Wow, here’s one for you. I looked up from the chart I was writing out. Two policemen stood before me, flanking a reedy young man, a kid really, dressed in shabby clothes. One of the officers lifted up a paper bag and shook it. We got called by this kid’s parents. They said he was acting goofy, high on drugs or something. We found him with this.
Bill, the emergency room charge nurse, peered over the top of his glasses. Okay, he said. What’s this?
This, the officer said, shaking the bag again, is a hamster--a dead hamster.
Bill pushed his glasses back in place, waiting for the payoff. Uh-huh, he said.
The second officer leaned forward. He had it in his mouth.
I hadn’t been listening closely, but at this point I stopped working on my chart and looked up at the boy. Bill didn’t even skip a beat. Did he say why?
Scarcely audible, the boy answered, CPR.
Yeah, Officer Number One added. He told us that he was trying to perform cpr on the hamster. That’s why he had it in his mouth.
And he was doing this in the garage, said Officer Number Two. He had the car hood up and the battery out of the car and he had--
--He had some stereo wires hooked up to the battery and was trying to shock the hamster, Officer One broke in. You know, defibrillate it--like the paramedics do. That’s when his parents called us.
Bill looked directly at the boy. You tried to defibrillate a hamster?
The boy nodded and took a deep breath. It seemed like a good idea.
His parents showed up half an hour later. I still hadn’t had a chance to get in to see the boy. All I knew was that he was 17, older than he looked. His parents, the Deans, were well dressed, very well dressed. They must have come from a well-to-do neighborhood out of the usual service area of our er. The father was wearing an expensive suit; the boy’s mother- -tall, slender, and elaborately coiffed--was carrying an expensive leather handbag. They glanced around nervously at the usual bad-news er crowd. A woman sat next to them, holding some bloody gauze to her head. She was a prostitute who had suffered a scalp wound inflicted by her pimp. On the other side of them were gurneys, where drunks were sleeping it off.
I introduced myself to the Deans and took them over to a quiet corner. So, I said, what’s been going on?
I think it’s drugs, Mr. Dean said. I don’t know where he’s getting them.
Randall’s never touched drugs, Mrs. Dean said vehemently. I don’t know how you can think that.
How else do you explain all this? Mr. Dean whispered fiercely to Mrs. Dean.
I can’t, Mrs. Dean replied, equally fiercely. But there has to be an answer. She stood there tight-lipped, ashen-faced. Obviously these two had been disagreeing about their son for years. They looked off in different directions, both appearing anxious and bewildered.
Tell me what the problems have been, I said.
Mrs. Dean groped for words. I could see she was not accustomed to sharing details from family life with a stranger, even if the stranger was a doctor. Last week he got the keys out of my purse and went joyriding. He ended up smashing the car. I couldn’t believe it. He knew he wasn’t supposed to be driving the car.
He’s always been more or less of a discipline problem, Mr. Dean added. Basically he’s a good kid, but he’s so damn irresponsible. We took him to see a psychologist last year, and the psychologist did all these tests and said he had . . . What is it he’s supposed to have?
Attention deficit disorder, said Mrs. Dean.
Right, attention deficit disorder. Which makes sense to me in a way. He can’t finish anything he starts.
Mrs. Dean broke in. The psychologist said he was learning disabled. Or dyslexic. She said this is why Randall does so poorly in school when he’s so very bright according to his test scores.
About the hamster, I said.
He’s a bright boy, Mr. Dean said. He knows everything there is to know about taking a bicycle apart and putting it back together. He spends hours and hours in the garage.
The hamster-- I said again.
Rocky? Oh, he’s had that old hamster for years. Mr. Dean sighed, still absorbed with his own worries about Randall. He hasn’t been attending classes at school all year. I’m sure he’s going to flunk several courses.
I guess we spoiled him, his mother added. We never went through anything like this with our other children. Mrs. Dean paused and took a deep breath. The school psychologist says that a big part of the problem is that Randall has absolutely no self-esteem.
Mr. Dean stared down at his hands. How can you give your child everything and he still ends up with no self-esteem?
I understand, I said. I was lying. I was sure I didn’t understand any more than they did.
We’ve been desperate, Mrs. Dean said. Nobody can give us any answers, so a couple of months ago we went to this seminar on Tough Love.
I’m sorry, I said. What?
Tough Love. It’s a course on how to, well, set limits on your children. She reached into her handbag and took out a hardback book. The title said something about Tough Love and child rearing.
At this point a patient came in with fluid in the lungs, so I rushed off and didn’t get back to the Dean family for another hour. When I returned, the parents were sitting off to one side, arms folded stiffly, the mother with her purse in her lap. Randall sat on the examining table.
Hi, Randall. I’m the er doctor today.
The boy, looking down at his sneakers, said nothing.
Randall, I said gently, what was this about you stealing the car?
Randall shrugged his shoulders, head down. They wouldn’t let me drive the car.
Mr. Dean broke in. He lost his driving privileges because of his grades. When he brings his grades up, he can use the car.
Randall, I said, how do you feel about that?
The boy looked up suddenly at his father. I knew I wasn’t supposed to drive it, but I was confused. I wrecked it.
Randall, Mr. Dean said, leaning forward, are you doing drugs?
Randall thought for a moment, as if he were trying to remember.
No, not for a while.
Randall, I said, pulling my chair up close, did you kill your hamster?
The boy slowly nodded his head.
Because of what happened.
Tell me, I said.
Rocky is dead because I killed him. I killed him because he was dead. His name is Rocket J. Squirrel, but he’s not a squirrel. He’s a hamster. Randall lifted up his hands and stared at them. Then he looked at me. I broke his neck.
Why would you do something like that? his mother asked.
Randall shrugged. So I wouldn’t kill my father.
I heard a sharp intake of breath behind me and a sigh. I leaned forward and put my hand gently on Randall’s knee. I was pretty sure what was coming.
Have you been thinking about killing your father?
The boy shrugged and then said, Yup.
Since the car. Since he wouldn’t let me . . . maybe before. I think about it a lot. I don’t think it’s normal to think that.
Randall, I said, have you been hearing voices?
He looked at me as if I had guessed a secret he thought had been perfectly hidden.
I continued, You know, people talking to you who aren’t really there.
Oh, Randall said and stared back down at his shoes. I’m not sure.
How do you mean you’re not sure?
Well, see, you have to understand--it’s about the sewer system.
The sewer system?
Yes. There’s a force in the sewer system that’s run by nuclear power. He looked up at his parents as if this would explain everything. It’s tracking my thoughts. I shouldn’t even be talking to you because it’s actually spying on everything I say. Randall looked almost relieved as he said all this, as if the strain of keeping these thoughts a secret had finally been too much for him. When you talk to me, it’s like you are joining forces with it. The sewer system is taking over my body and making me extinct.
I turned around and caught a glimpse of Mrs. Dean. She had a hand raised to her mouth and was staring at her son as if she had seen a monster. I turned back to Randall.
I’m sorry about the car, he said. He was rocking back and forth. I was just so confused--figured if I wrecked it, you know, killed the car, then I would end the confusion in my head. He looked up toward his parents and even smiled a little. He whispered loudly, I’d like to go home. It’s very difficult sitting around an emergency room watching yourself die.
He looked back down at his feet again and resumed rocking.
When I stepped outside the examination room, Randall’s parents both rushed me, pulling me aside.
What’s the matter with him?
Well, I said, jotting my notes on Randall’s chart, it’s not drugs. The screen for drugs in his urine already came back clean. Now we need a psychiatrist to evaluate him. I was trying to move them along; after all, there were other, sicker patients. But when I looked up and saw Mrs. Dean’s face, I felt ashamed for trying to brush her off. Yet I was not really in a position to diagnose Randall’s illness; that would take a psychiatrist and months of observation. But how could I leave them hanging until we got a psychiatrist there?
Well, I said with a sigh, I’m not a psychiatrist, but I can tell you what I think it is. People who talk the way your son is talking now are often having their first psychotic break. It happens with schizophrenics.
They stood silently for a moment. In some way, I thought, they already knew this.
You mean like a split personality? Mrs. Dean asked.
It’s not really that. The split is not inside the person. The split is between what the person perceives and reality.
Mrs. Dean’s face was bunched up; her husband’s was unreadable. Should I not have said anything?
Schizophrenia is a mental illness, Mr. Dean said, finally summoning himself. How is it treated?
Medication. A supportive environment can help.
Supportive environment. You mean, like a psychiatric hospital?
Sometimes that’s helpful.
Mrs. Dean was kneading her hands. You don’t grow out of schizophrenia . . . if you have schizophrenia.
No, not usually.
But he is going to be all right, isn’t he? she asked. He is going to go back to normal eventually? Isn’t he?
I don’t know, I said. I didn’t want to say what I was thinking, which was that someone with a first break at 17 had a poor prognosis.
He’ll never be all right? she asked. Tears slipped out of the corners of her eyes. Never, never?
Shh, her husband said. He put his arm around her and pulled her close so she could cry in peace.
There may be no disease more frightening than schizophrenia-- frightening for the caregivers, but even more frightening for the patients themselves. Their world comes apart at the seams, voices sprout from nowhere, paranoia blankets the landscape, strange impulses become overwhelming obsessions. Even after decades of research, the disease’s origins are poorly understood. Its symptoms are thought to arise from structural and chemical abnormalities in areas of the brain that are involved in thinking and feeling. These abnormalities ultimately cause severely disordered thinking.
Symptoms can wax and wane, but during a break, patients are often disorganized and delusional. Frequently they require hospitalization. At other times patients may be able to function more normally, but many can never live independently. Although recent advances in medication have allowed many schizophrenics to lead productive lives, most patients continue to have some symptoms of thought disorder. No one is ever cured.
A baby howled in a nearby room as I walked back to the nurses’ station. I had a headache and, for some reason, this headache was associated with a mental image of Mr. and Mrs. Dean, not as they were now but as they appeared shortly after the birth of their last son, Randall. I could see proud parents and a sleeping baby. I could envision the big plans, high expectations, good schools, tennis lessons, piano recitals--all the things attentive parents lavish on their last child.
I sat down at the desk and put Randall’s chart in front of me. Seventeen-year-old male, previously healthy, presents with-- I stopped. Presents with what? Psychosis? Illusions? Hallucinations about the sewer system? A whole new and senseless world? I thought about Mr. and Mrs. Dean stumbling into this other world--a world of institutions, mind-numbing tranquilizers, locked wards, and disembodied voices.
For a moment I hated my job. Randall’s parents may as well throw the Tough Love book out the window; their son’s problems lie far beyond its reach. Maybe I’m wrong, though; I’m not a psychiatrist. Another image of Mr. and Mrs. Dean flickered through my mind. I could see them sitting in the dayroom of a psychiatric ward in some prestigious institution. They are dressed up for a visit with their son. They are nervous. After a while the room starts to fill with psychiatric patients, people whose paths the Deans never dreamed they would cross: street people, the homeless, the psychotic, the depressed, the muttering old women and the stiff-gaited young men, the manic addicts, the zombies. The Deans are sitting in this place, waiting for their son, holding each other’s hands. It is here that they finally see that even if they give their son all the love in the world, it may still not be enough.