Chapter 30

CHAPTER 30

Maddy doesn’t remember the psych ward in Georgia. She’s ransacked every cluttered and dusty corner of her brain, at first frenzied and later with a detached ambivalence, trying to find something, even a sliver of a moment, but there’s nothing there. Those three days are completely blacked out. According to Dr. Weaver, they had her bulldozed with heavy medication, in a pharmaceutical straitjacket, and she guesses that the part of Maddy’s brain responsible for laying down new memories was closed for business. Maddy takes note of the word guess .

And her memory of the events that led up to being hospitalized is also spotty, riddled with black holes. She remembers shots of whiskey, a line of cocaine on a playing card, the girl with the bumblebee tattoo, and doing her set at a comedy club. She’s not sure how she ended up there.

Her mother flew back with her to Connecticut, where she was admitted to Garrison yet again, where she’s spent who knows how many days mostly sleeping under the familiar weighted blanket of several powerful meds, adjusting like a gradual change in season to some new cocktail, some new reality.

She’s sitting on Dr. Weaver’s sofa, next to her mother, November all over again. One of the leaves on the tall potted plant in the corner is brown, curled and crispy at the edges. She finds it interesting that part of the plant had to wither and die for her to know for sure that it’s real. The new plum-colored accent pillow tilted against the arm of the sofa is begging her to lie down, distracting her from what Dr. Weaver and her mother are saying.

“This is exactly what happened last time,” says her mother. “You put her on an antidepressant and that caused a manic episode.”

Her mother’s voice is accusatory, shaking. Her face is etched with fury and fear and is unfamiliar without any makeup. She’s wearing oatmeal cotton sweatpants with a matching zippered hoodie and white designer sneakers. She holds a pen in her hand and a pad of paper in her lap. She’s taking notes, something she didn’t do last fall.

“The medication she’s been on has antidepressant properties, but it’s not an antidepressant. There’s no data to support that quetiapine can precipitate the onset of a manic episode in someone who is stabilized on lithium.”

“But that’s exactly what happened.”

“I don’t think we can say that, Amy. Maddy admits that she stopped taking her meds a few days before the bachelorette party, and she was getting very little sleep, despite what she self-reported on the mood app. Her tox screen from the ER shows she had cocaine in her system and a blood alcohol content of 0.12 percent. Any one of these factors alone could’ve destabilized her and caused her to swing manic.”

Her mother cups a hand over her mouth and breathes deeply. She then angles herself toward Maddy.

“What are you trying to do to yourself?” her mother asks, her voice flooded with defeat and disbelief.

Maddy aims her gaze at the potted plant and doesn’t answer. Producing articulate, intelligent sounds from her mouth takes an astronomical amount of energy, and since her answer would require a long explanation, she remains mute. She was already manic when she started drinking and snorted the cocaine. She was immortal and flying high, an exuberant yes to any impulse that sparkled or gifted her with a little more buoyancy. Whiskey shots and cocaine were definitely byproducts of her mania, not its catalyst.

“Well, if it wasn’t the quetiapine, I blame those comedy clubs more than anything. Her sister said she’d been going every night for months. I could kill Emily for allowing it and not saying anything. But that’s how I think it all begins. She starts thinking she’s a comedian.”

Maddy sits up straighter, summoning the energy to speak.

“I am a comedian.”

“Stop that. You’re a student at NYU. It’s the bipolar that makes you think that. You’re not a comedian.”

“I am.”

“This is crazy,” her mother says to Dr. Weaver, seeking an ally. “She’s never shown any interest or inclination toward comedy before the manic episode in November. She can’t—”

Dr. Weaver extends her palm, a stop sign, and nods.

“Aside from whether being a comedian is a real aspiration or a manic delusion, I don’t think pursuing it is healthy for the stability of Maddy’s mental health at the moment.” Dr. Weaver turns her head to Maddy. “Going to comedy clubs every night probably means you’re out late—”

“Open mics are at five or six o’clock,” Maddy whispers.

“And, if I’m remembering correctly, these are all in bars, so you’re probably surrounded by a lot of drinking and drugs. This isn’t a stable environment for someone with bipolar.”

Has Dr. Weaver read or watched the news lately? Wild fires, floods, refugees, war, another mass shooting. The whole world is an unstable environment. Dr. Weaver might as well tell her she’s not fit to live on this planet.

“Definitely not,” says her mother, in full agreement. “She’s not going back to New York.”

“I think that makes sense. Maddy, let’s focus on getting you stabilized and hopefully we can get you back to New York as a student in the fall.”

Maddy’s heart crumples like a dead leaf. No more comedy clubs. If she hasn’t already missed it, she won’t be doing the New York Women in Comedy Festival. All that progress, all that momentum, all for nothing.

Emily will probably be relieved to be rid of her. She doesn’t need the added stress of dealing with her steaming hot turd of a sister right before her perfect wedding. Poking the tender space where her front tooth should be with her tongue, Maddy cringes, imagining how mad Emily must be at her for ruining her bachelorette party. She wants to apologize and beg for forgiveness, but she hasn’t seen her phone since the airport in Nashville, and Emily hasn’t been to Garrison to visit.

And she’s missed too many shifts at Starbucks with no explanation. She’s for sure already lost her job. Simone must be wondering what happened to her. She’s probably texted Maddy a bunch of times before giving up, unable to fathom why Maddy would ghost her.

“When can she come home?”

“I think by the end of the week she’ll be ready.”

“Good.” Her mother sighs in great relief. “I was able to get her an appointment for Monday with an oral surgeon who will hopefully be able to put something in her mouth that resembles a tooth before the wedding.”

Maddy imagines posing for pictures with Emily and the other bridesmaids. Everyone but Maddy, smile .

“Just a few more days here so we can monitor things as we start her on new meds.”

“I don’t want her on an antidepressant.”

“I understand. We’re going to try something else. Maddy, do you remember why you stopped taking the lithium?”

Maddy pretends to think and then shrugs.

“A lot of people stop taking it because the drug is actually doing its job. They feel good and so they start to wonder why they have to take all these pills every day when they’re not sick.”

Dr. Weaver pauses, her face a question mark, provoking a response. But it feels like a setup, as if any comment from Maddy will release a trapdoor in the floor beneath her, sending her into a treacherous free fall. Maddy stares at her, stone-faced.

“How were the side effects?”

“Horrible.”

Dr. Weaver nods, tapping her pen on her bottom lip.

“Okay, I normally don’t like to give up on a drug that’s working, but let’s try you on lamotrigine instead. It’s another mood stabilizer, but it has milder side effects than lithium, so that’s good. It’s not quite as effective as lithium at preventing mania, though, so we’re also going to keep you on quetiapine.

“They put you on a high dose of that medication in Georgia. If you remember, you’ve been on a fairly low dose of quetiapine for its antidepressant properties, but it’s also very fast and effective at treating and preventing mania. So I want to keep you on that, for maintenance. We’ve been tapering the dose to something more reasonable, so you’re not so heavily sedated, but we’ll probably leave it at a little higher dosage than you were on before.”

“So that should keep her from going manic again,” says her mother, checking.

“Yes,” says Dr. Weaver.

“Good,” says her mother, circling something in her notes.

“How does that sound to you, Maddy?” Dr. Weaver asks.

It sounds like her new meds will pull hard on the antimania lever with a lighter touch on antidepression, an imbalanced solution her mother seems eager to agree to. Maddy gets it. If one side of her regulatory seesaw is going to go flying in the air or crashing to the ground, her mother would much rather it be depression than mania.

When she’s depressed, her mother knows where to find her. She’s a catatonic lump in her bed. Morning, noon, and night. She barely ever leaves her bedroom, never mind the state. It’s all very manageable for her mother. Worst case, she’s cutting herself, which is ugly and embarrassing to look at but to date hasn’t resulted in any unauthorized air travel or emergency-room phone calls from Atlanta. She’s not spending all her money, doing coke in a bar bathroom, or getting her front tooth knocked out when she’s depressed. Depression is so much more ladylike than mania.

But her mother doesn’t have to live it. Maddy’s last depression was a colorless, hollowed-out quasi-existence alone at the bottom of a deep dank hole, no sunlit hopeful perspective available to her psyche, no will to call for help, no belief that anyone would answer even if she did, no rope for climbing out or hanging herself with, either a welcome relief from the endless death rattle that was breathing in and out. The aftermath of mania is the worst kind of hangover imaginable, but she’d take the wild, chaotic ride of mania over depression any day.

And hypomania, that glittery on-ramp to mania’s superhighway, is the best fucking state of being in the Universe, almost worth the cost of whatever wreckage ensues on the speedway. She’d order venti iced oat-milk hypomania all day long. Her senses heightened, she’s able to see patterns and details she’s never spotted before, that maybe no one has ever spotted before. Her creative juices flow like water from a fire hose. Her ideas are unique, brilliant, and limitless. She requires almost no sleep. That combined with her speed-of-light thinking make her wildly productive. If these doctors could figure out a cocktail of meds that could keep her cruising in mania lite, she’d swallow those pills religiously and forever, whatever the side effects.

Dr. Weaver continues to look at Maddy, her gaze gentle and pleasantly assured, awaiting an answer. Maddy has forgotten the question. She slumps deeper into the sofa cushion.

“I know you didn’t ask for any of this. Try not to get discouraged. I have many patients who live thriving, healthy lives with bipolar. That’s a realistic goal for you, Maddy. And I’m here to help you get there, but I need you to collaborate. Can we agree that you’d like to avoid another manic episode?”

Maddy manages a weak nod.

“Good. You have to make this about you, Maddy. If you don’t own your bipolar, if you’re not honest with yourself or us, if you don’t stay on your meds and incorporate the things we’ve identified that keep you regulated as part of your lifestyle, then you’re going to keep ending up here.”

Maddy knows that Dr. Weaver’s words were well intended as helpful advice, a pep talk even, but they land in Maddy as an ominous warning, a foreshadowing, a threat. A massive chill runs through her.

She doesn’t want to experience another manic episode. But she also doesn’t want a new combination of drugs with a new set of side effects. She doesn’t want to live in Connecticut with her mother. She doesn’t want to be restricted to rigid bedtimes or drinking sparkling cider instead of champagne at her sister’s wedding.

She doesn’t want bipolar disorder.

She doesn’t want any of this.