Praying for Sleep

patient for merely five months but her insights into his plight, and his improvement under her care, were inspiring. It was, Kohler reflected, a true tragedy that no one would ever know how effective Muller’s treatment of Michael Hrubek might have been.
    Like Kohler, Anne Muller divided her time among various hospitals and happened to have come across Michael at a small state facility where she worked with severe schizophrenics. Impressed by his intelligence and struck by his unusual delusions, she campaigned to pry open the doors of expensive Trevor Hill and have Michael admitted as a pro bono patient. The hospital administrators—preferring patients that were more “mainstream” than Michael (that is, able to pay their bills)—had resisted her efforts at first but had finally acquiesced, largely because of her own prestige and talent and pigheaded manner.
    His first day had been spent in a restraint camisole. Then he’d calmed and the feared garment had come off. Kohler glanced again at Muller’s notes, jotted in the first week of the young man’s commitment:
    Pt. is hostile & suspicious. Afraid of being struck. (“You hit me on the head, you’re one dead fucker, make no mistake.”) No apparent visual hallucinations, some auditory . . . Motor activity is extreme, restraint at times necessary. . . . Affect flat or inappropriate (Pt. began sobbing when noticed book of American history; later Pt. laughed when asked about maternal grandmother and said she was “one dead fucker”) . . . Cognitive functioning good but flights of ideas indicate purely random thinking at times. . . .
    Although the many state hospitals in which Michael had been committed undoubtedly blended together into a grim stew of memories, Trevor Hill might very well have stood out pleasantly in his mind. In state facilities, patients wore filthy clothing and sat in drab rooms with blunt crayons or Play-Doh for entertainment. Many of the men and women had the indentations of lobotomies on the crowns of their heads and were regularly third-railed by electroconvulsive-shock technicians or sent into insulin comas. But Trevor Hill was different. There were far more orderlies and doctors per patient than in the state hospitals, the library was full of books, wards were sunny and windows unbarred, the grounds landscaped with trim paths and gardens, and rec rooms stocked with learning toys and games. ECS was used occasionally but medication was the major tool of treatment.
    Yet, as with all schizophrenic patients, getting the right drug and dosage for Michael was a major task. One young resident at Trevor Hill had naïvely asked him what medicines he’d taken in the past and the patient answered like a diligent medical student. “Oh, lithium. Generally, chlorpromazine and its derivatives are contraindicated for me. I’m a schizophrenic—make no mistake about that—but a big component of my disease is manic-depression. You may know that as bipolar depression. So, lithium has generally been my drug of choice.”
    The impressed resident prescribed lithium and under the drug’s effect Michael went berserk. He threw the ward’s television through a window, leapt out after it and got halfway through the main gate before being tackled by three burly orderlies.
    After this incident Dr. Muller took over treatment personally. She put Michael on a loading dose of Haldol—a dosage larger than he would ultimately need but intended to stabilize him fast. He improved immediately. Then began the fine tuning, balancing the drugs’ effectiveness against the side effects of weight gain, dry mouth, the uncontrollable moving of the lips that antipsychotic drugs cause, the nausea. His regimen included, at various times, Thorazine, Stelazine, Mellaril, Moban, Haldol, and Prolixin. Thirty milligrams of this, one hundred of that, up it to two hundred, no, better mix it. Eighteen hundred of Thorazine, no, go higher, switch to Haldol, ninety milligrams of it, well, that’s the same as forty-five hundred of Thorazine, too high, how’s his dyskinesia? Okay, back to Stelazine . . .
    Muller finally settled on what Kohler himself found worked best with Michael: high levels of Thorazine. Michael’s treatment consisted of this workhorse drug and his therapy with Dr. Anne. She met with him every Tuesday and Friday. And what was distinctive about his sessions with this psychiatrist was that unlike so many of his doctors in the past she listened to what he had to