Death Grip (33 page)

They push back, these Chesapeake flatlanders with no concept of anything higher than the Alleghenies. “Okay, Matt,” says the social worker. “Fair enough. You don't want to be on lithium. But I don't think you need to worry about toxicity if you can't get out of bed in the first place.” I bite my tongue. I've gotten good at that. Another part of the plan is to taper me directly off Ativan, substituting the epilepsy drug Neurontin as an anxiolytic, slowly increasing the dosage as the benzo wanes. This will take about two weeks. Neurontin is the second drug I will shed back in Boulder, and its withdrawal will be horrendous. I will augur in, grit my teeth, and taper off 2,100 milligrams amidst three weeks of pain, horror, and ghastly hallucinations. Such will be my resolve. Neurontin's generic name is gabapentin and, like Zyprexa, it has been the focus of prosecution for aggressive, illegal off-label marketing, in this case by Warner-Lambert, a division of Pfizer. The molecule, a GABA analog, is structurally similar to GABA, having been formulated to mimic the neurotransmitter, though it's unclear if it works directly on GABA receptors. Neurontin will take the edge off, but also makes me dizzy and bleary, and I don't like the 100-milligram capsules that float at the back of my throat and the 600-milligram horse pills that stick going down. I've never, believe it or not, cared for swallowing pills—at least not the physical act of it.

The doctors also add the tricyclic antidepressant nortriptyline, which, they tell me, is useful in treating anxiety. “It has been very well studied,” one psychiatrist barks at me when I dare to question his selection. He's younger than I am, in his late twenties, with a vaguely unctuous demeanor to match his outthrust jawline. Studies; doctors love their studies. Studies upon studies; studies that reverse earlier studies; studies in which the data is later shown to be flawed or manipulated; studies sponsored by drug companies; studies run by KOL doctors on the Big Pharma take; studies conducted with an outcome already in mind, in which the data and sampling are tailored to fit the predetermined conclusion; and studies that cite other, previous and possibly flawed studies, a mad game of research telephone. Studies: Turn on the news and there's another damnable study telling you what to do with your life, and which pill to take for it. Doctors love studies, often more than they love actual patients. At Hopkins, outside five minutes each morning during rounds, I won't speak with the doctors more than twice, and neither are there any therapists or psychologists to meet with individually. On the Affective Disorders unit, everything is treated as a chemical malfunction of the brain, the organ, and not a crisis of the mind, emotions, or soul. The doctors rush to and fro in their white coats devising chemical cocktails, but never stop to chat in the halls. Sad people, you can tell, make them uneasy. Messy, snotty, smelly, teary, gray-skinned sad people are, in corporeal form, best left to the nurses. Perhaps this brisk veneer of officialdom is necessary to lend their whole drug-and-shock circus medical legitimacy, to somehow elevate the black art of psychiatry from its ignominious roots of basement asylums, lobotomies, imprisonment, and torture. The contradiction is highlighted during morning rounds, when a half-dozen doctors, residents, and interns come to hover over my bed in a hyenas' killing circle. Some look like they're barely out of high school with their pink, newly minted skin. They ask me to rate my moods—anxiety, depression—on a scale from one to ten, as if I am telling them how badly a broken ankle hurts. I spit out numbers, lie still on my crinkly plastic mattress, and try to project a smile through my caul of pain, fear, and disorientation, undignified in my boxers and with my wan, winter torso bared to the assemblage.

Each night as darkness descends over the Meyer Building, a cloak of smoggy, river-cooled air drapes the city and I enter the blackest hours—the insensate, cave-newt doll coiled unblinking at the matryoshka core. The hospital lights paint the other patients' skin in cadaver green-whites; I shake as I push food around my dinner tray. When they glance at me, their eyes retract snail-like into bottoming sockets. Voices clamor and clash, a shambles of sound. Security guards saunter by, putting on their best swagger for the pretty nurses, blue blazer tails swaying, trailing a wake of testosterone. I'm eating starch, starch, starch, and my wastes smell like the cafeteria food. I am becoming the hospital, stale roll by stale roll, rubbery broccoli spear by rubbery broccoli spear. My dad brings in some items, gourmet crackers and chocolates. I share them with the other patients. The soap—even the shower soap—comes from wall dispensers, with a cloying odor of bleach and cotton candy. This viscous pink hand soap starts to seep into my skin, to merge with my cells and turn me into gelatin. Some nights the smog morphs into a lowering bank of halogen orange and a light snow spits, so I crack my window the prescribed half-centimeter, inhale the moisture, and recall that I was once alive in a meaningful way. That I was “a climber.”

My father has lent me a digital radio and I listen to that. When it is off, I set it on the window ledge by photos of Kasey and Clyde, by my stuffed frog Smeech. I call Kasey each night but she doesn't always answer, or when she does is usually walking somewhere, huffing into the phone, distracted, out with friends or leaving work, her boot heels clicking over the pavement. On a good night, I'll get three hours of sleep. You don't really sleep in a hospital—there's always some to-do out in the hallway, nurses rushing about, cleaning people bantering, floor-waxers thrumming, lights eternally on, someone coming around to pester you about something. Because they're monitoring my progress off Ativan via pulse rate and blood pressure, the nurses awaken me twice a night for vitals. This is a “medically safe” taper: As long as I'm not having seizures, then everything is hunky-dory. Sometimes a nurse will come in and find me hugging myself in bed, saying, “I love you, Matt. I love you,” because these are still words that a person needs to hear.

Night terrors begin to penetrate my sleep, like when I was a child of ten. I wake up one night in a room red-orange with reflected street light and stand wordless before the blur of metal mirror in some primordial epoch when the earth shook with the tantrums of the gods. I do not recognize the man looking back. I can register only shock and disappointment smeared across his features, veins of white threading his hair, eyes burning like embers. My final dose of Ativan comes on December 4, 2005—almost seven years ago at the time of this writing. Two nights before that an ancient fear kicked me out of bed. I ran down the hall barefoot, groaning, wringing my hands. By the time I completed a half-lap around the ward I realized who and where I was, and slowed to a halt at the nurse's station to ask for warm milk. The doctors will learn of the incident, will hold me an extra few days to “make sure you're not running down the halls screaming anymore!” as the lead doctor says in a jokey tone. As if I amuse her, as if the fear that has destroyed my life is somehow funny to this woman.

I pass the days shuffling to groups, observing, cataloguing as a distraction to take my eyes off the clock where I must mark the hours until the next crumb of Ativan. There are the major-depressives, stents lewdly adangle from their arms and resembling bovine aortas, lined up on stretchers before the elevators as they await morning electroshock. Then the eating-disorder patients, IV machines their constant companions, curled into themselves in the dayroom chairs, downy-limbed, ethereal, dozing. One girl hugs a teddy bear, and you can tell that she'd be stunning if she gained forty pounds, or sixty. I'm starting to forget the words for things—at art therapy, I can't distinguish a hammer from a saw on the pegboard. The doctors worry about me being “snowed under” by Neurontin, but I tell them to keep it coming because I'm apprehensive about how much worse I'd be without it. I feel the terror coiling in my gut like a snake. I always feel like I need to shit, whether that's the case or not. They move us around in elevators, using a key to activate the lift, ascending and descending through the throat of the colossus. We go to the first floor twice a day for art therapy and cognitive-behavioral therapy. I construct a wooden key holder from a kit for my father and present it to him during visiting hours. He and his girlfriend are moving into a new house next to Patterson Park, and I hope they appreciate my gift. I can't really tell; they do a good job of pretending. In exchange for however many thousands of dollars he's paying, I can offer my father a key holder. One day another patient, a frail, waif-like woman, erupts during cognitive therapy. She has been receiving ECT, been hospitalized and shocked before, relapsed, whispers like a mouse, and rarely makes eye contact. The poor, poor woman: Her depression radiates off her like a fierce, almost holy aura. The psychologist, up there before the blackboard confident in her white Hopkins lab coat, is trying to goad the woman into answering some pointless question when the woman starts slamming her fists down on the table screaming, “It's hopeless,
hopeless, HOPELESS!”
We always have cognitive therapy after lunch, at 1:00
P.M.
At that time of day my hands go numb and the veins retreat into my arms, obscuring the roadmap of vasculature cultivated through years of climbing.

Two weeks in, I meet another climber. We're standing in the elevator together and slowly come to recognize each other. He is a photographer, and in a better year we collaborated on a shoot down in New Mexico: muscle ripping up limestone, the camera shutter clicking, warm June air pregnant with flowering cholla cactus and chamisa. I had just returned from six months in Europe, where I'd spent the final month in Corfu, then climbing in Provence. I was skinny, tan, psyched, had weathered that first benzo withdrawal and felt well again. The photographer resided in Santa Fe, making a good living playing. Now, however, he lives back East, consumed by rage, breaking computers, throwing things out his windows, thinking of ending it. He asks me why I'm here, and I say it's to quit benzos. “Oh, yeah, like Klonopin,” he says. “I was on that and then stopped pretty quickly. What a nasty one that was…” How long ago? I ask. Oh, a year, he says, maybe less. I tell him I've read about the pills on the Web, and that they can cause problems well after you stop. He nods his head, as if recognizing some truth.

It's an illuminating conversation, one I will repeat with half the patients on the ward, all having been at this time or in the recent past withdrawn from benzodiazepine tranquilizers. It's somehow fitting to have these chats at Hopkins, the hospital in part responsible for William Styron's bestselling memoir of depression,
Darkness Visible
. (It was at a Hopkins-sponsored symposium that a talk given by Styron turned into a
Vanity Fair
article, later expanded into his seminal book.
1
) I've read
Darkness Visible
three times—it's a page-turner—the first while still on benzos. I stopped on pages seventy and seventy-one in particular to reread two paragraphs. Here Styron describes telling a hospital doctor, upon admission for his suicidal depression, that he had been taking 0.75 milligrams of Halcion every night. Halcion is an infamous pill, the shortest half-life benzodiazepine (two hours) and one banned in certain countries for negative effects including amnesia, depression, anxiety, and psychosis. The doctor, duly appalled, tells Styron that this is triple the standard dose for someone his age and switches him to the slower-acting hypnotic Dalmane, after which the author's “suicidal notions dwindled and then disappeared.” Even as he accepts responsibility for carelessly taking so much Halcion, Styron implicates it in supercharging his depression—not as the sole culprit (he also points to his abrupt withdrawal from alcohol, among other factors), but a pill without which he “might not have been brought so low.” Styron also calls out benzos in general, writing that his own cavalier attitude toward them had formed a few years earlier “when I began to take Ativan at the behest of the breezy doctor who told me that I could, without harm, take as many of the pills as I wished.”
2
Styron also bemoans the “promiscuous prescribing of these potentially dangerous tranquilizers.”

Unfortunately, little has changed since the book's first printing, in 1990. They hand out these pills like candy, and then yank you off way too quickly if they bother to do so at all.

I soon learn that all my fellow patients who were on benzos have in fact stopped
abruptly,
some upon doctor's orders, some self-directed, and some on this very ward. One gentleman a year earlier had a Hopkins doctor taper his three milligrams of Klonopin in less than a week; he paced laps around the halls, not sleeping, feeling like he “was on crack.” He'd been bouncing in and out of hospitals ever since, playing med roulette. Another, a young woman, very smart with bright, intense eyes and of Middle Eastern heritage, is a hospital veteran—her family hospitalizes her every time she becomes manic. She tells me she takes three or four milligrams of Klonopin out in the world, but stops cold turkey before each hospitalization because she knows that the doctors will take the pills away once she's inside. At Hopkins, she paces and paces and paces, day and night until ordered to her room. Another woman, middle-aged and divorced, tried to commit suicide a year earlier via a Klonopin overdose, after which she was no longer given the drug. Now she is lower than low, trying ECT for her depression. Another patient, a fellow in his early twenties, cold-turkeyed Klonopin but used marijuana to temper the withdrawal. He ended up holed up with a sniper rifle in a motel across the street from a park before they brought him in. Another, a retired farmer who sustained a head injury falling off a ladder, is being tapered rapidly from his “sleeping pills”—Ativan, it turns out. He lines up at the med station an hour early, pleading for his meds, saying he feels “funny.” A woman whom I've remained friends with, a vibrant, talented woman who held a high-powered university job, has been yanked off two milligrams of Xanax in only a week after her admission two weeks earlier. This, I tell her, is likely too fast, and a blush of realization blooms across her face. “Oh, my God,” she says. “That explains so much—I've been so angry, so mean to my husband and short with him when he visits. And I can't sleep, and all these heart palpitations and panic attacks I've been having…” Whenever she can, she uses her day pass to run laps around the outside of the Hopkins complex, even on days bitter with wind and snow.