Laura Riley

Laura Riley, who suffers from bipolar disorder, has found that the changing seasons deeply affect her, and she dreads the long, dark winter months that can put her in the hospital. (Sun photo by Jed Kirschbaum / June 2, 2002)

Second of two parts

Do you have current reasons for living?"

"I hope I'll get better. You can't get better if you're not alive ..."

"Do you have doubts things are going to improve?"

"Well, yeah!"

"Do you believe your doctor when he says you'll get better?"

"My doctor wouldn't dare tell me that."

In a small windowless office in Baltimore's VA Medical Center, study coordinator Aaron Jacoby took notes on the state of Laura Riley's emotional well-being. The 28-year-old doctoral student, with his Palm Pilot efficiency, and the 46-year-old veterinarian, with her faded jeans and penchant for irony, were determined but awkward partners in a scientific duet. Week after week, they worked from the same set of questions. Week after week, they labored to determine whether the patient was getting better.

It was July 2001. Laura Riley suffered from bipolar disorder, a deadly mental illness that had caused her to give up her veterinary practice in large animal medicine the year before. Now she was trying extreme therapy: A pocket-watch-sized generator, surgically implanted in the upper left side of her chest, was sending regular stimulation to the part of her brain controlling mood. Dubbed the "brain pacemaker," the vagus nerve stimulator was being studied in clinical trials. Researchers hoped it would help stabilize the moods of patients for whom other treatments had not worked.

Laura's illness first appeared in 1997 after she stopped drinking. In the four years since her diagnosis, she had tried more than 30 medications and a course of electroconvulsive therapy. She had spent more than 100 days in psychiatric hospitals fighting suicidal depression.

Any improvement in her condition seemed worth the risk of serving as a medical guinea pig.

While all study participants were implanted with vagus nerve stimulators, only certain devices were activated during the acute phase of the trial. Jacoby did not know whether Laura was among the participants whose vagus nerve stimulators had been "turned on." Officially, Laura did not know, either. But a strange new sensation coursing through her throat eliminated any doubt. Every few minutes, when the device went off, Laura felt electrical impulses roll up her neck like a "million little air bubbles." They prickled, made her feel like coughing. It didn't hurt, but it wasn't pleasant. She supposed it felt like those buzzers people use for surprise handshakes.

The stimulator also made her voice quiver periodically, like a bad connection on a telephone. Before the interviews with Jacoby, protocol required Laura's device to be turned "off" by another researcher to eliminate any tell-tale signs that might bias the study. After the questions, she would be switched "on" again.

Laura realized having the device in her body was a crap shoot. It was like tinkering around under the hood of a car, trying to pull the right wire or bang the right component, until the engine started. Were the charges frequent enough? Did they last long enough? Were they too strong? No one knew. It was possible that the stimulator could even make her illness worse.

Once again, she was navigating uncharted waters. But this time the season was on her side; unlike the short, dark days of winter, summer was usually kind.

Laura began each research session tackling a lengthy list of questions ranging from the banal to the painfully personal. Clipboard on her lap, she checked off little boxes that described the severity of her aches and pains, her sad feelings and panic symptoms, her irritability and hopefulness during the previous seven days. Did she wake up too early? Sleep too late? Eat too much? Too little? How well could she concentrate, make decisions? She pondered her vision of the future and her ability to feel pleasure. She tried to remember how frequently she had thought about death, about suicide, about sex.

In their interviews, Jacoby would go over similar material in greater depth. The questionnaire he used, the Hamilton Depression Rating Scale, was developed in 1960 by British psychiatrist Max Hamilton. It was still considered a "gold standard" for assessing subtle mood changes in depression trials.

Laura couldn't remember some things, like how many times she sighed each day. And there were other topics -- like how often she thought about suicide -- that she didn't want to discuss. It was hard enough to talk about those things with her psychiatrist, Mark Crandall, who knew her intimately. Here, she was a color-coded binder in a clinical community of individuals known to posterity only by their numbers.

When she could, Laura chose to look at the bright side.