by Sandra Block
“You guys all set?” His eyes are bloodshot, and his hair is mussed up. “Jason, who’s up?”
“A new one. Ms. Clark,” Jason answers as we start walking down the hallway to see the patients.
“All right. What’s the quick and dirty on this one?”
“Sixteen-year-old female with new onset of probable psychosis.”
“Because?” Dr. Berringer’s voice is scratchy.
“Because she thinks her cat is talking to her.”
He pauses. “Did you say ‘her cat’?”
“Her cat,” Jason confirms.
“Okay, I thought I’d heard them all. What’s the cat saying exactly?”
“The cat is giving her secret messages that people want to harm her.”
“By actually talking?”
Jason pauses. “To be honest, I’m not sure if the words are in English or if she’s going by the meow.”
“It’s a feline conversation one way or the other,” I break in.
They both stare at me. I find myself less patient on my new dose of Adderall.
“Yes. That’s correct, Zoe,” Jason says, in not the warmest tone.
Dr. Berringer knocks on the door, and we walk in to find an aide helping with a sponge bath behind a curtain. “Be ready in a second,” the aide yells out.
Dr. Berringer squeezes his forehead. “We’ll come back,” Dr. Berringer calls to her, and we exit into the hallway. Rounding is full of such missed opportunities to see patients: They’re in OT, EEG, CT—usually some sort of acronym. “All right. So we’ll have to meet the cat whisperer later. Who else is up, Jason?”
A little voice inside me is dying to scream out “Me, me. Call on me! I’ve got a new patient with anorexia!” with my arm leaping off my body like I’m back in second grade and the chair is a prison. The increase in Adderall is clearly having a paradoxical effect.
Jason swipes his gelled-up bangs, which are on the orange side today and in need of a highlighting appointment. “My next one is Brandon Gellman.”
“Oh, we saw him on Friday, right? Cutter?”
“Burner,” Jason says. A sixteen-year-old who burns himself with cigarettes to stamp out the less pleasant feelings swirling around in his head.
“Oh, yeah, that’s right. We’ll circle around to him at the end. How’s Jane?” He turns to me. “Rumor has it she’s talking.”
“Who told you?” I ask, annoyed that someone just made off with all my thunder.
“Nancy.” He looks at me funny. “Said she was asking for food. Do we know who she is yet?”
“No. Not yet. Hopefully soon. Soon, soon, soon.” My foot taps out a song on the tile.
“Patience, fair Zoe,” he says, his voice tired. He scans his patient list and then folds up the paper into a square with trembling hands. “You know what, guys? I’m sorry. I am just feeling like crap.” He does look a pale shade of green, his forehead glazed with sweat. “My wife has the flu. I’m probably coming down with it.” He puts the paper in his long lab coat pocket. “I’ll get one of my partners to cover for this afternoon, if you don’t mind.”
“Oh no, of course, that’s fine,” I say. Jason and I nod reassuringly. And if we did mind, we most certainly wouldn’t say. Dr. Berringer gives us a shaky smile and walks off, leaving us standing there with a cartful of charts in the middle of the hall and no one to run rounds. Our fearless leader, vanished.
“Well, ain’t that just the shit?” Jason asks.
“Odd, isn’t it.”
“What?”
“The shit. I mean, what kind of expression is that?”
He raises one eyebrow. “Zoe, you know what?”
“What?”
“Sometimes you’re really annoying.”
* * *
There’s no mistaking Chloe Brown’s diagnosis. She wears it like a badge, a purple heart in her own private war. Painfully symmetrical collarbones, dull teeth, and sores lining her fingers from purging stomach acid.
“So, has anyone explained the rules to you?” I ask.
“Yup,” she says with a loud sigh. “Been there, done that, know the drill.” The war has left her ravaged but not defeated.
“So you know then,” I continue, “you gain points based on participating in group and gaining weight.”
“As I said, not my first time at the rodeo.” She tucks a Kool-Aid-red strand of hair behind her ear with chipped black fingernails.
“Okay,” I answer, ignoring her hostile vibe. I lay my pen down on the table with a soft, slapping sound. “It might sound trite, Chloe, but we’re really here to help you. That’s all any of us are trying to do.”
She remains slumped in her bed, staring at the whiteboard decorated with perky red marker: “Today is…Monday! Your nurse’s name is…Nancy! Lunch is…mac and cheese!” I’ve had their mac and cheese; it’s nothing to exclaim about.
I lean back in the chair, telling her with my posture that I’m open to sharing, then wait a long moment before gathering up my pen and chart. The intake has been carried out. There’s not much more to discuss right now. Or at least Chloe doesn’t think so. “You’ve had your weigh-in. Group therapy at eleven. I guess I’ll see you tomorrow.”
She doesn’t answer.
“If you need anything in the meantime, just call me. Dr. Goldman.”
“Who’s the attending?” she asks.
“Dr. Berringer.”
She rolls her eyes. “The great Dr. Berringer.” Her red bangs hang in spikes over her eyebrows.
“You know him?”
“Yeah, you could say that. I had him last time I was here.”
I nod, giving her time to elaborate, but nothing is forthcoming. “Did you have a problem with him?”
She smirks. “Yeah, I have a problem with him. He’s an asshole.”
Her response surprises me. Most of the patients love Dr. Berringer. The parents, especially the mothers, won’t stop raving about him. “Okay,” I answer, evenly. “Would you like to tell me more about that?”
“Yes, I’d love to tell you more about that, Dr. Goldman!” She claps her hands together. “He’s the most egocentric individual I’ve ever met!”
“Because?” I ask.
“I don’t know.” She shrugs. “I guess you’d have to ask him. An overindulgent mother, I’m thinking. That would be the Freudian explanation anyway.”
“Right.” Sometimes you need to quit when you’re ahead, and she is the last patient of the day. “Maybe we can talk more about that tomorrow.”
“I’m counting the minutes,” she says, rolling her eyes again, harder if possible. A seizure-inducing eye roll. I stand up to leave, figuring she’s probably just splitting, meaning someone is either all good or all bad. Black and white, no gray zone. And this can shift. Dr. Berringer may be the devil today and her savior tomorrow.
On the elevator, a man in a turban walks on, cradling a coffee in his hands. A priest steps in on the next floor, nodding at the man in the turban and then me.
“How’s the weather up there?” he asks with a broad smile. I smile in response to this question I’ve heard a million times. It’s hard to get mad at a priest. In the lobby, health-care folks in scrubs and white coats mix it up with the civilians: patients and visitors. They all line up for the coffee shop, jonesing for their fix. People are scattered about the room in various states of disarray. A balding man in a suit, pacing with a bouquet under his arm. A very pregnant woman in sweats, staring at the vending machine. A redhead, stiff in his wheelchair, drooling and grimacing while his mother stands next to him eating pizza. A resident talking on his phone, his scrub hat lopsided. Automatic doors slide open to a fading blue sky, and I feel a twinge of sadness at these folks in the lobby who have to stay in the hospital.
But it’s time for me to go home.
* * *
Someone is sitting in my usual eggplant-colored settee by the fireplace at the Coffee Spot (annoying, but it’s not like I had a sign on it), so I’ve settled into a bo
ne-colored sofa chair by the window, the faux leather flaking off its arms. The night grows darker outside, a soft rain dotting the sidewalks.
Acing the Psychiatry RITE sits on one side of the table, and a thick journal article, “Catatonia: A Case Series and Literature Review,” is on the other. Both untouched. Eddie walks by, straightening up the table to my left. The chair knocks against the table legs. With a sigh, I open up the RITE book, flattening out the page.
Your patient has been diagnosed with bipolar disorder. After trials of several other medications, you decide on topiramate. What potential side effects should you counsel your patient about?
a) tremor
b) weight gain
c) hirsutism
d) suicidality
e) nephrolithiasis
I circle b, because every psychiatric drug seems to cause weight gain, then immediately check out the answer below. E. Kidney stones, damn it. Topamax is known to frequently cause significant weight loss. Of course it is. Probation is starting to look like a life sentence. I take another sip of decaf espresso (an oxymoron, I know, but my heart has been trying to escape from my chest all day), readying myself for the next question, when Scotty wanders over.
“How’s life?” He sits beside me in the French-blue chair, crossing his long legs at the ankles. The music changes to Vivaldi’s Four Seasons, of course.
“Life is life,” I answer. “How about you?”
“Similar,” he says, downing the last of his coffee. “I was going to visit Mom’s gravesite on Sunday if you wanted to come.”
“Oh.” I play with the pages of the book. “I don’t think I can because—”
“Quick, think of an excuse,” he says. Snarkily, I might add.
“What’s your problem?”
“I don’t know.” He leans back again. “Sometimes it’s like you care more about Jane fucking Doe than you do about Mom.”
“It’s not like there’s a contest.”
“You know what I mean.”
I take a deep breath. “Obviously we just have different ways of dealing with Mom’s death.”
“Obviously so.” He checks his watch. “The Charles Schwab thing came up empty by the way.”
“What Charles Schwab thing?”
“For the bonds. I told you I was going to talk with that woman from Charles Schwab. She said they can’t go back that far, but she has some nice ETFs to sell me if I’m interested.”
I cackle. “I bet.”
We sit another minute, not talking, and I notice my foot tapping to the music. Scotty yawns, then catches the eye of a skinny blond girl a couple of tables ahead of us. He glances at the floor a second, and when he looks back up at her, she’s still watching him.
“Aren’t you still seeing what’s-her-name?” I ask, because I actually don’t remember her name.
“I don’t think so,” he answers, which isn’t an answer as far as I’m concerned, then strides over to meet the newest what’s-her-name. Brushing his hand through his already messy hair, he bestows his trademark eyebrow raise upon her, then says something. Who knows what? No doubt a well-worn pickup line that only he can carry off, and she laughs with her friends, throwing her head back with strands of golden hair shining under the lights. Target acquired. My brother and his way with the fairer sex, one of life’s great mysteries.
I turn the page, but the next question is over three paragraphs, which seems like an inordinate amount of reading right now (again, cue ADHD and utter Adderall failure), when luckily an e-mail pings onto my phone to save the day. Probably another coupon from Banana Republic, but I check anyway. It’s a chain e-mail from a medical resident who barely qualifies as an acquaintance. Delete. I abhor chain mails, a gratuitous source of angst. The next question is also way beyond the pale of what I’m willing to read, so I sail on to question number five.
Anorexia is often associated with
a) depression
b) OCD
c) anxiety
d) borderline personality disorder
e) all of the above.
I picture Chloe rolling her eyes with disdain over “the great Dr. Berringer,” which probably has a lot to do with answer d.
As I sit there, the rain hitting the window in silken taps, a sudden, overwhelming exhaustion overtakes me. It brings me back to my high school years, when we were still experimenting with stimulants, trying to get the right dose and the right combination to corral my thoughts into line. There is the surge of dopamine release.
But then there is the crash. I had forgotten about it.
Chapter Ten
I hardly recognize Jane out of bed.
She is leaning over the art table, her elbow against the scratched rubber siding, with her head on her arm like she’s about to go to sleep. But she is wide awake, in deep concentration as her left hand draws out a picture. I pull in closer to see.
“That’s great,” I say.
She does not answer right away. “Thanks,” she manages quietly.
“She’s very talented,” the art therapist agrees, smiling. Donna is a large woman (or zaftig, as my mother would have more gently put it) in a willowy, wine-red outfit. She always favors shapeless outfits in earth tones, like she found out her color was “autumn” at a makeup counter once and she’s sticking to it. “I taught gifted and talented kids in the Williamsville school system for twenty years,” she says. “And I’m always amazed that our kids here are heads and tails above all of them.” She washes off some paintbrushes, a muddy purple color flowing into the sink. “I guess with burdens come talents.”
The pictures are good, actually, much better than my stick-figure composition would be, my artistic achievement having plateaued around second grade. “What was the assignment today?”
“Self-portraits. It helps to see how they visualize themselves,” she explains. “Tells me about their hopes and fears. That sort of thing.”
The life sort of thing. I inch back over to Jane and flip through her drawings from the last week. There is one with numbers and letters. Symmetrical and straight, no bubble letters like another tween might have drawn. Plain numbers and letters interspersed with symbols of the sun. Perfect circles with spokes radiating off in glistening yellow.
“What do these mean?” I ask her.
Jane shrugs and keeps drawing.
“I told them to just draw what they wanted yesterday. This is what she came up with.”
Numbers and letters and suns. Part of the recovery process? “I like them.”
Jane pauses. “Thanks.”
I glance at my watch, slim and silver with a pearl face. My mom’s old watch. “See you later, okay? We’ll be rounding this afternoon.”
Her pastel crayon sticks to the paper. “Okay.”
Walking out of the art room, I ready myself to see Chloe next, taking a deep breath. Every day, I walk into Chloe’s room with my head up and walk out with my head down, feeling like a human punching bag. I drop the bulky chart on her table and pull up a chair. “I see you’ve lost a bit of weight.”
Chloe has lost a pound, a major achievement in the Eating Disorders Unit, where every ounce is monitored. “Yup. Reportedly that’s the big news today.”
I readjust my chair with a squeak. “Any idea how that could have happened?”
She appears to think about this. “Evaporation?”
It takes all my training not to laugh.
“Or maybe not,” she continues. “I’m a bit hazy on the water cycle these days.”
I nod. “I was thinking more along the lines of hiding food.”
“Now,” she chides me, “you know that’s against the rules.”
“I do know that. But that doesn’t mean you’re not doing it.” She doesn’t answer my accusation. “In any case, you know the rules. You won’t get any privileges for losing weight, unfortunately.”
She blows her bangs out of her eyes, and they plop back down. “No privileges. Woe is me.” The tendons in her wrist stick out like taut
rubber bands, her pulse throbbing under her skin.
It strikes me then that I need to change my tactic here. She doesn’t see me as an ally, just another pain-in-the-ass adult in her life telling her to do what she fears and abhors most: to eat. Tomorrow, I won’t talk about food at all. Maybe that will buy me an inch with Chloe Brown. She is looking out the window now, a soft rain slicking the street below.
We both turn to the doorway as Dr. Berringer walks in with a perfunctory knock. He looks spick-and-span today, refreshed and fully pressed. Like he got over his flu.
Chloe refuses to meet his gaze.
“Hello, Chloe,” he says. She still doesn’t respond. “How are you doing?”
After a tense minute, she shrugs, not looking at him. Her face is hot red. “I’m back. So obviously it wasn’t the ideal outcome.”
He sits down in the chair next to me, his knee brushing against mine. His hair is damp and smells of shampoo. “It’s going to take time, Chloe. But we’ll get there. You were getting better, and we can get there again.”
She turns her whole body away from us toward the window.
“Chloe?”
“Yeah, yeah, yeah. I’ve got to eat. It’s not healthy. I’m not actually fat. I have a body dysmorphic disorder. Blah-blah-blahsy-blah-blah.” She is talking right to the wall.
“I know you’re angry,” he says. “But I’m not sure why.”
“Then you’re not a very good psychiatrist.” There are tears in her voice.
He starts to say something, then stops with a frown. He gives me a helpless shrug and motions toward the door.
“See you later, Chloe,” I call out to her.
She doesn’t answer. “We’ll give her some time and come back,” he says, once we’re in the hallway. “How’s Jane doing today?”
“Good, she—”
A middle-aged woman in a purple suit with a flouncy, cream-colored top interrupts us. “Hi there. Are you going to see Jane Doe?”
“Yes,” Dr. Berringer says.