SECOND OF THREE PARTS
Gretchen Ertl for the Boston Globe
Days of crisis, compassion, faith, and futility
There may be a more exhausting journey than that of the mentally ill, their families, and their caregivers. But for those locked in the cycle of hopes raised and dashed, it’s hard to imagine what it could be.
This is part two of a three-part series chronicling a young man’s struggle with the mental illness that took control of his life at age 17, pressing him, his family, and the health care system to the limit. It is a tragically-too-common story; it is Michael Bourne’s story.
It took hours for Peggy to learn what had become of her son. That morning, Mike had gone as usual to his day program, where people with mental illness socialized, took classes, and had access to counselors. But he’d gotten angry and screamed at a staff member.
So the staff member sent him to the hospital, under a state law known as Section 12.
Only one month had passed since Mike Bourne had been discharged from his last long hospital stay. His family — his mother Peggy; his aunt Rhonda — had been optimistic that he would remain well. But they knew there were no guarantees, after years of living with his mental illness. And now, as springtime blossomed, Mike was getting sick again.
The Section 12 law, which allows doctors, police, and a few others to send someone to an ER against his will, could only be used if the patient was judged a serious danger to himself or others. It was a step not taken lightly. An ambulance pulled up, and Mike was escorted outside.
But in the emergency room at Norwood Hospital, clinicians soon concluded that Mike posed no risk of serious harm. He was “not suicidal or homicidal,” they wrote in his record. “He would like to go home.” A doctor gave him Ativan, an antianxiety drug, to calm him down, and released him the same day “with his condition improved.”
Mike’s girlfriend was a patient elsewhere in the hospital, still recovering from a blood clot in her lung. He went up to her room. Renee called his mother to let her know he was there, and Peggy sped to the hospital to pick him up. In the car he was upset; people were trying to steal his freedom, he said. He vowed never to go back to the day program. Then he lunged at the car door and jumped out. Peggy circled back and picked him up again, unharmed.
Later that night, Mike called the police. “I don’t know if I should take my meds,” he told them. “Some of my friends have died.” He was sure the pills were dangerous.
Take your pills, the dispatcher advised.
The next morning, Mike was up early, and he was wearing his suit. It was never a good sign.
ELOPEMENT RISK, read the sign on the heavy, locked door of Unit 36. The sign told visitors to make sure the door closed behind them. If they didn’t, someone inside might escape.
Mike had been born here on a July morning in 1979, back when this wing of Norwood Hospital was the maternity ward. It was here that his grandmother had been the first to hold him, gazing down adoringly at the 10-pound baby.
Now, against his will, he was back.
He’d gone to his day program again that morning, despite his vow the day before. But for a second consecutive day, he’d blown up at a staff member. For a second time, he’d been ordered into the ER. This time, though, a doctor decided to admit him to the hospital’s psychiatric ward.
Mike sat in a small, bare room where patients met with their visitors. He wore a vest and a suit jacket; his hair was smoothly slicked back. He could not understand why he had to stay here. Yes, he had gotten angry, he had screamed and cursed — but did that make him dangerous? It wasn’t his fault but the staff member’s, who had insisted on rehashing his outburst from the day before.
“What, I can’t yell? I can’t swear?” he loudly demanded. “I’m an American citizen and I’ll say whatever I want. As long as I don’t use my fists, what does it matter?”
He seethed, shifting uncomfortably in his chair. Since he first got sick in 1996, Mike had been confined in this hospital so many times it wasn’t worth counting, and now he was recalling all his old grievances against the ER staff. He claimed that a nurse had once ignored his pleas for water as he lay helplessly in restraints, and that on another occasion staff members held him down and inserted a catheter by force. A technician who took his blood, he was convinced, had tried to choke him with a hand around his throat. The hospital investigated, found no evidence supporting his claims, and said that in one of the instances Mike was highly agitated and had to be restrained.
Something worse had happened too, Mike claimed, a thing he could not get out of his head, even if no one but his mother and his girlfriend believed it. It had happened some five years before, he said, when the hospital, now part of the Steward Health Care System, had a different owner. He claimed an ER security guard — mad at Mike for being disruptive — had pushed his face into a body on a gurney, telling him the patient died because Mike refused to stop yelling.
“What, I can’t yell? I can’t swear? I’m an American citizen and I’ll say whatever I want.” — Mike Bourne
The hospital found no evidence of that, either. But Mike was consumed with the horror he said he had felt. When he encountered the same guard in February, Mike had lashed out, punching the man in the face. “Now we’re even,” he remembered saying. The outburst had brought an assault charge, still outstanding against him.
The hardest part of being mentally ill, Mike often complained, was that no one ever believed what he said. “No jury would ever take my word,” he said.
And here he was, feeling imprisoned in this place again. He rocked back and forth in his chair, his hands clasped in his lap. He was still suffering the same nagging pain from the biopsy in his mouth; the staff had given him some Orajel.
“Orajel,” he sneered in disgust. “At least in the Civil War, if they cut your leg off, they gave you alcohol.”
The psychiatrist here had evaluated him, Mike said, and told him he could leave on Monday, if he didn’t cause problems over the weekend.
Mike intended to do just that. He would keep his mouth shut, get out, and return to his work, trying to restore America’s lost greatness.
“I’m just trying to change the world, to make things better,” he said.
A few miles away in her living room, Peggy hung up the phone. She sat on the couch feeling paralyzed. Mike had called her from the hospital, asking her to bring him a coffee from Dunkin’ Donuts.
She didn’t like giving him caffeine when he was sick. She thought it made his symptoms worse.
“Can it be decaf?” she’d asked him nervously.
Mike had exploded at the suggestion.
Sitting there alone, she felt overwhelmed by grief, the weight of all these years, all these disappointments. She’d had such hope when he came home in April, but it was turning out like it always did. All she wanted was to care for her son, to give him what he needed to stay well. But time after time, it came to this — his anger, just below the surface, and her constant, cautious efforts to avoid provoking him.
It was exhausting, and so complicated, when every interaction was so fraught with tension. She longed for the better times, when he was well, when they laughed together and he told her that he loved her. Her mind traveled back to his childhood, so far away and yet still so vivid.
Mike had been a performer, a boy with a spark, funny and mischievous and full of energy. “A joy to be with,” as his grandmother described him.
Peggy wanted that boy back.
She gathered herself for the trip to Dunkin’ Donuts. Maybe she should bring him decaf without telling him. Maybe she should just give in — it was only coffee. As she mulled her options, an unwelcome thought appeared: as long as he was still like this, she did not want him home.
Rhonda could see they needed to try something new. Mike was sick again, and he needed to be treated — not for a day or two, but for long enough to help him. And Peggy was struggling, trying to cope on her own.
Decades ago, when big state hospitals were in charge of mental health care, patients had case managers who tracked them after they got out, coordinating their services and staying in touch with their doctors. Now outpatient care has been outsourced by the state, to a dizzying array of private providers. Communication between them can be spotty. There are still some state caseworkers, but their services are not available to all, and for those who qualify, the help is optional. From Mike’s perspective, caseworkers had been most visible at discharge, offering help with things he didn’t need, like getting food stamps or finding an apartment. After that, Mike and Peggy said, the most caseworkers seemed to do was call once in a while.
Though he was in the hospital now, it wasn’t likely Mike would stay there long. Norwood Hospital was not equipped for long-term care. For that, the staff would have to send Mike to another hospital, and Rhonda suspected that wasn’t likely. Over the past dozen years, the number of state hospital beds for adult long-term care declined by roughly half, to 626. The downsizing saved money, and improved many patients’ lives, closing some hospitals that had been rife with mistreatment. But it also meant patients like Mike sometimes waited for days in emergency rooms. Or, Rhonda feared, the ER might send them home instead.
“Yes, the community is the best place for people with mental illness,” she said. “But when they can’t manage in the community, it needs to be dealt with.”
Rhonda called the private hospital in Quincy where Mike had most recently been treated. They said they were willing to take him back. They could get him stable, Rhonda thought — they had done it before — and then they could draft a different discharge plan, with someone other than his mother to monitor his meds.
That would be the key, she thought, to making next time different, for Mike and for Peg.
First, though, they had to find a bridge, to get Mike there. Neither his mother nor his aunt could check him in against his will. Mike was an adult without a guardian, legally in charge of his own care — and the last thing he wanted was a long hospital stay. That left his family dependent on a doctor or a judge. They needed Norwood to take the initiative.
It was complicated for hospitals, too. They had to respect the rights of patients — if patients aren’t deemed a danger, they have to be let go — and there were legal hurdles to clear if they pursued further involuntary care, by petitioning a court to commit a patient.
Hospitals don’t have to listen to family, and often they hadn’t. But Rhonda made the phone call anyway, and asked a staff member at Norwood to consider sending Mike to Quincy. She knew it was a long shot, but it felt like doing something.
“Yes, the community is the best place for people with mental illness. But when they can’t manage in the community, it needs to be dealt with.” — Rhonda Bourne, Mike’s aunt
As Rhonda had expected, nothing came of her plea. Mike was released from Norwood Hospital on Monday. A doctor noted that Mike denied having harmful thoughts and showed no psychotic symptoms. The psychiatrist met with Peggy to discuss any concerns.
The doctor also prescribed different medications. But it didn’t matter. Mike wasn’t taking his meds anyway.
Almost as soon as he got home, his neighbors started complaining again to police. He was arrested and charged with disturbing the peace. A judge sent him to a different emergency room, in Brockton. But its psych unit was for people 55 and older, so he couldn’t be admitted.
The hospital could, however, find him a bed elsewhere and send him there against his will for three days under the law. If a doctor at the psychiatric hospital thought more care was needed — and Mike did not consent to be treated — the hospital could petition a court to order a commitment.
The Brockton hospital kept Mike in the ER for two days, then released him. Now he was home again, back on his front porch.
His feet, in sneakers, were propped up on the railing. He was shirtless, in a Red Sox cap and shorts. It was blazing hot. His neighbor Dave, a tough and wordly veteran of the music industry who’d had his own conflicts with neighbors on the street, leaned on the railing smoking a cigarette.
“I’m sick of this shit,” Mike said loudly, his gaze fixed on the house across the street. “Someone keeps calling the cops on me.”
“Michael, this is why,” said Dave, his voice weary and exasperated. “Yelling and screaming is not going to do anything except get you in trouble.”
“What am I supposed to do?” Mike asked.
“Just talk like we’re talking now,” Dave said. “Chill out.”
It sounded easy, but it was so hard. There were too many thoughts careening through Mike’s head; so many things he needed to take care of. He felt harrassed by his neighbors, boxed in by their constant complaints, and the feeling fed his mounting anger. He was worried, too, about terrorists — he thought they had slipped into the suburbs undetected — and it was his mission to let people know. But his neighbor didn’t want to hear it. Dave went into his apartment and shut the door.
“I’m sick of everybody in my life,” Mike said. “I work better on my own.”
The phone rang and Mike grabbed it. It was his mother, calling to check on him.
“I don’t need your help!” he screamed, his voice a furious roar. “Goodbye! Go to work! Go to work!”
“I’m sick of everybody in my life. I work better on my own.” — Mike
At her office in Norwood, Peggy hung up the phone, startled by Mike’s unchecked anger. She was finding it hard to concentrate at work. She was distracted, full of fears for her son.
The chaos was accelerating, and she could barely keep up. Every night she tried to reconstruct the day’s events: combing through the mail, playing phone messages, searching for clues.
The day program had sent a letter. They were done with Mike; he could not come back, after the two disruptive incidents. For Peggy, the news seemed to open a perilous gap. It was only May — the summer stretched ahead — and Mike’s days would be empty and unsupervised.
She prayed a lot.
Lead me, God. Where are we going now?
Mike was still on the porch as evening fell, the light growing longer, neighbors coming home from work. He watched them getting out of their cars. Then he called out to one of them.
“Do you love me or no?” he asked in a jovial tone.
The neighbor turned toward him, wary and uncertain.
“Sure,” she said after a pause.
“I don’t know why they hate me so much,” Mike remarked under his breath.
He went inside the house and came back with a fistful of old photographs, pictures of high school parties he had hosted; smiling girls and rows of open beers. One photo showed an old girlfriend he’d met at Mad Maggie’s, the pool hall where he’d worked for years. He had loved that job. He lost it when he got sick.
A Madonna song came on inside the house, the bright thump of “Holiday” floating out to the porch:
You can turn this world around
And bring back all of those happy days
Put your troubles down
It’s time to celebrate
Mike was quiet, looking at the photos. They were souvenirs from the time before. The time when everyone liked him. When he was like everyone else. He didn’t have that anymore, but he did have something. The yellow brick road, the way he felt off his meds — at least he still had that.
Later on the police were back at the house, responding to another noise complaint. They stood in the living room and watched as Peggy handed Mike his pills and he swallowed them.
In the morning Mike walked across the street to talk to the neighbors who lived there. “Why do you keep calling the cops on me?” he asked.
Because you’re disturbing the peace, the women said, according to Mike. Because you’re using obscenities.
That afternoon when his mother got home from work, Mike was on the porch with his music on. In the sunny driveway, on her way into the house, Peggy paused to dance for a minute with her son — a show of support, a message to the neighbors, that they stood together, without shame, with love.
When night fell, though, her moment of boldness was gone.
She could feel him getting worse. And she was afraid.
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