Stone 588

ACKNOWLEDGMENTS

The author is grateful to all those who helped him in the bringing about of this book.

Especially Jonathan W. Stewart, M.D., Assistant Professor of Clinical Psychiatry at the Columbia University College of Physicians and Surgeons and Research Psychiatrist, New York State Psychiatric Institute; Marvin S. Belsky, M.D.; Dr. Ruth Ochroch; Roger D. Powell, M.D., orthopaedic surgeon; Joyce N. Cox, R.N.; Thomas Gouge, M.D., New York University Medical Center.

And Ben Jacobson, Detective (ret.), New York City Police Department; Jerome Allan Landau, attorney, former Special Agent, U.S. Treasury Department, Internal Revenue Service, Intelligence Division, and U.S. Strike Force Against Organized Crime; Scott Towner, gemologist, G.I.A.; Simon Abraham, president, Amasian Gems, Inc., New York, Bangkok, Geneva.

And Adnan Khashoggi; Robert Shaheen; Robert J. and Patricia Lovejoy; Richard and Anastasia Capalbo; Bernard and Patricia Nunez; Lucienne Dodge; Pia Kazan, Paris editor. Harper's Bazaar; Michael and Susan Torlen; Jack Tirman.

And Sterling Lord and Ann Harris.

Brushing her hair again.

Janet Springer sat in her fat armchair and gave little mind to what she was doing. Only when she pulled the bristles of the Mason Pearson brush too painfully across her scalp did she let up, relax her grasp of the handle, and go back to normal brushing.

She'd been at it for over an hour. Three hours was not unusual. Cadently, stroke after stroke, through the strands on the right side of her dark, straight, shoulder-length hair. It caused tiny electrical crackles that Janet considered encouraging. At the end of each stroke she gave the brush a sharp snap, as though to cast a substance from it. She often told herself it was silly, that she didn't really believe an inch of the idea that brushing, no matter how strenuously, might help the inside of her head. Nevertheless she was drawn to the brush, especially when she felt her between days slipping away.

Janet's right arm, doing the brushing, seemed independent of the rest of her. The rest of her was still as rock. Her feet were precisely together on the floor, the knobs of her ankle bones touching. Her knees were aligned and her thighs served as a vise for her free hand. She sat exaggeratedly erect, the upper part of her stiffened, her hips locked, breasts, throat, and chin thrust forward by the bow of her spine. She appeared to be in a contrived posture, perhaps begging for audience. However Janet had not, on an impulse of solitary dramatics, struck the pose. It had come over her while she was sitting there, a change degree by degree that tightened her lips, clenched and covered her eyes so they were now seeing inward more than out.

Thoughts were darting about in Janet's mind so rapidly that even the most unrelated ones overlapped. She felt her brain was deliberately trying to confuse itself, mazing among the convolutions in her skull. She knew the symptoms. What they were leading her to. From all the times before she knew it was futile to battle them. She hadn't expected, just hoped with the merest of hope, that she might remain indefinitely in the phase of between. Even a few more days of it would have been a blessing.

Signs of shift had begun in her a week ago. Only an edginess at first, but before long that had grown into explosions of irritability. Set off by inconsequential things such as not being able to find at once her place in a book she'd been reading, or having a postage stamp slip and stick awry on the comer of an envelope. She also dropped things more, and when she did, dropped her eyeglass case or whatever, her immediate reaction was to blame it, kick at it. She talked louder, faster. She was stuffed with energy, expelled some by lying on the floor to hook her feet in under the couch and do a hundred sit-ups. She used a white wool sock like a mitten to wipe dust from the floor beneath the bed and the dresser. Pecked lint from her dark wool sweaters at two in the morning. Her sleep was brief, black intermissions. She came wide awake the instant her eyelids parted.

Last night she hadn't slept at all. For hours she lay nude with the covers thrown off. Shivering was a diversion. At intervals a face had peeked in at her through the clear plastic square in the door. Each time she'd sat up and glared, a disturbed look. Once she'd gotten up and paced the room for a long while, with her eyes closed because that helped her pretend she was walking straight, going places. When she returned to the bed and was lying face up, closing her eyes made everything worse. Thoughts dropped to the back of her head in a deranged heap from which they were fired back up at her in no sensible order.

Chanceless wishes.

Addictive memories.

Numerous sexual impossibilities.

At dawn she considered packing. She mentally sorted through her many pretty things and put aside some that would be right for this month, April, in Rome.

Twenty-six-year-old Janet Springer.

She had been at High Meadow for three years. It was the longest time she'd spent at any clinic. During the ten years before High Meadow there

had been five other private clinics. They were always huge Connecticut houses, the former country retreats of wealthy city families back when there'd been no concern about heat or help. Protected by acres, situated as though hidden, such houses were perfect for their present purpose. (Who knows over the years how many in the line of the original owners had returned and were, even now, tucked away in familiar rooms?)

Janet called the clinics "keeping places." They were where she was kept. Within driving distance of home.

She had been moved from one keeping place to another because she was more of a problem than she was worth. Those clinics that admitted her sooner or later regretted having done so. They made up thin excuses for insisting she be removed. Some were honest about it to a point, let it be known they couldn't cope with her. She was too complicated a case, could not be properly treated. Their preference was a patient like a tame bird into whose mouth they could drop on schedule doses of compliance and predictability. Thus the staffs of the clinics, from ordinary attendants to head doctors, were, in their own way, as hooked on anti-psychotic drugs as the patients. So many milligrams of this or that prevented bedlam.

Janet was an exception. It wasn't that she refused to take the drugs; she would have willingly done so and been grateful for the relief.

Thorazine was the first anti-psychotic medication tried on her. Her system could not tolerate it, or any of the chlorpromazines. When given haloperidol she also had an adverse reaction. The drug that promised the most for Janet was lithium carbonate. She asked for information on it and read every word they brought her, over and over, until she was convinced that lithium was intended for her and all the problems she'd had with drugs up to then had been necessary — leading her to lithium. Lithium was a wonder. It could alleviate her emotional extremes, the agitations and the funks. It could keep her balanced. No longer would she be swung by her sick head on that terrible pendulum. Lithium had helped other manic-depressives.

She wanted it.

She prayed to whatever force that controlled her body to allow her body to accept it.

The chief of the clinic reviewed Janet's medical history, more thoroughly this time. Her past intolerance to drug therapy made him reluctant. He noticed that, for some reason, lithium had never been tried on her. Perhaps it had been too new, radical, considered dangerous. Up to now, he himself had had only positive results prescribing it. If it worked on this difficult patient it would be a feather in his medical cap. It might even call for a paper for the American Journal of Psychiatry.

The doctor ordered that Janet be given three hundred milligrams of lithium three times a day, a cautious initial dose. His double-underlined instructions were that a blood sample be drawn from her each morning prior to medication to determine her serum level. If her serum level went above 1.6 or if any adverse symptoms were observed, he was to be notified, personally, at once.

When Janet's lithium therapy began she was optimistic. She didn't have any apparent adverse reactions to it, and with each passing day her hope increased.

Out of psychological habit she was, of course, sensitively aware of her moods, and when she felt herself mentally lifted in a lighter, unfamiliar direction she was sure it wasn't her imagination. She was in the outer limits of happiness, she believed. She actually felt giddy, as though her throat was crowded with tiny lighter-than-air bubbles she couldn't possibly hold in.

The most ordinary things amused her: the snug adjacency of her own toes, a bird outside cocking its head, the naive blankness of a piece of letter paper. She giggled while alone at a water stain in a corner of the ceiling — her private Rorschach that she purposely supposed into the craziest creatures and situations she could think up. It was fun for a change to be genuinely elated. The lithium was indeed working.

She noticed other changes.

She was dizzy at times, which seemed to go along with her giddiness. Her mouth was dry and had an unpleasant metallic taste, which persisted no matter how often she rinsed. Her hands twitched, jumped often as though startled. Nothing important, she told herself. Her hope wouldn't let her complain.

The eighth day of lithium began with:

"Good morning, Janet."

"Good morning."

"How are you today?" the nurse asked.

"Better, thank you." Janet's words seemed to come out swollen and stuck together. She remained in bed, extended her arm. The nurse drew the daily blood. Janet sat on the edge of the bed. She looked in the direction of the bathroom and was about to rise and go to it when she felt a glowing hollow-ness inside, just below where her ribs came together in front. Suddenly, her head turned aside on its own and her right arm flew upward like a puppet's and her eyes rolled in their sockets.

She fell to the floor, just dropped.

She cried out, one short sound that seemed squeezed from her. Her legs knifed up, knees to chest. Her elbows dug hard into her. She gasped for breath, apparently unable to get air past her throat. Her skin took on a blue pallor. There was no stopping it.

Her body went completely limp, as though drained of all its substance.

But the next moment she was invaded by more tension than she could possibly contain, tightening her tissues to the tearing point.

Foam came from her mouth.

The convulsions lasted for several minutes, then ceased abruptly. Her eyes were open, but she was unconscious when they lifted her onto the bed. Her pupils were fixed, dilated. The nurse removed the ballpoint pen she had in emergency forced between Janet's teeth to protect her tongue. Deep teeth marks were visible on the shaft of the hard pen.

When Janet came to she was confused, couldn't recall the seizure, none of it. She felt tired, sleepier than ever. Her last thought before giving in to sleep was how disappointed she was.

The blood that had been drawn that morning showed Janet's lithium serum level at 2.2, more than high enough to cause toxicity in her central nervous system. What puzzled her doctor was how subtly and quickly the lithium had built up in her system. He had escaped having her death or coma on his reputation by perhaps only a day or two. When he entered the episode on Janet's medical record, his bottom-line notation, printed in capital letters not to be overlooked, was: caution: lithium carbonate should never be ADMINISTERED.

At other clinics other approaches were tried on Janet. Dosages were halved and halved again for her, until they were practically immeasurable. Whenever a new psycho-tropic drug was brought out, Janet managed to have it given to her. Nothing worked. She suffered reactions, not just severe side-effects but often life-threatening direct effects.

The doctors were challenged and stumped. Three of the country's leading psychopharmacologists were consulted. They studied and speculated but were unable to recommend a beneficial course. They chalked it up to having something to do with Janet's natural psychochemistry, which was obviously complicated and messed up enough to be unique.

Janet Springer.

Given up on.

Now, there she sat in her room on the third floor at High Meadow. Her fat armchair faced a large double window of numerous individual panes, small panes of safety glass. The frames of the window appeared to be made of wood but were really formed steel that had been painted. Less disheartening than bars or mesh.

As much as possible had been done to make Janet's room unclinical and yet safe for her. It would never be as nice as home, of course, but those who loved her had seen to it that she was surrounded by familiar and cherished things. Against one wall was her own bed, and along the opposite wall a soft sofa from home. Other furnishings that had been brought were her father's six-drawer upright dresser and a small Queen Anne-style writing desk her mother had always treasured. On the floor was a 9-by-12 Chinese rug, a nice thick one that had been carried in on the shoulders of her two brothers.

Other normal touches had accumulated: a particularly friendly pillow, a colorful handmade throw, certain books they knew she liked to reread. Audrey, the woman her brother Phillip loved, had given her, among other things, a subscription to the weekly newspaper called W, somehow knowing she would at times be entertained by that snobby nonsense.

Photographs of those she could not be with were hung and placed around. A few were serious portraits but most were candid snapshots of special good times that helped her feel included. A photograph of her father was in his last passport, which she kept standing open on the dresser top: him looking out with an impatient expression, the officially embossed State Department seal marring his plain, small, knotted tie and dark, correct suit. Nearly all the stamped entries on the pages of the passport were London and New York. The last foreign one, on a page by itself and stamped so hard its magenta ink had smeared, was Belgian. It was dated ten days before he'd died. Janet often imagined him alone and not feeling well in Antwerp.