When I was in medical school, my younger brother, Tim, traveled to Berlin for his art. He was thrilled to meet his artistic heroes and experience Europe with his girlfriend.
Landing back in Seattle, he texted, “Flight was perfect. Just for me.”
“So glad!” I replied. “I’m ready for pickup duty.”
“They’re escorting us out,” he wrote.
That sounded ominous, but everything seemed routine as I loaded the tired and hungry duo into my car.
As we drove off, however, Tim said, “It was totally amazing! All the best artists were there and wanted to meet me. They were obsessed with our pet pug, Paris. Every time I showed them a picture it was like something magical happened. They all could tell that Paris connected everything in the world. And then, on our flight home, the pilot called ahead to make sure the landing was special for me, and the plane landed, and they all knew we were home.”
In the rearview mirror, I raised my eyebrows in alarm at his girlfriend, who nodded, looking anxious.
“Tim, what do you mean ‘They knew?’” I said. “Who are ‘They?’”
“The important people,” he said. “They set it all up. It was beautiful.”
We stopped at a diner, and when Tim went to the bathroom, I asked his girlfriend, “When did he start talking like this? What happened to his mind?”
She said he hadn’t been sleeping much in Berlin and that his thinking had become increasingly bizarre. She wasn’t sure if he’d been hearing voices, but he was convinced people were following him and muttered to himself in a way that worried her. She wiped her tears away as Tim emerged from the bathroom.
I wanted to take him directly to a doctor, but he was uninterested.
“How about you take me to the skateboard shop?” he said.
Skateboarding was Tim’s early love. In middle school, he and his buddies would either be out skating the streets of Boise or encamped in our basement watching skateboarding movies.
Sitting in that diner booth, I remembered what I had learned in psychiatry. I knew Tim had to consent to an emergency room visit unless he posed a danger to himself or others or was “gravely disabled,” meaning unable to care for his own basic needs. Despite being dramatically altered and delusional, Tim was none of these.
I promised to take him to the skateboard shop the next morning, something tangible to buy me more time to get him some help.
After dropping them off, I called our mother, who turned the tables and asked me — the medical student — what to do. I spent my days poring over textbooks, anticipating questions my supervising doctors would ask, in charge of nothing. Thrust into the new role of family medical guide, I felt lost.
I wasn’t sure what my brother needed, but I knew it was more than I could give. I called a few mental health clinics, but without a prior diagnosis, they said they couldn’t see him — a maddening Catch-22.
I picked him up the next morning, a few hours of total sleep between us. He talked boldly about the magic of the world and kept glancing at a gray car he thought was following us.
A bit of new skateboard gear later, Tim finally agreed to come with me to talk to someone about his trouble sleeping. I took him to the only place I knew, the emergency room where I had just spent a month learning emergency medicine.
I felt vulnerable in a very different way from when I first donned a short white coat and entered these same doors. As a medical student, I worried that I wouldn’t know how to help patients. Now I was terrified that they wouldn’t be able to help my brother. After I registered Tim, I whispered to the nurse: “I’m not sure how long I can convince him to stay.”
She got us right in. We waited in a bare room, Tim pacing restlessly.
Just as Tim demanded to leave, the psychiatrist came in. She thought his condition was either a drug-induced psychosis or a new psychotic disorder, something only time could sort out. She found no compelling reason to hold him and sent us off with a prescription for a sleep aid and a handout of mental health resources.
I was 26, and I walked out with the weight of my 23-year-old brother’s psychosis on my shoulders. I called every number on the handout, all unavailable. The earliest appointment was weeks away.
I had been taught that someone with a psychotic break needed prompt evaluation and treatment. I called the psychiatrist, and she reiterated that there was nothing more they could do. I politely got off the phone and then yelled in frustration.
Over the next year his diagnosis was confirmed: schizophrenia.
Tim started medication, which helped for a while. He was never quite himself, though. He broke up with his girlfriend and stayed in Boise.
Over time, Tim’s paranoia ramped back up, and he was unable to live a “normal” life. He took his medications, had them adjusted when the voices in his head became louder and more frightening, and watched his world shrink.
These days, many years later, Tim lives alone in a small house, a living situation made possible by our mother’s daily care for him. Even at his most organized, he is unable to hold a job or interact meaningfully with more than a few known people. When I join my mother on one of her visits, Tim tolerates a few minutes of conversation with me on his doorstep.
“How are you?” I ask. “Doing some art?”
“I’m fine,” he says. “Some art sometimes. Mom comes by every day. Mom, what time tomorrow?”
“Nine,” she says.
“OK then,” he says. “Good to see you both. I have to go. Mom, tomorrow at 9?”
“Tomorrow at 9,” she says. “With your coffee.”
“With my coffee,” Tim says. “Nine tomorrow. Good.”
“Good to see you, Tim,” I say. “I love you.”
“Bye,” he says, then retreats inside.
Tim was always our artist. When he was 6, he started drawing comics, including one of a pig in a pen who was nonchalantly smoking a cigarette. On the side, he added a hand with a pointer finger aimed at the pig. His caption read: “Thers No Reeson That PiGs Cant SMock.” I was tickled to find this comic years later and had it printed on a T-shirt.
The evolution of Tim’s reality has been reflected in his art. In art school, his works involved playful colors and geometry with a graffiti influence that led to a gallery job and that trip to Berlin. After his diagnosis, his canvases morphed into increasingly distorted perspectives and disturbing monsters.
Today, as an emergency physician, I often care for patients with psychiatric conditions. Recently a family brought in their 22-year-old son when he started hearing voices. He wasn’t a danger to himself or others, and he adamantly refused hospitalization, so both involuntary and voluntary pathways to admission were closed.
I spent hours calling psychiatrists before finding one who would see him quickly. I can still see the expressions on his parents’ faces when I told them that the best we could offer was a clinic visit later that week. I told them I understood how hard it is to navigate the mental health system for a loved one, and that they were doing the right thing. I apologized for our broken system and for what was happening to their son. They couldn’t know how deeply I felt it.
Another young woman brought in by her parents was convinced that the C.I.A. had planted electronic chips in her brain, and upon meeting me she determined that I was also C.I.A.-affiliated. I spent most of a busy shift working out a plan for her. That time I had more luck, as the on-call psychiatrist agreed that her illness warranted hospitalization. It felt like a win, but only for that day, because I knew their family was just starting the long, painful path of dealing with this disease.
Now, many years since Tim’s visit to my emergency room, I still see the place through his eyes. I care for Tim when I care for others suffering from mental illness. When I bring them a sandwich, a warm blanket or a dry pair of socks, I feel like I’m doing so as a family member. I remind my medical students and residents that our patient, who may say bizarre things that make them want to laugh, cry or run away, is someone’s child, sibling or cousin.
This is my way of loving my brother, of expanding our relationship beyond a few minutes on his doorstep. I wish Tim could understand how much better a doctor I am because of him. For him, really.
The post My Brother Has Schizophrenia. This Is How I Love Him. appeared first on New York Times.
