by A. F. Brady
“Well, you better pull it together before you go in there. You look like you slept in a gutter.”
“Fabulous. Thank you, David. But whatever, I’m totally fine. How’s Rachel? What kind of mood is she in?” Definitely not totally fine. I smooth my hair into a bun and pick the sleep out of my eyes. I swish some Listerine in my mouth and spit it into the garbage can.
“Rachel seems okay. We just finished our meeting and everything went fine. Good luck.” He walks out of my office, clearly disappointed, clearly disapproving. I can’t be bothered to worry about what David thinks. I check my face in a compact, grab a stack of patient files and walk confidently to the conference room.
Rachel is sitting at the head of the table with her back to the door. The conference table looks enormous when there’s only two of us sitting around it. I arrange my files in front of me as Rachel says hello, and then I stand to get myself another cup of coffee.
“Grab one for me, too, would you? Mine is the Tweety Bird mug.” Rachel calls after me as I slip into the lounge.
“Sure, how do you take it?” I yell through the cracked door.
“Light and sweet, please.” I prepare our two coffees, then walk them back into the conference room with trembling hands. As I place Rachel’s cup in front of her, coffee sloshes over the lip and wets the table. “Thanks, Sam.” She wipes up the coffee with a thin tissue and takes her first sip. “So, let’s get started. Remind me how many of your patients are on meds here?”
We’re in our monthly medication-management meeting. Each clinician meets with Rachel once a month to review how our patients are doing with their medication: Are they taking it? Do we suspect they’re tonguing it? Is it having the desired effect?
“Everyone except Richard,” I say.
“Okay. How’s it going with Richard? Not really a med-management question, but still. We haven’t had a chance to catch up.”
“Making progress, I think. He’s a tough guy, and he’s still certainly not interested in answering questions about his incomplete file, but I’m beginning to sense that the violence rumors are nothing but hearsay. He’s more like a stone wall than anything else.” My eyeballs are jiggling inside my head.
“Well, I’m glad to hear you’re making progress. We’ll discuss that further at our next patient meeting, okay?”
“Great.” I feel the hiccups starting to form deep in my chest.
“Last time we were here, we were discussing Adelle. Something wasn’t working. I think we discussed changing her dosage or talking to the psychiatrists about trying a different medication?”
I flip through my files until I see Adelle’s, and I have no idea what Rachel is talking about. I have no notes in her file about changes in medication. “Um, yeah. We were going to add in olanzapine, see if we can get her bipolar symptoms stabilized.” Does Adelle even have bipolar? When I don’t know what the fuck I’m talking about, I usually just throw around industry jargon and hope no one else is paying attention.
“Okay. Watch the interactions there. She’s got a history of alcoholism, right?”
“Yeah, but she’s been in treatment and away from booze for many years. She’s in her nineties now, probably won’t be an issue.” My breath is hot and thick.
“Just monitor for liver function, and keep an eye out for anything seizure or tremor-like. I’ll make a note of this. Hopefully, we find more success with the olanzapine than we have with the risperidone. I wouldn’t want to compromise the system of such a fragile woman.” Rachel writes something in her book.
“Okay.” I scribble a wobbly note in Adelle’s file to have her psychiatrist sign off on olanzapine. I feel the hangover sweats soaking the armpits of my sweater.
“What about Shawn? We’ve gotten some reports that he’s completely out of it in groups. Very forgetful, confused. Have you determined if this is med related?”
Rachel is going too fast for me, and I’m having trouble keeping everything straight in my head. Shawn… Which one is Shawn again? I shuffle the files. “Uh, Shawn is fine. Actually—” I can see my brain forming the lie, and I want to stop myself, but I don’t “—he has been showing signs of memory improvement, less confusion. I think we should stick to his current medication plan as it is, let it do its job. Shawn is only twenty-six. I assume the confusion is a lack of attention, honestly.”
We continue moving through my caseload, discussing the details that I can’t seem to remember about all my patients. A violent headache is taking hold of the tendons behind my eyes, and I fake my way through the meeting, feeling both drunk and hungover, until I can finally stand up to leave.
I hold the door open for Rachel as I walk out into the hallway. She looks at me quizzically, still sitting in her chair. “I’m staying here, Sam. I’ve got meetings with the rest of the staff.” She screws her face into a judgmental grimace. “Try to get some sleep tonight.”
DECEMBER 16TH, 2:12 P.M.
I’m covering a group for Julie, who couldn’t be bothered to come to work today. She probably had a meeting with her wealth manager to discuss stock options and pork bellies. This group is a spectacular waste of my time, because the only counselor responsibility is to monitor what the patients are doing on the computers.
Porn and gambling websites are blocked all across the institution, as well as social media sites, gossip sites or anything containing dangerous keywords like guns and drugs. I can’t figure out how to circumvent this blockage, but some of the young patients are tech wizards; they manage to find some way around it and end up jerking off in the computer room. So, this is essentially what I’m doing in the computer room right now: making sure no one is breaking into porn sites and decorating the underside of the desks. I’m wearing AJ’s scarf, and I periodically pull it up over my nose to inhale his scent. It brings me directly to his apartment, and my legs start to tingle and my stomach gets warm.
Eddie and Adelle are next to each other, and both of their computers don’t work. Eddie keeps pushing the button on the monitor and waiting for something to happen. Adelle is patiently watching him. Lucy is on the other side of the room, looking at academic websites. She’s planning on taking her GED, and she wants to prepare herself. She has a stack of papers that she took out of the recycling bin and is copying down every word she sees on the screen.
Eddie leans over Adelle and pushes the button on her monitor. Nothing happens.
“Ssssssam, the compuuuter’sss broken.”
“Why don’t you try one of the other ones?” I say without looking up. I’m gazing into my coffee, searching for answers.
“This lady’ssss computer’ssss broken, too.” Adelle turns ever so slightly in my direction, and I groan to my feet and walk over to them. I push the same button Eddie has been, with the same result. I get down on my knees and poke the button on the tower between the two computers. I listen for anything to happen.
“Hey! My computer died!” Tyler looks around trying to figure out what happened.
“Sorry, Tyler. Hang on a sec.” I push the button again, turning Tyler’s computer back on. I finally find the right one, and Eddie’s computer creaks to life, but Adelle’s stays blank. There isn’t another tower down here. I peer back up onto the desk, and there isn’t another tower up there, either. Adelle’s monitor is attached only to the keyboard and the mouse, and it doesn’t even have a power cord going to the wall.
The computers we have are ages out of date, the technology is about ten years behind, and here we are using dead monitors plugged into nothing to help our patients learn modern technology. Welcome to Typhlos. What a bunch of bullshit.
“Eddie, what are you doing on the computers today?” I ask, hoping he and Adelle can practice some patience and teamwork and do a computer project together.
“I don’t know, Sssssam, what sssshould-we-dooo?”
I stand behind his chair and lean over the desk to reach for the mouse so I can find a game or an educational program that they can work on together. Eddie doesn’t
move his hand as I descend onto the mouse, and we end up holding it together, and I push and pull his hand and arm with mine. I open a program designed to help with recall memory and information retention.
“Would you two be willing to work on this project together? Maybe you can help each other to learn and remember?” I’ve already done more than I wanted to do in this joke of a group, and I’m getting fed up and frustrated. Adelle removes her Coke-bottle glasses and polishes them on her scrubs top. She perches herself at the edge of her seat and gently pushes Eddie’s elbow, encouraging him to move the mouse and start the game. Eddie does, and the first box that pops up on screen asks for a name. Satisfied that they are willing to work together and I can go back to zoning out, I leave them and return to my seat by the door. After a few minutes of deliberating, I see Eddie and Adelle type “Eddelle” into the name box on the screen.
I look around the room and see various copies of the Diagnostic and Statistical Manual of Mental Disorders that mental health professionals use strewn about. Instead of drifting into a semiconscious state, I walk around and start tidying up. There’s a copy of the third edition of the diagnostic manual, the DSM-III, opened to the section on personality disorders. This is more of a history lesson than anything else; so much has changed. There are notes in the margins, but they’re in smudged pencil, so I can’t tell what they say. Some of the pages have their edges bent down. I close the DSM-III and walk around the room to pick up the other books.
Two copies of the fourth edition are also out on desks. I read the familiar words and strain to see what the notes in the corners say. There are initials and check marks in the margins, as well. F.W. and S. something.
As I close the books and stack them in the crook of my arm to put back onto the bookshelf, I notice that one of the monitors was left on, and no one in this group is using it. I approach the monitor to turn it off and discover an open Wikipedia page about personality disorders, and to the right of the monitor is a Post-it pad. It’s not a Typhlos one, but for some reason I think I’ve seen it before. I survey the room to figure out who could have been looking up diagnostic criteria, but no one in here knows how to work the computers well enough to find this. Suddenly I feel like I’m being watched, but as I scan the room again, all I see are patients slowly tapping on computers or dozing off in their chairs.
DECEMBER 19TH, 1:19 P.M.
I need to smoke. I can’t go out now—it’s freezing outside, and there are too many people between me and the door, and I don’t want to look at anyone’s face.
I pace my office, which is too small to pace, so essentially I walk in miniature, tight circles, and I realize this is making me feel insane.
My windows are on the left side of the building; they’re not in the front where some staffer may see me if I were to lean out, but up on the third floor above the side street.
My Lunch sign is already affixed to the outside of my door, and I don’t have any groups for another hour, so I would have time to air myself out and even brush my teeth.
Knowing that my coat already smells like cigarettes, I rationalize that it won’t make much of a difference. I pull open the window and carefully tuck all my hair into my hood. I take off my shoes and stand up on the patient chair so the whole top half of my body is out the window. My gloves are on, which makes it hard to grip the cigarette and the lighter, but at least my fingers won’t smell.
I finally get the cigarette lit, and all this concentration and effort is paying off. As the smoke fills my lungs, the unending sense of panic begins to fade. I focus on blowing the smoke away from the open window, and the thin white wisps disappear in tiny tornados of bitter cold. It’s bright, and my sunglasses are in my handbag. Squinting, I watch the plumes flow out of my mouth. I look upward toward the warmth of the sun and suddenly choke on the cigarette smoke as I see Rachel hanging out of her office window.
“Sam!” I hear a flustered whisper scream call my name. It’s Rachel. She’s leaning out the window of her office, with her hood pulled over her hair, clutching a pink Bic lighter in her left hand. “Put out that cigarette and come to my office. Now.”
Without saying a word, I throw my still-lit cigarette onto the street below me and pull back into the office. My heart explodes in my chest and the panic begins to rise like bile in my throat. What the hell is Rachel doing smoking out her window? I hurry to get my shoes back on and my coat up on its hook.
I grab my water bottle, take my toothbrush out of my emergency sleepover bag and brush my teeth, quickly spitting into the garbage can. I spritz on perfume and use the Febreze that lives under my desk to spray my sweater and hair.
Rushing up the back stairs to Rachel’s office, I take the steps two at a time. My heart is racing from a combination of horror, fear and nicotine. I can feel my jugular straining against my neck.
I’m winded when I reach Rachel’s office, and I knock despite the laminated In Session, Quiet Please sign on her front door. I try to camouflage my anxiety with the veneer of professionalism, but I feel the sweat trickling down my sides. I can sense the golden-girl image tarnishing.
Rachel inches the door open and pulls me inside, quickly closing us both in before the smell of cigarettes can escape into the hallway.
“Sam, you’re smoking?” Rachel has already hung up her coat and reassembled herself.
“Yes, I’ve always smoked. Granted, never out my window, but yes, I have been a smoker since I started here.” I sit down in her patient chair, even though she didn’t invite me to.
“But now? Still? You’re still smoking?”
“I’m sorry, I totally understand that smoking out my window is completely impermissible and out of line. I promise you, it won’t happen again.” I hear the apology come out of my mouth and marvel at Rachel’s hypocrisy.
“No, I’m not—I don’t mean the rules, I just—I can’t believe you would smoke while you’re pregnant. Someone as educated as you are.”
“Pregnant? I’m not pregnant! Oh, my God!” The spins are back.
“You’re not pregnant?” Rachel seems genuinely shocked.
“No! Where did you hear that?”
“Oh, God. Samantha, oh. I thought—ahh. I came by your office the other day to discuss some things with you, and I heard what sounded like vomiting coming from your office. I guess I just assumed that you were having morning sickness, and you stayed in your office to avoid telling people. Oh, I can’t believe I jumped to such a conclusion. I’m sorry.”
“Oh—I…” I’m caught off guard. I thought I would have to excuse the smoking, but now I’m being called out on throwing up in my garbage can. Fuck. “Yeah—I’ve been really, uh, ill. I get these migraines, and sometimes they make me really nauseous. I don’t often have time to make it to the ladies’ room. It’s an absolutely disgusting affliction, but, not quite pregnancy.” I’ve had this lie sitting in my back pocket for years, assuming I couldn’t possibly go undetected forever. I’m watching Rachel’s eyes and hoping she buys it.
“Oh. Well, I’m sorry to hear that. I had no idea you suffered from migraine headaches. My ex-husband had those. They’re quite debilitating.”
“Yeah, it’s fine. I’ve had them for a long time, so I’m used to it at this point.” Are we going to discuss that we were both just smoking out the window?
“I’ve noticed you’re slow to react sometimes in the staff meetings—now I understand why. No wonder you looked so exhausted and out of it when we had our meeting the other day.”
“Sorry if that happens. I try to hide it, but sometimes it just gets the best of me.” Garner the sympathy, get the shine back on me. I can masquerade a hangover as a migraine all day. “What brought you to my office the other day? You wanted to discuss something with me?” I need to quickly maneuver the conversation away from anything that’s making me look bad or weak. Or pregnant.
“Uh, yeah. I did.” Rachel shifts uncomfortably in her seat. “But obviously we should address the elephant in the room.”
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br /> I hold up my hands in a gesture of surrender. “Your secret is safe with me, Rachel.”
“Well, thank you, but it’s absolutely inappropriate for me to be smoking out my office window.” She releases the breath she’s been holding since I walked in. “These are just very trying times, and sometimes I get overwhelmed like anybody else.”
I seamlessly switch to psychologist mode and furrow my brow to listen. I cock my head slightly to the left and give an almost imperceptible nod, encouraging her to keep going.
“Things have been stressful here,” Rachel continues. “I’m sure you, of all people, have been able to sense the chaos.” She makes a grandiose gesture with her hands, seemingly trying to indicate that the whole unit has gone up in flames.
I’m nodding along, interested and also somewhat guilty that I haven’t noticed the severity of the chaos.
“We’re in—” She leans toward me to tell me the details like little girls sharing secrets on the playground. “We’re in, like, extraordinary financial straits right now.” Rachel throws her back into her chair and spins it away from me, clearly uncomfortable releasing this information. She’s rubbing her temples, and I notice for the first time that she has chewed her cuticles and they’re red and raw.
“I haven’t been disclosing any of this to the staff, and I know the other administrators have been playing it close to the chest, as well. But, frankly, I was just smoking, and since you were, too, looks like professionalism is out the window, so to speak.” She looks over her shoulder at me and smirks. “And I trust you, Sam.”
“Rachel, I’m so sorry. I had no idea that Typhlos was in such trouble.” Things are starting to make sense; of course we’re in trouble. The staff has been irritable, and the admins are nowhere to be seen. The sick days are adding up all over the place. The paint is peeling; the toilets remain unfixed. More and more patients are filing in and no more staff has been hired to manage them. Caseloads are case overloads. I begin to wonder how bad it really is.