OTHER WRITING

 A Birthday Duet

I had been waiting for the other shoe to drop since September 2014 when my 21-year-old son went AWOL from residential treatment in North Carolina. Max had unraveled about a year earlier as a college freshman in Olympia --- a result of copious amounts of alcohol, various recreational drugs, mania, and complete deregulation. A three-week stint in a highly regarded psychiatric hospital in Salt Lake City produced a copious discharge report citing bipolar disorder, addiction, and a host of anxiety issues. My hope was that the residential treatment program in North Carolina would reset my handsome boy with the chocolate brown eyes.

Always motivating me forward was my unshakeable belief that Max wanted to be well. No matter that he scoffed at sobriety and grew tired of the structure imposed by treatment. It wasn't enough that in North Carolina he had made friends and the staff had quickly warmed to his charms. His tennis had improved and he learned to play the djembe drum.

Apparently, he figured that six months was more than enough, so he used what little savings he had to buy a plane ticket and return to Olympia, crashing on couches and drinking his way back into mania. We had embarked on the "relapse is part of recovery" path.

The dreaded call came two days before my 64th birthday in April. "Max was at a party at Nate's house last night,” my husband, Robert, reported after hanging up the phone. “He slept over, and this morning he was running around half naked, trying to hump someone. He wanted to stay and help clean up after the party, but Nate asked him to leave. He said everyone likes Max, but his friends are really worried about him."

As I listened to Robert, my emotions toggled between fear and faith and this paradox catapulted me into action. We bought our own plane tickets and headed north to Washington.

I had always wanted to be a mother. I met Max's father, Philip, at a mutual friend's wedding. After dating him for a year, I consulted a fertility specialist.   My 40th birthday was approaching and I was concerned that time was running out. The doctor advised me to start trying to conceive and recommended that I negotiate with Philip before choosing to use an anonymous sperm donor.

 Philip was young, good-looking and fun to be with, but he only lived in the moment. He wasn't ready to be a father. Nonetheless, my longing became a dull ache I faced each morning as I sipped my coffee. At last, Philip agreed to help me have a child, convinced I would be a superlative mother, even if his own role was still to be determined.

The first year of Max's life was a grand adventure; neither Philip nor I wanted parenthood to curtail our penchant for exploration and spontaneity. The three of us traveled together throughout the summer, crossing the country in our Volkswagen camper and eventually flying to Europe. When Max turned one and I wanted more security for my son and myself, Philip was ambivalent. We decided to live apart and he quickly found another partner.

It was very hard for me when Philip left, but my ability to care for Max, both physically and emotionally, never wavered. It was so much easier to address my son's needs than my own. This pattern of tending to others ahead of myself echoed aspects of my childhood. My parents were deeply committed to me and my siblings, but I could not be wholly myself when I was with them. My father was often depressed, and even as a young child, I was aware of wanting to make him happy and to ease his mind. My mother also cared deeply for us, but her need to make everything okay meant that she was unable to take the time to really listen when I was struggling. There were times when I didn't feel protected by either of my parents. Perhaps as a result, I wanted Max to always feel free to express himself to me. To be open and honest and for me to be able to hear whatever he had to say.

Max was not even two years old when he and I moved from Marin County back to San Francisco. I explained the move in great detail, having decided that it would be best for both of us to return to the city where we had good friends and lots of support. We had been living in Marin for just under a year, primarily to be closer to his father. Philip, however, was on to his next chapter.

Max's tears came quickly and as he ran circles around the packing boxes, he yelled at me. "How will my Daddy know where to find me?" I held him close and reassured him, but I was very worried about the effects of his having a father with no clear commitment to his son.

 When Max was in pre-school, I consulted with a well-regarded child psychologist. He advised me that the infrequent visits that Philip refused to plan ahead could be more harmful to Max than not seeing him at all. And so, there was a period of time in which Max did not see his father. When Max started kindergarten, Philip agreed to consult a therapist with me in order to discuss his being a more reliable part of his son's life. Eventually Philip made a commitment to see his son every three weeks.

Over time I had become concerned that Max had an unusual amount of difficulty calming himself to focus on the present moment. This mostly meant he raced around the house at the prospect of company coming for dinner, was sometimes less than welcoming when new friends entered his space, but also unhappy when not included. He was sensitive to transitions and rejection. The child psychologist suggested a round of neuropsych testing to get a clearer picture.

Dr. Gibson, a kind and reputable neuropsychologist, noted that Max interpreted the inkblots of the standard Rorschach test as bloodied people falling out of airplanes that were full of holes. The people were on fire as they fell to the ground. This image and others like it were frightening or disjointed. The testing occurred in April 2002 and the events of Sept. 11, 2001 had occurred only 6 months earlier.

Although I believed Max had been protected from the reality of these tragedies, it was clear that Max's responses were consistent with children who become overwhelmed by their thoughts and are very anxious. Dr. Gibson recommended that Max work with a talk therapist and spend more time with his father. I gave Philip a copy of the report and though he called Max more often, their visitation schedule did not change.

At this point in time I had been dating Robert for two years. He offered to pick Max up from school and take him to his therapy session. Robert liked routines, and he and Max developed a rhythm. They chose snacks at Walgreens, drove to a set of tennis courts within walking distance of the therapist's office, and played together until Max's appointment.

I appreciated Robert's steady presence in Max's life. As a neuropsychologist himself, Robert understood how important it was for Max to develop secure attachments to the important adults in his life.

 Robert's son was fifteen months younger than Max and we slowly began to blend our families. It was challenging, however, for me to trust Robert. Since Max's father was only peripherally involved, I was the parent with the strongest financial and emotional ties to Max. I was protective of Max and, though being a single parent was difficult at times, I cherished the unique relationship I had with my son. Robert had a more detached parenting style and at times I perceived him as judgmental. Nonetheless, he was making inroads with Max.

Robert and I were married when Max was in middle school. Robert was a devoted husband and over time his relationship with Max solidified as I learned to step aside to let the two of them forge their own bond.

As Robert and I boarded the plane to Washington, I carried a small, green iPod.  A gift from my husband so I could tune out the noise in my head and the worry in the pit of my stomach. Over and over again I listened to "The Cave" by Mumford and Sons.

"I will hold on hope and I won't let you choke on the noose around your neck"

The music energized me as I personalized the lyrics. I was holding hope that Max would choose stability and sobriety. This was the music I imagined dancing to from moment to moment to keep my son from choking on the noose of his challenges.

I had always danced, beginning when I was nine in the living room of my parent's house. I took a myriad of dance classes, was in my high school's performing group and continued dancing in college and after graduation. There were years of classes and performances as a member of several, small dance companies. I felt most satisfied and involved in my own life when I was dancing.  I loved being on stage. Dancing wasn't about caretaking others. Although my only obligation was to the choreography, my gift as a performer meant I could improvise my way out of any errors, unbeknownst to the audience. I felt a kind of control and independence I did not feel in other aspects of my life.

A whole new chapter, and a very different dance, began the day Max was born. As a single mother there was much less certainty, hardly any choreography. And the missteps inherent in parenting were not so easily covered up.

In addition to mastering specific movement repertoires, I had also learned how to create performance pieces which encouraged the dancers to respond spontaneously to music or spoken word. This ability to improvise helped me when I became a mother as being a parent involved much more improvising than I could have ever imagined. Sometimes, however, it was hard to find solutions even as I remained open and willing to react spontaneously to the soundtrack of my life with Max.

 I brought Max into the world without a committed father on the scene and I was the oldest mother among those I met as I joined parenting groups or the PTA. I struggled between relishing my uniqueness and wanting the safety of something resembling "normal," like a partner who could nourish both Max and me. 

As soon as the plane landed in Seattle, I got a phone call from the hospital where Max was being held.

"We would appreciate you getting here as soon as possible." The social worker’s voice was clipped, as if Max being on her watch was an unfortunate interruption to her carefully orchestrated day.

"Of course. We're on our way. Is he okay?" Resisting the temptation to apologize for Max's behavior, I just wanted to make sure he was safe.  

"He’s being well taken care of. He's met with one of our crisis intervention specialists who will meet you when you arrive. Her name is Abigail Forester." The social worker's tone softened as if she recognized the voice of a concerned mother.

Max called next.  He was crying hysterically.

"Where are you? Are you almost here? When will you be here? Please get here soon, please. This place is a dump."

"We're on our way. I love you!" My tone was definitive. Not only did I want to leave no room for him to doubt my support, I needed to assuage my own fear that Max had relapsed.

 "Me too," he said.

The hospital complex in Olympia included several small buildings. Robert and I stood outside trying to orient ourselves to the layout.

Words and phrases tumbled out of my mouth. "I think she said to go to the emergency room. Is it over there? Look, here comes a nurse," In the midst of stress, Robert's pace always slowed whereas mine accelerated. He stood motionless, watching me.

"I know you're anxious. Do your breathing," he responded.

"We just have to find Max. Look over there, a bunch of ambulances are parked, that must be the emergency entrance." I was walking and talking, leaving Robert unable to discern more than the panic in my voice. He caught up to me as we approached the receptionist.

" My son was admitted last night. A social worker told us to let you know when we arrived. She said the crisis intervention specialist would meet us here." I said. She located Max on her computer.

"Have a seat, please."

I didn't want to have a seat. I didn't want to wait.

"She said she would be here. I flew here from San Francisco. Where is my son?"

"I'll page Ms. Forrester for you. Please have a seat," she repeated, making only rudimentary eye contact.

Robert guided us to some empty chairs. My agitation appeared in sharp contrast to the resignation I saw on the faces around me. People were gazing into their cell phones or reading to the toddlers on their laps. Bags of McDonalds signaled that at least one meal had been consumed while waiting. A couple slumped in their chairs, her head resting on his shoulder. I even heard snoring from across the room.

Ms. Forrester appeared 45 minutes after our arrival.

"I think he's just a young man philosophizing," she said.

I cringed.

I thought the social worker in Olympia was being dismissive. Max was bright and articulate. Sometimes his naturally chatty nature and tendency towards unbridled enthusiasm for a good burger could momentarily mask the mania. Sometimes Max was experiencing a milder hypomania, and the less sophisticated assumed his passion was within the normal range. Just a year earlier, as a college freshman, Max's symptoms were masquerading as academic engagement, and even I was just beginning to recognize the signposts of my son's dysregulation.

Robert and I had arranged a family Skype call and Max updated us as he paced back and forth across the screen.

"I just finished my class. It's so stimulating. Brett is so awesome. I can't stop writing down my observations. I keep making all these connections. I can't sit still. We watched this movie, 'Zeitgeist,' last night in the on-campus apartments. I couldn't sleep..."

Within moments Max's excitement morphed into hostility. Then he was crying.

I was stunned and speechless. Robert knew something was wrong and was so uncomfortable that he left the conversation. As always, I was there to reassure my son. "It's okay Max. Honey, it's okay."

In reality, however, nothing was okay. He had lost contact with reality and we needed to know what was going on. Thirty-six hours Max agreed to have us escort him to the psychiatric hospital in Utah.

 “I'll finally get to find out what is going on inside my brain," Max had said. I was sure I heard some relief in his voice.

We told Ms. Forrester about the exhaustive report from the psychiatric hospital and his stint in North Carolina. Since Max's arriving back in Washington, I had been footing the bill so he could see Dr. Edwin Case, a psychiatrist in Olympia. I was very worried when he returned to his cohorts, but I maintained hope that this new psychiatrist could encourage Max's sobriety and compliance with the medication he had recommended. Max was back in school even though he had not found a job or a stable living situation.  I didn't feel I had any control over whether or not he was drinking or if he was eating regularly or getting enough sleep. But I was so anxious for him to return to school and at least have the semblance of normalcy that though he had not met my conditions for support, I started writing checks.

Unfortunately, the hospital hadn't bothered to call Dr. Corbett, although I left him a message right after the hospital called me.  I was sure my son had not been evaluated by any of the hospital's psychiatric staff.

"Let's go see Max. We can discuss a discharge plan," Ms. Forrester said.

 Max was standing in the doorway, and he hugged me briefly. The only furniture in the room was a single bed with a plastic mattress cover and some flimsy sheets. It appeared to be a room where they held persons who might be a danger to themselves or others.

There was gratitude in his embrace, but he didn't seem relieved. It was as if his anxiety was a small motor running inside of him, and he had lost the key to turn it off. He was barefoot and wearing hospital-issued pajama bottoms. His long hair was obviously dirty, but his small, gold nose ring was still in place, and his too small t-shirt revealed the tattoo on his left bicep of Lake Atitlan in Guatemala, drawn from a photograph taken when he and a friend traveled together after high school.

Ms. Forrester turned to face Max and patronized him as if he were a small, petulant child. "Max, I'm happy to let you go with your parents. The nurse will get your things. I know you had a number of suitcases when you arrived. I hope you have a good visit with your parents." And just like that she was gone.

I was never tempted to correct the assumption that Robert was Max's biological father. Before going off to college, Max had lived with Robert and me full time. He saw Philip only every three weeks, the same schedule we had adopted so many years earlier.

Although I was always the first point of contact whenever Max was struggling, Robert often stepped up to help me navigate the myriad layers of my son's challenges. Unlike Philip, whose involvement with his son often stopped with their shared DNA, Robert 's credentials were both personal and professional. He participated in conversations with a range of medical professionals, sometimes came with me to visit Max when he was hospitalized or in a treatment program and listened with kindness and empathy as my worries threatened to derail a peaceful night's sleep.

A real nurse arrived and I was grateful that at least someone appeared willing to help. "Okay Max, let's make sure you have everything," she said.

His gaze darted from one item to the next as he segregated two large suitcases, a worn backpack, a cardboard shoebox and a plastic crate.

"I had to pack quickly, but there's more stuff in my room at the apartment. We can go there tomorrow," he commanded.

He was full of ideas as the words came somersaulting out of his mouth, but there was no genuinely interactive communication. He spoke in monologues, giving orders and lecturing to us.

"They took everything ‘cause when I got here, I told them I wanted to hurt someone. I was telling the nurse how I had seen God and stuff like that. I was kidding; I just wanted to see their reaction.  I really wanted to go to a psych hospital in Las Vegas. And then I could write a paper for my class. I wanted to do research. But it was too far to drive to Vegas. I have class at 6:30. I still need to do my homework. But I've got to move out of my friend's apartment and I want to come home for Mother's Day and the garage sale. And there's the concert I told you about. And Jared invited me to his parents' house in Santa Barbara. They're really rich."

The irony of Max's pressured speech was that in eighth grade a second round of neuropsych testing confirmed that he processed information exceptionally slowly.  This meant it took him longer to understand and respond to input. The world moved at a faster pace than was comfortable for him. As he moved through school, he got extra time to take his exams, and often stayed after class to question his teachers to make sure he fully understood a particularly fast paced lecture or his reading assignments which often took him longer to plow through. The battery of tests which Dr. Gibson administered also highlighted anxiety and difficulty focusing, with a tendency to become overwhelmed.

Rather than appearing overwhelmed as he loaded his things into the back of the SUV we had rented, Max was hyper-focused on the task at hand.

 I, however, could feel myself swept up in the tsunami of his psychosis which was always characterized by the packing and unpacking of shitloads of random stuff. I knew that this was only the beginning of another Mr. Toad's Wild Ride.

"Are you hungry Max?" Robert said, with a matter of fact, soothing inflection in his voice. I stood by, trying to decide where to start.

"Yeah, " Max said. "They fed us, but it wasn't very good. I'm really tired. Are we staying at the Red Lion?"

That was a question I could answer. "Yes, we got you a room next to ours."

Arriving at the hotel, we loaded our suitcases onto a luggage cart which we maneuvered down a dark hall to our two, first floor, standard rooms. Max promptly rolled his desk chair outside, and set up shop with his laptop, cell phone and Marlboros.

Over time I had gotten used to seeing Max smoke cigarettes as I realized that this was the least of my worries. Eventually, others in recovery would tell me that smoking provided camaraderie after AA meetings. Tobacco was a stress reliever, albeit a cancer causing one. I also learned that it was the hardest addiction to beat, and would most likely come after some time in sobriety.

I had first discovered a pack of cigarettes in Max's room when he was a high school junior. He later told me that he wasn't the only one of his friends to smoke, but unlike him, their usage dropped off by the time they had graduated and started college. At the time, I didn't know very much about my son's addictive personality, and bipolar was definitely not a conversation starter. We reviewed the health risks, and for all I knew he was a very occasional smoker. My concern was reignited when we met in Rome during his Gap year before college, in the fall of 2012.

I would periodically find him smoking outside while I perused a shop or art gallery. We argued.

"Mom, you don't understand what it means to be 18. I'm an adult and I can legally smoke in the US, and I can drink in Europe. I'm just doing what the Italians do...wine with meals, and grappa with an espresso for dessert!"

Max determined that tobacco and liquor were some sort of rite of passage he was entitled to. He finally agreed to have only one glass of wine a day, and not to smoke in my presence. I kept him busy, and refused to buy him cigarettes. I made temporary peace with the situation, and naively assumed things would quiet down when we returned home. Here at the Red Lion hotel in Olympia, as I averted my eyes from his paper cup full of cigarette butts, it was clear that they had not.

Lunch in the hotel dining room seemed the safest option. As long as Max wasn't swearing at me and was willing to sit still long enough to order his meal before going outside to smoke, it was at least a two-star outing.

Robert and I watched Max devour a hamburger and declare it better than hospital food. His enthusiasm for a good meal was something he and I shared. But this lunch was tinged with mania as Max was engrossed in his sandwich. There was a noticeable tremor in his hands, and warm, red juice from the burger dribbled onto the frayed cuff of his soiled, long sleeved tee shirt.

"Mom, you can have my fries. I know you like fries, eat some fries," Max directed.

"Thanks, I'll have a few with my salad."

"Robert, you eat some. We can't waste them. The waitress will think we didn't like them. I can never eat all my fries. Why do they think everyone who orders a burger wants fries?

         My son's frustration with this over-abundance of French fries seemed somewhat mollified as Robert dipped into the pile on Max's plate.

         "Mom, I need your help. I made some messes. I need to make amends. We need to buy things for people. I lost stuff. I borrowed stuff. I need to make a list…"

         "Okay honey. A list is a good idea. We can work on that after you see Dr. Corbett. He can see you this afternoon. Let's go back to the room and get ready for your appointment."

         As Max got older, it became more challenging to determine how involved I needed to get. Was he so stressed that I needed to manage his environment or was a sudden burst of hyperactivity just an expression of his enthusiasm?  When he was younger, I created the structure which Dr. Gibson recommended to decrease his anxiety and the overwhelm that could easily sneak up on him. Guests for dinner, holiday preparations, or just one too many activities. His anxiety was my cue to come on stage and offer help.

         To merge with his mania, however, was something else. I had to be willing to dance with him in order to save him. But would I lose too much of myself?

After lunch Robert and I cajoled Max into taking a shower and changing his underwear. It appeared that his personal hygiene had been spiraling downward over the past few weeks. He presented me with the first of many piles of dirty laundry.  I didn't mind sorting and folding. I was glad to be assigned a task with a clear outcome.

         "I'm going to the front desk to get change," I announced.

         "Mom, I don't care what you do. You can knock on my door when it's time to leave for Dr. Corbett's ."

I was too tired to protest his rudeness. Max hadn't been a particularly rude teenager. He had always been generous with his "please" and "thank you." Friends and even strangers remarked on this good manners and easy sociability.

When he was manic, however, he yo-yoed between gratitude for my presence and dismissing me as if I was his only problem in an otherwise perfect world.

Robert encouraged me to take a walk. "He'll be okay. I'm going to lie down. I love you."

Sometimes I thought Robert's reassurance was a tactic to avoid confrontation. I was the hands-on, Jewish mother. He was the passive, Gentile stepfather. He was, however, far more involved than Max's biological father who made only brief appearances when a particular crisis captured his attention. I was grateful to Robert, and kissed him.

My equilibrium returned after a walk and folding a load of clean laundry. I was curious about Max's impression of the psychiatrist I had never met. I questioned him on our way to their appointment later that afternoon.

"Do you like working with Dr. Corbett?"

 "I don't know. He's my psychiatrist.  I like him; he's the best psychiatrist I've ever had. He's really smart, but he's down to earth. Like everyone in Washington."

I flinched as Max reinforced his enthusiasm for Olympia.

15 minutes into his appointment, Max invited us from the waiting room into the doctor's office.

Dr. Corbett stood to greet us. He was huge. Tall and portly and completely circular. He wore a grey business suit, an unremarkable tie, a goatee and wire rims. His voice was low and sonorous. Robert and I sat on chairs across from one another, while Max returned to a small coach facing Dr. Corbett who sat back down in his swivel, desk chair.

"So," Dr. Corbett began slowly. "Max and I have discussed his taking some additional medication. I'm going to prescribe the antipsychotic Xyprexa since this is what he was taking when he was discharged from the hospital in Utah. I have a lot of experience with this drug, and my patients do well on it." Edwin Corbett spoke slowly and carefully, and I imagined his unhurried pace appealed to Max who was flipping through a magazine as our conversation began filling the room, like dense fog. I was still trying to see clearly how serious things had once again become.

When Max abandoned the North Carolina treatment program and returned to Olympia. I had been shocked, angry and very disappointed. I didn't condone his choice with financial support, but my love never wavered.  It was important to both of us that I maintain faith in him, and in his future. He got a customer service job with Verizon and a friend agreed he could camp out in her unheated laundry room. We stayed in touch by phone and I visited at his request a few months after his arrival.

During my visit I felt very sad to see his worn sleeping bag lying on the cold, linoleum floor. A few boxes and a suitcase formed a ring around the sleeping bag, as if demarking the only space in the house which, at least temporarily, belonged to Max.  I encouraged him to attend local AA meetings and see Dr. Corbett regularly. I wanted to imagine he was drinking less, getting enough sleep to keep mania at bay and being compliant with whatever medication or vitamin supplements had been recommended by his North Carolina team or here in Olympia by Dr. Corbett.

Several months later I gave the okay for him to start school again.  I agreed to pay a small amount of rent so he could live with a couple of college friends. He had his own room, and though it was unfurnished, his sleeping bag lay on a beige, wall to wall carpet instead of the cold, hard surface of his former residence. His room was heated along with the rest of the apartment and I was hopeful that these changes meant Max would begin the hard work of committing to sobriety and maintaining his mental health.

When we got the call from Olympia about Max's erratic behavior, I knew that central heating and a carpeted floor had done nothing to address my son's instability. I was once again compelled to partner with Max. I would have to improvise with him until we could agree how to address his challenges.

Over lunch at the hotel Max had told us he wanted to go back to the psychiatric hospital in Salt Lake City because they knew him, and he thought the staff could tell him what was going on.  He wondered if he was indeed relapsing or had some new and different disorder?

The three adults in Dr. Corbett's  office liked this idea, but it turned out that Max was ambivalent.

"I changed my mind. I don't want to be in another hospital. Maybe if I hadn't gone to St. Peter's. But that place really sucks, and I'm sick of hospitals. Maybe I'll just live at home for a while."

I glanced at Robert, looked helplessly at Dr. Corbett and tried to ignore the nausea brewing in my gut. I loved my son to the moon and back, but I couldn't imagine his living at home. He was of my blood, and a stranger all at once. This was another moment when I thought it best not to respond, but rather to leave Max's request hanging over us, like a small, dark cloud.

I was beginning to understand that neither I nor Dr. Corbett had been fully cognizant of just how unstable Max had become since his arrival in Olympia.

 It turned out that Dr. Corbett had never seen Max when he was manic. Somehow Max had kept it together - at least in the doctor's presence - since leaving North Carolina, but his recent return to school and his problematic living situation had been the tipping point. Dr. Corbett was smart enough, and his credentials were appropriate, but I was never quite sure if he and Max had tackled any of the hard stuff. Max acknowledged that he didn't follow all of the doctor's suggestions, though I never found out exactly what those were.

When he started working with Dr. Corbett, Max had given me permission to speak with the doctor. He was resigned to my needing to be an integral part of whatever team of professionals was working on his behalf, but Dr. Corbett didn't give me much to go on. He liked Max and was very supportive of my involvement. His strongest belief was that ones' family should be an integral part of the healing process.

 Max was good at engaging his therapists in conversation about possible career choices or the women he was dating. He could turn a conversation to focus on topics quite unrelated to the need for him to acknowledge his challenges and do the hard work of redirecting his life. I didn't want to acknowledge that my son was so disconnected from the truth of his addiction and his bipolar that he could be manipulative in order to avoid the truth.

Now in Dr. Corbett's  office Max agreed to take the recommended antipsychotic and some additional medication to help with his anxiety. We filled the prescriptions and he decided dinner was more of a priority than his 6:30 class.

I was curious about how Max was managing even one class. He told me he had been keeping up with the reading and weekly writing assignments, but I had my doubts. I had reluctantly okayed his enrollment as a part-time student so he could ease his way back into the academic fray. His class was taught by one of Evergreen's illustrious radical elite. A brilliant economist whose hellfire and brimstone approach overwhelmed and inspired Max. Could Max sort through all of the information coming at him in order to even take notes? If he was manic, he could be disruptive in class. When not, his teachers were impressed with his academic enthusiasm and insightful questions.

Perhaps because I was a single mother, and Max's most consistent ally, my steadfast focus began the day he was born. When he was a toddler, I had to decipher his responses to various stimuli. Was his chattiness with strangers a nervous habit or indicative of feeling comfortable around new people? Was he careening down the hall because he was excited to welcome guests or overwhelmed that he would have to share me and his toys? As he got older there was testing to highlight learning challenges versus behavior related to anxiety.

Having Max as my focal point was like spotting to keep from getting dizzy during a challenging turn. As a young dancer I had learned to maintain a constant orientation of my head and eyes to maintain control and prevent dizziness. It was an extremely useful technique and helped me maintain my equilibrium as I did chaine turns across the ballet studio or a barrel turn in the middle of a piece of modern dance choreography.

For a center floor pirouette, I focused on my own reflection in the mirror at the front of the studio. I would stare straight ahead, plie into the turn and keep my eye contact as my body turned in space. Of course, there was that split second when I lost the spot as I whipped my head around to once again look straight ahead. A series of turns across the floor meant finding some spot or fixture on the side wall as I turned ever closer to completion.

Spotting my way through a turn became automatic. Unlike executing a specific piece of choreography, I had to keep adjusting my pace in relation to Max. Sometimes I had to turn faster, and at other times I needed to slow down. I was always a watchful and engaged mother, but it got harder as he got older and addiction and mental health challenged my beautiful boy. My love and commitment to my son was not necessarily enough to keep him from spinning out of control and to keep me from getting dizzy and lost in my feelings of helplessness.

Over time as I partnered with Max, I would learn to pause between the turns, to take a breath and to find my balance. I ultimately realized that I didn't have to choose between Max and myself. And in fact, focusing on myself rather than on my son ultimately provided him the space to take responsibility for his own recovery.

Returning to the hotel after dinner that night I was too exhausted to keep turning the wheels of worry about all of the uncertainty that lay ahead.  The next day was my birthday and if nothing else, I could at least give myself the gift of a good night's sleep.

The next morning Max joined Robert and me for breakfast, although he would soon refuse to even enter the dining room.  Like everything else there was no way to predict any of his behavior while we were in Olympia.

"Happy Birthday, Mom. What do you want to do today?" Max was upbeat, as if the previous 36 hours had never happened.

 If I had been at home in San Francisco I would have joined three close friends for a dim sum lunch and a walk on the beach. Robert had made dinner reservations at Chez Panisse. There would have been phone calls from my siblings, a few cards in the mail and at least one floral delivery. I always looked forward to my birthday as it gave me yearly permission to do only what made me happy for one, full day.

On this April 28, 2015 happiness was a complicated request. I was relieved to be in a hotel room adjacent to that of my only child. I was thankful that he was no longer in the emergency room at St. Peter's hospital.  I appreciated that Robert had flown with me to rescue Max. I was grateful to my boss for giving me time off. Carefree? Joyful?  Lighthearted and buoyant? No, on this Tuesday in April I was anxious, scared and intermittently angry. Luckily, I was also hungry.

Robert was more tolerant of free, hotel breakfasts, but even I had to admit that the Red Lion buffet was a cut above the rest. I was relieved to see Max helping himself to scrambled eggs, bacon and remarkably ripe fresh fruit. During the height of mania, his non-stop chatter ceased only when he stepped aside for a cigarette break. His fragile mental state constantly derailed his appetite.

This was actually the second consecutive birthday I had spent away from home in order to support and encourage Max. The previous year I had been in Mill Spring, North Carolina as my birthday coincided with Family Education Weekend at the bucolic treatment program where Max had landed after his hospital discharge.

 Robert, Max and I spent time with other residents and their family members learning about all aspects of health and healing related to mental illness. We met with Max's therapist, psychiatrist and coach. We shared organic meals in the residential dining hall. There was contra dancing, a lavish outdoor barbeque and activities designed to enhance family communication. The only downside to the weekend was Max's` constant refrain that he wanted to go back to Washington.

"This program is about figuring out what you want out of your life. And I want to go back to Olympia and my friends. Evergreen is the only college I want to go to. You know I can leave here whenever I want..."

Max did become less strident as the North Carolina weekend progressed. He was grateful Robert and I had come to see him. Over the next five months he would move successfully through the program while maintaining his allegiance to Evergreen and a level of denial about his fragile mental state. Max had agreed to be admitted to the hospital in Utah and the extensive psychiatric evaluation. And he was willing to follow up with residential treatment. He had done so not because he really believed that he needed help, but rather because I was not offering any other option for financial support. He had also become quite fond of his psychiatrist at the Utah hospital, and so agreed to residential treatment as a way to assuage all the adults who cared. His buy-in turned out to be temporary and so against everyone's advice, he left North Carolina to return to Olympia.

And now, one year later, Robert, Max and I discussed the options for celebrating my birthday in Washington.

"The taxi is picking me up at 2 from the hotel, but we could have lunch together," Robert began.

"Oh, I forgot you're leaving," Max said as he dumped more sugar into his third cup of coffee.

I resisted the urge to comment on the quantity of caffeine he was consuming. I was still reluctant to use the word, "addiction," though I recognized that caffeine, soda and cigarettes were his legal drugs of choice.

"Yes, let's all go to lunch," I said. "There's that place by the water. Where we went last time we visited. The food was good, and it has a great view. It's a weekday so we probably don't need reservations."

 Anthony's Hearthfire Grill had a wall of glass windows overlooking the Puget Sound, and a small beach where shorebirds skittered in and out of the water. It was quiet and unhurried.   I was relieved that we had choreographed the next few hours, though I had no idea what would happen after Robert returned to San Francisco.

During lunch Max was contemplative as he revealed more about his time in Olympia since leaving North Carolina. Even though he had been working, we learned that he had  resumed drinking and had not been regularly taking any medication.

"You know, I've been drinking for a while. I mean, I told you I was going to drink again. But I waited until after Grant's funeral. A lot of people didn't though. I know, it's a shitty way to deal with grief!" he said as he took another bite of his Caesar salad. His roommate from freshman year had recently overdosed on heroin.

"Mom, I don't feel like I belong anywhere. I thought everything would be better once I left North Carolina. I feel like my friends in Olympia are a bad influence, my high school friends are all really successful and people like Jesse care about me, but don't have any idea what I've been going through. I just feel really alone. I know you're trying to help, but I don't want to do any of the things you suggest."

Max spoke freely about the problems of his current living situation - where everyone either drank or smoked pot - and the challenges of returning to school. Since returning to Olympia he had started a variety of projects - singing with a local band, making terrariums, and writing a play - but nothing held his interest for more than a few weeks, and sometimes only a few days.

 The cast of characters he collaborated with was noticeably unreliable. I would come to find out that some of his friends were aware of his instability and while sympathetic, they were also growing tired of dealing with his mania and the drinking which only made things worse. They were obviously not trained to help Max and were naturally focused on themselves as they, too, navigated the bumpy terrain of young adulthood.

Robert left for the airport soon after lunch, and I was left alone with Max and the remainder of my birthday.

"I'm sorry Robert had to leave. Now what do you want to do?" Max asked. He still sounded somewhat strident, but I also detected his desire to accommodate me.

Suddenly my birthday felt like a burden. And this dance with Max seemed endless.

In the world that existed before Max was born, I spent many hours memorizing and practicing choreography, whether it was my own or material generated by others. Space, time and energy were the essential elements of any piece. When Max was born, he joined me on stage and our life together became a different kind of dance, but these elements of choreography still reverberated throughout our life together.

For space, Max and I always preferred the beach. Our favorite stage. Ever since he was a toddler.  When we lived in Mill Valley, we often spent Sunday mornings at Muir Beach. He would dribble the wet sand into fanciful castles while I read the Sunday New York Times. He was happy to wade into the chilly, Northern California surf and still loved running straight into the cold water no matter the outside temperature.

As he got older, the coast became a place where Max could reclaim some part of himself.  Home for the holidays during his freshman year of college, he drank so much we had to call the paramedics. After spending the remainder of New Year's Eve in the emergency room, we brought him home to sleep himself sober. When he finally woke up at 3 pm he was scared and apologetic. He cried into my arms, declaring that he didn't want to die. We drove to Pacifica and climbed the hilly terrain overlooking the ocean that had always been a source of strength and contentment for us both.

Even while plotting to leave the treatment program in North Carolina, he requested that we take time to explore the beaches of the Outer Banks along the coast. I knew nothing of his plans as our feet imprinted into the soft, wet sand.

Over the years when there was an occasional chink in the armor of his resistance to give up drinking, Max imagined sunning himself in Malibu, detoxing with the stars. "I need to be in a warm place, on the beach. You know Mom, I 've always liked the beach."

"Time" in a dancer's vocabulary refers to the rhythm, speed and syncopation of movements. It is never just a question of right or left, but knowing how quickly or slowly a pattern moves across the stage. Is one dancing in time to the music or are various rhythms happening simultaneously as the movement itself provides an alternate beat? Just as musical notes can be accented, dancers must learn which gestures to emphasize and the quality of each phrase. Are the arms flowing as if gently pulling aside a chiffon curtain, or do they move slowly and deliberately through space as if pushing huge boulders?

With Max and I, time could slow down and appear to stand still.  Whether he was struggling as a more typical high school student or spiraling down the rabbit hole of mania, all of my other obligations and priorities moved backstage. The rhythm and speed of my own life was often determined by Max's mental state, rather than the phrasing of my own dreams, desires or goals.

When Max was manic, he had more energy than usual.  He became restless as he fidgeted, frequently changing his posture and position. I had to speed up in order not to lose the thread of a conversation or to track his whereabouts as he literarily careened through the streets of Olympia or San Francisco.

When Max was depressed, his energy flagged. Even as a young adult he would refer to having the "scratchy feeling," his euphemism for wanting to go straight to bed.

"Can you rub my feet?" he would ask if we were together. Sometimes the invitation was an opening for me to lead. I might suggest ways in which he could take better care of himself or get help.

As I ruminated on the ongoing duet with my son, I imagined this birthday as a kind of intermission for both Max and me. We were now backstage, resting and sorting out our options. Would there be more turning points taking us backwards before we could move forward?

What I was beginning to understand is that partnering with Max meant learning to pause between the turns, to take a breath and to find my balance. Eventually I would come to realize that I didn't have to choose between focusing on Max's well-being or focusing on myself. In fact, "spotting on" myself rather than on my son would ultimately provide him the space to take responsibility for his own recovery.

A year from now Max would be living in Portland, and the nature of our duet will have changed once again. How will we get there?  Max is maturing and I am paying more attention to my own life. But the choreography is still unfinished. There is still much to be discovered and resolved. I am still in the dance, partnering more and more with myself.