E sther’s Journey Part I

Esther woke up at 2 a.m. to find her 20-year-old son Duvi screaming in the front yard. She did the smart thing and called an ambulance to bring him to the local emergency room. Duvi received a cursory medical evaluation and was subsequently seen by the hospital’s overnight psychiatrist. After hearing Duvi’s concerns about the Mossad and some strange connections related to the lottery the psychiatrist recommended that Duvi be transferred to a psychiatric hospital for further evaluation and management.

At the psychiatric facility Duvi was reluctant to take medications at first. But when another patient told him that he might be stuck there all summer if he refused treatment Duvi decided he’d play ball. The doctors recommended a low dose of an antipsychotic medication which Duvi agreed to try on condition that he’d be discharged sooner rather than later. This was certainly a good thing as Duvi hated the hospital and his mother cried every day when she came to visit.

Duvi’s symptoms improved over the course of a few days and his treatment team started discussing discharge. Later that day Duvi admitted to the doctor that he had been smoking marijuana with a few friends the night he was hospitalized and the psychiatrist told him that this could have been the cause of his psychotic episode. The next day at his family meeting the psychiatrist told Duvi and his mom that he might not need the antipsychotic medication in the future if he could stay off of drugs.

Duvi left the hospital before Shabbos and even though Esther was happy to have him home she had no idea what to do or where to turn. Her son appeared relatively normal on the outside and kept talking about how he was looking forward to enjoying the last weeks of the summer with his friends before returning to college.

Esther a very bright woman — an educator at a local college and a community leader who had lost her husband to cancer a few years back — did the sensible thing and sent her son to see a world-renowned psychiatrist for ongoing treatment. But while the doctor was well known for his research Esther found the psychiatrist’s bedside manners and interpersonal skills to be lacking. The doctor was especially insensitive when he told her that Duvi would need ongoing treatment with antipsychotic medications and that the most likely diagnosis was schizophrenia.

Esther, heartbroken by this piece of news, sought a second opinion and that’s how she happened to find her way to my office. I saw Duvi for a 90-minute consultation where I reviewed his records interviewed him and shared my thoughts on his diagnosis and various treatment recommendations. When we were finished I planned to see Esther to offer the same information and to answer any other questions she might have.

Esther was known as a rock to her friends and was always there to help problem-solve or at least to serve as a shoulder to cry on. Even when she lost her husband she’d kept on giving to the community and remained the family’s stabilizing presence — she’d been there to raise grandkids and marry off her youngest daughter. With her other children doing well and having started families of their own Esther had garnered a reputation for wisdom and resilience and became a sought-after source for counseling young women on marriage motherhood and dealing with unrealized expectations. But now she was on the other side of the table — a mother with a son who had just been discharged from a psych ward after his first psychotic episode. The hospital’s psychiatrist had left her in limbo and the world-class doctor had left her crushed. Esther had dozens of queries but as I answered questions about genetics side effects and percentages it was very clear she wasn’t listening to anything I was offering before she burst into tears.

I handed her a box of tissues and asked “Do you want me to tell you that it’s going to be okay?”

“No I just want the truth. If he’s going to be a chronically crazy street person I’d just rather know it now and get used to it.”

“He’s not going to be a ‘chronically crazy street person ’ ” I told her. “Not because I know for sure what will be but rather because it’s clear to me that he has a loving mother who is willing to work together with him to ensure that he gets the highest quality care.”

“The first psychiatrist told us he just needed to stay off of drugs and now the other doctor told us he has schizophrenia and would need to keep on taking medications ” she sobbed. “What are you telling me?”

“Well ” I said “It’s certainly a possibility that Duvi is suffering from schizophrenia but we won’t know for sure until after we’d seen how he recovers over the coming months.”

The bottom line was that Duvi was a human being and whether or not he had schizophrenia he was a person first — and her child. “I’m going to tell you a story before I tell you anything else ” I said.

I offered Esther a cup of water and she took it. I waited for her to make a brachah and then continued “Many years ago Rav Ovadiah Yosef had a granddaughter who was very ill. After extensive treatment the doctors told his son to come to the hospital to say goodbye. When Rav Ovadiah heard this he came to the hospital full of fire and walked right up to his son to tell him ‘Hashem gives doctors the right to heal patients but He never gave them the right to tell others to give up!’ From there he went straight to his granddaughter’s bedside and prayed with tremendous concentration.”

Esther interrupted me “So what are you telling me Dr. Freedman?”

“I’m telling you not to give up hope. You’ve always been a woman of faith and I know how much chizuk you give to the community.”

She sighed. “I like the story and I appreciate your compliments but what about my son?”

I told her the truth. “Look I can’t know for sure what will be. On one hand he’s got a lot going for him in that he’s smart motivated has family support and is generally a healthy kid. But on the other hand there are always a bunch of kids out there smoking marijuana once they come back from college and for some reason Duvi was the one who ended up in the hospital that night. But what I know for sure is that that you need to stay positive for Duvi and for yourself.”

“So it wasn’t just the marijuana?”

“Again we can’t know. We don’t have blood tests or even stethoscopes to figure this kind of thing out. All we have is the good news that he’s currently without symptoms and has been so since he left the hospital. That’s very good news. We’ll just have to wait and see how he responds to the treatment over the next few months.”

“I’m even more confused now ” she said justifiably.

“For kids like Duvi ” I explained “it’s too early to say ‘schizophrenia ’ but it’s too late to say ‘just a bad reaction to marijuana.’ He’s somewhere in between and the main thing right now is to keep him sober and engaged in treatment. That’s why I’m recommending for him to continue his medication for now and for him to have ongoing follow-up with a psychiatrist even after he goes back to school.”

“And what should I do in the meantime?” she asked.

“We’ll stay positive together and I’m going to be here in case you’d like to come back and speak with me again. For whatever it’s worth Rav Ovadiah used to say that one of his greatest joys was watching that same granddaughter grow up into a woman blessed to raise her own family. Nothing is impossible when Hashem is in charge.”

Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham a national leader providing mental health treatment and outreach within the religious community. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.