[2]

Kim and I are playing in the cul-de-sac at the end of our street. Between us, we have a bucket of chalk and four Barbies. We use the chalk to draw a neighborhood for the dolls on the pavement, meticulously etching each street corner while the mid-summer sun toasts our untainted skin.

“Over here”, I tell Kim and she hurries to my side to see the Barbie-sized bakery I have drawn. It is complete with an awkward two-dimensional awning and red-striped curtains. She draws the baker outside. “You forgot the most important part”, she says.

We play for hours, her thoughts completing my ideas, her rationalism solidifying my unsteady notions. I draw houses, she adds the entryways. I draw chimneys, she adds the smoke.

The sun begins to set and my belly is growling. I know that Mom is making tacos for dinner. Kim grabs my hand and pulls me to my feet so we can walk home. We walk a few yards, our tiny fingers entwined, then I pull away at a sprint. “Race you!” I yell over my shoulder, but I’m already ahead. When I get to our gravel driveway, I look back. Kim struggles to catch me, but she falls, her knees scraping the rough asphalt, her glasses careening ahead of her down the street.

_____________________________________________________________________________

The beige plastic chair in the visitor’s lobby of Tucker’s Psychiatric Ward was digging into the sides of my hips. I readjusted myself in the chair much better suited for a kindergarten classroom, and glanced around at the other inhabitants, the tired-looking woman in her thirties rocking a crying baby, the slovenly man hunched in the back with his knees up to his chest.

In the past three days, Kim had physically recovered at MCV, received a full psychiatric evaluation, and been transferred in an ambulance to the painted cinderblock walled psychiatric ward at a nearby Richmond hospital. She had made a fast recovery physically, Dr. Andrews said, but we were all holding our breaths that she would make the same progress mentally.

My parents had reserved a room for a week at the Marriot Hotel on 5th street. They wanted to be as close to the hospital as they could, and they spent the first two days living the stiff hospital room chairs, taking shifts to get coffee, food, or sleep.
My father had come over to my house for dinner just last night while my mother remained hovering over Kim’s bedside. He wandered my small rental house in awe. “It’s beautiful, Maddie. I’m really sorry we don’t get to come up enough,” he said looking around to take in the sea foam walls and leather sofa. His eyes latched onto a photo collage over the living room sofa, and he leaned in to get a better view. “You and Kim were so tiny here,” he whispered to the black and white print of two babies covered in sand at the beach. “Did you ever think we’d end up like this?”

I hadn’t been able to visit Kim once at MCV, and not because I didn’t have the time. I just couldn’t stand the thought of seeing her in what might have been her death bed, the tubing digging into her flesh, the mummy-like gauze wrapped around her sewn wrists, the irritating clicking, humming, and gurgling of the machines sustaining her life. Dr. Andrews had described the process of her blood repletion to me that night of the suicide - I had only just begun saying the word to myself, but I still could not bear to let it leave my lips – how they hooked her into the IV machine and began pumping her full of fake blood, other people’s blood, anything they could to fill her vessels and move oxygen through her body once more.

Her wrists were healing nicely, now, my parents had informed me on the phone. The sliced fresh was sewn easily back together. The holes on the underside of her elbows where the IV lines had bitten through were simply covered with a piece of cotton and taped as if it never happen, as if it had all been a child’s game. But I knew the part that really mattered, her mind, was split into a million pieces and every piece of eating herself from the inside out.

The elevator door opened to my right. An Asian man with only a few inches on my 5’4” frame smiled when he small me. He walked briskly over to my side, thrusting a thick white hand at me as he approached. “You must be Madeline, right? I’m Dr. Le, the head psychiatrist at Tuckers.” He did not wait for my reply before hurrying back to the elevator, excitedly commanding, “Come, come!”

The elevator doors closed in front of us when Dr. Le pressed the button for floor 3. “The elevator here is the only one that goes to the psych floors. The other elevators in the hospital,” he gestured behind him with a stubby arm, “don’t have access to these units.” He chortled and added, “for obvious reasons.”

The elevator door opened to a floor divided into three visible sections, two separated by long glass walls from the middle, where the nurses station connected the glass sides via a series of locked doors. I could see people behind the glass in my periphery, but I refused to look, instead keeping my eyes focused on Dr. Le’s pin striped shirt moving in front of me.

Dr. Le pulled a keychain from his pocket and used a short gold key to open the gated half door into the nurse’s station. I followed him past three nurses urgently writing in maroon three-ringed binders, through the back of the square nurses station, and down a short hall with four doors. He opened the last one on the right, extending his left arm to prop the door opened while I entered.

“Welcome. Have a seat,” he gestured to two narrow suede armchairs in front of a towering mahogany desk.

The room was painted a warm tan, the color of just-right biscuits from the over, a stark change from the sterile beige walls that filled the rest of the hospital. A small window to my left captured the parking lot outside. I found myself wishing to be out there, to feel the cleansing spring air as I sped away in my car. On the wall above Dr. Le’s head, three framed diplomas hung proudly honoring his credentials.

“Now,” he began, “where shall we begin?”

Were we here to discuss my psychological state? I could not help but wonder. “How is Kim?” I insisted instead.

“She is doing well. I’m sure you’ve heard her diagnosis. What do you know about bipolar disorder?”

I shook my head, dumb. I remembered a lady in our neighborhood growing up whom they called bipolar, and I pictured the day we found all those dead cats behind her house. I shuttered at the thought.

“Well, like any other psychological diagnosis, it affects every patient differently, but we usually differentiate the disorder into two separate diagnosis based on a patient’s symptoms. We call those bipolar one, your classic cases, and bipolar two, a much more common phenomenon. Both disorders are characterized by two distinct phases of mental instability: mania and depression.” He gently tossed each hand to the side as separated the phases verbally. “Still with me so far?” He asked.

You could tell by his patience and gentility that Dr. Le had children. Guessing from his age and his career training, I’d imagine they were just toddlers at this point

“Now I’m sure you are aware of some depressive symptoms. Again, each patient is different, but we usually look for signs like a generally down mood, huge weight gain or loss, excessive sleep, and a general apathetic attitude towards life - that is to say, one might lose interest in the things he or she used to enjoy.”

I remembered dinner with Kim last month around her 26 birthday. We were halfway through our salad when I asked about the sprint triathalon she trained for every spring. “Oh, I’m not doing it this year. I’ve just been too tired,” she told me, starring blankly at the lettuce on her fork.

Dr. Le continued. “Now, for the mania, you really just have to imagine symptoms that are pretty much the opposite of what we just discussed. A manic person usually takes excessive risks, has a grandiose image of him or herself, takes on too much all at once. After talking extensively with your parents, I do believe that Kim is not just depressed, but bipolar. Her manic symptoms are less pronounced, so at this point I would classify her as bipolar two. It’s nothing to be scared about, and I assure you that it is a disorder than can be controlled.”

“How?” I found Dr. Le’s straight-forward explanations were comforting.

“Drug therapy, mainly. Then we supplement pharmacotherapy with cognitive-behavioral therapy. Counseling, essentially. If those don’t work together, we look towards other options, for instance, electroconvulsive therapy.

I imagined Kim strapped to a hard wooden table, her arms and legs flailing as two a spider-web of electrodes sent electricity soaring through her body. God, I hope the drugs work, I thought.

“With Kim, since her major problem seems to manifest itself in depression, we’ve chosen to start her on a mood stabilizer called lamotrigine. Drug therapy is completely individualized on a patient-by-patient basis, so if what we’ve chosen for Kim doesn’t work, we’ll switch. There are a number of different drugs and combination available. Since she presented in such an extreme state of depression, we are also going to start her on an antidepressant called sertraline. In combination, I think this regimen will work really well for her.

I have to warn you though, these things will take weeks to work. The antidepressant, in particular, usually takes weeks to see full benefit, and we can’t make a lot of changes until we hit that point.”

This was turning slowly into a nightmare. “How many weeks are we talking?” I propped my elbows onto the smooth wood desk.

“Four to six. We’ll probably know by four if we can switch or not, but I’d really like Kim to remain here with us until we get her over that first hurdle.” He made the motion of leaping over a hurdle with this right arm. “After that, she can probably manage on outpatient visits and regular therapy sessions.”

I began to melt into my chair once more. The image of Kim in the fetal position on a old wood-frame sofa surrounded by slovenly old men shouting obscenities began to suffocate my normal thoughts, and I squeezed my eyelids tightly to keep from crying. How could my sister end up here, in this place, with a bunch of lunatics for Christ’s sake?

Dr. Le graciously gave me a moment to compose my thoughts. Then leaned across the wide, flat desk, momentarily bridging the gap between the medical and human, to squeeze my hands in a way that made me think he knew his patients as more than just a diagnosis, more than just a list of progress notes and medications.

“Now,” he finally spoke. “How about that visit?”