Saul was one of the first patients in San Diego to scream at me. I remember the first time seeing him. I went into the field with my nurse to see patients in their homes. We came to his independent living facility (ILF), which was house in a poorer neighborhood in San Diego. I followed my nurse, Annie, into the house, into the kitchen, down the hallway. She was calling out the patient’s name. He appeared from one of the bedrooms. There were other residents of the house watching us, not bothered by what is a very routine intrusion.
My patient, I’ll call him Saul, was angry about not having Artane, one of his medications. He spoke quickly, his eyes pried wide open; he was visibly dirty, his hair short but pushed up in strange directions. He was wearing an oversized camo jacket, a t-shirt and cargo pants. The conversation about medication changed course erratically. I tried to introduce myself but he looked at me with disdain and rambled on. Soon he was mumbling out threats about bombs, becoming more animated and difficult to understand. I followed Annie’s lead as we walked out of the house and Saul followed us. We got back into her car and Saul stood by Annie’s window gesturing wildly, now screaming about Artane and bombs. She offered him a bottle of water through her cracked window but he refused. She pulled forward carefully and we left Saul there standing in the street shouting. This was one version of Saul.
There was another version that appeared months later. I drove to a different ILF to see Saul. By this time I had begun seeing patients on my own in their homes. Saul emerged from a quiet house where I was not invited in. We sat in some lawn chairs on the driveway. He was silent, eerily so. I asked him all of my usual questions about sleep and mood and appetite and medication. His gesticulated quiet, one-word responses. He was losing weight. He complained of being hungry frequently. Since he appeared to have stopped using meth, I wondered if he was on too much antipsychotic medication and being dulled by that. I offered to reduce his medication and he agreed to this. I suggested supplementing with food from food banks but he quietly and hopelessly said the others in the house would eat it.
There was another version of Saul that was in my office only a few weeks ago. His hair was dyed jet black. He was wearing an ill-fitting sport jacket and a button down shirt. He was happy and relatively at ease. We went through the regular questions. His thoughts were linear and easy to follow. He wasn’t what anyone would describe as “normal” but he was good. Saul looked good and he felt well. A few days later he was dead from methamphetamine overdose.
I have other stories about my psychiatric patients that sound more like successes. I like telling those stories better. But what I’m really learning to appreciate is the wobble. The wobble is the the fluctuation between the ups and the downs, the victories and defeats, the moments when I feel my capability and the ones when I feel my weakness. I used to spend so much time focusing on those high points that I forgot about the beauty of the lower half of the curve. And there is beauty there.
Maybe we miss it because the cycle happens too quickly. A couple of days ago I got an upsetting text from my ex-husband. I responded reasonably, initially, but then I devolved. I felt justified. I probably was. That night was a bit of a tailspin. I chose to numb out the fear and pain rather than let it pass through me. I went to sleep early.
The next morning I woke to my alarm at 7am. There were broken rain clouds visible through my bedroom window. I could see the wind was blowing so there was a thought that I should stay in bed—a compelling, logical thought. I had another thought too: “You have R this weekend so this is the last morning for the next four days when you have the luxury of being able to walk to a coffee shop and sit and write.” This was enough to get me out from beneath the covers and on my way.
The morning air was crisp and the big clouds were more majestic than threatening. The little neighborhood coffee shop was buzzing with caffeine and good mornings. I sat down with my laptop to write and I pulled out what I had been reading the night before:
“Only birth can conquer death—the birth, not of the old thing again, but of something new. Within the soul, within the body social, there must be—if we are to experience long survival—a continuous “recurrence of birth” (palengenesia) to nullify the unremitting recurrences of death. For it is by means of our own victories, if we are not regenerated, that the work of Nemesis is wrought: doom breaks from the shell of our very virtue. Peace then is a snare; war is a snare; change is a snare; permanence is a snare. When our day is come for the victory of death, death closes in; there is nothing we can do, except be crucified—and resurrected; dismembered totally, and then reborn.”A Hero With A Thousand Faces, Joseph Campbell
I realized that I had been reborn in the morning. I shook off the night before and rose again. Maybe that is all we are asked to to. Rise again. Rise again. Rise again. The happy ending we dream of, we wait for, we anticipate with bated breath, maybe it’s just the transcendence of the rise. It’s the moment when I pop my head above the cloud cover and feel the warm sun on my face. Even as I know I will sink down under the gray layer again. It’s inevitable!
So the other night I was dismembered and the next morning I am reborn. The acceptance of this cycle/process feels free. It means that I don’t have to mire myself in shame, I can simply wake in the morning, wonder at my dismemberment for a moment, then shake it off and be born new. As I walked home from the coffee shop, I thought about the ways nature teaches this: the daily sunrise and sunset, the seasons, the lifecycles of plants, insects, animals. It’s like God was thinking, “I’ll just repeat this symbol absolutely everywhere I can so maybe they can get it.” There is beauty in the wobble. I see it, even in the life of my patient, Saul, who never freed himself from the numbing agents. I see it because I witnessed some of the occasions when he poked his head above the clouds and felt the sunshine on his face. And surly a God that teaches us to rise again in every iteration of nature, legend, scripture, folklore and fairytale, has made a way for us to rise again.