Chapter 60: Day and Night

April 25, 1985, McKinley, Ohio

I was startled awake by my phone ringing sometime after going to bed on Wednesday night. I carefully got out of bed, glancing at the alarm clock, which showed 1:47am, moved across the room, and answered the phone.

"Mike," I said.

"Mike?" a whispered voice came through the handset. "It's Angie."

The time and the whispering made it clear she was making the call without her parents' knowledge.

"Angie? It's almost 2:00am."

"I know," she replied. "But they won't let me talk to you!"

"You mean your parents?"

"And the doctors! I don't have anyone to talk to who understands me and cares the way you do!"

"Have you talked with Father Stephen?" I asked.

"He sides with my doctors! And all they do is give me drugs! I don't need the drugs, Mike! I'm fine!"

She actually DID sound fine, minus the whispering. But I'd known her for nearly four years, and when her medication was right and there was no stress, she seemed normal. But she'd had three incidents, each one worse than the previous one, and each one related to me in some way.

"I don't know what I can do, Ang," I said gently.

"Talk to Doctor Mercer and Doctor Hoffman! Tell them I'm OK! Please?!"

I actually COULD talk to them, though telling them Angie was 'OK' wasn't something I could honestly do because I had no idea how Angie was. But I could talk to them, and it would be a way to defuse what could potentially be another major breakdown, one from which she might not recover. That said, there were serious limits to what I could do.

"I'll call them today," I replied gently. "I promise to do that if you promise to go back to bed and follow your parents' rules."

"OK," she whispered reluctantly.

"I promise I'll call, Ang. I mean that. Now, go back to bed, please."

"Thank you," she whispered, and I heard the click as she hung up.

I replaced the handset in the cradle and went back to bed. I tried, but couldn't sleep because I kept thinking about Angie, so after about twenty minutes, I got up, made some tea, then picked up Doctor Zhivago, the penultimate book we were reading for Doctor Blahnik's class. I read until dawn, said my morning prayers, then went out for a run, during which I mulled over the situation with Angie.

One thing I was sure of, and that was that if the doctors were convinced that the drugs were keeping Angie on an even keel, they weren't going to stop prescribing them. Twice, as far as I was aware, they had weaned her from the antipsychotics, but the antidepressants hadn't been able to keep her from having what I called a 'meltdown' over something to do with me.

The problem was that my research had revealed that the biggest problem with mental healthcare was overmedication. I read two articles about using diet and exercise, and ensuring sufficient sleep, as well as church attendance, helping in mild cases, but those studies had been challenged, in some cases vehemently, by those who felt that medication was the best solution. But then, I'd read a study of how patients who had been committed were treated, and I was appalled.

As Doctor Johnson had implied, what I was finding was that the provision of mental healthcare was poorly supported, poorly understood, poorly funded, and over-reliant on pharmaceuticals. In effect, patients who were suffering from anything beyond mild illness were drugged into compliance, and no REAL help was given. The ones with mild illness were often drugged as well, but not to the same degree. And those researchers and therapists who objected to medication were being shouted down. One article suggested that the major pharmaceutical companies were behind that push, and that article had resonated with me.

But where did that leave me with Angie? Was there anything I could do to help her? I was in no position to assume any responsibility for her care, even setting aside my marriage, which was but a month away. I had neither the resources nor the time it would take to provide the kind of care she needed. Even doing the nearly unthinkable — giving up on medical school and breaking things off with Elizaveta — wouldn't solve the problem because I was basically only qualified for entry-level jobs, and even those options were limited because I would only have an undergraduate degree in biochemistry.

I knew that Mrs. Stephens did not work so she could be there for Angie at any time, and that was only possible because of a combination of Mr. Stephens having a good job and the disability payments Angie had received from Social Security when she was completely unable to work. Even then, it was a stretch, and I knew it put significant strain on the family — emotionally, physically, mentally, and financially.

So what could I do? Make the phone calls, of course, at least to start. And have a talk with Father Stephen as well. Beyond that, I didn't know what I could do. Even if Angie lived closer, I would have to take into account my responsibilities to Elizaveta and ensure whatever help I provided didn't interfere with our marriage. And there was no real question about that decision — I wanted to marry Elizaveta, for all the practical reasons she'd given and I'd thought about, but also because I was in love with her.

My talk with Jocelyn on Sunday night had triggered a series of images and thoughts and helped me understand exactly why and how we had blown our relationship to bits. The most important lesson I felt I could take away from that conversation and the contemplation of what had happened was that I had to be open and honest with Elizaveta about everything, lest some tiny issue fester and eventually wreck our relationship. In hindsight, which was often 20/20, I understood that Jocelyn and I had never addressed the issue that had wrecked 'Jos and Mik' — our true feelings for each other at age fourteen.

For me, it was part of the main issue which Liz had identified — I, like my dad, had avoided confrontation at every turn, save sparring in karate. It had taken Jocelyn's accident, her betrayal of trust, my immature response to that betrayal, and a terrible year apart, along with everything that had happened with Liz, to teach me that my dad's solution was the wrong one, on just about every count. In some ways, running away was worse than violent confrontation. In the end, I was sure the solution was found in the middle.

When I finished my run, I scribbled down some thoughts onto a piece of loose-leaf paper, then took a shower and dressed in shorts and a T-shirt. It was plenty warm, and I had no classes on Thursday, so being completely casual was an option. I checked my watch, and I noted I had about thirty minutes before breakfast, so I made another pot of tea and sat down once again with Doctor Zhivago.

When Clarissa, Sophia, Robby, and Lee showed up at my door thirty-five minutes later, I asked Clarissa to step in for a moment.

"Angie called just before 2:00am," I said.

"Uh-oh," Clarissa replied.

"I know. Anyway, she asked me to talk to her doctors about the medication. You know what I've found in my research, right?"

"Yeah," Clarissa sighed. "Nothing good. What are you going to do?"

"After breakfast, I'll call Doctor Hoffman, Doctor Mercer, and Father Stephen and hear what they have to say. I'm pretty sure I know what the doctors will say. My fear is that they give Angie grief over calling me, and that creates a problem all by itself."

"She asked you to call them, so it's not like she expects you not to tell them."

"I agree, but I need to convince them to let it go and focus on the real issue."

"How did she sound?"

"Like Angie when she was functioning. But I'm positive she's on antidepressants and at least some amount of antipsychotics. And every time they've weaned her completely from those, some interaction with me has caused a meltdown, and they've increased in severity each time."

"Blaming yourself again?"

I shook my head, "No. I'm simply acknowledging the facts. Her symptoms really began in High School, and nobody realized, which I totally get because teenagers aren't exactly mentally or emotionally stable to begin with!"

"With YOU being the prime example!"

"I won't argue with you, Lissa. Anyway, we shouldn't keep the trio waiting. Let's go have breakfast, and we can talk more afterwards."

Clarissa agreed, so we left my room, and I locked the door behind us.

"Everything OK?" Robby asked.

"Angie called last night."

"Uh-oh," he replied.

"Exactly what I said," Clarissa declared.

"Let's have breakfast and worry about any ramifications after I talk to the doctors."

They agreed, and we moved to the elevator and rode down to the lobby. When we arrived at the cafeteria, a few of our friends were already sitting at our usual table.

"Mike," José asked when we sat down, "did you hear two guys dropped out as RAs for the Fall?"

"No. When did that happen?"

"On Tuesday. One of them was Gary, the guy from the 2nd floor, who was going to be our RA. I was thinking about applying."

"You'd be great! And that would help continue the Rickenbacker 8 tradition!"

"For sure!" Robby agreed. "The last thing we want is an RA who isn't totally cool like Mike has been."

"How about somebody cooler?" José asked with a smirk.

"That's a pretty low bar," Clarissa teased.

"Love you, too, Lissa," I said, my voice dripping with sarcasm.

"Don't they have alternates?" Lee asked.

"Supposedly, they had only exactly the right number of qualified applicants," José replied.

"How'd you hear about it?" Jocelyn asked.

"You know Dona's campus job this year is in the admissions office, right? She heard it there. They're going to post flyers today. I'm going to go put in my application at 9:00am."

"You'll have my support for sure!" I replied. "Are they going to do a new survey?"

"I have no idea. Melody wasn't sure either because this really does amount to an emergency because they need to find two people before August, and school is out in just over four weeks."

"You know, I didn't even check, but who is the RA on the female side of the floor?"

"Karen, from the 5th floor," Dona said. "She's OK. I'm pretty sure Dean Anderson hand-selected her the way she did Gary before he dropped out."

"Why did he drop out?" I asked.

"I'm not sure. Does it matter?"

"No. It's not really important."

We finished breakfast and headed back to the dorm. Clarissa came to my room with me at my request.

"I think I'm going to call Father Stephen first," I said.

"Because of the article you read, which said that religious people had better outcomes, on average?"

"Yes. I'm curious how often she was in church during Holy Week and if Father Stephen saw any improvement in her mental state."

Clarissa nodded, "Makes sense. Should I leave?"

"Probably. I'll come find you, OK?"

"Of course!"

She hugged me, then left, closing the door behind her. I picked up the handset and dialed the office at Saint George in Loveland. The woman who answered the phone put me right through once I identified myself.

"Good morning, Subdeacon. Christ is risen!"

"Truly He is risen!"

"How can I help you?"

"Father, this might sound like an off-the-wall question, but how often was Angie in church during Holy Week?"

"She hasn't missed a single service since she came home from the hospital."

"And how would you say her demeanor was?"

"At first, the drugs had a big impact, but as they've reduced her dosage, she was serene and calm. Why are you asking?"

"I read a research article which indicated that people with conditions similar to the one from which Angie suffers have statistically significant better outcomes if they are religious. May I share something in complete confidence with you?"

"As long as you aren't trying to hide something from Father Nicholas, yes, of course."

"I'm not, and I'll speak to him about this. Angie called me very early this morning, just before 2:00am. It was obvious from the time and the fact that she was whispering that she was doing something of which her doctors wouldn't have approved."

"No, they wouldn't. She's asked to see you, but her psychiatrist thinks that's a very bad idea."

"And what do you think?"

"That I can't second guess professional medical opinions. I think, in the right context, it would be OK spiritually for you to see her, but I have to defer to her doctor."

"Do you know if the medical team is in agreement?"

"I'm not privy to their internal debates, so I honestly have no idea. What are you thinking, Subdeacon?"

"She asked me to talk to them about the drugs. As part of the research my professor has me doing for my abnormal psych class into the provision of mental healthcare, I've discovered just how messed up it is, once you get beyond the kind of general life counseling I've had with Doctor Mercer, or other things which can be effectively treated just by talking them through and making minor changes in your behavior.

"Once drugs are involved, it's a complete and utter mess, as is institutionalization, which only exacerbates the issue with overuse of pharmaceuticals. Besides that study about religious people, there are also studies which show that mild symptoms can be controlled by, and more serious symptoms somewhat attenuated by, proper diet, exercise, and sleep. Angie used to run and go to karate. Do you know if she's doing those things now?"

"She's not, and she wasn't before her most recent incident."

"And that makes me wonder if a combination of diet, exercise, sleep, church, and staying away from me might mean she could go back to just the antidepressants. I know she was on antipsychotics, sedatives, and antidepressants when she went home."

"They took her off the sedatives just before Holy Week," Father Stephen said. "And I know they've reduced the antipsychotics, but it's obvious they're impacting her because she's still a bit slow when talking about complex issues, and she still has some difficulty reading anything beyond about a fifth-grade level."

"That's how she was one of the times I saw her in the past."

"May I ask how you plan to keep her away from you when you're the one person on the planet she feels is truly on her side?"

"That's a problem for a different day," I replied. "But I think I know my next step."

"Which is?"

"To talk to Doctor Mercer and see if she's willing to go to bat for Angie with regard to the drugs. The last time I spoke with Doctor Hoffman, one of the psychiatrists, they were thinking that Angie would need antipsychotics on a permanent basis. That's what Angie wants to stop, I'm sure. The antidepressants didn't bother her, really, because the dosage was low enough that there really weren't any major side effects. I'm sure they increased that dosage as well."

"Be careful, Michael. You aren't a medical doctor. At least not yet."

"I understand. And that's why I decided to only call Doctor Mercer. She and I can discuss it, and if she thinks it's reasonable, then she can present it to her colleagues. Talking with you made me decide that trying to have this conversation with an MD wouldn't be appropriate. I have something of a collegial relationship with Doctor Mercer, though obviously not a full one because of my status."

"Then I'll let you go so you can place that call. Please let me know the outcome, and I'll see you on the 26th for your wedding."

"Thanks, Father. See you then."

We said 'goodbye', and I pressed the switchhook so I could place the next call. As I'd expected, Doctor Mercer was with a patient, and her receptionist promised she would call back in about thirty minutes. I thanked her, hung up, then went to find Clarissa. She came back to my room with me, and I put on Around the World in a Day by Prince and the Revolution.

"I think that's the right approach," Clarissa said after I'd given her the rough outline of the conversation. "My concern is the same as Father Stephen's — how do you deal with the fact that you're basically the only person she trusts, but you're also the trigger for her breakdowns?"

"That is exactly the question I have to ask Doctor Mercer. It's a serious conundrum because even if I were to set everything and everyone else aside, I couldn't be what she needs, and the State of Ohio says I can't be what she says she wants."

"You're not actually considering something like that, are you?"

"No," I replied, shaking my head. "Well, that's not quite true. I'm considering it, but only in the sense of trying to understand the impossible situation from Angie's perspective. The best I can do at this point is support her, and even that is difficult. It's not from lack of desire or will but from what amounts to simple helplessness. What really scares me is that at some point, in the ER, I'll be helpless to save someone. You know it will happen."

"Which is why we need to be there for each other," Clarissa replied. "You know I'll probably have the same situation; I suspect every doctor eventually does."

"True."

We sat quietly with the music playing, waiting for Doctor Mercer to return my call, which she did just before the 'A' side of the album finished. When I answered the phone, Clarissa left the room so I would have some privacy.

"Hi, Mike. What can I do for you?"

"I wanted to talk to you about Angie. She called me just before 2:00am this morning and implored me to speak to her doctors about getting her off the medication."

Doctor Mercer sighed, "I'd hoped to prevent that."

"Not to be an ass about it, but seriously? I mean, short of locking her up, nothing could prevent her from eventually finding three minutes when she could make a phone call."