CHAPTER 12

Pills, Light, and T-Shirt Vendors

Dr. Graham always spoke first at our sessions, and today was no different. I sat down at the end of the sofa, my usual spot, and crossed my legs.

"As I said at the end of our last session, Maggie, I want to discuss your energized periods. Let's begin by talking about your body. Physically, how do you feel during these periods?"

Answering this question required no thought at all. "Amazing."

"'Amazing' is a rather vague description, Maggie," he retorted.

"Awesome," I said. He peered at me over the top of his wire frame glasses--chastisement. I got the point. "I could run a marathon without breathing hard. My body revs like NASCAR, I love it. When I'm energized, nothing can stop me. I want to conquer the world."

As usual, he scribbled on his notepad, and I waited for the next question. Glancing around the room, I thought it looked different, but I couldn't figure out why.

"And mentally, how do you feel?" he asked.

"Like a genius. School work becomes clearer and the whole world becomes interconnected. I see relationships between things most people could never imagine. My creativity shifts into overdrive. I've written some of my very best papers while hyper. If I woke up with that energy level every day, I would be number one in my class."

He twisted his head. "Excuse me," he said. "I worked out yesterday and now I'm a bit stiff."

I smiled.

"Maggie, do you sleep during these periods?" he asked.

"As I said before, sleep shuts off my brain. Most days, I prefer being asleep because being awake is hard work. When I'm energized, it's opposite. I want to stay awake and busy.

"How are your thoughts when you're energized?"

"My mind races, but the thoughts are positive. They motivate me to attack my 'to do' list--clean, exercise, cook, write papers, get ahead on classwork. The best part is I do everything ten times better on those days. Life flows easier and clearer. Sam referred to them as Beautiful Maggie days. If I woke up in that condition every day, I wouldn't be in this room talking to you," I explained. "Switching back to your question about sleep for a moment, I think I avoid going to bed when I'm energized because I know it will disappear by the time I wake up."

He wrote a few more notes. I scanned the room, still unable to figure out why it felt so different.

"How often do you these days occur?" he asked.

His voice interrupted my analysis of the notebooks piled high on his desk. Each, I imagined, contained the words of other patients. People who sat on this sofa, dreaming of a drug, or therapy that would give them the ability to control their own emotions and thoughts--normalcy.

"Not often enough. I don't keep track, but let's just say if I marked the days on the calendar, it would take a long, long time for the pen to run out of ink."

"Do these high-energy days occur before you have an episode or afterward?"

I thought about this question for a few seconds. Good days were like sunshine in Pittsburgh, rare but glorious. "I've never noticed a pattern, partially because, like I said before, they don't happen very often. So whether the energy hits before or after an episode, I don't know, but I do consider my good days a blessing. And today would be an excellent time for one. Two of my professors dumped a ton of homework on us this week, and my apartment is a mess," I replied, worried my answer sounded flippant.

Dr. Graham didn't flinch, so I assumed my answer was acceptable.

"You do realize, Maggie, that you're describing hypomania?" he asked.

"Yeah," I replied and shrugged. How could I not understand? The information on the internet left no room for misinterpretation. These days were the other side of the illness, so technically speaking, even my good days were bad.

Dr. Graham nestled back into his recliner and removed his glasses. As he picked up his coffee cup, I shifted my eyes to the window--new curtains, that's what was different. "Hey, Dr. Graham, I like the new curtains."

He set the coffee cup down. "Thanks," he mumbled. "Linda picked them out."

How cute, he's embarrassed about the curtains. For a shrink and non-talker, he was an okay guy.

"Maggie, I believe Karen hit the target with her hunch. It's impossible to be one hundred percent sure because a precise method of diagnosing is still decades away, but your symptoms do fit on the bipolar spectrum. Because you have never been hospitalized, and your lows are more significant than the manic side, I feel confident in calling it Bipolar 2."

Being diagnosed as bipolar followed by any number would be distressing to most people--not me. His words triggered relief, which flooded my body and tears oozed from the corners of my eyes--joy. My episodes had a name. Dr. Graham didn't realize it, but his words were a gift--an acknowledgement--my lack of emotional control was not my fault. For a brief moment, he watched me smile, then returned to his frantic note taking.

"Great, it has a name. Can you fix it? Is there a drug that will help?" I said, unable to contain my excitement for another heartbeat.

"Actually, there are quite a few drugs, but every person reacts differently to them. One, which relieves the same symptoms exhibited in another patient, may do nothing for you. In fact, it's possible that a drug could make you worse. Because much of the brain's chemistry remains a mystery, trial and error remains the most effective method of ascertaining a good fit for a patient. At this point, I'm hesitant to take you off the Zoloft, because it does seem to be having some positive effect. Another drug, used in combination with Zoloft, has been shown to provide relief for people with your symptoms. This drug will be a good place for us begin."

My hearted pounded as I wrestled with desire to jump off the sofa and dance around the office. Even my blood pumped through my veins enthusiastically. "Let's go. Write the prescription."

He shook his head and made a clicking sound with his tongue. "Slow down, Maggie. These drugs can cause serious side effects. Your decision to take this medication must be an informed one. I am prescribing you a relatively low dosage, but understand that sometimes a drug works well in the beginning and loses effectiveness as your body learns to tolerate it. So I'll monitor you closely and adjust the dosage if necessary.

Dr. Graham lectured for a considerable amount of time on the possible long-term side effects of this particular medication. His tone underscored the seriousness of the drug, and I listened to every word he said. To make sure I paid attention to the side effect emergency procedures, he repeated them twice--stop taking it immediately and call him.

"Maggie," he said handing me a business card. "I know you are very close to your sister-in-law, Amy, and she lives near you. I want you to give her my card."

"Why?" I asked.

"As I said, there are side effects associated with using the particular medication. If you become incapacitated, I want Amy to know who to call. It's prudent to include family members in the treatment process, because there is always the potential for the patient to be unaware that an event is occurring."

I dropped it into my bag. His thoroughness and conservative attitude toward the medication grated on my over stimulated nerves. Even as I listened and nodded, my brain begged him to, Shut up and give me the damn pill!

After his fifteen-minute speech ended, I listened to his bracelets clank as he wrote the prescription. After tearing it from the pad, he extended his arm. "Please call if you have any questions or feel anything strange."

I assured him I would call and promised to hand deliver his card to Amy over the weekend. He scheduled my next appointment for the Monday after Thanksgiving. As I turned to grab my coat and bag from the sofa, mentally mapping my route to the nearest pharmacy, I heard him clear his throat.

"And Maggie, this drug must be taken in the morning. If you fill the prescription today, don't begin taking it until tomorrow."

"Damn," I mumbled under my breath as I walked out of his office.

I drove straight to the pharmacy. The pharmacy assistant asked me if I wanted to wait for the prescription or come back later?

"Wait. I'll wait. How long will it take?" I asked, in a shrill tone. I paced up and down the aisles until the prescription was ready. The poor assistant's face paled when I leaned too far over the counter and snatched the bag away from him.

Once I held my little white bag containing the pills and the three page long official warning label, I sprinted to my car and ripped open the bag the moment my butt landed in the driver's seat. The pills were real, in my hand, and my heart pleaded, Please work for me.

On Wednesday, I had an early class. Usually, it was a struggle for me to get up. Sam woke me for early classes by smothering me with kisses. Now I was dependent on the unsympathetic snooze button on my clock radio. Today, I beat the alarm. By the time it went off, I was in the kitchen reaching for the small bottle sitting on my counter top next to the toaster. I ripped off the child-proof lid and dumped the brown pill into my palm, holding it while holding my cup under the tap. The pill slid down smoother than any I had ever swallowed.

I closed the bottle and set it back on the countertop. Stupid, I thought to myself. Why did I feel so excited? It took two weeks to feel anything on the Zoloft, and this one will undoubtedly be the same.

Throughout my morning ritual, I contemplated the life-changing potential of this new medicine. I was not an optimist by nature, so this enthusiasm surprised me. I wallowed in a daydream, in which the pills made me totally normal, Sam moved back into the apartment, and together we planned our wedding. Maybe it was more of a prayer than a fantasy.

I tried to push all the negative stuff Dr. Graham talked about out of my head. Some of the side effects he mentioned sounded awful, but I refused to consider the potential of them happening to me. The small pill didn't have a choice. It had to work, because my life depended on it.

After showering and dressing, I grabbed my books, coat, and walked toward campus. Outside, on Fifth Avenue, the sun tried to break through the heavy cloud cover. The racket created by ambulance sirens, bus air brakes, honking car horns, and screaming police cars attacked my ears, and the smell of exhaust assaulted my nose. A typical morning.

Stopping at the corner, I thought about my Aunt Mildred. She loved to say, "Life can turn on a dime."

But, in my experience, real change came slowly and painfully. I could say my life changed the moment my dad died. But it would be a false statement. That change occurred little by little, beginning the moment he got sick and ended the day he died. His death was the finale of a process. Same thing with Sam. He didn't suddenly leave. He forgave me after many episodes, but each one left its mark. His change culminated the day he walked out of our apartment, a victim of something he couldn't understand or alter--my behavior.

Maybe my life didn't change on a dime that morning, either. But standing on the corner of Fifth and Biglow, it sure felt like it did, because while waiting for the traffic signal to change, a light in my brain switched on.

In the seconds that it took the green light to change to yellow, the world came into focus. By the time the signal glowed red, the campus was bathed in glorious light. The film of sludge, which had distorted my vision, cleared. It was like replacing the old television set with a high definition set--remarkable clarity. Clarity I didn't know existed.

I couldn't process the changes happening to my body. Stress melted away and a sense of what I could only describe as joy replaced it. Impossible, no small pill could create the light and brightness. But I didn't have any other explanation.

I did a three hundred and sixty degree turn, trying to absorb it all. The Cathedral of Learning, the student union, and even the tee-shirt vendor on the corner appeared sharp and defined. I saw details all around me that weren't there yesterday. The traffic signal continued to change, and the cars flowed, but I stood on the corner smiling.

Once I finished gawking at the Oakland scenery, I pulled out my cell phone and hit number seven on my speed dial.

On the other end of the line, I heard the familiar words of Karen's voicemail.

After the beep, my words surged. "Yes, my brain is noisy. It's like a carnival, an amusement park, a freight train, anything noisy, and it's been that way for my whole life."

I finally understood her question, because for the first time, my brain was quiet.