Against Medical Advice

Copyright © 2008 by James Patterson

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

Little, Brown and Company

Hachette Book Group, USA

237 Park Avenue, New York, NY 10017

Visit our Web site at www.HachetteBookGroupUSA.com.

First eBook Edition: October 2008

ISBN: 978-0-316-03965-9

To the Angels

To Dr. Ruth Bruun, the angel who pulled us up when our own wings were broken. Your dedication to all of your patients who have struggled with Tourette's syndrome cannot be measured, and you are loved and renowned for your profound wisdom and very great heart.

And to Jessie, our daughter, who weathered a childhood filled with great sadness and great inspiration. And yes, one day we will go to Disneyland.

— Hal and Sophia Friedman

Cory's Dedication

In my thirteen-year search for help, I traveled to places far from home and met many people, young and old, with medical conditions so extreme that I could not have imagined they existed.

I will never forget these special friends and their heroic battles with the phantoms that inhabited their minds.

I understand them, and they understand me.

I hope that this account of my life, which in many ways might be similar to theirs, will give them and others like them a measure of comfort and hope. And I'm grateful to my father and to James Patterson for helping to tell my story to the many people who might benefit from it.

To those like me, who are forced to travel a road that few others can even conceive of, I wish you peace, and a way home.

—Cory Friedman

Preface

"ONE MORNING in MARCH of 1989, just before my fifth birthday, I woke up as a normal, healthy boy. By that afternoon, I had an irresistible urge to shake my head — continually — and the course of my life changed in ways few people had ever seen or could begin to understand.

"Before long, my body became an explosive, volatile, and unpredictable force with a mind and personality of its own. It jerked and twisted, bent in half, and gyrated without warning until I was almost always in motion.

"I bit down on my teeth until I actually broke them and howled in pain because of the exposed nerves.

"I twisted my back around with such force that I tore muscle tissue and had to be drugged asleep to stop myself from doing it.

"My mind fed me thoughts so frightening I couldn't even talk about them to my parents.

"It didn't take long before I saw myself as the oddest person in my town. I felt like a boy on the end of a puppeteer's string.

"What made it even worse was knowing that I was also the puppeteer."

This is the story of Cory Friedman, and what follows is his remarkable journey, a story of triumph against all odds.

I met Hal Friedman in 1975 in New York City, at the J. Walter Thompson advertising agency, where we were both writers. We never imagined then that more than thirty years later, we would collaborate to write a book about Hal's son's heart-wrenching experiences.

Over the years, I would hear about Cory and his devastating struggle with Tourette's syndrome, obsessive-compulsive disorder, and anxiety disorder. But until Hal asked me to read an early draft he had written of Cory's story, I had no idea how severe a torment this lovely family had been living through. I knew that his complex condition was nearly impossible to treat. In fact, thirteen doctors and approximately sixty potent medicines after Cory's first traumatic head shakes, his debilitating symptoms were still unchecked.

When the downward spiral of his symptoms led to severe depression and hopelessness, and when all of Cory's doctors and their advice and medicines had proved to be false hopes, Cory's family staged an intervention that was as daring as anything that had preceded it, maybe even more so.

I was drawn to Cory's harrowing story because of what it says about the power of love, courage, and determination, and I was proud to join Hal in writing it. I knew that Cory's story had to be told because it would give hope and comfort to so many others struggling in all walks of life. Cory was in a living hell, but in climbing out, he showed us that it is possible to survive — and even thrive — against unbelievable odds. For me, that makes him a hero.

Hal and I are honored to bring you Against Medical Advice on Cory's behalf. My hope is that you, too, will be inspired by the courage, heartbreak, sacrifice, and ultimate victory of Cory Friedman and his family, and by the sheer invincibility of the human spirit.

— James Patterson

A Father's Prologue

THE EVENTS RECOUNTED HERE took place over what seemed like — to those of us who lived it — an endless thirteen-year period covering Cory's life from age five to age seventeen. We decided, with Cory's blessing, to tell his story in his own voice, because this conveys most powerfully what it was like for Cory to live through these experiences.

Some names and other identifying details of friends, doctors, and medical institutions have been changed.

The extremely unusual events portrayed in this story have been reconstructed from Cory's own accounts, from detailed medical diaries that were kept by his mother throughout the period, and from direct family observations. Cory confirms that this narrative presents an accurate portrait of his life story.

Over the four years it took to write this book, I was continuously tormented by the decision of whether or not to make the most intimate details of Cory's life public. Finally, I went to Cory for the guidance I needed, and he resolved the issue in a single sentence, without hesitation:

"If it will help other people like me, yes."

—Hal Friedman

Part One

A LOST CHILDHOOD

At the Edge of Madness

Chapter 1

I'M SEVENTEEN YEARS OLD and lying like a pathetic, helpless lump in the backseat of our family car, being transported to a place that treats crazy people.

This is an exceptional event, even for me. I know that my brain causes unusual problems that no one has been able to treat, but being insane isn't one of them.

How and why I've gotten to this point is complicated, but the main reason I'm here is more immediate. I've finally found the one thing that brings me peace — alcohol.

Now this self-medication has become a life-threatening danger that I cannot fix by myself. The doctors at the place I'm going to promise they can help me. I've heard that one before.

After about an hour, we arrive at a large brick building with a sign that reads DRESSLER PSYCHIATRIC HOSPITAL. In a split second the reality of what's happening becomes very real and very scary.

"Why does it say that?" I call from the backseat, my heart suddenly pounding.

"Don't worry about the sign," my mother says to calm my rising panic. "They treat all different kinds of problems here, Cory."

Dad looks as worried as I am but says softly, "Let's not deal with this now, okay?"

Not deal with going to a hospital for psychos? Sure, no problem. What can my father be thinking?

Inside the main entrance, I enter a very crowded, somewhat noisy waiting room. Being on view always makes me uneasy, so as soon as I start to walk, my feet need to perform a triple hop, three quick steps only inches apart, which throws me off balance.

I have to do this in order to satisfy a tension that is building up in my legs and can't be released any other way. Sometimes this trips me up so much that I go flying to the ground.

I do the triple hop a few more times before reaching out for the safety of one of the empty waiting-room chairs.

Welcome to my fun house, folks.

Chapter 2

MANY OF THE PEOPLE in the waiting area are still staring at me as my right hand shoots up in the air with the middle finger extended. Oh boy, here we go, I think. Giving people the bird is another one of my involuntary movements, or tics, that pop up exactly when they shouldn't. Try telling people that one's not deliberate.

Another middle-finger salute. Hi, everybody!

For a moment I think about the new medicines I'm taking, which are, as usual, not doing their job. Wellbutrin for depression, Tenex to keep me calm, Topamax as an "experiment" to see if a seizure medicine will help. So far I've been on fifty or sixty different medicines, none of which have worked — and a few of them can become deadly when washed down with Jack Daniel's.

Psychiatric hospital. A place for insane people, I'm thinking.

I know I'm not insane, even though the things I do make me look that way. But I do have a fear that I can think myself insane, and being in this place could push me over the edge. Going insane is probably my worst fear. If it happens, I won't know what, or where, reality is. To me, that's the ultimate isolation — to be separated from my own mind.

Eventually a receptionist calls my name and then starts asking me strange, bewildering questions. One of my eyes begins to twitch rapidly, and my tongue jumps out of my mouth like a snake's.

Occasionally I make a loud grunting sound like I've been punched hard in the stomach. Often my tics come one at a time, but today they're arriving in clusters of three or four, probably due to the stress.

I once told my parents that they couldn't live through a single day with what I go through every day of my life, and that was when I was a lot better than I am now.

It takes another hour or so for my parents to be interviewed by a doctor. When they come out, I can see that my mother has been crying. My father looks exhausted and edgy.

When it's my turn with the doctor, I can't stop myself from shooting him the bird, too. The guy is good about it. He totally ignores it. He's young and gentle and pretty much puts me at ease.

"I drink more than I should at night," I tell him, skipping the part about almost burning down my parents' house when I passed out on the couch with a lit cigarette. "I guess I like to get a little tipsy."

This is the understatement of the year. Tipsy is my code word for totally wasted.

The doctor gives me a complete physical, and when it's over he says I'm as healthy as anyone he's seen, which strikes me as very funny.

"So I guess I can go now?" I joke, punctuated by an involuntary tongue thrust.

"Yeah, right."

Later, back in the waiting area, a male attendant approaches us and asks for any medicines we might have brought.

"What do you mean?" my father asks.

"He needs these," my mother cautions, taking out a large plastic bag crammed with pill bottles.

"The doctors will take care of that," the attendant answers.

Mom reluctantly turns over the stash.

A while later, a female nurse approaches and leads the three of us deep into the rear of the building.

Everything is a lot different here. It's darker and there aren't any people around. It's a spooky place.

I fight off a really bad feeling that I'm going somewhere I won't be able to handle.

Eventually we stop in front of a massive door with a sign that says JUVENILE PSYCHIATRIC WARD D.

Mental kids, I think.

"That's not me," I snap, pointing to the sign. "Mom, you know I'm not crazy."

The nurse says, "We get all kinds of people here," as though arriving at an insane asylum is an ordinary event in anybody's life.

"You're here for your drinking," Mom adds, "which they treat."

"It doesn't say that on the signs."

The nurse takes a large metal key out of her jacket pocket, and I freeze at the sight of it. I've never been in a hospital where the doors have to be locked. I come to a sudden realization: You don't lock doors to keep people out. You lock doors to keep them in.

Chapter 3

DAD GETS IT, too. He and I exchange fearful glances, and he lightly touches my arm.

The door opens as if it weighs a thousand pounds. When I refuse to move, my father holds on to my arm tightly and guides me into the ward. The main corridor is small, maybe fifty feet long, before it turns off at a right angle. There are no nurses, doctors, or equipment around, not like any hospital I've been in.

Three boys are standing together at the end of the hall. They stare at me and whisper to one another. Then they disappear.

A man hunched over a computer in a small office turns out to be the ward supervisor. He's dressed in very casual clothes and doesn't look like a doctor.

He keeps working for a while, and when he finally turns to us, I notice that his eyes are unfocused. He seems to be either stoned or a little retarded. If I didn't know who he was, I'd guess he was a patient.

After going over my papers, he leads the three of us farther into the ward. There are small offices on either side of the main corridor. One of them is for dispensing medicine and has metal bars over the opening.

We take a sharp right turn. All of the patients' rooms are off this corridor. There's also a common area with a TV playing, but no one is watching it.

"How many kids are here?" I ask.

"Right now, eleven. Never more than fifteen. That's a hospital rule."

As we pass by the rooms, I count about eight kids and have no idea where the rest are hiding. All are teenagers, none as old as I am.

The three boys I saw before appear again at the end of this corridor. As I get closer, they split up and walk past me, deadly serious. This is not a bunch I want to be around when the lights go out. And that includes the supervisor.

I'm getting more uncomfortable by the second. My skin is oozing a cold sweat. Hop. Hop. Hop.

I can't do this. I'm ticcing like crazy now.

In a moment we come to a large sign on the wall with rules printed in thick black letters.

NO TWO IN A ROOM

DOORS MUST REMAIN OPEN AT ALL TIMES

ALL ARTICLES IN THE PATIENT'S POSSESSION UPON ADMISSION WILL BE CONFISCATED

PERMISSION REQUIRED TO LEAVE PREMISES AT ALL TIMES

NO STANDING ON WINDOWSILLS

NO STANDING ON UPPER BUNKS

I wonder about this last one, then look up at the ceiling and understand. The entire area is covered with a metal grating. The openings in the grid are too small to put your hand through. This whole ward is a giant cage.

My heart is pounding as if it wants to jump right out of my chest and die on the hospital floor. How bad must this place be if people have tried getting out through the ceiling?

"I'm not staying here!" I shout to my parents. "Don't you understand? I can't do this."

I back away, then turn and start for the main door, the only way out.

I want to run but hold myself in check so it doesn't look like I'm trying to escape; I don't want anyone to come chasing after me.

"I'm not like these people," I call back to my father.

My sudden decision throws my parents into confusion. I think coming to a place that looks like this is as much of a shock for them as it is for me.

"I'm not crazy! This place will make me crazy."

My father's expression changes slightly, and I can see in it a small ray of hope. He seems sympathetic yet angry at the same time, and I can't read which emotion is winning.

"You can't give up without trying," he says finally. "Give it time to work out."

"I'm leaving. Didn't you hear me?"

"What choice do you have? Think about it. This isn't your choice anymore."

This message sends me into a rage. I'm spinning out of control. I'll crash my way out if I have to.

I quickly rush to the door and stop when I see that there's another golden rule on it, etched on a bronze plate. This one stops me cold.

NO ONE PERMITTED OUTSIDE AFTER 6 P.M.

My watch says seven twenty. We've already been in this so-called hospital for more than three hours.

I try the door anyway. It doesn't move, not even a jiggle.

My anxiety spikes way past panic. If they lock me up, my life will be over. I'll die of fear. People can die of fear. I've read about it.

"Take a few deep breaths and try to calm down," my mother says when she catches up to me. "I know you're scared, Cory. We'll work something out. We always do."

"I promise I'll stop drinking on my own," I plead, my voice cracking. I'm completely helpless, dependent on her — as usual. "I swear it. Please, Mom, I know I can do it on my own. Don't make me stay!"

Chapter 4

WE'RE BACK in the supervisor's office, and he's just returned after leaving us alone for a few minutes to talk. My parents are having a really hard time deciding what to do. My father is usually fast with decisions, but this one is giving him trouble.

Finally, he takes a breath and delivers the words I've been praying for. "We don't think this is what we need for our son after all. We had a different idea of the hospital before we came."

I'm joyous inside. My father has done a complete about-face and is now going to fight for me. I want to hug him.

Unbelievably, the supervisor isn't taking my father seriously. He shakes his head as if he doesn't care what my dad just said.

"I'd appreciate you letting us out," my father announces.

He has to say it again before it seems to sink in with the guy.

"It's not possible for Cory to leave," the supervisor reports without any emotion. "Once a patient is admitted to the ward, New York State requires a minimum seventy-two-hour stay. It's the law."

"But we're not admitting him," my father explains. "We're going to leave right now, before he's admitted."

"He's already admitted," the man says more strongly. "It happened when he came through that door. Seventy-two hours, no exceptions," he adds, delivering what to him are just simple facts.

To me the number of hours — seventy-two — is like a death sentence to be executed in slow motion.

My father jumps up. "I want to speak to the hospital administrator," he barks. When the supervisor still doesn't react, he says, "Let me put it another way. I demand to speak to the administrator."

The supervisor thinks about it, then shrugs and picks up his phone. In a minute he hands the receiver to my dad.

My mother and I look at each other nervously. Everything is riding on this next conversation.

My father takes the phone and tells the administrator what's going on. He listens for a long time, and my mother and I don't know what's being said.

"There has to be a way," he says finally, obviously very frustrated. "What if someone came here by mistake, like we have?"

The debate continues, and he's beginning to lose his temper, which isn't like him.

"Even a criminal can post bond and get out of jail. What do you want me to do, call a lawyer?"

My father keeps going at the administrator. It seems hopeless. Then, all at once, he stops talking. "Yes, I understand. Thank you. I will." He hangs up and turns to us. "Maybe" is all he says.

Mom and I are both surprised when we hear who he's calling next.

"Dr. Meyerson! Thank God you picked up."

Dr. Meyerson is my current therapist. It's an absolute stroke of luck that he has answered his phone this late in the evening. We usually get his answering machine.

"We have an emergency here, and you're our only hope," my father continues.

The two of them talk for a few more minutes as he explains the situation.

After a while he lets out a deep breath.

"Say it just like that?" he asks. "Exactly that way?" He nods to us, then thanks Dr. Meyerson and hangs up.

My father turns to the supervisor and announces defiantly, "I request the release of my son AMA."

The man cocks his head suspiciously but doesn't respond. Not a word.

My father repeats the special code letters, this time as an order. "We are leaving the hospital with our son AMA. I'm told you understand what that means."

In a moment, the supervisor nods reluctantly, then gets on the phone again.

While he's talking to someone high up, my father explains, "AMA is an acronym for against medical advice. It's a legal code that allows the hospital to go around the law. It means that we understand the hospital advises against it, and it shifts responsibility to us — the parents — and our therapist. It lets the hospital off the hook in case a patient . . . harms himself or something."

"You know I wouldn't do that," I reply, to reinforce his decision.

"It's the only way we have a chance of getting you out of here."

"And what if we'd never learned about AMA?" my mother asks. "Or if Dr. Meyerson wasn't around or didn't pick up?"

My father shakes his head. "We were lucky. Very lucky."

I study my father's face. He looks older than I've ever seen him. He's worn out. It's been as long a day for him as for me.

"Sorry, Dad."

He nods, but he isn't happy. "You know that we haven't fixed what we came here for."

It's not a question.

A long time later, the nightmare is finally ending. The supervisor is still waiting for whatever approvals he needs. My breathing has almost returned to normal.

Eventually someone comes into the ward with papers and the required signatures. The supervisor gets his key, and the thousand-pound door swings open again.

It's been five hours since we entered the hospital. I walk out the front door without looking back.

The ride home to New Jersey is silent. No one has the energy to say anything, and nothing we can talk about seems important compared to what's just happened.

My mother lets me smoke a cigarette, then a second one, and after that I fall asleep. In an hour or so, they wake me in New Jersey and I drag myself into our darkened house.

"I really mean it, Mom. I'm going to quit drinking," I tell her before going to bed. "I know I can do it."

I'm not lying. I really believe I can.

It's the middle of the week, and my resolve lasts until Friday night, when my body is again driving me crazy. After my parents go to bed, I sneak down to the basement and chug five or six big swallows from a bottle of vodka my father thought he'd hidden when he'd squirreled it away in the back of an armoire in the living room. In a short time, the bottle is only half full.

I fall asleep with my head reeling. Images of the psychiatric ward are getting hazier. I have a dim awareness that despite my honest desire to change, my absolute need to change, I won't be able to.

Something else is going to have to happen. And happen soon.

In the Blink of an Eye

Chapter 5

MANY YEARS BEFORE my narrow escape from the psychiatric ward, my mind begins to play terribly cruel tricks on my body. My life changes forever sometime before my fifth birthday, with a simple shake of my head. Just like that.

It starts as I'm playing a video game. I feel an unusual, intense tension building up in my neck, and I think the only way to relieve it is to jerk my head to one side. A little while later, the tension is back and I do it again.

Soon my head is twisting more and more often, and the muscles in my neck are beginning to cramp.

I'm starting to get scared. Remember, I'm not quite five years old at the time. I'm just a little kid.

I try to stop, but the more I hold back, the stronger I feel the need to do it. My parents are looking at me, wondering what's going on.

That makes three of us.

When I wake up the next day, my head shaking is more or less a continuous thing. By lunchtime I know that my mother and father are worried because they aren't talking as much as they usually do.

By the following afternoon, the three of us are on our way to see a doctor. My father is driving pretty fast, and it feels as if we're in a speeding ambulance. At first I think it's my pediatrician we're going to see, but it's not.

"Is it going to hurt?" I want to know, stepping into an unfamiliar office.

"No, honey. This is a doctor who just wants to talk to you. This is a talking doctor."

In her office, Dr. Laufton asks me a lot of questions, such as "Do you ever feel like you have extra energy?"

"I guess so," I answer, because I think that's what she wants to hear.

Looking back, I realize this wasn't a good question. How could a kid my age have any idea what extra energy feels like?

"Why do you think you shake your head so much?" she asks after that.

Just thinking about it makes the shaking more violent. "I don't know. It feels like it wants me to," I say in between head thrusts.

That evening, my mother gives me a little pill to take. It's called Ritalin. I fall asleep pretty fast, but in the middle of the night I wake up feeling very restless and frightened.