Elephant in the Sky (17 page)

42

Throughout the rest of the morning, Nate had stirred and woken a few times, but had always been groggy and would quickly fall back to sleep. While he remained fixated on being at the zoo with Pete, Noah, and me, he wasn't overly agitated, and we were able to hold off on giving him any more Lorazepam.

Shortly after lunch, Dr. Aldridge walked into the room. She brought with her a positive energy that filled the room, and she offered Pete and me a warm smile as she introduced herself and shook our hands. I could see why Addy had said everyone loved her.

“I hear you've had a rough couple of days,” Dr. Aldridge sympathized. “Pretty scary too, I imagine.”

“Yeah, it's been tough. But thank God we found Nate and he was okay.”

“Indeed. He's a very lucky little boy. And he's in good hands now. Addy's one of our best nurses, and I can tell that she already cares a great deal about your son. I just spoke with her and she updated me on how Nate has been since I saw him yesterday.”

Beside us Nate stirred, thrashing his head from side to side, as if to warn us that he'd soon wake up. Dr. Aldridge cleared her throat. “It's not surprising that your son is still delusional and talking about monsters. We know there's something going on in his brain that's causing him to experience the psychosis that's making him say those things. You have to remember that, in his mind, the elephants really exist, and he can see them all around him. It would be a very scary thing for a nine-year-old. So we're going to work hard to figure out what's going on, and provide him with the best treatment possible to make him well.”

“Will he need more meds?” I asked.

“Likely,” Dr. Aldridge replied. Her answers were honest and direct, which I appreciated. “But let's not get ahead of ourselves just yet. What we need to do first is figure out what's causing the psychosis.”

“Wouldn't it be bipolar disorder?” I asked. “Do you know that my father has it too?”

“Yes. I saw that in Nate's chart. I can see why you would say that, given bipolar disorder is genetic. And it could very well be what's causing Nate's psychosis. But first we need to rule out everything else.”

“So it's psychosis that Nate is having at this point? That's how we refer to all of this?”

Dr. Aldridge nodded as she glanced in Nate's direction and observed how he was stirring in his sleep.

“What causes it?” Pete asked.

“To be honest, it isn't fully understood. It can definitely be caused by a mental illness, such as bipolar disorder. But there are other contributing factors as well. A stressful event may trigger a psychotic episode, for example. Or psychosis can be brought on by drugs like marijuana or LSD, although I don't suspect this in the case of Nate simply because of his age. It could also be brought on by another medical condition. There are many causes.”

“Does it happen to a lot of people?” I asked. I felt myself holding my breath, hoping that Dr. Aldridge would tell me it happened all the time. My misery needed company.

“More than you might think. About three in one hundred people will experience a psychotic episode at one point in their life. Some will have only a few episodes, or it could be one episode lasting just a few days or weeks. Others will experience symptoms more frequently, and some will have the condition for life.”

“So Nate could be okay? This could be a fluke?” I asked, praying for Dr. Aldridge to say this could all just go away.

“It's a very small possibility. But with a family history of mental illness, we need to be certain of what's going on.”

“So what should we do now?” I asked.

“Unfortunately, there is no specific test for psychosis. It's more a matter of recognizing the behavioural and thought disorder patterns to make the diagnosis,” Dr. Aldridge explained. “I'd like to do a full physical examination on Nate, including a thorough history evaluation and blood tests. Based on what we find, further diagnostic tests may be warranted.”

“What kind of history evaluation? We can begin pulling the information you need if it will help.”

“We'll need to know his full family history, as well as a complete medical overview. Things like recent or past head trauma, and possible neurological symptoms like headache patterns or visual disturbance. I'd also like to know about any previous medications Nate has taken. Really, I need to know everything about your son. I'd even like to know about his dietary history, and how Nate eats on a regular basis.”

Pete and I both nodded, and I grabbed a pen and pad of paper from my bag to start taking notes. I was already struggling to keep up.

“What kind of blood tests will you do?” I asked.

“The initial tests will focus on the most common organic causes. We'll do a CBC, or a complete blood count, in order to measure the concentration of Nate's white blood cells, red blood cells, and platelets. I'm going to order a liver function test to measure his liver enzymes, and also look into Nate's thyroid function. The blood tests will cover a lot, actually. Right down to things like Nate's vitamin B12 and folate levels so we can exclude nutritional deficiency.”

“Okay, just give me one sec.” I scribbled on my pad of paper at arm-numbing speed.

“It's great to write things down. I always encourage the parents of my patients to do so. I know all of this can be very overwhelming,” Dr. Aldridge said. “But don't worry if you don't capture everything. We're here to help you with whatever you need. I can answer any questions you might have, and Addy is always here to help explain things again, if needed.”

I put my pen down and searched Dr. Aldridge's eyes. She was so genuine and kind in her approach, and I instantly trusted her. “Is my son going to be okay?” I asked.

“Mrs. Carter, we're going to do everything possible for Nate. We're going to work hard to find out what's going on, and then we'll work together to give him the best possible treatment.”

It was a vague answer that I'd heard far too often on TV shows and movies. Dr. Aldridge's direct answers had flown the way of the cuckoo bird when I'd asked for her to look into a crystal ball, but I knew she was just being honest with me. Of course she couldn't predict the future. No one knew if Nate was going to be okay: we had no idea what was wrong with him. All we could do was take every step that was needed to try to figure out what was wrong with him, and then work towards making him better.

Dr. Aldridge continued, “Once we've ruled out all organic causes, I'll begin to do a psychiatric assessment on Nate. We'll all need to work together on this, including Nate. It's one day at a time around here.” Dr. Aldridge tucked a strand of dark hair behind her ear and gave us a big smile. “Now, if you'll excuse me, I have a few other patients to see. Do you have any other questions for me before I go?”

“Is this psychosis … is it normal to happen to someone so young?” Pete asked.

“It's unusual to see psychosis in someone as young as Nate. And it's often a bit trickier than dealing with adults. The fantasy lives of children, and issues of developing language and cognition, impair diagnostic accuracy. Particularly when differentiating between something like bipolar disorder and other mental illnesses, such as schizophrenia. Which we can't rule out either.”

Schizophrenia. I shuddered at the mere mention of it.

“But it does happen to children as young as Nate?” Pete probed again. He was fixated on Nate's age, and I couldn't help but wonder if he was fishing for an answer to support his previous denial of anything being wrong with our son. I needed Pete to wholeheartedly support me in our quest to identify what was really going on.

“Yes, it can. It happens at all different ages, although diagnosis typically happens in the late teens or early twenties.”

“So Nate is really young for this?”

“Yes, he is, Mr. Carter. But he
is
experiencing psychosis for some reason. And we know there
is
something going on with your son. Nate's actions are not normal. I know it's all very scary, particularly given Nate's young age, but finding out what's going on as soon as possible is a good thing. Because it means we can help him sooner. I've seen what happens when a child's mental illness is not treated: every part of their life suffers, including relationships, school functioning, extracurricular activities, and so on. Early treatment with proper medication and therapy will help Nate become a fully functioning, stable kid. It means the difference between a balanced, healthy life and one that is so out of whack it becomes all-consuming and prevents them from being successful in all walks of life.”

I nodded, taking in what the doctor was saying. She made a good point, and I felt better speaking with her. I knew Nate was in good hands.

Once Dr. Aldridge left, Pete and I sat in silence, lost in thought as we watched our sleeping son. Eventually, I forced myself to take advantage of the calm before the storm by responding to some emails, including Jack's from the day before. I told him that I'd be available when possible via email and conference calls, but that I didn't know when I'd be back in the office. I had no idea how he would respond, but I had no choice in taking a physical leave of absence.

I was just hitting send on Jack's email when Nate started shuffling anxiously in bed, jolting from his sleeping position and screaming wildly. He thrashed from side to side, crying out in what seemed like pain, and spitting through his wailing words that the elephants were trying to kill him.

I froze in my seat. Pete jumped up and tried to hold Nate down, for fear that he might hurt himself. Or us.

“Go get the doctor!” Pete gasped right before Nate elbowed him in the face. I knew instantly he'd have black eye.

I jumped up and pulled the buzzer to call the nurses' station, but Addy had already seen what was going on through the window. She rushed in and was immediately followed by a medical and security team who shouted at us to step away from our son before they jumped directly into the chaos of thrashing arms and legs.

Our nightmare had started up again, and I watched in terror, crying into Pete's shoulder and praying for it to all go away.

And it did, moments after the next shot of Lorazepam was plunged deep into our son's leg.

43

Our drugged-up son slept through all of Dr. Aldridge's medical tests. His blood was drawn by Addy on multiple occasions, and he didn't even flinch. I doubted that he even felt it.

An on-call doctor whom we hadn't previously met came to listen to Nate's heart and lungs. He examined his abdomen and did as much of a physical assessment as he could to a sleeping body.

A psychologist named Isa, who worked closely with Dr. Aldridge, came and interviewed us about every aspect of Nate's life. We talked directly in front of our son about everything the doctors needed to know, including his history of odd behaviour. How he'd run away on more than one occasion. How Nate had started doing weird things, like stealing. Or how obsessed he often became with random things, like gum. We told Isa about Nate's sleep patterns, and we explained how, on so many nights, our son refused to go to sleep. How we always found him up in his room doing strange things. Nate didn't hear a word.

Dr. Aldridge came to Nate's room to ask Pete about my father's condition, and my husband revealed everything he knew, including the name of the Florida doctor to whom he had talked at the beginning.

We talked about all the bullying and everything we'd been through as a result. We told her about all of the times Nate had been sad, and we rated his moods on a scale of one to ten, trying to distinguish between gloomy and depressed. I tried to recount what I could, but everything seemed to be blurring together.

We told Addy about what Nate liked for dinner, and what he refused to eat. What his favourite sports were. What happened the time he had an anxiety attack in the hospital. The questions were exhausting and never-ending. No aspect about our son's life was left uncovered.

A few hours later, the blood test results came in, and Dr. Aldridge came to discuss the findings. Everything appeared to be normal, right down to Nate being properly nourished.

“So what do we do next?” I asked Dr. Aldridge as I took Pete's hand under the table. We were sitting in one of the quiet courtesy rooms.

“I'd like to start giving Nate a low dose of a drug called Risperidone. It's an atypical antipsychotic that has proven to be effective, and I believe it will help Nate begin to think clearly and function normally again. Essentially it will help restore the balance of certain natural substances in his brain.”

“Does he really need it?” I asked.

“Yes, I believe he does. It will help to stop the mania and delusions he's having, and will allow me to really speak with him, so we can continue investigating what's going on with him and begin to move forward.”

“But might this just be the start? If it doesn't work, or if Nate has side effects, then we need to move onto different drugs? Or stronger drugs?” As a mother who subscribed to her fair share of parenting magazines, I'd read the articles on overly medicated children, and was petrified of getting into a vicious cycle of drugs that we couldn't get out of. There were so many horror stories.

“You're right. Finding the right medication does take a certain amount of trial and error. And this might not be the right drug for Nate. But it's what I believe we should start with.” Dr. Aldridge's eyes were warm and compassionate, and her voice was clear and firm.

“What are the side effects?” Pete asked. I looked at my husband and noticed for the first time how tired he looked. His eyes were bloodshot and puffy, and his right eye was turning black and swollen thanks to Nate's elbow. “Can you tell us, honestly, what we're in for if we give our son this drug?”

“Yes. Of course. I want you to make an informed decision,” Dr. Aldridge responded. “The main problem with Risperidone is that it commonly causes weight gain. It can also lead to hand tremors and restlessness.”

“Is that it? Is there anything else?” As Pete listened to the doctor, he pulled at the stubble that had begun to form on his jawline.

“There's more. Sometimes dizziness, drowsiness, fatigue, muscle stiffness, nausea, constipation, increased appetite, which is often what contributes to the weight gain. Dry skin, nervousness. Sometimes it leads to difficulty concentrating …” Dr. Aldridge's voice trailed off, and she paused before continuing, “I know it's a big decision. And all of this is very overwhelming. I've brought you some things you can read, if you're interested. It covers a lot of ground, and if there's anything else you're wondering about, I'm always here to talk.”

“Would you do it?” I asked, cutting her off. “If it were your son. Your child. Would you give them the drug you're recommending?”

“Yes, if I were in your situation, I would,” Dr. Aldridge said simply. “I know the risk of side effects is scary. And no one would ever want any of them for their child, including me. But I'm prescribing this medication for Nate because I believe the benefit of Risperidone is greater than the risk of the side effects.”

I nodded, picking up the jam-packed, glossy brochure from the table. What she was saying made sense to me. Given our current state, we needed to pick the best bad solution. A plan that offered a likelihood of benefits that outweighed the risk of harm.

“What do you think?” I asked, turning to my husband, who was now leaning onto the table and burying his forehead in his hands. He suddenly seemed smaller to me. Almost like he had been crumpled by a life that had quickly become too complicated.

Pete looked into my eyes. When he did, I lost sight of the bloodshot puffiness of an overly tired man who had been hit in the face by his son, and simply found truth. “I want to do what's best for Nate. If Dr. Aldridge believes that it is Risperidone, then that's what I think we should give him.”

I nodded. “Okay, then. Let's do what you feel is best, Dr. Aldridge. Let's give him the drugs you've recommended.”

Dr. Aldridge explained she would begin working with Nate as soon as the Risperidone started to kick in and he was thinking more clearly. He needed to be able to carry on a conversation. She wanted to talk to him about all he had experienced and felt over the past few months. She'd exhausted our side of the story, but it was really his version that was more important.

“How long do you think it will be before we see an improvement?” I asked.

“It might take up to six weeks to see the full effect, but he could start feeling a lot better much sooner than that. As soon as he can carry on a conversation with me, I'll begin to work with him.”

“Six
weeks
?!” I cried. I felt like I'd been kicked in the gut.

“Yes, it could be six weeks. But it could be much sooner than that as well.”

Six weeks would take us to Christmas. We couldn't wait that long for Nate to get better. And I couldn't be away from work for that long either.

“Six weeks,” I repeated. “Is there anything faster?”

“This isn't a race, Ashley. It's about doing what's right for Nate. I know six weeks seems like a long time, but it might not take that long to kick in. We might begin to see significant progress right away. And I'll be working with Nate throughout the six weeks, regardless.”

“Dr. Aldridge is right, Ash. And six weeks is nothing in the realm of his lifetime.”

I sighed. I knew they were right. But wasn't medicine supposed to be a quick fix? Like Tylenol to a headache? Or Gravol to an upset stomach?

“Will Nate need to be here the entire time? When can he go home? And what about school?”

“It will depend on how Nate responds to the drugs. If he's not agitated or dangerous or experiencing minimal psychosis, there's no reason he can't go home and come to the hospital to meet with me.”

“And school?”

“That, too, will depend. Let's try not to get ahead of ourselves, okay? In the meantime, why don't you begin talking to Nate's teacher about what she'll be covering over the next few weeks? When the time is right you can begin to introduce school back into his life, whether that's at home or back in the classroom.”

I nodded, tears springing to my eyes as thoughts of Nate falling behind in school entered my mind. I tried to stop my racing thoughts of what that might mean, and if he might need to repeat a year.

“Try to not to worry about it, Ashley,” Dr. Aldridge said. “Based on what we've learned about Nate so far, it seems like he's a really clever kid and will be able to catch up quickly.”

“I know. You're right.”

“Of course I'm right. I'm a psychiatrist!” Dr. Aldridge laughed. I smiled in response, thinking that, although her lighthearted words were meant to be a joke, they were actually rooted in something extremely serious.

Dr. Aldridge
had
to be right. Because it wasn't just our son's education that depended on it but also his overall mental wellness.

And the rest of his life.