Death Grip (26 page)

And remember also that
we
asked for this, that we're voting with our wallets. Just as McDonald's quickly and cheaply fills our guts, so, too, do psychoactive pharmaceuticals slap Band-Aids over our souls. It's the same quick-fix thinking that keeps us all opening our wallets for the latest, greatest “cure”—anything to keep from feeling the pain of existence. But life is pain; life is death and decay and entropy. As a climber, I should have known this—I should have known better. We're all always but one breath—or handhold—from oblivion.

A few days after my appointment with Dr. Porridge, my leg finally feeling better, I almost perish climbing one hundred feet up the First Flatiron as I free-solo with my friend Rolando, a talented Argentinean alpinist and mountain guide. That afternoon, I lock up and freak out on the little ledge where I'd lost it before, and Rolo has to coax me out of trouble. He points out handholds as I steel my frazzled nerves and traverse hard right off the formation, to where it blends into the hillside. The minutes there, shaking, terrorized, exposed on the face, feel like hours. I'm inconsolable until back on terra firma, and no longer have any business climbing without a rope, or maybe at all. It's never been this bad before. Perhaps I should try this Zyprexa—at this point I'll try anything. The antipsychotic turns out to be about as calming as eight Benadryl and a pot of truck-stop coffee … on an empty stomach … during a meth binge. The first time I take one, Kasey and I are out to dinner with friends at The Hungry Toad, an unpretentious pub where climbers and families congregate in north Boulder. I have fond feelings for the Toad, having stopped in for a burger or cider after long days on the rocks. This night we're at a table in the rear, and I've hidden in the far back corner by the bathrooms. I swallowed the Zyprexa right before we came—the doctor said to try it with food. Now, glassy-eyed, with rubber lips and a paralyzed jaw, I sit silently and observe my friends talking as if through an aquarium. Someone asks me about a climb somewhere and I stammer an answer, slurring the syllables: “Umm-Err-Yarr-Zass-A-Gorrrd-Climb.” I'm ten seconds behind, in a dead world being unwoven by devils. Lizzy is out with us and keeps asking if I'm okay—she'll later tell me that a friend of hers, similarly drugged up on psych meds, took his life in his early twenties. She is worried that I'll do the same.

The next night is little better. Kasey is out at the bars with friends until the wee hours—it's been like this lately: her going out, me staying in—and I can't sleep. I take a Zyprexa and lie atop the covers, buzzing and sweaty. The bedroom's two slat windows give east from on high, down past the back drive into Boulder. It's hot but clear, and the stars are out. I peer upside-down at them through the glass, muscles locked with mortis. I fumble into the next day, bristling with chemical rage. On night three, my final one on Zyprexa, I get no sleep at all. I feel like puking, perspiring freely out on the couch alone, thoughts coming in a frenetic, dissociated rush like derailing train cars, heart slamming, too dizzy to read or watch TV, counting drywall dots on the ceiling. This “freak-out” pill has not helped. Like the Risperdal, Seroquel, Ambien, Depakote, lithium, nortriptyline, Neurontin, and Sythroid soon to come, Zyprexa only makes me sicker. All neurotransmitter systems are complementary and interdependent, and when one is on fire—in my case the GABA system—pouring more chemicals onto other systems only fuels the original fire. Ask any firefighter: Pour gas on a fire—any part of the blaze—and the whole thing will grow.

One milligram a day, Klonopin, Baltimore, Maryland, September 2005:

This psychiatrist is wearing sock garters—
sock garters
—and he's sitting here trying to tell me that I'm crazy because I get up early during summer to climb mountains. Each time he crosses his legs his slacks ride up his pale, hairless shins and I can see the garters, like old-lady pantyhose, holding up his black dress socks.

“No. You don't get it. I said I was getting up at 2:00
A.M.
to climb the peaks around Carbondale because I was training for a specific objective and—”

“But why so early? You said you weren't sleeping, right? That you sleep less in the summer.”

“No. I was sleeping just fine; I'd set my alarm and get up. Like I said, I was heading out on a big trip to California and wanted to get in shape, so I'd get up before work and climb the Maroon Bells to train. Also, you have to be up and off the peaks early, before the thunderstorms, so I'd get an ‘alpine start.' That's just how we do it in Colorado.”

“So you're saying that you're getting up alone at 2:00
A.M.
to head up alone free-climbing along the mountaintops. I'm sorry, but this sounds like mania to me,” he says.

“No, no, no; you're not hearing me. You start early so as not to get caught above tree line—there's nowhere to hide and you're totally exposed if the weather moves in. Have you ever been in a mountain thunderstorm? It's scary.”

“I'm sure that I haven't,” the doctor says. “So I suppose I'll believe you.”

He scribbles more notes, head down, caterpillar eyebrows waggling. This cat is freakishly thin, as in “picked-last-for-kickball” thin, and it occurs to me that he's probably never set foot in the mountains and that no matter how explicitly I explain whatever facet of climbing he'll find some way to misconstrue it as psychiatric illness—bipolar risk-taking, manic early awakenings, depressive slumps when I'm fatigued after a long day on the rock, cyclothymic mood swings as I ride out a roller-coaster redpoint campaign. We're sitting in a windowless room within the belly of the Johns Hopkins Meyer Building, across Wolfe Street from the School of Public Health, where my father has chaired the Epidemiology Department for the last ten years. Hopkins has a sprawling medical campus the size of a small city, teeming with steel-and-glass skyscrapers that loom over the hospital's original ornate brick buildings. The campus has its own subway stop and a network of underground tunnels; there are armed guards on each corner and in every parking garage to keep the hoodrats away. My father knows how bad my anxiety has become, so after much coaxing on his part I've flown out to consult a Hopkins psychiatrist. Given the hospital's sterling overall reputation, maybe they're smarter than the ones in Colorado. Or perhaps not: This guy still can't grok what I'm telling him, probably because his ears are plugged with free Abilify pens and Seroquel samples.

In the end, I can't help myself. I blurt it out: “It's not mania—it's
training.
It's called being smart,” I say. “Everyone gets up early to climb the Fourteeners.”

The doctor looks up, squints at me nonplussed as if I'm speaking Swahili, goes back to scribbling.

I think back to those predawn starts for the Maroon Bells and Pyramid Peak up by Aspen, some of Colorado's steepest, gnarliest Fourteeners, with wedding-cake striations of loose red and purple sandstone. I think back to all the ridge link-ups I did in the Rockies and Sierra Nevada, stringing together ten or more technical summits in sixteen-hour continuous solo pushes. I can picture my headlamp bobbing off cobbles in the trail as my airways tightened with cold predawn air, wondering if mountain lions lurked in the aspen glades. I remember the forty-odd songs on my MP3 player, which I came to know by heart by one season's end, and the time I lost the cairns on North Maroon and headed up the wrong gully in the dark, encountering smooth, fifth-class headwalls, pressing desperate mantels on wet, rounded ledges as I made for a stegosaurus skyline, as night spread into infinity behind me, the void velvet and hissing. I think of the venerable bighorn sheep I found atop North Maroon, starting to bloat with decay, having chosen this summit to lie down upon and die. I can smell skunky sky pilot wafting from fractures in the rock as I scrambled past stands of cheerful blue columbine and white tufts of alpine phlox. I recall watching the sun pierce the jagged pink horizon from fourteen thousand feet, of seeing rolling green-tundra and red-talus basins spread at my feet blazing yellow with dawn. I smell the screen-door ozone odor given off by rocks accidentally dislodged. I can barely, just barely, remember what it's like to be strong enough to treat peaks some might climb only once in a lifetime like a jog around the park. I miss the unfettered movement, the all-day spiritual buzz I'd get when soloing ridge link-ups, the man-on-the-moon energy of being alone all day in the mountains, the endorphin bath when I finally stopped back at the trailhead. Yes, I must be manic—must be unbalanced—to want to wake up early to experience something like this.

What other explanation is there?

The doctor will write it later in his eight-page evaluation, what $500 of my father's money purchases at the Johns Hopkins Hospital's Affective Disorders Consultation Clinic: “The patient does describe episodes that are suggestive of mild possible hypomania. He describes in the summertime lasting 3 or 4 months, having significantly more energy and sometimes getting up very early in the morning to rock climb, even at 2:00
A.M.
”

Two things: A) This clown can't tell rock climbing from mountain climbing. And B) Who doesn't have more energy in summer? It's always been this way: Of Russian and Irish extract, I get a little sadder, a little slower, a little sleepier in winter like a hibernating bear, and when summer comes I feel re-energized and become more mobile. This doesn't make me manic; it means I calibrate to the seasons the way that man always has until artificial constructs like psychiatry came along with labels like “Seasonal Affective Disorder.” It means that I'm a climber and know the true length of the day, the natural rhythms of our planet.

“Well, we'll just have to agree to disagree on this point,” the doctor says, closing the discussion.

We talk for a long time—an hour and three quarters—he taking my family, drug-use, and mental-health history, I answering dutifully in the defeated whisper that has become my speaking voice. At the end of the session we discuss diagnosis and treatment. The doctor delivers his verdict:

“What I think we're looking at is depression and anxiety worsened by taking too long to come off benzos,” he says. “I look at it sort of like pulling off a Band-Aid: You need to just yank it off, or you'll only prolong the pain.” In the evaluation's History of Present Illness section, the doctor will write, “Nowadays, panic attacks are present several times a day with much anticipatory anxiety.”

“But I'm going pretty quickly,” I say. “A quarter milligram every two weeks. I—I couldn't go much faster.”

“It's actually really slow,” he says. “I think you're just prolonging your agony.”

I think about the two-day spike in symptoms, in fear, I've felt after each cut and how it now takes me the entire intervening two weeks to “stabilize” before my next cut—and how I can't stomach the thought of speeding things up. In my head, I can't picture a Band-Aid, but more like a pressure bandage applied to a gashed artery—rip it off too quickly and you'll bleed out. I have a copper battery taste in my mouth, one that's been there for weeks, my liver digesting itself. I smack my lips and swallow.

“I stopped Valium abruptly years ago, like I told you, and I basically went insane. I don't see how I could go through that again.…”

“Yes, but this time it's different,” the doctor argues. “You haven't been abusing the Klonopin, though you have been on it for far longer than the Valium. So I think a rapid taper would be relatively safe, and of course we can monitor it. This benzo is really keeping you down.”

“But how exactly is it making me more depressed, more anxious? I don't get it. No one has really explained this to me.”

“Look, these tranquilizers are very dangerous. We see a lot of patients come in here on them, and we always take them off right away. Benzos can depress you, in particular Klonopin, and you've been on it for years, which is far too long.”

“And so the depression gets worse, as well as the anxiety?”

“It could be, and it could be that with less and less benzodiazepine in your system, it's hitting you on the way off as well, making you more and more anxious,” the doctor says. “I fear that if you continue to taper slowly, your problems will only go on and on … Regardless, you need to come off these pills, and I think we need to go ahead and get it over with.”

At last, a doctor who acknowledges that the benzos might be my problem, who doesn't shovel the blame back onto me by telling me that my tough taper is some anomaly or insinuate that it's all my fault because I have a history of substance abuse. I feel a vast sense of relief. Maybe Hopkins can help.

“Okay, and how would you do that?”

“Well, I'd increase your Paxil dose to twenty-five or even fifty milligrams and take you very rapidly off this last milligram of Klonopin…”

Shit.

“That much Paxil? But I've never been able to take more than ten milligrams.”

“That might be true—and you might attribute any increase in anxiety to the Paxil, but it would in all probability be because we're going rapidly off the Klonopin, and because it gets harder with each cut. Think of it this way: The last milligram is the toughest. It's like getting a heroin addict off methadone. It's most difficult when you go from that last increment to zero, to having no more of the drug in your system. You're going to have to feel much worse for a little while in order to feel better, Mr. Samet.”

“Quickly?” I ask. “How quickly?” I'm trembling.

“A week, a few days … we'd just have to see. We go by blood pressure and heart rate—it's a medically safe taper.”

“And I could do that staying here in Baltimore, like at my dad's, and coming to check in at the hospital?” I think of my father's place, a row house on Federal Hill, of how it might feel to weather the withdrawal there. I could sit out on his rooftop deck, watch boats chug into the Inner Harbor, do breathing exercises, count floors on the downtown skyscrapers, try to walk when I felt well enough.