After her shower and a greasy, satisfying breakfast at Waffle House, Rebecca drove to the county hospital Monday morning. It was a tiny complex of small buildings, each painted the same institutional slate gray and surrounded primarily by pine trees. There were a few lonely flower beds flanking the front door, and she could see a couple of wooden picnic tables behind one building, where two men sat smoking.
She pressed the intercom at the front door and gave her name and her mother’s name. After a moment, she was buzzed in and directed to a small waiting area with burgundy padded chairs and a single magazine rack. She thumbed through last year’s Christmas edition of Woman’s Day, flipping the pages without really seeing them. Soon a woman in hot-pink scrubs with large, poufy red hair came into the room. “For Lorena Williamson?”
Rebecca raised her hand. “That’s me.”
“Hi, dear, I’m Kathy Winslop, the charge nurse. I was here when they brought your mom in.”
“How is she?”
“Well, you know, she’s had a rough time. She is up and about today, a little more coherent, and did sign the paperwork giving us permission to speak with you about her treatment.”
“More coherent?” Rebecca did not know her mother had been incoherent.
“Yes,” Nurse Kathy said, nodding gently. “I’ll let Dr. Sussman tell you more. Here’s my card, though. We nurses are here more often than the doctors are, and this has my extension if you need to reach me with any questions. One thing your mom really needs is some clothes. Have you been to the house?”
“Yes,” Rebecca said. It was almost a whisper.
“Yeah, I heard about the house,” Kathy said with sympathy. “Maybe, if you know her size, it will be easier to just buy her a few things. She’ll need comfortable pants and T-shirts, and a pair of plastic flip-flops for the showers. We give them slippers, but to tell you the truth, they aren’t very nice. You can always bring her some softer ones if you want. She’s got a toothbrush, but again, they’re nothing fancy. No razors or floss are permitted, no mouthwash with alcohol, no belts or shoes with laces, and absolutely no medications. Not even Tylenol. If they transfer her to Mountainside, she can work her way up to the day unit and they will let her have some of that. But not here. Okay?”
Rebecca could not even process what she was hearing, but she nodded, hoping someone would repeat the list to her later. “When you bring her stuff back, just drop it at the front desk over there, and they’ll deliver it. Now, let’s go back and you can see her.”
Her mother was in a small room that reminded Rebecca of a college dorm, only less optimistic. There were two twin beds, each with a sickly mauve bedspread and grayish-white pillows. Each side of the room had a nightstand and a tall cabinet made of white pressboard. The cabinet had a bar across the top for clothes on hangers, and each nightstand had a large plastic cup resting on it with ALABAMA BOARD OF MENTAL HEALTH printed on the front. The lights were plastic, built in to the walls, with no cords. Rebecca noticed there were no drawers in the nightstands or doors on the cabinets. All open shelving. No place to hide.
Her mother’s roommate must have been out in the common area with the other residents, because one of the beds was empty, with a navy sweater draped across it. On the other sat the woman Rebecca had known every minute of her life but now barely recognized. Lorena Williamson was gaunt and pasty. Never a large woman, Rebecca thought her mother must have lost about forty pounds since she had seen her last. Her eyes were sunken and red, her arms bony beneath sagging flesh. Rebecca wanted to cry.
Nurse Kathy spoke from the doorway. “Mrs. Williamson, your daughter Rebecca is here.”
“Your daughter Rebecca.” In case my mother doesn’t know me, Rebecca thought grimly.
Lorena looked up blearily. “Becky?”
“Yes, Mama.”
“Did you finish your homework? I told Mrs. Pindergrass you had to do your homework before you could go outside. Where is Cory? Where is your brother?”
A painful lump collected in Rebecca’s throat, but she did not want to cry. Not now. “Mama,” she said gently, sitting down next to her mother on the bed. “Cory’s gone. He died, remember? Years and years ago.”
“No,” Lorena said lightly. “You’re thinking of something different. Don’t worry. I’ll wait up for him. You go on to bed, now.” She patted Rebecca’s hand.
Rebecca rose obediently, grateful for an excuse to leave the room, even if it was imaginary. She kissed her mother on the forehead. “I’ll be back soon,” she muttered. She wished it didn’t feel like a lie.
When they were back in the hall, Rebecca turned to Kathy with tears in her eyes. “What is going on? She’s never been like this. Is this because of the mess at the house?”
Kathy put a gentle hand on Rebecca’s arm. “She’s actually better today than she was yesterday. She was nearly catatonic and wouldn’t eat. I was afraid we were going to have to send her to the main hospital for dehydration. Dr. Sussman will be able to explain better, but from what I know, this seems like more than just the hoarding issue.”
Hoarding. Of course, that’s what it was. Rebecca had always known it, that her mother’s “collecting” and “saving” things was not normal. She had sensed it was getting worse as the years went on. Wasn’t that why Daddy had moved out? But she had never put the word to it. There were TV shows about hoarders and even though Rebecca had never seen one of them, the commercials always made her uneasy. She wondered darkly if her mother would end up on TV, too.
Kathy led Rebecca to an office at the end of the hall. It was larger than many of the rooms they had passed, but not a luxurious office by any means. Three of the walls were swimming with books—on shelves and credenzas and piled high from the floor, with papers sticking out every which way. On the back wall were four imposing filing cabinets, one of which was topped with a wilting plant. On the others rested binders, boxes of office supplies, and a single dusty frame containing the Serenity Prayer against a background of fading watercolors. Not exactly setting a great example, Rebecca thought.
Dr. Sussman looked far, far too young to be a psychiatrist—more like a child playing doctor. He wore a checkered shirt unbuttoned at the collar under his white lab coat, no tie. He sat in what had once been a polished red leather executive chair, but it had seen better days and was worn in patches. He was signing forms in a stack of manila folders, and when Kathy introduced her, he smiled tersely at Rebecca and continued his work. He handed Kathy the stack of completed folders, holding the last one on his desk.
“I’ll stop back by in a few minutes, Rebecca,” Kathy said behind her before departing.
“Hi, Ms. Williamson,” Dr. Sussman said formally, reviewing the file on his desk.
“Rebecca, please.”
“Sure. I’m Will Sussman. I’ve been your mother’s primary treating psychiatrist since she was admitted. Though, obviously, we work as a team here.” He glanced at the door as though including the rest of the staff. Rebecca was not sure if this was for her benefit or in case someone was passing by, so they would not feel slighted.
Rebecca repeated the question she had just put to Kathy. “What is going on? My mother seems very confused. Does this have to do with the hoarding?”
Dr. Sussman shook his head, still looking at the chart. “Good question. Clinically, hoarding should not have anything to do with her orientation to the here and now. Um, the confusion. Anyway, there’s some dispute in the research, but most professionals agree that hoarding is on the obsessive-compulsive spectrum.”
He fished around for a large binder under some papers on the desk and opened it, flipping pages while he talked. “While OCD and related disorders can sometimes feature delusions or magical thinking among their symptoms, they are not generally characterized by pervasive confusion about time and place, nor the catatonic state your mother was in when she was brought in.”
Rebecca wrinkled her brow, trying to wrap her mind around what he was saying. “What does this mean?” she asked meekly.
He seemed to notice her in the room, then. His voice softened and he took a less academic tone. “Sorry. Have you heard of OCD?”
“Yes.” She had, though she hoped he would not ask her to give a definition.
“Okay, well, hoarding behavior is pretty much a special form of OCD, which is a pathological response to anxiety. It’s not ‘normal’ behavior, especially when it gets to the point where your mom is, but usually a person who has OCD or who hoards, they are still mostly in touch with reality. They have a skewed view of things, of course, but usually just related to certain rituals, like in your mom’s case, holding on to stuff.
“But Mrs. Williamson seems to have something else going on as well. As you pointed out, she’s confused about when and where she is. And when she first came in, she was completely dissociative—that is to say, disconnected from reality. She was either unable or unwilling to even speak at first.”
“So what does it mean?” Rebecca repeated. “I mean, will she get better?”
“It depends,” he said. Then hurriedly he added, “Well, let me say this. I’m very encouraged that she is more lucid today than when she came in, and I’m hopeful that means she will continue to improve. But mental illness can be hard to predict, so I don’t want to tell you she’ll be fine in a certain number of days or weeks.”
Mental illness. He had said the words offhand, but to Rebecca they were as stark and foreboding as though they’d been stamped on her forehead.
“Why—,” she stammered, choking back tears, “why is she this way?”
And will I be this way, too? Am I doomed? Thoughts too shameful to voice.
He sighed. “So much about what we do is a mystery,” he said. “The human mind is extraordinary and powerful. It can hide itself, protect itself, and sometimes heal itself, and we don’t always understand why or how.”
Great, Rebecca thought. I have no idea what’s going on and this guy thinks he’s Gandalf. She caught herself twisting her ring, and then gripped the arms of the chair to still herself.
Dr. Sussman did not seem to notice her frustration. “My guess would be that your mom had sort of a predilection toward the hoarding, or at least to some form of OCD. Those things are often at least partly hereditary. But environment plays a role, too, and sometimes a traumatic event can not only trigger a worsening of the OCD, it can cause the kind of psychotic break your mom seemed to experience this week. You had a brother who died, is that right?”
“Yes,” she said. “In a car accident.”
He was flipping through the chart. “When was that?”
“In 1997. He was eighteen.”
Dr. Sussman made a note in the chart. “Thanks,” he said. “It’s been hard putting everything together.”
Poor you, Rebecca thought acidly. She tried to remind herself that this man was helping her, and her mother, no matter what a jackass he might seem.
“Had you noticed the hoarding before that?” he asked.
She tried to think. “I don’t know. I was only sixteen then.” Her father used to tease her mother for being a pack rat but it never seemed crazy to Rebecca. She saved silly things like wrapping paper and old sour cream containers, but Rebecca had always thought she was just thrifty. They had never had money to waste, that much was certain.
Will Sussman made a tent with his fingers, sitting back in the chair and looking at her directly. “I can’t know for sure, but if I had to guess, I would say that maybe your mom was always a little inclined toward hoarding, which basically means that keeping certain things made her feel less anxious sometimes, but that the trauma of losing your brother caused her to spiral out of control, so that the hoarding behaviors became harder and harder to keep in check.”
For a jackass, he was pretty good. This description fit almost exactly with how things had been after Cory died. First it was that her mother did not want to get rid of anything belonging to Cory, not even his old clothes and baseball gear, which were just collecting dust in the shrine she had made of his room. Then she began to collect little things, like magazines she was saving in case she needed a new recipe for something. But she wasn’t cooking or even eating much; Rebecca and her dad survived on TV dinners and the Hardee’s drive-through.
Then came the garage sale phase, which started late in Rebecca’s junior year of high school. Her mother developed the ambitious idea that she would collect and refurbish “antiques” and knickknacks for resale. A well-meaning friend of hers, probably hoping to help Lorena develop a hobby after mourning for her son, had offered her a booth space at the big antique shop in Gadsden. For months, Lorena went garage saleing every weekend and came back with the most inexplicable loads of junk. Broken record players, children’s toys, dry-rotted furniture. “I can do something with this,” she would say, adding each item to the pile that started in their living room and eventually took over most of the kitchen.
“I can do something with this,” Rebecca muttered.
“Pardon?”
“That’s what she used to say, all the time. Mom. She would bring home junk and say ‘I can do something with this.’ It was like her mantra or something.”
“Oh, yes.” Dr. Sussman sounded distracted. He was scribbling on a pad.
They were the words Rebecca and her dad came to dread most. At first, Lorena would look to them, bright eyed and expectant, for their approval of whatever she had found. She would tell them elaborate stories about where the item came from, or how it would look with a fresh coat of paint. After a while, though, she stopped showing them her treasures when she acquired them, which was often when no one else was home. They would simply appear on the pile or on the back porch, or sometimes even in the back of the closet or the trunk of a car. As the months passed, the quality of the items diminished and the quantity increased. Very few of the items she had painted or refurbished sold at her booth, so the logjam was at their house.
In the early years, Rebecca’s dad would help control the chaos. He would insist that Lorena cut back on her garage sales. He would make sweeps of the house: reorganizing, putting the less desirable items in the backyard shed, even throwing things out from time to time. After Rebecca moved to Georgia for her senior year and then went on to college, however, it became harder and harder for him to keep her mother in check. Lorena became defensive and angry when challenged. She retrieved treasures from the trash. And when he put her on a strict budget to curb her garage sale habit, she began accumulating newspapers and food containers in place of knickknacks.
Rebecca had been in her midtwenties when her father got his own apartment. He’d come to Atlanta and taken her out for dinner when he told her. He wasn’t divorcing Lorena, he insisted. He never would. He loved her mother always. “I just can’t live in a home where there’s no place for me,” he had said sadly.
In a way, she admired how long her dad had held to this idea. For nearly seven years, he had been faithful to Lorena, scarcely unpacking his suitcase at the new apartment. He’d gone home twice a week to bring food and to sit with Lorena for a meal. Rebecca gathered that he tried to clean up a bit while he was there, and that once in a while he even spent the night with his wife. But how long could a marriage go on that way?
Eventually Richard had rented his own house—the lonely bungalow off a two-lane highway he lived in now—but he was still paying the mortgage and the bills at Lorena’s place, without question. Rebecca was not sure when he had started seeing Sonia. She’d been absorbed in her own life, and resisted understanding her father’s relationship as long as she could. But Sonia had kept popping up in conversation, and as it became clear they were more than friends, Rebecca and her dad silently agreed not to delve any deeper.
Richard had not divorced Lorena, but he had left her all the same. His name was on the insurance card she was probably using during her stay here, but it was not Richard Williamson sitting in the chair across from this arrogant guy in the white coat. Daddy would have known what to say, or at least would have asked more intelligent questions than she was. But for now, Rebecca was it.
“So what happens next? What about the house?”
“Well, technically the house part is up to the Department of Health at this point, but I can say, from what I’ve seen, that if you are able to get it cleaned up within the next ninety days or so, they will allow you to have the condemnation revoked without having to jump through too many legal hoops.
“Normally with hoarding behavior, I suggest having the patient present to help clean out the home. It’s more therapeutic that way and more likely to actually help with the disorder. In this case, though, since she’s having some comorbid dissociation and obviously needs ongoing treatment for that, you may have to clean the house without her.”
“Me? Clean the house?”
“Unless you decide to sell it, as is. You can hire a company to come clean it, if that’s the way you want to go. They can be expensive and the challenge there is that they don’t know what you might want to save—if anything, I don’t know—but then at least you don’t have to do it yourself. It might be harder on your mom that way, when she’s able to realize what has happened. But you have to do what’s best for your situation.”
“I have to clean out the house,” she said. She did not know why this had not occurred to her sooner. Of course she had to clean out the house. Who else would do it? Dad? Sonia?
“Or you could just walk away and let the bank deal with it.”
“What?”
“If she still has a mortgage, you can let the bank foreclose on the home. The mess will be theirs to deal with. Of course, then your mom would need somewhere else to live and you would lose any equity that’s in the home. For that, you’ll need to talk to your attorney or financial advisor, actually. I can’t really advise you on all that stuff.”
“Of course,” Rebecca said numbly. Lose the house? Where would her mother live?
“In the meantime, I’m going to do what I can to stabilize her medication in the next few days and get her transferred up to Mountainside,” he was saying. “Your dad has really good health insurance—someone said he’s a mail carrier, right?—so I think we’ll be able to get her a spot over there that won’t bankrupt her. They really have more to offer long-term residents than we do here. It’s a nice campus. You’ll like it.” He attempted a facsimile of a warm and personable smile. “Flowers and pretty views and stuff.”
Until that moment, it had not occurred to Rebecca to consider who would be paying for her mother’s care. Her dad? Maybe. For most of his life, there was nothing he would have denied his pretty wife, even after he had moved out. But now? Now it was complicated. There were two house payments, two sets of bills. And Sonia. Now there was Sonia. Rebecca had a fair bit of savings stashed away—one of the few perks of being a single workaholic who rarely spent money—but she had no idea how much her mother might need. And she had to work, she couldn’t care for her mother full-time.
It was too much. She stood up. “Thank you.” It came out in her airline voice.
Dr. Sussman looked startled. “Um, you’re welcome. Kathy’s not—well, it’s okay, I can walk you out.”
He came around the desk, saying something about how he was planning to go to lunch soon anyway. As though this mattered to her. As though anything mattered right now, other than being outside these walls and away from this nightmare. She was in the parking lot before she even realized what was happening, clutching Kathy’s card and a tenth-generation photocopy of a list of personal items acceptable for inpatients.
The one thing she was sure of, as she drove away and navigated back to the two-lane highway to Oreville, was that she could no longer pretend none of this was happening. Her dad would have to be in the loop. And it was time to let her friends know what was going on. She pulled over and scrolled through her list of contacts, head swimming.
Before she got to Marci or Suzanne, the name appeared, and she knew it was the right call. “Hey, Jake. It’s Rebecca.”