Everywhere and Nowhere: A Journey Through Suicide, by Donald Antrim

One Friday in April, 2006, I spent the afternoon and evening pacing the roof of my apartment building in Brooklyn, climbing down the fire-escape ladder and hanging by my hands from the railing, then climbing back up with sore palms and lying on the roof, in a ball, or stretched out on my back or on my stomach, peering surreptitiously over the ledge. The roof is painted silver. The building is four stories tall. A group of my friends, each of whom had been on the phone with me, one after the other, all through the morning, when I’d been alone and dialling wildly, had got busy calling one another. Janice owned a car, and she and Nicky were coming across the bridge from Manhattan, but there was traffic, and no one knew where I was.

From the roof, the world seemed to scream. I heard sirens—police, ambulance, and fire. What agency would come for me? A helicopter was flying overhead and circling back. The woman I’d just run from, the woman who had rushed over from work ahead of the others, who had been with me downstairs in my apartment, Regan, my partner then, my caregiver, thought that I’d gone to the street. We had been fighting over something I’d done. I’d hurt her, and we were both in anguish. She spoke harshly, and I ran away to die and end her burden.

The sun was setting, and the sky over New Jersey was orange, and I was in my socks, shivering. I was afraid, not anxious or scared but afraid for my life. I didn’t know why I had to fall from the roof, why that was mine to do.

Or, rather, I did know. I was in psychosis, a fatal emergent illness, and I knew what the suicide knows. I knew that I would die. I felt that I had been dying all my life.

When telling the story of my illness, I try not to speak about depression. A depression is a furrow, a valley, a sloping downward, and a return. Suicide, in my experience, is not that. I believe that suicide is a natural history, a disease process, not an act or a choice, a decision or a wish. I do not understand suicide as a response to pain, or as a message to the living. I do not think of suicide as the act, the death, the fall from a height or the trigger pulled. I see it as a long illness, an illness with origins in trauma and isolation, in deprivation of touch, in violence and neglect, in the loss of home and belonging. It is a disease of the body and the brain, if you make that distinction, a disease that kills over time. My dying, my suicide, lasted years, through hospitalizations, through more than fifty rounds of electroconvulsive therapy—once known as shock therapy—through recovery, relapse, and recovery. It can seem recent in memory, though at times it feels ancient, far removed, another lifetime, another life and my life.

I was hanging from the fire escape. I kept a slight toehold. The sun was low; the air was cold. I was wearing socks but no shoes, and my palms were scraped and beginning to blister from letting go a little, one hand at a time, falling out at an angle, sideways or backward, then grabbing fast for the rail and clutching tight. I gazed down at the concrete patio and the chain-link fence surrounding the back yard. The yard was inaccessible, small, and neglected. My apartment is on the third floor, and windows in my kitchen and bedroom overlook it, though you’d have to stick your head out to see much. I’d never looked at the yard for more than a minute.

Below me was the small patio area littered with trash, and a stairwell leading to the locked basement and the boiler. The rest was hard ground. Since that time, since 2006, new people, a family, have moved into the first-floor apartment, and they’ve replaced the old chain-link fence with one made of wood and put in a barbecue and a picnic table; I can hear their children when it’s warm out, along with, on school days, even in the cold winter months, older children, neighborhood kids, playing and screaming on the rooftop playground of the private school a few doors down the street.

Recess was over; school was out; night was falling. I had no children. I held on to the railing. It was less dizzying to look down than up. Clouds crossed the sky. Here and there, I could see people having after-work cocktails on private decks on neighboring roofs—it was the beginning of a spring weekend. Now, remembering that day, I wonder what those people might have thought of the man scrambling from fire escape to rooftop and back, letting go with one hand, flopping down on his belly to crane over the edge. Did they imagine that he was doing work, maintenance or repair, some job they couldn’t clearly make out? If they had known the man’s troubles, had known the man, would they have understood that he was about to die? Or would they have imagined that he was trying to live?

It was getting darker, and I could hear traffic on the street below, people driving home through Brooklyn after work. I was cold; I’d been up there a long time. I didn’t know that it had been five hours. It could have been any amount of time. I had on pants, a shirt, and socks. My hands and clothes were dirty from the rooftop. I remember how loosely my pants fit, how thin I’d become over the winter. Where was my belt? I shoved my hands into my pockets and squeezed my arms against my sides, holding up my pants, trying to get warm.

I’d written about my mother, her alcoholic life and her resignation in death, and my role as her son, savior, and abandoner. I began writing the year after she died, too soon for writing to be safe. The book, “The Afterlife,” is divided into seven parts, the number of years, in classical myth and literature, that is considered an appropriate period of mourning, and the number of years it took me to complete the manuscript. It is an accounting of the death of my family. Writing the book had been an excitement, but publishing it was an ordeal. I didn’t know that the book wasn’t about me, that it was about something shared between writer and reader. It was a movement from exposition to scene, defense to acceptance, mortification to love. But my old worlds—Florida, Virginia, the places of my childhood—were costly to rebuild. I was engaged in betrayal: mine of my mother, hers of me, mine of myself.

When I was in my early twenties, out of college and living in New York, on East Eighty-fifth Street, I returned again and again to Miami to rescue my mother. My father had left her and precipitously remarried, and she was drinking herself to death.

One night, back in New York, back behind the lines, as we say, I was with friends at the Madison Pub, a dark old bar on Madison Avenue in the Seventies, up from the old Whitney Museum. The panelled walls were scarred with the carved signatures of literary men—Walter Winchell’s was the biggest. I was drinking a Manhattan. There was a pay phone at the back of the bar; I left my drink on the table, went to the phone, picked it up, called my mother, and listened to fifteen rings, twenty rings, twenty-five. There was a sound, someone picked up, but there was no voice. “Mom, Mom, Mom,” I said, and then hung up the phone, picked it back up, and dialled my grandfather, my mother’s father, in North Carolina. He worried over his daughter all the time. I told him that she was in trouble. I told him that I had to go to Florida. I stopped at the table and told my friends that I had to go, and then walked uptown to my apartment, where I packed, checked the stove, turned off the lights, locked the door behind me, and hurried down the stairs, onto the street and into a cab that just about ran over my foot when I opened the door before the driver had stopped; from there, east on Eighty-sixth Street, left on the F.D.R. Drive, and across the bridge.

My grandfather had a ticket waiting, and I took the last flight of the night from LaGuardia to Miami. My mother lived in a new two-story duplex, cheap construction on a canal. The yard was bare, the front door was open, and light shone out. In “The Afterlife,” I describe bottles on their sides in the doorway and on the carpet in the living room, empty bottles. I describe my mother standing on the stairs. In my memory, she wears a long nightgown. Her ankles and feet are blue, and blue-veined. The doctors had told her that she would die if she drank. I suspect that that night, after a long binge, she came close. She was forty-five, fifteen years younger than I am as I write this. I sat with her through her delirium tremens, and held her hand, or kept my hand on her arm, while she shook. She’d been drinking and quitting, and in and out of hospitals and A.A. for two years. My grandfather and I had taken turns watching over her, going to her, through that time. He and I were in contact. He wanted to know if I thought that she would be all right. He knew that she hadn’t ever been. That night in Miami, in my mother’s duplex, after she’d fallen asleep, I cleared the bottles and cleaned the floors and fed the cats. A few days later, once she’d eaten and rested and slept, I drove her to A.A., to what people in recovery call the rooms, rooms in churches and community centers and sometimes schools, where she had friends waiting, friends she had met before and friends she was about to meet; and a sponsor. And, once again, she embarked on sobriety, which lasted, this time, for the rest of her life.

I was born in Sarasota, Florida, on a September night in 1958. In the story that my mother tells of my birth, I was taken from her by force. Her mother, my grandmother, pulled me out of my mother’s arms and kept me. My mother was not allowed to hold me. My father, who had graduated from college the summer before on an R.O.T.C. scholarship, was away, training to command tanks at Fort Bragg, North Carolina, where, eleven months later, my sister, Terry, would be born. My mother told me that she and I were distraught; I cried and cried, but her mother would not give me back. There was panic, she told me, and more fighting and crying, and it took my father a day and a night to get there.

Where was my grandfather? I knew my mother’s father as a docile, suffering man. When I was very little, he’d fallen off the roof of the house, while replacing tiles, and broken his back. I remember that house. It was a two-story white stucco bungalow with a red tiled roof, Venetian blinds, a mowed lawn, a paved driveway and carport, a front door that wasn’t used, a guest bedroom downstairs, and three bedrooms upstairs. My sister and I lived with our grandparents when our parents were divorcing for the first time. They would remarry a few years later, when Terry was seven and I was eight, and then divorce again when we were in our early twenties. But, at the time that I am writing about, Terry was five and I was six. I remember lying awake in the heat. Fans blew. Downstairs, a sunporch with orchids and potted shrubs faced a little square yard planted with orange and tangerine trees. There was wisteria and hibiscus. The air was wet and sticky. Down a little walkway out back was the two-story garage where my grandfather spent part of each day, where he had tools hung on a pegboard, stacked paint cans, a worktable with a vise, and beer in an old refrigerator. The garage smelled of paint thinner, insecticide, and lawnmower fuel. My grandfather sat at a bench and mended kitchen-cabinet drawers, or rewired appliances, or sanded wood, while sipping from a can. He chewed cinnamon gum and toothpicks.

In “The Afterlife,” I report that my mother was subjected to Munchausen syndrome by proxy, a form of abuse that is carried out, usually by a parent or a caregiver, as unnecessary medical or surgical intervention. My mother recounted a succession of operations, demanded by her mother and performed by compliant doctors. In one story she told, she was a teen-ager, at Sarasota Memorial Hospital. Under anesthesia on the operating table, her chest cut open, she heard the doctors pronounce her dead. She could not move or speak, but she could see them peering down at her. The long story of forced visits to doctors, of my grandmother’s control of her daughter’s body, the authoritarian cycle of manipulation, intimate violation, and symbolic repair, was never understood in my family, and it implicates my grandmother and grandfather, together in collusion or complicity, in crimes against their only child. “They drank,” my mother told me shortly before she died. She told me that they fought and were violent, and that her mother had tried to drown her in a well when she was tiny.

I was in my socks on the fire escape. I was cold, underweight, and scratched up from the roof’s rough surface, from crawling to the edge and leaning over to peer down. I imagined my body on the ground. It was something that I could picture. But the fall, how long would that last? My motor control was failing. I clutched the railing, then let go a little, then grabbed hold, then let go again, but caught myself.

I was not on the roof to jump. I was not there to kill myself. I was there to die, but dying was not a plan. I was not making decisions, choices, threats, or mistakes. I was, I think—looking back now—in acceptance. It was a relinquishing, though at the time I would not have been able to articulate it. I did not want to die, only felt that I would, or should, or must, and I had my pain and my reasons. If you have had this illness, then you’ve had your reasons; and maybe you’ve believed, or still believe, as I have, that it would be better for others, for all the people who have made the mistake of loving you, or who one day might, if you were gone.

Depression, hysteria, melancholia, nervousness, neurosis, neurasthenia, madness, lunacy, insanity, delirium, derangement, demonic possession, black humors, black bile, yellow bile, the black dog, the blues, the blue devils, a brown study, the vapors, a funk, a storm, the abyss, an inferno, Hell, a pain syndrome, stress, an anxiety disorder, lack of affect, an affective disorder, a mood disorder, panic, loneliness, bad wiring, a screw loose, a mercurial temperament, irritability, schizophrenia, unipolar disorder, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, attention-deficit disorder, borderline personality disorder, laziness, pain, rumination, grief, mourning, malingering, unhappiness, hopelessness, sadness, low spirits, invalidism, despondency, dysthymia, detachment, disassociation, dementia praecox, neuralgia, fibromyalgia, oversensitivity, hypersensitivity, idiocy, an unsound mind, cowardice, obstinacy, apathy, recalcitrance, spleen, a broken heart, battle fatigue, shell shock, self-pity, self-indulgence, self-centeredness, weakness, withdrawal, distraction, distemper, a turn in the barrel, a break in a life narrative, bad thoughts, bad feelings, coming undone, coming apart, falling apart, falling to pieces, willfulness, defiance, thoughts of hurting oneself or others, the thousand-yard stare, craziness, rage, misery, mania, morbidity, genius, suicidality, suicidal ideation, aggression, regression, decompensation, drama, breakdown, crackup, catatonia, losing one’s mind, losing one’s shit, losing one’s way, wasting away, psychic disorganization, spiritual despair, shame, raving, the furies, a disease, an enigma, a tragedy, a curse, a sin, and, of course, psychosis—suicide, in the past and in our time, has been called many things. Whatever terms we use, whatever the specific nature of their origins and progress, our so-called mental illnesses are themselves traumatic and stigmatizing. They isolate us from others.

I was thin and cold. I held my arms to my sides. I peered up at the clouds and the jet planes and the sunset. It was hard to look at the sky. I couldn’t hold my head up. I was taking Klonopin for anxiety and insomnia. My mother was dead, and my socks had holes. The light hurt my eyes, and sounds felt like sharp little jabs at my head; when the helicopter came, that afternoon on the roof, I hunched over, protectively. Was the helicopter coming for me? Regan had raised her voice with me. It was happening more and more.

She and I were in the living room. It was a bright April Friday. She’d rushed to Brooklyn from her office in Manhattan, panicked after hearing my voice on the phone, and of course Janice and Nicky were on their way in Janice’s car, in traffic. For months, Regan had been with me, sleep-deprived, anxious, angry, afraid, untouched, breathing my cigarette smoke, not eating, not laughing, morose—the winter. Then, in early spring, I had staggered into Manhattan and spent the night with a former girlfriend. I remember Regan screaming at me that I would go to Hell, and that she hoped I would die.

I wrote so many letters. Most suicides don’t; we don’t leave last testaments. I wrote them all winter long, on a notepad, while sitting on a tarp on the living-room floor. Writing, moving my arm, my wrist, my hand, was effortful. My grip on the pen was rigid, and my hands ached, and were always cold. I wrote an opening, ripped the page from the pad, and began another note. The notes were apologies. Sometimes I called friends and held them on the phone. I was fine, I told them. When I lay down, I crossed my arms over my chest, in the position of a corpse.

But then I was up, startled, pacing, shaking, scared, awake without having slept, worrying about my heart, spreading out the tarp, not wanting to leave a mess, and then sitting with pills, pad, pen, and a knife, an old Sabatier that had been in our kitchen when I was a boy. The blade was rusty. None of the letters got finished. At the end of the day, at around five or five-thirty, before Regan came over after work—she was a poet but worked then as an administrator at a hedge fund—I stored the tarp, replaced the knife in the kitchen drawer, cleaned the ashtrays, put away the pills, and buried the suicide notes deep in the garbage.

On the roof, late that day in April, after running from the apartment and up the stairs, after a session of hanging from the fire escape and letting go in stages, I climbed the ladder to the roof and huddled against the stairwell bulkhead, next to the door to the stairs. I was breathing fast, and my body hurt. Beyond the Brooklyn rooftops was Manhattan. Lights were on in the skyscrapers. The pain seemed to come from my skin and my muscles and my joints and my bones. But when I touched myself I couldn’t find anything. I felt as if I hurt everywhere, but also nowhere. My chest was constricted, as if a weight were pressing in—but from where? There was no weight, no feeling of a source or origin or cause, nothing to palpate. I’d say that it was the pain of being crushed or squeezed to death, but I’ve never been crushed or squeezed to death. Have you? Have you felt as if your body were collapsing from the inside, collapsing and hardening? Where was Regan? Where were my friends? I wanted a bullet. I’d wanted one since Christmas, to eliminate an itch behind my temple. I remember lying in bed, imagining the bullet easing in. Was Jesus waiting, or a trip into brightness, some stellar afterlife, like the one my mother had imagined on her deathbed? Was death knowledge, or nothing, or might I wake up, a baby again, born into some new violence? What were the chances? Might I, after falling, be maimed and alive? If I was gone, would Regan live?

I grew up sleep-deprived. I was sickly. I wasn’t robust. I couldn’t keep up in school, and often missed days. I had anxiety, allergies, and asthma, and irritable-bowel syndrome, and headaches, and, starting in fifth grade, when I was ten, awful and incapacitating back spasms. They began early one morning before school, in the upstairs bathroom in our house on Lewis Mountain Road, in Charlottesville, while I was bending over the toilet, throwing up after a night of staring around my dark bedroom, struggling to breathe, listening to the fighting.

Sometimes, in the middle of the night, my sister and I crept out of our rooms and sat in our pajamas on the landing, behind the bannister, afraid to look. You could say of our childhood that she played in her room, while I went out to the yard. Or you could say that she fled into her room, and that I fled outside. I made friends, but my friends were always changing; our family moved almost yearly, moved up and down the southern Atlantic seaboard, or sometimes just across town—Sarasota, Gainesville, Charlottesville, Tallahassee, back to Charlottesville, and then south again, down Interstate 95 to Miami. Pretty much every year, we packed up the old house and unpacked into a new one: single-story, two-story; driveways, sidewalks; screened porch, no porch; three cats, four cats; swimming pools, beaches, ponds; a converted Army barracks in Gainesville, a bungalow in Tallahassee, suburban tract houses in Miami, a farm at the foot of the Blue Ridge Mountains.

I remember, as best I can, the houses. I remember the crying. I remember the questions: If he kills her, and the judge asks me what I saw, what will I say? If she kills him, and the judge orders me to tell what happened, how can I speak? If he kills her, and goes to prison, what will happen to Terry and me? If our mother kills our father, and goes to prison, what will we do? How can I prosecute my father? How can I accuse my mother?

I imagined myself on the witness stand. I was in fifth grade. I remember that I was failing math. For a time, I had tutoring, but couldn’t solve the problems. While the teacher talked, I imagined a courthouse scene. There was a lawyer, and it was quiet; people waited for me to speak.

I imagined the knife.

There were knives in the kitchen, and I remember my mother screaming, one night in Charlottesville, when I was ten and Terry was nine, the year in the house on Lewis Mountain Road, that my father was trying to kill her with one. My father was a graduate student then, a T. S. Eliot man, at the university. I don’t have good memories of him, only memories. Even the bad times, in recollection, seem somehow not to include him, though he was right there, drunk, sarcastic, maudlin, a phantom. He died in 2009, of a heart attack, after falling asleep on my stepmother’s shoulder, on a layover in their journey from Fort Worth to Venice for Christmas. Maybe the knife that my mother was screaming about that night was the Sabatier that I took from the drawer when I left home, back in the late nineteen-seventies or so, and then, nearly thirty years later, carried from my own kitchen in Brooklyn, through the bedroom, up the hall, moving fast, off balance and stumbling to the living room, where I laid it on the plastic tarp, beside the pills, and then sat on the tarp, next to the pills and the knife, sat out the day, smoking, trembling, not yet dead.

When I was a boy, in bed I brought the covers up to my chin, wrapped them tightly around me, and lay without moving. I held my arms close to my sides, or crossed over my chest. I gazed up at my model airplanes, moonlit, hanging by threads from the ceiling. My chest, my body, felt tight, tight in the sense of a contraction, but also tight in the sense of being bound and squeezed. I remember that I felt paralyzed, or not exactly that, though something like that. I wasn’t paralyzed. It was just safer to lie still. Nonetheless, I shook, though not in a way that you’d notice—it was more of a hum. I felt numb yet in pain, and breathed shallow breaths, restrained.

Even now, at sixty, if I cry hard I will be frightened, and you may find me in a corner, crouching, turned toward the wall, my hands raised to protect my face. I will sob and shake, and make myself small, and beg, Please, go away. I will not be able to look at you. If you touch me, I will scream in pain and run from the room. Why can’t you see that it would be better for you without me? If any single feeling has defined my life, it is the feeling, more an awareness than a thought, that only lonely rooms are safe. This is how I feel and imagine shame, not as guilt or regret or remorse, not as some particular emotion or amalgam of emotions, but as a basic provision, abjection, the condition of those who have been cast out, neglected, harmed.

The sun had gone down, and I was on the roof. I couldn’t stand straight. I couldn’t walk straight. I couldn’t pull my shoulders back, or take a deep breath. I was forty-seven, middle-aged, at the time of life when, for men living on their own, the incidence of suicide rises. I could see the city in all directions, buildings and bridges. My friends Janice and Nicky had driven from Manhattan across the East River, and Regan—I didn’t know where Regan had gone. That had been earlier, such a long time before. There had been a plane in the sky. I remembered a helicopter. I realized that I would go to a hospital. I’d been ruminating over hospitals, imagining them, fearing them. On the roof, looking out across the city, I pictured Gothic piles and state psychiatric prisons, stone dungeons and brick barracks; and the wards, paint peeling, floors stained, locked and dark, fenced in.

I opened the door to the stairs, stepped through, and drew the bolt behind me. For months, Regan and others had told me that I wasn’t well, that I needed to get better. What did they mean, better? When had I been better—​when had that been? I imagined that I would be in the hospital, in hospitals, for a very long time. I’d been seeing my psychotherapist, on the Upper East Side, as well as, for prescriptions, a psychiatrist who was connected to a Brooklyn hospital. In the winter, he’d prescribed a benzodiazepine, Klonopin, for the daily panic and terror that began after I delivered the finished manuscript of “The Afterlife” to my publisher. Sometime around the New Year, my heart started pounding. I checked my pulse over and over with a watch, hour after hour, day after day. Regan assured me that my heartbeat was normal, but I contradicted her, and then asked for reassurance. I paced, and every night at two, three, four o’clock, woke up sweating. Waking was sudden—the new dark day. My gut seized, and I rolled into a ball. I felt as if my body were burning. But I was also cold and shivery. I’d tried antidepressants, years before, unsuccessfully, and again, also unsuccessfully, during the months leading up to the day on the roof: S.S.R.I.s, which target the mechanisms that control the neurotransmitter serotonin; an S.N.R.I., which affects both serotonin and norepinephrine levels; Wellbutrin, a dopamine enhancer; and Lamictal, a mood stabilizer developed to treat epilepsy, and now also used to treat a broad range of clinical psychiatric conditions. Klonopin is a strongly sedating drug with a long half-life. Like other drugs in the benzodiazepine family—Valium, Ativan, and so on—it is addictive; its effects are systemically transformative. Over time, I adapted to a schedule, one little yellow pill, four times a day, a schedule around which, over the winter and into the spring, I organized my worsening days and nights, counting down the hours and minutes to each new pill.

I recall a visit to the psychiatrist in his office. Leaving the house for any reason was scary and difficult; I felt, walking out of the building and down the sidewalk, as if I could not make it to the corner, and often I didn’t. My legs were heavy, and trembled; out on the street, the pain in my chest became sharper and more crushing. I told the doctor that I thought the Klonopin might be making things worse.

I remember that he was sitting at his desk. He sketched a picture on a piece of paper. It was a picture of crossing perpendicular lines with a waveform running along the horizontal axis, a graph showing a sine curve. The sections of curve below the horizontal axis he labelled “depression,” and the area above the axis “anxiety.” The doctor explained that benzodiazepines might worsen depression but help with anxiety, and that I seemed to have more anxiety than depression, and that there should be a middle ground. He pointed to the picture. It was an explanation for a child. He was trying to reach me, to get through to me. Why couldn’t I understand? His voice was insistent, and I could hear, and feel, that he wanted the session to end. Agony and anxiety. I told the doctor that I understood the drawing, but nonetheless believed that the medication itself was a problem. He wanted me to try cognitive behavioral therapy, which focusses directly on symptoms, thoughts, and behaviors, rather than on the origins and historical experience of illness in the patient’s life. The doctor asked if I had been thinking of hurting myself. Was I having suicidal thoughts?

I made it down the first flight from the roof, and then the second. My clothes were filthy, and my hands were black. I held the bannister. I wasn’t going to die that day. I padded in torn socks along the landing to my apartment. The door was unlocked. Nicky, Janice, and Regan were in the living room. They came toward me, but then retreated, as if afraid of getting too close. Where had I been? What had happened? Why had I scared them? I remember that they made a circle around me. Nicky told me that we were leaving for the hospital. A bed was waiting—the psychiatrist had arranged for a pre-admit. I told my friends that I wanted a cigarette. I’m not certain that I washed my hands and face. I remember looking in the bathroom mirror. Dark circles showed around my eyes. I put on a belt. Nicky told me to forget the cigarette. I put on a coat. Nicky drove Janice’s S.U.V. to the wrong hospital, where we tumbled in, got directions, and rushed back to the car. You would’ve thought that I was dying. I remember traffic and lights.

We were there. Regan helped with the forms, and later Janice and Nicky drove back to Manhattan. A nurse came with a plastic trash bag, and I took off my belt and unlaced my shoes and tugged the laces through their holes and handed them over, and Regan and I put laces, keys, change, and the belt, anything that might be used for harm, into the bag. The nurse took the bag, and I was led to a small room. Regan waited with me.

A doctor came. The doctor asked how I was feeling. I named the wrongs I’d done in my life, the people I’d hurt, catastrophes and losses. He told me to try not to worry about all that—I needed to get well. I asked him why he didn’t hear what I was saying, and he told me that when I felt better I might take a different view of my life. I asked him how long I would be in the hospital, and he said that he didn’t know. Then Regan had to go. It was late at night. I told her that I didn’t want her to leave me. After a while, a man arrived with a wheelchair. He rolled me through the halls to the elevator. Upstairs, on the ward, I told the nurse that I’d been taking Klonopin, but thought that it was having a bad effect, and asked for Ativan, a shorter-acting benzodiazepine, and she saw her way to that, and I woke up the next morning in a white room with a narrow view of rooftops.

I was in a room of my own. There wasn’t much to it. The ward was rectangular, with steel doors, cinder-block walls, a nursing station and medication dispensary, an isolation room for stressed or threatening patients, and, behind the scenes, offices, supply cabinets, closets, restrooms, and, presumably, a communal area for the staff. Patients’ bedrooms lined the hallways. A common area doubled as the dining room. The television was on all day. Patients leaned in doorways and sat on beds. Nurses checked the rooms, counting us every twenty minutes throughout the day and night. Many of us had had more than one hospitalization. Some knew one another from earlier stays. Had I been admitted before? What was I taking?

By the next day, Saturday afternoon, my body felt lighter, and my thoughts, I thought, were pretty clear. Was it the Ativan? I stayed on my bed, or talked on the pay phone down the hall. I called my father and my sister and my friends, and told them where I was, and then I joined a table with male patients and a supervisor, who gave us disposable razors, shaving cream, and water in cups. My hand shook; the razor scraped my face. I remember a young man who had brain damage from sniffing chemicals from a paper bag. He told me that he was Dominican. He looked like Jesus. He had long black hair, and spoke with kindness, but his sentences ended before communicating much meaning. He passed me a pocket Bible. I still have it in a drawer. Regan came during visiting hours, bringing clean clothes. A few old friends were with her that Saturday. Or was it Sunday? The nurse unlocked the door, and my friends showed their backpacks and bags, and signed in, and then we all visited, as my Tennessee relatives used to say, in the common room. My friends told me that I would get better. What did they know? I wore my own pants and shirt, not a hospital gown. I was ashamed, and they seemed abashed. I felt that. Or I should say that we shared in that.

On Monday, the in-patient doctors and their residents came. The ward busied, like any workplace at the start of a new week. My own doctor, the prescribing doctor, was not at the hospital. I told his colleague that I was all right, and that I believed I could go home.

We were in my room. The doctor was making morning rounds. I sat on the bed, and she sat on a chair that she’d dragged in from outside. (There were no chairs in those rooms.) “Do you think you’ll be safe?” she asked.

“Yes.” I told her that I’d had a scare, but that I didn’t think it would happen again.

“How are you feeling now?”

“Much better.”

I wasn’t lying. I’d slept some. I was momentarily safe.

“Are you having thoughts of harming yourself?”

“I think I’ll be O.K.”

“Can you tell me what brought this on?”

I told the doctor that I’d written a book about my mother, an alcoholic who’d lived a horrid life. I told her that the book was scheduled to come out in June. I told her about losses and errors of my own, and she watched my face and listened to my voice. Later that day, the hospital approved my discharge. A nurse brought the plastic bag, and I laced my shoes and signed the papers and sorted my things back into my pockets. I put on my coat. The nurse with the key chain led me down the hall and unlocked the door. I left the ward and walked toward the elevators. The door closed behind me, a heavy sound, and then I heard the key turn in the lock.

I rode the elevator to the lobby. I left the building, crossed the street, and got into a waiting car. Sometimes, when I think of that day, I remember that Regan had come to get me, and that we went home together. Mainly, though, I remember that I was on my own. It was about three o’clock. I was wobbly. I had my Ativan. The day was sunny; the world seemed to shimmer. I opened the bottle of pills and shook one into my hand. I was breathing rapidly. My skin felt prickly. The world did not look right. Brooklyn was unfamiliar. I don’t mean that the driver took a novel route. Was it the brightness in the light, a sharpness to the day, that Monday afternoon? I put the pill on my tongue. People passed on the sidewalks and crossed at the lights. It was early spring. The houses and shops were in rows, and the trees were already flowering—pink, violet, white. I recognized Prospect Park, and my neighborhood, and my street. Surely I would be all right. I paid and thanked the driver, and then hurried upstairs, shut the door, and turned the lock. The living room was as I remembered. Things were where they belonged. The view out the windows hadn’t changed. I crumpled onto the sofa. Where was I?

I stayed out of the hospital for five weeks. The symptoms that I’d gone in with, that I’d lived with for months, returned. I didn’t sleep that first night home. Regan told me that I would be all right, it would be all right, but I knew that I wasn’t safe. I remember waking, startled, sick with a burning in my chest—the worst kind of waking. I got out of bed and fled up the hall to the front of the apartment, then paced the living room, where I sat down and got up, sat and got up.

It went that way every night, and it was the same during the day, not just most days but every day. The itch in my temple, the need for a bullet, was constant. The itch wasn’t topical. It wasn’t itchy skin. It lay deep. If I scratched it, I might feel clarity and peace. Without the bullet, I would never again have either. But had I ever felt clear? When had I been peaceful? How long until it was time for another Ativan? Some days, I lay in bed, picturing the bullet moving slowly through my brain. The image soothed me. Outside the window was the fire escape. How to die? Who would find me, and then remember finding me? Who would have to remember that? I would leave a note, begging Regan not to unlock the door but to call the police instead. Children played and yelled on the rooftop of the school down the street. My hips and back, my arms and legs felt stiff, though loose, somehow. Later, Regan would come back from work, and I would try to eat. My jaw was tight, and it was hard to swallow. Regan and I spoke less and less. At night, she stayed in the front room, and I mainly went in back. Sometimes I took out my cell phone and dialled person after person.

What were my crimes? What are yours? What do you look forward to? I looked forward to poverty, abandonment by my remaining family members, the inability to write or work, the dissolution of friendships, professional and artistic oblivion, loneliness and deterioration, institutionalization and the removal from society—abjection and the end of belonging. The calm that I’d had for a moment in the hospital was gone. I slept two or three hours, and then sat up watching the light change with morning; and, later, during the day, took the death position, phoned those who might answer, or sped from back to front in the apartment, dragging the tarp. It was April, and then May, an eternity in real time. I worried about my shoulders. Over the spring, the joints had seemed to weaken. I could control my arms, but felt also that they were somehow just hanging there. Perhaps this was, as it were, an instance of hypochondria—I’d had a history of dislocations when I was younger. But what to make of the strange fluctuations in balance when walking, the tipping sideways, one way and then the other; or the effort required to hold a cup or a glass, or to write with a pen? How had I become so clumsy and uncoördinated? Why did sounds hurt? Why the adrenaline, the ruminations, the bullet and the knife, and when had the light begun to feel like sand in my eyes?

I remember stumbling downstairs and out of the building. I stuffed keys, cash, and my meds into my pockets and called a car. The subway was too terrifying. I would press myself against the platform wall and hyperventilate.

I gave the driver the address, an orthopedic clinic on the Upper East Side, not far from the apartment where I lived in my twenties, back when my mother was getting sober, back before everybody started dying. There’s a hospital not far from my apartment in Brooklyn, but it didn’t occur to me to go there. On the ride into Manhattan, I lowered the window and felt the air.

When I was a boy, I often got carsick. The time that I remember best was in the Smoky Mountains, on hairpin turns outside Asheville, North Carolina. My grandfather was driving, and my grandmother sat beside him, my mother’s parents. My sister and I were in the back seat. I must have been five or six, and Terry four or five. Maybe it was 1964. I remember trees and valleys and the motion of the car. I recall that the car was white, with red upholstery, and that we were on a trip, and that my grandfather liked to speed, and that my grandmother turned and reached back to hand me an apple. It was a yellow apple. The apple was mushy and dry, and the road wound left, right, up, down through the hills. Now, as I write this, I wonder where we were going, where we’d been; and it seems to me that this was a time when our grandparents had taken my sister and me from our mother and father. We were heading across the mountains, then south to Sarasota, to the house on Wisteria Street. We’d visited relatives in Tennessee. Our parents’ marriage was ending. I threw up on the seat, and my grandfather stopped the car. He and my grandmother put down towels, and my grandfather told me that if I got sick again I could stick my head out the window and breathe, and I’d feel better.

The clinic was busy. It was a big, modern place. I barged up to the desk. The receptionist asked if I had an appointment. I said that I needed a doctor, and she asked me what the problem was.

“My shoulders.”

“Your shoulders?”

People behind the reception desk turned and whispered. I was shaking. I hadn’t shaved. I’d got skinnier since my weekend at the hospital, and my clothes were big, like clown clothes.

I remember the receptionist telling me that there were no appointments available, but that I could make one for another time. I pleaded, “It’s important! Can I talk to a doctor? Isn’t there a way?” My throat was tight, and my mouth dry. I remember worrying that I was shouting.

She told me to wait.

I recall sitting in the waiting room. Was I holding a clipboard, a pen? The waiting room was quiet. I do my best to remember.

A doctor appeared. He was young, and wore a white coat. Would I accompany him down the hall?

We went into a room. I didn’t climb onto the examination table, and the doctor didn’t sit on his rolling stool. We faced each other. He seemed wary. He asked me what was wrong, and I said, “It’s hard to pinpoint. It feels like my arms are falling out of the sockets.”

“Both arms?”

I was breathing fast. “It’s more on the left.”

“Can you rotate?”

I swung my arms in the air. I told the doctor that if I raised and brought my arms too far back the shoulders might dislocate.

He briefly poked and manipulated, going through the motions, and said, “I’m not finding anything out of the ordinary.”

“There is!”

He took a step back and said, “You’re welcome to make an appointment. But I don’t think the problem is with your shoulders.” Then he told me that he had patients to see.

He opened the door and walked me back along the hall, past the reception desk, and across the waiting room. People watched. The doctor held the door, and then quietly shut it behind me. I rode the elevator to the lobby. On the street, I called my friend David, who lives in Nyack, twenty miles up the Hudson. David had stayed on the phone with me through the winter and the spring, listening patiently to my jagged talking. I raged to David about my physical condition, and he shouted, “Why aren’t you in a hospital? You need to be in a hospital!”

I thought of Anne. We’d been friends in college. She was a year behind me. I remembered that she’d gone to medical school and become a psychiatrist, and I recalled hearing that she practiced at Columbia Presbyterian, at 168th Street and Broadway, near the George Washington Bridge and the top of Manhattan. I didn’t phone her that day after leaving the clinic, but the next day, or maybe the day after, I got in touch with Anne, and she told me that she was an in-patient doctor in Columbia’s psychiatric emergency room.

I remember where I was when Anne picked up the phone. I was on the little sofa in my living room. I told her about the Klonopin and the Ativan, Regan and the roof, the infantilizing doctor and the Brooklyn ward; and I promised her that I was not thinking of hurting myself, though dying was my only thought. I was lying, of course. I couldn’t bring myself to do otherwise. What would I be admitting to? I insisted that I did not need a hospital.

She said that I sounded sick. She told me to come to Columbia Presbyterian. They’d take care of me, she said; they’d help me get better. She told me that it was dangerous for me to stay out on my own, that I’d be safe in the hospital, and that I needed treatment. What did she mean, treatment? I told her that I would consider what she was saying. She then gave me the phone number of a colleague in private practice, another Columbia doctor, whom I’ll call Dr. T. “Everyone respects her,” Anne told me.

Dr. T.’s office was on the Upper West Side, in the Nineties, near Central Park, on the ground floor, facing the street. Diplomas hung on the wall above a desk. Freud’s works, the Hogarth Press Standard edition, sat in their faded blue jackets behind glass doors in an antique bookcase, and a fainting couch for patients in analysis was spread with kilim rugs, a touch taken straight from Freud’s Vienna consulting room. Everything looked secondhand. The doctor sat in a corner, near the window, writing notes on a pad. I sat in the middle of the room, in a red armchair. The upholstery was frayed and tearing. The doctor warned me that I was in danger, and that damage and harm would accrue and intensify. She meant brain damage. She told me that if I stayed out of the hospital I would die.

Later that week, on a Friday, I called a car and asked the driver to take me to 168th Street and Broadway. On the drive, I phoned Regan, my father, and my friends, and told them that I was going to Columbia Presbyterian.

I felt calmer in the car than I had at home. I breathed more easily. It was a clear day. I remember the drive up the West Side Highway. The Hudson River was on the left, and I could see the George Washington Bridge ahead in the distance. The trees in Riverside Park were green. I hadn’t planned. I’d taken some things—my keys, some cash, but not much else. I’d stopped writing and reading long before, and hadn’t bothered with a book.

The car pulled up in front of a building made of stone. I saw doctors, nurses, and ambulances. There was the emergency room. I paid the driver, got out of the car, and walked toward the entrance. ♦


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