“Listen,” he said the minute they hit the street, “your sister isn’t doing well. She’s in a sort of manic state and I suspect she’s going to crash. But it’s definitely going to get worse first.”
“Are you saying she’s manic-depressive?” she asked. “We were told that was a misdiagnosis. That she’s actually—”
Dr. Gitter waved his hand impatiently. “Borderline. I know. Brattleboro sent her records. From what I can see, that’s pretty accurate. What I mean is: I suspect there’s a psychotic break around the corner. She’s flying. Which could mean she’s abusing her meds. You need to take them and mete them out to her.”
Emily knew she could not do this—and, really, did she need to? She saw Clara take her pill each evening. “She’s an adult. I can’t really—”
Again he waved his hands, cutting her off. “You can.” He pursed his lips, which were wide and dark, and shook his head. “She has a serious history of abuse.” He sucked his lips for a moment, then whistled. “I can’t believe they gave her Klonopin. You know, right, that it’s like the thing now. K-pin. King Pin. All the kids do it. It’s cheaper than coke. Cheaper than crack.”
“No, I had no idea, so you think—”
“Yes—”
“But it seems to be working,” said Emily, aware that she was flailing, that she, somewhere in the back of her mind, did have an inkling that Klonopin was one of those drugs—Ritalin, Vicodin, OxyContin—that was always showing up in the paper, found in the bloodstream of some Choate suicide, or in the glossies (“Confessions of a K-head”) or whatever, and that, yes, okay, maybe she’d suspected Clara’s newfound focus verged on the manic, on the potentially—but just potentially—chemically induced.
“Maybe.” The doctor shrugged. He wasn’t wearing a coat, she noticed, despite the cold wind that surged up around them, blowing dried leaves in a little circle at their feet. They were still outside the door to the building that fronted Emily’s little back-house. “But it could just as easily be the Prozac and Tegretol. Now, that I get—” And on he went, talking, Emily thought, largely to himself, about various drug protocols and combinations, and the difficulties of medicating borderlines, who are famous for overdoing or ignoring their drugs, until Emily could stand it no longer.
“I don’t think she’s on Prozac—”
“I saw her file,” he said, almost angrily, as though Emily were responsible for all this—but then, she supposed, she was. “They have her on Prozac and Tegretol, which is pretty standard. The Klonopin is just as needed, for anxiety.”
“Okay, okay,” said Emily, raising her hands in a gesture of surrender. “I’m sorry,” she added, uncertain what she was apologizing for.
“It’s okay,” said the doctor, shoving his hands deeply into the pockets of his jeans. He was cold. She should walk him to the subway, send him back to wherever he came from—uptown, most likely—but he kept talking. “This is serious stuff. The bottom line is: she needs to be hospitalized, long-term. For starters, let’s get her to the clinic tomorrow morning. We’ll start up the ECT again—she definitely needs to finish the first course of treatment—”
“No,” she said. “Wait. This is too much. I mean, I mean…” Her voice drifted off and he looked at her patiently as he’d no doubt been taught to do in medical school. She wasn’t sure where to begin. “I mean, presuming I can actually get her there—she thinks she’s all better, you know—I, we, don’t have any money. We can’t pay for a minute at Payne Whitney. She doesn’t even have insurance.”
He shook his head, a gesture of impatience. “Dr. Lang will figure it out. Don’t even think about that.”
Emily thought this doubtful, but was tired of quibbling. “Okay, but I have to talk to my parents—”
“Your parents,” he said, “released her to your care. You’re in charge.”
“Yes, that’s true,” she said, but her own patience was tapping out. Who was this guy to tell her what to do? He’d spent an hour with Clara and thought he knew exactly how to cure her.
“Well, then,” she said, slowly, icily, “I need to think before I commit my sister to a mental institution.”
The anger on his face mirrored hers. “Oh, come on. Don’t be melodramatic. You’re not committing her. Your sister is ill. She’s not going to get better with intermittent therapy. She needs a consistent course of treatment. She needs to start up the ECT again and start working with one doctor, over a long period of time. Months. A year. Or more. She needs analysis and behavior modification and closely monitored meds.” He ticked these last three off on the fingers of his left hand—fingers that had gone red from the cold.
Emily was so furious she couldn’t speak. Her mouth, against her will, hung open. “Why don’t I walk you to the subway,” she said finally, swallowing to bring some moisture back to her mouth.
Dr. Gitter ran his hands through his hair, so that it stuck up in peaked tufts, and nodded.
In silence, they turned down Bedford, where the sidewalks were suddenly full of people talking and laughing, pleasantly lit from brunchtime Bloody Marys, the girls of Williamsburg in their scuffed boots and jeans and beaded cardigans beneath vintage coats with Bakelite buttons, their arms twined round the narrow waists of shaggy-haired boys, who moved along the avenue as if they owned it, boys like Curtis.
“Listen, think about all this and we’ll talk on Monday. But seriously, this is serious. You don’t want to play around, okay?”
“Okay.” And then he was gone, trotting down the grayish steps that led to the train. Emily leaned against the chipped iron fence that encased the entrance, staring down into the dark maw of the station, the muted roar of an arriving train just audible from below. This had not gone quite as she’d expected, though she wasn’t sure now what she’d expected, but certainly not bring your sister in tomorrow. Like, seriously, she thought, watching the crowd emerge from underground, a surge of volatile, chattering bodies. This is serious. Okay, dude.
She returned to an empty apartment. Clara had retired to Sweetwater, no doubt, with her friends, to play pool and sip a postbrunch beer (though, should she be drinking? Why had Emily not asked this before? Why had her mother—or Clara’s doctor—given her no instruction? She should have asked Dr. Gitter). Relieved, Emily collapsed in a heap on her bed, as she tended to on Sundays lately, now that Clara’s weeknight gatherings were bleeding over into the weekends. The crowd, the food, the smoke all conspired to exhaust her, though, in truth, she didn’t mind so much, losing her one day of solitude—the less time to reflect on things the better. What troubled her was the expense of all the nice food Clara insisted on serving. Braised lamb shanks over couscous. Chili with three different kinds of sausages and sirloin that she ground herself in the Cuisinart. Lox and sable on Sunday mornings. Every night she cooked enough for a dozen, saying, “We’ll put the leftovers in the freezer.” But there were never any leftovers. The constant stream of visitors—each offered a bowl of whatever was on the stove—made sure of that.
Meanwhile, the SSI money had still not arrived, and Emily was beginning to think it never would. She’d read up on the subject—online, at work, as usual—and discovered that it could take years to kick in. The previous week, she’d taken out a cash advance on her credit card, which she’d used only three or four times in eight years, as she knew she couldn’t afford to keep a balance, not with her student loans, her newly doubled rent, and so on. Still, when the crisp twenty-dollar bills shot out of the cash machine—just as they did when she withdrew money, her own money, from her account—she felt a keen icy relief, that dissolved an hour later when she got home and looked up the interest rate. Twenty-five percent. Plus a four percent fee.