Madness (5 page)

‘Have you ever fallen in love, Kate?' Helen asks the following week.

‘With other minds, oh yes. Many times. Right now for example . . . with ee cummings and Matsuo Bashō. And I've fallen in love with other souls – twice.'

‘What about with all of another person, someone you actually know?'

‘I don't think so. Not physically. Not with another body.'

‘Did you ever have a high school crush?'

‘Yep,' I smile, remembering.

‘With whom?'

I flush. ‘Virginia Woolf.'

Helen smiles. Then she says, ‘Do you think that's unusual?'

‘I don't know. Is it? Reading her journals and her fiction kept me alive.'

‘Yes, but
she
isn't alive.'

Later I wander down the corridor for another review with Jim. Another battery of questions, to which I give the same answers.

Yes, I have trouble sleeping.

Yes, I'm drinking too much.

Yes, I have trouble concentrating.

No, I don't have visions.

No, I don't hear voices that other people can't hear.

Yes, I think a lot about dying.

No, I can't cry.

He doesn't notice the burns on my hands; he keeps his arms and legs folded into himself as before. ‘We'll increase the mirtazapine,' he says. ‘Double it.' He smoothes his hair and ushers me out of the room. I leave with another prescription and walk to the bottle shop for more whisky.

shoot yourself bitch shoot yourself you're dying anyway

I walk faster. Wild Turkey, Jack Daniels, Canadian Club, Jim Beam, Famous Grouse, Woodstock, Ballentine's. It rains. Hard clear drops of water hit the warm ground and sizzle; the smell of hot asphalt rises into the air. I buy 700 ml of Wild Turkey and walk home in the rain. By the fifth drink I'm floating on the roof, up there with the daddy-long-legs and wisps of web, up there with Rose and Henry and the unholy spirit.

My little finger starts flickering first. Little tiny muscle fasciculations flick flick pause flick flick. Then my ring finger flick flick pause. Like they are keeping time. Like I have suddenly developed a sort of Parkinson's disease. I hear them at night rustling the sheets; I feel them carrying on their own little dance. Flickering.

Hana sits with Simon in the Community Clinic smoking area, curled up in yellow tights and a floral dress, her black hair catching the light, grey eyes pooling the light. When she speaks her voice is a low cadence.

‘The consumer liaison group,' she says. ‘I'm thinking of joining.'

‘Yeah?' says Simon.

‘Yeah, because of the wards, and here. I haven't seen the same guy here more than twice. I'm sick of having to repeat my history every bloody consultation.'

‘I got assaulted on the ward last time I was in,' says Simon. ‘Some guy in HDU tried to strangle me. Big bastard too.'

‘What happened?' I ask.

‘The music therapist was playing Bob Dylan, then this guy comes up behind me and puts his hands around my neck and squeezes. The music therapist and another patient hauled him off me, not before I'd turned blue. They called a Code Grey and stuck him in seclusion; he was out again the next day. Sick bastard.'

‘We've gotta do something about patient safety,' says Hana. ‘From the ground up, you know, like a union.'

I walk down the rabbit warren of brown corridors. Jim asks the same questions and increases the dose of mirtazapine by another 30 mg. On the way home my right hand starts to twitch. I lie in bed at night and listen to my foot and my hand and my fingers. Later my leg begins jerking from the knee down and pools of muscle contract in my back like ripples on a body of water.

garrotte garrotte garrotte the world will spin you into obsidian oblivion keep the fires burning watch yourself muddy red

‘There's something wrong with my glasses,' I say to the optometrist. ‘I can't read the newspaper. At all.'

‘Since when?'

‘Yesterday.'

‘Suddenly?'

‘I think it's getting worse.'

He looks closely at the glasses, holds them sideways, holds them up to the light.

‘I can't see a problem,' he says. ‘I'll examine your eyes if you'd like, but I think you'd be better off seeing a doctor.'

‘I am a doctor,' I say, irritably.

‘And you're shaking,' he says.

‘Sorry. It's these bloody glasses.'

The city is still warm in the very late evening. The sky has merged between grey and brown, heavy with cloud. There are ducks in the water of the river and ducks sitting on the grass along the riverbank. I walk to gain some perspective. I'm sweating. I can take only the smallest mincing steps. A couple of children come down to the river bank with their parents to feed the ducks pieces of bread; with their bright clothing and shining hair they make a counterpoint to the brown of the river. Most of the ducks take off in fright.

Across from the river people gather outside the arts centre after a concert, milling in small groups in filmy evening clothes, I catch the laughter and wonder about it. Over the bridge there is a small ferris wheel moving slowly on its arc, lighting the plane trees yellow and pink against the night sky.

In the morning I visit my GP, Jenny. I sit in the waiting room sweating with both legs jerking unrhythmically. I feel like a marionette.

‘Your blood pressure's awfully high. Your pulse is 140,' says Jenny.

I look at the roof and then at her fuzzy figure and there's sweat running down my face like tears.

‘What are we going to do about these jerks – this myoclonus?' she asks.

I try to shrug my shoulders.

‘Is it getting worse?'

I half-cough-half-retch. My head stutters. ‘I'm not . . . I'm sorry, I'm not managing,' I say.

Jenny takes one of my nasty, smelly hands in both of hers. ‘Hospital,' she says. ‘I'm going to call an ambulance.'

‘Oh shit. Shit.'

watch bitch you killer KILLER

The ambulance gurney slides through the Emergency Department doors and I'm assailed by fluorescent light. The ambos deposit me on a trolley in a cubicle where I wait, lying on my back. I lie quietly, thinking. Sometimes I am of the sea – the undercurrent unwinds me. My arms gather together and unfurl, gather and unfurl, held or lulled apart by notes played over and deep under the green-blue water. I have no soul to call my own. That which was, dives with the waves, is tossed amongst seaweed and breathes, breathes, briny water. My bones are brittle as shells. Molluscs covet my ears. A cerise squid engorges my mouth so its tentacles blow like jelly through my lips.

‘Kate?' A man in a white coat stands at the end of my bed; four others stand around him, in shorter white coats.

‘What's been happening?' he asks. I tell him about the twitches and jerks starting in my little finger and now involving my arms and legs and back and neck, and the sweating and the tremor and the terribly blurred vision. ‘I can't walk in a straight line.' My voice is gargled. He moves up to the head of the bed and flicks me suddenly in the centre of the forehead with his thumb and index finger. An onslaught of muscle contractions follows, am I having a grand mal seizure? He leaves the cubicle, taking his students with him, pulling the curtain behind him.

‘What do you think of that?' I can hear him talking clearly.

‘Epilepsy?' says someone.

‘MS?'

‘Hypermitotic brain lesion?'

‘Metabolic disorder?'

‘Meningitis?'

‘OD?'

‘She said she hadn't OD'd.'

‘She could be lying.' They walk away.

Breathing: the low moan of breath, the treacle-thick air, resistant lungs crack at the impact. And the heartbeat: muddy-red, red like ochre after rain, slow, fickle. It goes on despite the mind, to spite the mind. Spiteful. And the mind: thick with the grief of the god-awful awareness of existence. And pain: reaching out from the heart, down from the breast to the belly, to the pelvis, the deepest innards. Nestling there, nesting.

The jerking slows down, finally stops. I lie still. A nurse comes in, takes my blood pressure and temperature, inserts a needle in a vein in my hand, connects it to bag of normal saline and pins it up on a pole over my head. I say thanks; she smiles. The hospital is full of its usual noises: the ping of IV pumps, pagers, the squeak of trolleys on linoleum, people calling one another, the swish of cubicle curtains. A Code Grey is called to the psychiatry wing: threat of assault without a weapon. Someone is paranoid or panicked or in terror.

The experience of psychosis is an individual one. Oliver Sacks calls it a state where ‘the world is taken apart, undermined, reduced to anarchy and chaos'. R.D. Laing calls it ‘the only rational way of coming to terms with an insane world'. I call it a misapprehension of the nature of reality; a blurring of the line between what is Self and what is Other. At its basest level psychosis is terror because sound erupts through the ears into the mind, touch painfully ripples the hairs on skin, breath and voice drive the fantastical figures that float in the night in strange and unbalanced packs, and all nourish paranoia.

Later in the day I am admitted to the neuropsychiatric unit. Rose and Henry have disappeared – I am left with the others, full of bile and phlegm. They scream. I am creating shadow while there is light, and then in darkness, I am nothing. To be locked outside the heart of things – the air, the trees, the sky – is this life? Is nothingness a purity of the soul?

Neuropsychiatry sits at the clinical interface of psychiatry and medicine, focusing on brain-behaviour relationships. Do I have an organic illness or a functional one? Do I have a brain tumour? Am I mad? An electrode is clipped onto my forearm for an electromyogram (EMG) – a recording of the nerve signals in muscles. I'm told to relax or contract my arm; I'm flicked again and again on the forehead, setting off cascades of jerking and twitching. Jim from the clinic visits, sits at the end of my bed for five minutes. He decides to cease the venlafaxine in case I have Serotonin Syndrome.

Outside my window I can see a school and a church and a park where people are carrying on with the beauty of ordinary life. I lie in bed at night and watch the flowers on the curtains of my room wander up and down on the fabric in the half-light afforded by the lit corridor. I can't tell if their wandering signals a problem with my brain or my eyes.

The central nervous system is a finely tuned maze of nerve fibres and neurotransmitters. It controls not only motor and sensory function, breathing and blood pressure, but is also the seat of our personality, our desires, and our capacity to love and to harness creative energy. The nervous system is integral to daily survival, as well as to our ability to communicate and to how we understand the world and ourselves.

Fiona is my roommate in the neuropsych ward. She has Huntington's chorea – a genetic degenerative disease affecting a part of the brain called the basal ganglia. Fiona sits on her bed in the morning and applies lipstick in a loud wiggly line around her mouth. Photos of her children are propped up on her bedside table. She hasn't seen them for two months – not since she look an overdose of paracetamol and codeine while they were in her care. Her husband won't bring them in to see her. He doesn't visit either. Huntington's chorea has an inexorable course through chorea (jerking, writhing) to pneumonia, heart failure, dementia and death. When Fiona is discharged, she'll be transferred to a nursing home. She's 34 years old.

‘I'm forgetting everything,' she says as we sit together on the lurid green couch in the day room. ‘I'm a walking sieve!' We laugh. She has put her red cardigan on inside out, her ankles stick out from underneath her pyjamas, pale and vulnerable, her speech is slurred and every so often one arm or a leg contorts to the side, a sudden violent movement.

Medical staff send me off to have an electroencephalogram (EEG). First vaseline is dabbed over my scalp reminding me uncomfortably of ECT, then a thousand tiny electrodes are clamped on my skin; I must look like a modern medusa. Alpha waves are recorded when I close my eyes and beta waves when I'm asked to count backwards by 7 from 100, which I struggle with, the people in my head offering their black bile, and my muscles twitching at random.

The ward has people with epilepsy, young people who have had strokes, older people with Parkinson's disease and others, like myself, on whom a diagnosis hasn't been made. We exist in a bubble of illness as though the meaning of our whole lives is to be found within this one space and this one time.

Meaning.

Illness.

The beauty of ordinary life.

It is several days before I realise, suddenly and horribly, that I'm missing work. I ring my manager. She says my father called last week. Oh, thank you. Thank you. The relief, like sinking into warm water. Dr David S, grey hair, sombre blue eyes, walks into our room and sits in the chair at the foot of my bed. His nose is slightly bent; he touches it with just the tips of his fingers.

‘What are you angry about?' he asks. I look at him in surprise. He doesn't elaborate. I sit very still after he has gone, the people in my head crowding out mature thought. The jerks and twitches have dissipated somewhat so that I feel more like a human being. The following day I'm discharged. A diagnosis for the myoclonus is never made, or at least, never communicated to me.

Outside the hospital everything is moving fast: the wind, the cars, the trams, the people. I'm disorientated; I've been let into the light after a period in the darkness and my legs still won't work. They take malignant little steps, a half-shuffle, a sort of sashay sideways except that I'm not trying to dance. The intimate neuronal coupling between brain and legs that is required for walking – the sensorimotor cortex, the brain-stem, spinal cord, the spinal nerves and peripheral nerves and motor neurons and skeletal muscle – appears to have been somewhat abused.

I mince awfully slowly through the park where dogs are running into the wind and kids are playing soccer. The grass under my feet is short and springy though there are patches of dirt where no grass has grown since the winter football season. I sit down under a plane tree. The Buddha of Compassion, Avalokiteshvara, has eleven heads and a thousand arms. On the palms of his thousand hands is an eye, each of which radiates the gaze of compassion across the primordial universe. I often think of him sitting beneath a tree with his thousand arms, as the Buddha himself sat beneath the Bodhi tree, the sacred fig with its heart-shaped leaves.

The plane tree has an exfoliating grey trunk and knobbly joints; its leaves are maple-like, with lobes ending in spiky tips that are greener than the grass at my feet. Sunlight filters through the leaves, throwing their veins into silhouette.

kill yourself kill

I think about this. I think about my death, about where I might die, how I might die and about my body at the time of death– the stench, the bacteria, the excrement. I know what the brain looks like after death; I know what the heart looks like after death. I've stood in the mortuary of the hospital and assisted with the slow dissection of a human being, the removal of the lungs, the liver and spleen, the fragile brain – the seat of humanity. I've smelt the smell of death and seen death on the faces of those who have died, the body finally released. For a long time I sit under the tree. Shadows lengthen. Dogs bark. The street fills with cars. The wind picks up and ruffles the grass. The air is full of the smells of the city. I breathe. I am still. I think of Avalokiteshvara until it gets cold and darkness gathers. Then I shuffle home, Rose and Henry by my side.

To explain the six-day stay in hospital and the funny walking, I tell my manager and workmates that I've had an unusual reaction to one of my asthma meds. It's another four weeks before co-ordination returns. Thankfully, it's easier to get away with funny walking in a hospital, even as a staff member. I avoid other public places including the supermarket. This disconnection between brain and musculature is a most unwelcome reminder of my most unwelcome body.

Michael is sitting in a green vinyl chair in front of the Community Clinic in the late afternoon, smoking.

‘Hello Kate,' he says. ‘Will you marry me?'

‘Hi Michael,' I say. ‘No, I won't marry you.'

‘Oh. Are you here to see me?'

‘Helen and Jim.'

‘Can I walk in with you?'

‘Sure.' He stubs out his cigarette and loops my arm in his and we shuffle up the stairs together.

‘Can I sit with you?' he asks.

‘Sure,' I say. He pulls two chairs up close; we sit down, knees touching. He takes off his cap, leans forward, ‘I'm pretty smart. I live with my mum but she's good, she's good, yeah, she's good. She is. Want to shoot some pool?' He gets up, puts his cap back on and walks over to the pool table, whose green felt has almost all frayed away. I go to join him but Helen calls me from the entrance to the offices and I follow her down the passageway.

‘What do you think caused the shakes?' Helen asks.

‘Iatrogenic,' I say.

She raises her eyebrows.

‘Too much medication,' I say.

‘Where do we go from here?'

‘Round in a circle.'

She leans back in her chair, folds her fingers together under her chin. Her look is meditative. ‘You're feeling stuck?'

I nod.

‘Tell me about it.'

I tell her about sitting under the tree watching the light taken up into the leaves like syrup, watching the light and thinking about my death.

‘The Verve is right,' I say. ‘The drugs don't work.'

Helen smiles a little sadly. ‘One step at a time. How are you managing with the drinking?'

‘I'm drinking.'

‘Any alcohol-free days?'

‘Nope.'

I walk back outside, where Hana and Michael and Jack are sitting in the smoking alcove. Jack is the consumer consultant to the hospital and the Community Clinic. He's been a patient and is now a paid staff member. He organises meetings and workshops for patients and staff so that the hospital can learn from patients about what works and what doesn't. Hana has joined the team focusing on safety.

We sit together for a while in silence; companionable, smoke drifting to the sky. Michael smiles. His eyes are lit from deep inside, the brown penetrates. I walk home and take a couple of lorazepams. Rose is leaning over Henry as he stands by the sink. She washes his hands with bitter orange and bergamot, lathers fingers and palms and the backs of his hands where veins slide blue under the skin back toward the heart.

Such grace
says Rose. They hold hands and the soapy water runs over their fine joints and away. In the night I open the bottle of yellow lorazepam and the bottle of blue alprazolam. The tablets are scored down the centre and powdery opaque; they sit like small circles of desire in my palm. The night air is tender, unruffled. The trees' leaves are backlit through the moon. I take the lorazepam and the alprazolam without water. Addiction to benzos is an insidious thing. The trick is to find someone who will prescribe it and then someone else who will prescribe it so that one can live on double the amount any one prescription provides. I am not mainlining – yet.