations. Like her, they feel out of place. She thinks about Tony, wishing she had been able to see him again. After she cancelled their dinner, he left a note at the desk that said he had to go back to Des Moines. He wrote down his cell number, but she hasn’t used it. Her life is far too uncertain right now to add him to the mix. The note is still in her purse, a hopeful talisman. She turns her mind to plane reservations. If they leave early tomorrow, she can get Max back to their apartment and still have time to unpack his things. Even the thought of doing his
laundry makes her smile. Maybe Georgia, who has returned to Jonathan, can stop by Danielle’s apartment tonight, open the windows, and get a few groceries in so it won’t seem so deserted. Then maybe Max won’t remember they’ve been gone so long.
Celia returns and hands her a lukewarm coffee. Reyes-Moreno is running a few minutes late. Probably still meeting with Max’s team, she thinks. They work in packs here. No one shrink, neurologist, or psychiatrist—no one doctor responsible for anything. She takes a sip of the bitter brew. She’ll have to try and square things at the office as soon as she gets home—big-time. She feels a fleeting panic and then pushes it out of her mind. First things first.
So, what will Reyes-Moreno tell her? She’ll probably confirm all of the old diagnoses, tell her that the other doctors were mistaken, that they had him on the wrong medications. She smiles to herself. Max seems so much better. He looks more like, well, like Max.
The door opens and Celia comes in. Her eyes don’t quite meet Danielle’s. She is reminded of jurors who don’t look her in the eye when they file back into the courtroom after deliberations. Reyes-Moreno walks in and closes the door. She gives Danielle a broad smile and squeezes her shoulder. The knot of tension Danielle has felt growing somewhere around her neck just as suddenly disappears.
“Good morning, Danielle.” Her voice is soft and controlled. “How are you today?”
What appropriate niceties does one exchange with the person who holds your child’s life in her hands? “Fine, Doctor. And you?”
“Let’s sit, shall we?” She rolls the black swivel chair around until she faces Danielle, Celia slightly behind her. Danielle wonders what Celia is doing there, but doesn’t want to ask.
Instead, she crosses her legs and puts her hands on her lap. Ready.
Reyes-Moreno sits erect in her chair, eyes intent and focused. “Danielle, I know you’ve waited very patiently for us to have this meeting, and I’m happy to report that Max’s team has reached a definite consensus on his diagnoses and treatment protocol.”
Danielle discovers that she’s been holding her breath. She forces oxygen into her lungs. Reyes-Moreno begins in a singsong voice. “It probably won’t surprise you to learn that we are confirming a number of diagnoses Max has been given over the years.”
Danielle relaxes back into her chair. Same old stuff.
Dr. Reyes-Moreno continues, her rhythm unbroken. “We confirm that Max is autistic—Asperger’s—and suffers from an unfortunately wide spectrum of learning disorders and disabilities,” she continues in her soft, melodic voice. “He has both a receptive and expressive communication disorder, an auditory processing disorder…” Her voice drones on.
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.