What to do about Ahav?

By https://www.sandiegopsychiatricsociety.org/author
November 18, 2020

The Washington Post

By Hannah Dreier

October 24, 2020

A mother’s fight to save a Black, mentally ill 11-year-old boy in a time of a pandemic and rising racial unrest

Kelli Lewis comforts her son Ahav after he and his brother, Analiel, rear, got in a fight at their home in Decatur, Ga. (Bonnie Jo Mount/The Washington Post)

DECATUR, Ga. — Her 11-year-old was on the floor drawing. Her 9-year-old was next to him, playing with plastic robots. It was a rare quiet moment in the house, and Kelli Lewis used it to look around at what she needed to repair. She looked up at the ceiling, where there was a hole and some spreading cracks from a tree that had toppled onto the roof. She looked at the walls, damaged from all the times her 11-year-old, Ahav, had gotten upset and punched them. She looked at Ahav, wondering what she was going to do, and then she saw his suddenly cloudy eyes and understood the quiet moment was about to end.

“What’s going on?” she asked, crossing the living room past Analiel, the 9-year-old, and pressing her forehead against Ahav’s. “Tell me, are you struggling right now?”

Ahav shook his head no, but he was watching the corners of the room, where he sometimes saw shadowy figures. He asked Kelli for a hug and she wrapped her arms around him.

“Stay with me,” she said.

“I love you, Mommy,” he said.

She had just sat back down on the couch when Ahav lunged at Analiel, grabbed him by the neck and threw him to the floor.

“Ahav, stop!” she yelled, running over.

“I can’t move my neck,” Analiel said, crying.

“Oh, Lord,” Kelli said, taking Analiel’s head in her lap and turning to Ahav, and once again the chaos in this damaged house was in full roar, at the center of which was a 5-foot-2, 130-pound boy with the first traces of a mustache against whom everything about life in modern-day America seemed to be arrayed: his mental illness, his family’s poverty, his age, his size, his race and a pandemic that was eroding the already fragile systems that had been keeping him stable. He was gritting his teeth and pulling at his long twists of hair. “Are you hearing the voices? Tell me,” Kelli said, but instead of answering, he walked down the hallway and toward the front door, outside of which was a peaceful road in suburban Atlanta, which led to a six-lane highway, where several times this year, as his illness deepened, he had tried to throw himself in front of a moving car.

“Ahav!” she shouted, still holding Analiel and looking around for her phone. “Ahav!” she shouted again, but this time the response was the sound of the front door closing. Now she shifted Analiel off her lap, ready to tell the 911 dispatcher the words she had learned to use during past calls about a Black young man who might look out of control: “My 11-year-old son has a psychiatric diagnosis and he’s in crisis. He’s heavily combative, but he does not have any weapons.”

And then Ahav reappeared, holding something in his hands, a bag of frozen pineapple. He crossed the room toward Analiel, who was watching him.

“I’m really sorry. I didn’t want to hurt you,” he said, and placed the bag against Analiel’s neck.

He looked at Kelli.

His eyes seemed better.

“Did the bad thoughts take over?” she asked.

He nodded.

“Are you back with me now?”

He nodded again, and Kelli wondered again: for how long?

Kelli separates her sons during a fight. (Bonnie Jo Mount/The Washington Post)

What to do about Ahav? It was a question that for Kelli had become consuming in this year of a pandemic and growing racial unrest.

How would she get help for a boy who is Black and mentally ill and already vulnerable to some of the worst disparities in the U.S. health-care system even before the pandemic made things worse? Who fixes a boy when his family is on government assistance and the options for public services have been narrowed by shutdowns? Who saves him when he takes off running for the nearby highway and Kelli wonders if she should call 911, but hesitates because of her awareness that Black men with mental illnesses have been the most at-risk category in the country for being killed by police? Such are the day-to-day calculations of a mother living in increasing isolation with her sons, in a house where, when they moved in eight years ago, Kelli believed they had it made.

She was 41 then, and she and her husband moved there from downtown Atlanta because they wanted the boys to attend better schools. During the week, she taught drama at a private high school. On weekends, they hosted dinner parties. Ahav was the type of child who would get lost in creative projects, and when he was still little and confided to Kelli one day that there was a man in his body, Kelli interpreted it as another expression of his active imagination. But then came tantrums, followed by his throwing and breaking things, and by the time Ahav was 8, doctors were telling Kelli that while it was rare in children, all the signs pointed toward schizophrenia.

And so Kelli put things on hold. She began working from home as a travel agent. She stopped inviting friends over because of Ahav’s meltdowns. His worsening illness put more and more strain on Kelli’s marriage, and in 2019, after she and her husband divorced, she spent down her savings and signed up for public assistance. A family of three now, they were managing, but then, in the spring, Ahav’s school closed because of the pandemic, and at the same time, the medication he’d been on seemed to stop working. By the end of the summer, he was too scared to stay in his own room and was waking up next to Kelli most mornings as she herself awoke in a house where the oven door had been ripped off its hinges, the refrigerator was pockmarked with dents the size of a child’s fist, the wall near the stairs had a few slash marks in it from the time Ahav had found the one paring knife Kelli kept hidden in her bedroom, and there were new psychiatric prescriptions on the kitchen table, five in all.

There was also a pile of medical forms on the table from Ahav’s emergency room visits this year, the first of which had been in April, after Ahav told Kelli that the man in his body was ordering him to attack his family or hurt himself. The hospital had stabilized him and then sent him home because he was no longer in crisis and Medicaid wouldn’t pay for more days.

The second time, he had tried to jump out of a moving car. Again, he was sent home once he was stabilized.

The third time, he had pushed Kelli over and started whipping himself with a belt. He told her to stay away or he would jump out the window. “I’ll be dead when they get here,” he said as Kelli recorded him on her phone, hoping to have something to convince the doctors that he needed more help.

The fourth time, after the doctors had written that Ahav was being admitted for “homicidal ideation,” the hospital filed a complaint against Kelli with child protective services alleging negligence, which led to a mandatory investigation, a closed case and a conclusion that Kelli was doing everything she could to help her son.

The fifth time, Kelli, for a moment, thought Ahav had gotten a break. A new team of doctors recommended that he be hospitalized for several months, not just a few days, so he could meet face-to-face with therapists and also get on the right combination of medications. But then came word there would need to be a new psychiatric evaluation before Medicaid would pay for the longer stay, and the only doctor available to do one in person wanted an upfront fee of $2,500.

The sixth time was for “self-injury” — another stabilization, another release — and after the seventh time, when Kelli, who was just a little taller than Ahav now, had to restrain him from throwing himself out of her bedroom window, she couldn’t bear the thought of an eighth time, so she suggested to Ahav that they work together to find another type of solution.

“You have the power to get rid of the darkness. Do you believe that?” she asked.

He said that he did. “I can stay in control,” he promised.

She pulled Analiel aside, too, and asked him to keep an open mind. “I know you’re feeling powerless,” she said.

“He breaks literally everything,” Analiel said.

Kelli told him that Ahav was trying. “I promise you, if you don’t give up, and Ahav doesn’t give up, and Mommy doesn’t give up, we’re going to figure this out,” she said.

Ahav and Kelli play basketball on one of Ahav's good days. (Bonnie Jo Mount/The Washington Post)

Not every day with Ahav was a bad day, and when there was a good day, Kelli did what she could to take advantage of it. One afternoon, that meant taking Ahav to a pizza parlor. The outing started out well. The boys got up after they ate and were dancing together between the tables, but then a police car passed by and Ahav stopped dancing and wrapped his arms around Kelli.

“Ow! You’re hurting me,” she said.

“You called someone. You called the police,” Ahav said, on the verge of tears. Kelli tried to reassure him that no one was coming, but whatever she said was being drowned out by a fear of police that had taken root in Ahav in 2017 when he was having a meltdown, and someone witnessing it had called 911, and an officer who was trying to restrain Ahav had pushed him onto a chair forcefully enough to bruise his ribs.

Because of that, and because she had read about the many police killings of mentally ill Black men, and then the killings of George Floyd and Rayshard Brooks, who was shot to death in the Atlanta neighborhood where Kelli and Ahav once lived, Kelli had avoided calling the police for nearly three years. But a few months into the pandemic, Ahav threw a hard-shell suitcase at her head, leaving her too woozy to chase him if he ran toward the highway, and so she called 911, even though she feared Ahav might be too far gone to follow a police officer’s instructions.

“I have an 11-year-old son. He’s in crisis and he’s heavily combative,” she told the dispatcher. What happened after that was recorded on a body camera worn by a police officer named John Cummings, who, in a stroke of good luck for Kelli, was part of a recent effort to better handle mental health calls that had begun after an officer was charged with murder for killing a naked Black man with serious mental illness whose last words were, “The police are my friends.” In response to the killing, the department made reforms including increasing support for a unit that sends police and nurses together to crisis calls. Among the officers most eager to volunteer for those shifts had been Cummings, who now spotted Ahav walking on the shoulder of the road.

“Hey! Are you okay?” he called, jumping out and putting a hand on Ahav’s shoulder to turn him around.

Ahav was sobbing. Cummings sat him down on the guardrail. In a few moments, Kelli caught up with them in her car. She had red scratch marks down her arms, and Analiel was in the back seat, scratches crisscrossing his cheeks. For a moment, Cummings would say later, he thought of arresting Ahav, but instead he stayed with the family for more than an hour, talking to them and helping bring things under control, and that interaction became Kelli’s way to assure Ahav that the police were there as allies.

“Remember when the cop came and helped you out?” she would ask.

It was an interaction that gave her some trust, too, and a week later, when she caught Ahav with an electrical cord wrapped around his neck, pulling hard on both ends, she grabbed her phone and dialed for help. Again it was Cummings who responded, and again his body camera was on as he pinned back Ahav’s arms, trying to restrain him as Ahav twisted and squirmed.

“You’re acting like a fool,” he said. His voice had taken on a note of impatience.

“It’s disheartening because everything we did didn’t stick,” he would say later, explaining why he sounded that way. “Sometimes that’s just the way it goes.”

None of which he said to Kelli, but she understood anyway. She was used to people thinking they had fixed things and then getting frustrated when they did not stay fixed. She had been that person a few times herself before becoming who she was now, a mother who wouldn’t be calling the police again because of a son whose face was pressed against the window of a pizza restaurant, watching a road where a police car had come closer and closer before passing by.

TOP: Ahav hugs Kelli as she tries to get in a brief nap. BOTTOM LEFT: A family prayer before dinner at a local restaurant. BOTTOM RIGHT: Ahav speaks with his therapist while Kelli provides a supporting touch. (Photos by Bonnie Jo Mount/The Washington Post)

Every so often, Kelli allowed herself to think of the things she wanted: To live in a house undamaged by fists. To breathe in a house undamaged by mold. To be able to close her bedroom door and sleep through the night alone. To look at photos of her friends’ kids at summer camp without feeling sadness. To say yes to the men who asked if she could go out on a date sometime. To go back to teaching and earning a living. It was a list that, if she allowed it to, would go on and on, and it wouldn’t include anything about hospitals and police.

The solution, she realized, if there was to be one for Ahav, would have to come from therapy, but the only therapist she could afford was one whose services were free as part of a state program and who had to work remotely because of the pandemic. Still, it was therapy, and when her phone rang one day while she was with the boys at a laundromat, she answered and smiled widely for Ahav to see.

“Say hi to Miss Liz,” she said, and handed the phone over to Ahav, who tried to give it back. She pushed it to his ear again and wrapped his fingers around it, and he sank under a table piled with laundry, clutching the phone in one hand and his hair in the other.

The person on the other end was Liz Nelson-Cahill, a Black therapist who made it a point to describe Ahav’s illness as narrowly as possible, as “visual and auditory hallucinations” rather than schizophrenia, because she was skeptical of his diagnosis. She knew from her training that Black people are twice as likely to be diagnosed with schizophrenia as White people, who are more often diagnosed with less stigmatizing, more treatable mood disorders. And Black people, regardless of their level of mental illness, are more likely to be prescribed higher doses of antipsychotic medications. She thought Ahav could still make a full recovery by adulthood if he got good treatment now, and especially if he was somehow able to get into residential care, but first she had to establish rapport with him over a phone line.

“Hello, hello,” she said to silence.

In a moment, Kelli got back on the line and told her apologetically that Ahav had muted the phone. They decided to try again another day, but kept talking with each other as Liz, who was home at her kitchen table, pulled out the thick spiral notebook she used to keep track of clients. “So he’s backsliding a bit?” she asked, writing Ahav’s name on a new page and underlining it. She heard Ahav shouting in the background, and Kelli yelling, “Do not throw that!” Then she heard a crash.

“Backsliding,” she wrote.

The notebook’s other pages were filled with the names of other Black children from low-income families: a boy with psychotic symptoms who was mostly nonverbal, for whom phone therapy was not going to work; a girl who lived three hours from the only outpatient program Liz could find for her. Page after page was filled with notes about kids who were falling apart, and now Liz made new notes about Ahav as Kelli said, “I did have a victory to report, but —.”

“No ‘but,’” Liz said. “A victory is a victory.”

So Kelli explained that she had managed to get Ahav off the waiting list at a school with small class sizes and teachers who understood that his illness was sometimes affecting his memory. Liz congratulated her and suggested that over the coming week, until their next session, she should look for chances to remind Ahav that he was not just a product of his illness but the same studious, imaginative kid he had always been — “the real Ahav,” she called it.

It made sense to Kelli, and the next time Ahav lost control, she tried a version of it. They were in the car when Ahav started kicking his brother and then raised his hands to start punching.

“Hey!” Kelli shouted, pulling over. She ran around to his door. “Don’t you do that,” she said. Ahav was groaning now, clenching his still-outstretched hands into fists. “You have to figure out what coping skills you’re going to use right now,” Kelli said.

Wracking her brain to think of something that might work, she asked him to repeat with her, “I can stay in control.”

Ahav ignored her.

“Come on, baby, say it with me: ‘I can stay in control,’” she said.

Ahav took a breath and repeated the words reluctantly. They said them together again and again, and then Ahav let his arms fall, and when Kelli got back in the driver’s seat and looked at him in the rearview mirror, he seemed so happy that she couldn’t help but feel some hope.

When Liz called again, Kelli wanted to tell her about the succession of good days they’d had, including a visit to Ahav’s new school, and the way he’d whispered, “This is awesome” when he saw it, and the hug he had given her afterward, but before she could say any of that, Ahav was grabbing the phone out of her hands.

“How are you?” he asked Liz, and started pacing around the house.

Kelli was amazed to see him talking fluidly. He had slept on his own for the past four nights. The shadow people in the corners had vanished. He was even talking about redecorating his room for the year.

After a while, because he seemed so lucid, Liz asked if he could describe himself. Ahav responded right away.

“I think I’m smart and creative. That’s what I think about myself,” he said.

“And I would even throw ‘kind’ in there,” Liz said.

Kelli was laughing when she took the phone back. “Wow,” she said. “If this backtracks on me, I’m not gonna make it. But this feels different.”

Liz suggested that the new medications Ahav had gotten during his last hospital stay might be reaching therapeutic levels in his system.

“This is really happening,” Kelli said. “Miss Liz, we did it.”

That night, Kelli gave Ahav his usual assortment of pills and tucked him in.

Kelli gives Ahav another dose of the medications he takes for his illness three times a day. (Bonnie Jo Mount/The Washington Post)

“You’re doing so good. Can you feel a difference?” she asked.

“It feels kind of weird because I’m not used to it. I feel like my personality is changing,” he said. Kelli stayed stroking his hair. She thought he was asleep, but then he asked her, “Are you proud of me?”

“I’m so proud of you,” Kelli said.

She stayed a few minutes more, and then left him to go set up the house for the boys’ first day of virtual school. All of them had gone through so much to get to this peaceful moment: the friends who insisted that what Ahav needed was more time in church, or more spankings; the advice to get a therapy animal, which didn’t work out; the donated drum set for music therapy that sat unused because there was no money for lessons. But here they were somehow, and Kelli was so lost in thought she didn’t hear Ahav getting out of bed and coming into the kitchen.

“Mommy, I’m nervous,” he said.

She turned to him and saw he was pressed against a wall. “About tomorrow?” she asked, hoping it was just pre-school jitters.

“No, I’m scared,” Ahav said. He wanted to sleep in her bed. His eyes were darting to the corners of the room. “It feels overwhelming,” he said.

“Look at me,” Kelli said. “Are you feeling like someone is after you again?”

“I’m feeling like someone is in the house,” Ahav said, whispering. Kelli sighed and told him to go to her room.

The next morning, as the first day of school began, Kelli set out his bottle of emergency tranquilizers, just in case.

During his first-period science class, he asked to borrow Kelli’s glasses. Sudden blurred vision was one of the side effects of his new medications. By his third-period language arts class, he was slumped over in the chair. Soon, he was on the floor. Drowsiness was another side effect. During the lunch break, he went to take a nap on the couch, moving stiffly, another side effect. “Why are you walking like an old man?” his brother asked him.

Ahav stayed on the couch for the afternoon, snapping his fingers outside of the camera frame to try to keep himself awake, and that night, when he said to Kelli, “Don’t let them get me,” and dug his fingers into her waist, she gathered him onto her lap.

He was crying now, and she could feel his tears through her shirt. His legs rested on her thighs. His hand was on her cheek. She hummed a song for him and kept rocking him until he was asleep.

Kelli cries after another fight between her sons. (Bonnie Jo Mount/The Washington Post)

That night, as Ahav slept in Kelli’s bed, a tropical storm moved through, and when Kelli awoke the next morning, it was to the sight of new cracks in the ceiling and new water leaks. All day long, as Ahav struggled to stay alert in class, she put out pots to catch the water. Finally, in the evening, the rain let up, and she was able to coax the boys out of the house and into the car so she could drop off some juice at the house of a sick friend.

“I’m just going to run these up to the door,” she told them.

The boys were in the back seat, buckled in and quiet. She was gone for only a few minutes, but it was enough time for the boys to unbuckle and begin arguing, and when she got back to the car, Analiel was on the floor and Ahav was punching him over and over.

“Get up, get up, get up!” she began screaming. She grabbed Ahav under his arms, pulled him out of the car and forced his hands down on the trunk.

“You do not move,” she shouted and then turned her attention back to Analiel, who was motionless on the floor, eyes closed. “Are you hurt?” she asked, and when he didn’t respond, she pulled him into his seat and strapped on his seat belt. His eyes were still closed, and his body was limp. “Analiel!” Kelli said. She slapped his face. “Please don’t act like you’re knocked out if you’re not.”

“Oh, my God, I didn’t want this to happen,” Ahav said, crying, his hands still on the trunk.

Kelli told him to get in the car and then started driving. “This is all my fault,” Ahav said, sobbing now. “I’m sorry. I keep failing over and over again. I always make the same mistakes.”

“Ahav, I need you to get ahold of yourself,” Kelli said. She reached back to shake Analiel’s leg. “Analiel! Can you hear Mommy?”

He had slumped over and was lying almost flat in the middle seat. He often dissociated during stressful moments, and Kelli hoped he might be doing that this time even as her mind went to other possibilities. Should she go to the ER? Would Ahav think he was being admitted again and have a full-blown meltdown if she did? Was he going to jump out of the car? Did she have the child locks on? She reached under her seat for her purse and shook it, listening for the emergency tranquilizers she always carried for Ahav, and then remembered they were on the table, where she had put them for school.

Ahav starting to lose control in another meltdown. (Bonnie Jo Mount/The Washington Post)

Ahav was punching himself in the head now. She called Liz, but there was no answer. Analiel was still unresponsive, and she knew she should go to the ER. But she also knew Ahav needed his medication, and their house was on the way to the hospital, so she went there first, pulling into the driveway and turning on the car light.

That’s when she noticed the red lines welting up across Analiel’s neck and realized Ahav hadn’t only been punching his brother, he had been choking him, too.

She decided the side streets would be the quickest way to the hospital and started speeding through them, crying and hitting the steering wheel. “What has to happen? What has to happen in order for us to get help?” she said. Ahav was crying, too. “Analiel, please. I just want you to be okay,” he was saying, and then came another sound, Analiel gasping for breath. “Oh, God,” Kelli said, driving faster, and then she was at the ER entrance and the moment she had been dreading, and working so hard to avoid, was finally underway.

Analiel was in one room, surrounded by eight people who were cutting his shirt off and attaching monitors to his chest.

Ahav was in another room, where he sat alone, fidgeting with a scrap of paper.

In the first room, a doctor was trying to put a stabilizer around Analiel’s neck.

In the second room, Ahav’s eyes were drooping as the tranquilizer took effect.

In the first room, Analiel was screaming and asking for his mother.

In the second room, Ahav was stretched out across four chairs, fast asleep.

One boy sleeping. One boy screaming. And there was Kelli, running from one room to the other and caught in between, until a few hours later, when the doctors said they weren’t sure if Analiel had been knocked out by a concussion or severe oxygen deprivation, but he was recovered enough to go home.

It was after midnight now. The rain had started again. More water was coming into the house. Kelli put out more buckets. Analiel said he was hungry. Kelli cooked some hot cereal for him on the stove. And then she turned to Ahav, who was standing in the middle of the kitchen, watching the corners.

“Come here, baby,” she said.

“Is he really okay?” Ahav asked.

“They wouldn’t have sent him home if he wasn’t,” she said.

“I thought I had it together,” he said.

“You do have it together,” she said, and she pressed her forehead against his because what else was there to do in this house in need of so many repairs? Call the therapist again? Call the police again? Take him to a hospital again?

“It’s going to be okay,” she said, hugging him tighter and tighter.

What to do about Ahav. Kelli had her answer.

“I got you,” she said.

A quiet moment in three unquiet lives. (Bonnie Jo Mount/The Washington Post)


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