Trevor Hill was a renowned private facility in the southern part of the state. Michael had been Anne Muller’s patient for merely five months but her insights into his plight, and his improvement under her care, were inspiring. It was, Kohler reflected, a true tragedy that no one would ever know how effective Muller’s treatment of Michael Hrubek might have been.
Like Kohler, Anne Muller divided her time among various hospitals and happened to have come across Michael at a small state facility where she worked with severe schizophrenics. Impressed by his intelligence and struck by his unusual delusions, she campaigned to pry open the doors of expensive Trevor Hill and have Michael admitted as a pro bono patient. The hospital administrators-preferring patients that were more “mainstream” than Michael (that is, able to pay their bills)-had resisted her efforts at first but had finally acquiesced, largely because of her own prestige and talent and pigheaded manner.
His first day had been spent in a restraint camisole. Then he’d calmed and the feared garment had come off. Kohler glanced again at Muller’s notes, jotted in the first week of the young man’s commitment:
Pt. is hostile & suspicious. Afraid of being struck. (“You hit me on the head, you’re one dead fucker, make no mistake.”) No apparent visual hallucinations, some auditory… Motor activity is extreme, restraint at times necessary… Affect flat or inappropriate (Pt. began sobbing when noticed book of American history; later Pt. laughed when asked about maternal grandmother and said she was “one dead fucker”)… Cognitive functioning good but flights of ideas indicate purely random thinking at times…
Although the many state hospitals in which Michael had been committed undoubtedly blended together into a grim stew of memories, Trevor Hill might very well have stood out pleasantly in his mind. In state facilities, patients wore filthy clothing and sat in drab rooms with blunt crayons or Play-Doh for entertainment. Many of the men and women had the indentations of lobotomies on the crowns of their heads and were regularly third-railed by electroconvulsive-shock technicians or sent into insulin comas. But Trevor Hill was different. There were far more orderlies and doctors per patient than in the state hospitals, the library was full of books, wards were sunny and windows unbarred, the grounds landscaped with trim paths and gardens, and rec rooms stocked with learning toys and games. ECS was used occasionally but medication was the major tool of treatment.
Yet, as with all schizophrenic patients, getting the right drug and dosage for Michael was a major task. One young resident at Trevor Hill had naïvely asked him what medicines he’d taken in the past and the patient answered like a diligent medical student. “Oh, lithium. Generally, chlorpromazine and its derivatives are contraindicated for me. I’m a schizophrenic-make no mistake about that-but a big component of my disease is manic-depression. You may know that as bipolar depression. So, lithium has generally been my drug of choice.”
The impressed resident prescribed lithium and under the drug’s effect Michael went berserk. He threw the ward’s television through a window, leapt out after it and got halfway through the main gate before being tackled by three burly orderlies.
After this incident Dr. Muller took over treatment personally. She put Michael on a loading dose of Haldol-a dosage larger than he would ultimately need but intended to stabilize him fast. He improved immediately. Then began the fine tuning, balancing the drugs’ effectiveness against the side effects of weight gain, dry mouth, the uncontrollable moving of the lips that antipsychotic drugs cause, the nausea. His regimen included, at various times, Thorazine, Stelazine, Mellaril, Moban, Haldol, and Prolixin. Thirty milligrams of this, one hundred of that, up it to two hundred, no, better mix it. Eighteen hundred of Thorazine, no, go higher, switch to Haldol, ninety milligrams of it, well, that’s the same as forty-five hundred of Thorazine, too high, how’s his dyskinesia? Okay, back to Stelazine…
Muller finally settled on what Kohler himself found worked best with Michaeclass="underline" high levels of Thorazine. Michael’s treatment consisted of this workhorse drug and his therapy with Dr. Anne. She met with him every Tuesday and Friday. And what was distinctive about his sessions with this psychiatrist was that unlike so many of his doctors in the past she listened to what he had to say.
“You’ve said a couple of times now, Michael, that you’re worried about what’s ‘ahead.’ Do you mean your immediate future?”
“I never said that,” he snapped.
“Did you mean something ahead of you in the hallway? Was someone upsetting you?”
“I never said a word like that. Someone’s making up things about me. The government’s usually to blame, the fuckers. I don’t want to talk about it.”
“Do you mean ‘a head,’ like someone’s head, a skull?”
He blinked and muttered, “I can’t go into it.”
“If it’s not the head maybe you mean someone’s face? Whose?”
“I can’t fucking go into it! You’re going to have to use truth serum on me if you want that information. I’ll bet you have already. You may know that as scopolamine.” He fell silent, a smirk upon his face.
The therapy was no more sophisticated than this. Like Kohler, Anne Muller never tried to dissuade Michael of his delusions. She dug into them, trying to learn what was inside her patient. He resisted with the resilience of a captured spy.
But after four months Michael’s paranoid and contrary nature suddenly vanished. Muller herself grew suspicious-she’d come to recognize that Michael had a calculating streak in him. He grew increasingly cheerful and giddy. Then she learned from the orderlies that he’d taken to stealing clothes from the laundry room. She assumed that his apparently improved temperament was a ruse to shift suspicion about the theft.
Yet before Muller could confront him, Michael began to deliver the loot to her. First, two mismatched socks. He handed them to her with the bashful smile of a boy with a crush. She returned the articles to their owners and told Michael not to steal anymore. He grew very grave and told her he was “unable at this time to make a commitment of that magnitude.”
Important principles were involved, he continued. “Very important.”
Apparently so, for the next week, she received five T-shirts and more socks. “I’m giving these clothes to you,” he announced in a whisper, then walked away abruptly as if late for a train. The gift-giving went on for several weeks. Muller was far less concerned about the thefts themselves than understanding what Michael’s behavior meant.
Then, when she was lying in bed at three in the morning, the epiphany occurred. She sat up, stunned.
In the course of a long, disjointed therapy session that day, Michael had lowered his voice and, eyes averted, whispered, “The reason is, I want to get my clothes to you. Don’t tell anyone. It’s very risky. You have no idea how risky.”
Clothes to you. Close to you. I want to get close to you. Muller bolted from her bed and drove immediately to her office, where she dictated a lengthy report that began with a subdued introduction tantamount to a psychiatrist’s shout of joy:
Major breakthrough yesterday. Pt. expressed desire for emotional connection with Dr., accompanied by animated affect.
As the treatment continued, Michael’s paranoia diminished further. The thefts stopped. He grew more sociable and cheerful and he required less medication than before. He enjoyed his group-therapy sessions and looked forward to outings that had previously terrified him. He started doing chores around the hospital, helping out the library and gardening staffs. Michael, Muller reported, had even driven her car several times.
Kohler now looked up from the report and gazed across the gritty parking lot. Lightning flashed in the west. Then he read the final entry in the file, written in a hand other than Anne Muller’s. He found he could picture the scene upon which these notes were based only too welclass="underline"