Monday, April 30, 2007

No Escape

By Terrence McCarthy

Agnes was a rail thin 63 year old woman whose cackle laugh echoed like a car alarm throughout the unit. But it isn’t the sound of her laughter I remember most; it is the sound of her music.

There was an old piano in the patients’ dining room. It didn’t get played all that much. On most days it was just another piece of second hand furniture on a psych unit where second hand was the rule. The piano usually just sat there quietly, like a patient waiting for a visitor to arrive.

But whenever Agnes was on the unit, the piano came to life. And at least some of the depression that hung like a fog would burn off. For a while.

Agnes was what we called a “ Frequent Flyer. “ Her psychiatric history dated back to the 1960s when both she and her husband had been patients at the state hospital in Northampton. In 1978 the big story in the mental health business was something called “ Deinsitutionalization. “ State hospitals closed their doors and the mentally ill who had been living there for years went elsewhere. Some lived on the streets or in shelters. Others, a lucky few in the grand scheme of things, were referred to group homes. And then there were people like Agnes, who lived in an apartment where she took care of herself until she reached those points in her life when she just couldn’t do that.

The sound of Agnes playing the piano meant that she was feeling better. The crying jags had ended; the intrusive, frightening thoughts were in control. The treatment we offered, a combination of medications and talk therapy groups, was helping Agnes slog her way through another crisis.

When I think about Agnes I also think about a depressed middle aged man I will call Hank. Hank and I were in the dayroom watching television. He was as down as I’d seen him. “ Nothing’s working, “ he said.

“ How many more ECT treatment you have? “ I asked. ECT is electroconvulsive treatment, “ Shock Treatment. “ ECT was routinely administered to patients for whom medications and talk therapy did little or nothing to rescue them from deparession’s deep well.

“ I don’t know, “ Hank said. “ Two, three more I guess. “

I knew he’d had at least six treatments, which for most patients, was the normal course.

I changed the subject. Tried to engage him in small talk, but I wasn’t successful. His eyes never met mine. They were fixed on the screen. Some moronic sit-com was on and the laughtrack was driving me crazy.

Then I heard the music. Agnes was playing the piano. It wasn’t the classical music she liked to play most. It wasn’t Chopin, Mozart or Rachmaninkoff. The tune she was tapping out on the keys of the old piano was “ My Happiness. “

I looked at Hank and he looked at me. We both recognized the tune and, I think the irony of it being played in this context. Hank smiled.

Leave it to Agnes. Her music had cut through Hank’s depression like a surgeon’s scalpel pierces thick skin. Sure, it was a temporary thing. But on a unit like that one it made sense to savor magical moments.

As Hank and I listened to the music, I thought of something Dostoevsky wrote:

“ If a man has one good memory to go by, that may be enough to save him. “

The movie Shine was in the theaters at the time this all happened. Shine told the story of David Helfgott, a man whose mental illness did not get in the way of his becoming a world renowned pianist. The movie won many awards and had a very happy ending.

The actor Geoffrey Rush played Helfgott in the movie. Rush won an academy award for his performance. Best actor in a dramatic role. Another show. Another happy ending.

In the wake of the movie’s success, Helfgott went on tour. He played the piano poorly and got terrible reviews. Some critics added that he did not look well. And his behavior was odd.

Happy ending are nice. We Americans love them. But in my experience on the unit, there were few happy endings. Patients like Agnes came and went. Came and went. The sound of the piano didn’t signal The End. No credits rolled. Nobody grabbed his coat and walked up the aisle toward the lobby. The only ending the music signified was the end of yet another stay in the hospital.

That was the reality as I saw it. All of it, the breakdowns, the admissions, the meds, the groups, the treatment plans and the discharge plans – they were all part of a process. And for many, Agnes among them, a never ending one at that.

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