James in the Real World

by Owen Todhunter

  Richard Galinski was leaving work. He had just finished a conference call with the Atlanta office. He hurriedly searches his office for his car keys. He has his PA reschedule the rest of his entire afternoon so he can visit James in hospital. He finally gathers his things and catches the elevator to the rooftop car park. That is when he feels his pocket vibrate. He pulls out his phone but does not recognise the number. A feeling of dread runs through him. With great trepidation, he answers.

  “Hello?”

  “Yes, hello this is Dr Luanne Shaw calling. Am I speaking with Richard Galinski?”

  “Yes, this is Richard. How can I help you?”

  “Mr Galinski, you may not remember me from our meeting at my office but your son James is a patient of mine. I was wondering if you had a moment to talk.”

  “Oh, right, Dr Shaw. Yes, I do remember you.”

  “Please, call me Luanne.”

  “I’m sorry Leanne.”

  “No, it’s…”

  Richard cuts her off. “Can I take a message and get back to you later. Right now is not the best time. I’m actually on my way to the hospital to visit James.”

  Dr Shaw springs up from the desk. Immediately, she begins prognosticating a multitude of diagnoses. A Psychotic episode? Possible adverse reaction to prescription antidepressants? Patient displaying signs of self-harm? Loss of cognitive function brought on by multiple seizures? The long pause makes Richard uneasy.

  “Are you still there?”

  “Yes. Yes, I’m here. Sorry Mr Galinski. I wasn’t aware that James had been admitted to hospital. Is everything alright?”

  “I, um, I’m not sure. I don’t know exactly how to answer that question.”

  “What has happened Mr Galinski? Is James okay?”

  For the first time since the accident, Richard contemplates the question. He stops being distracted by the million things he has going on in his life. Is James okay? He lowers the phone as he reaches his black Mercedes. He looks around and sees that the parking lot is abandoned. He drops his briefcase and slumps to the oil-stained ground. Once here, he allows himself to cry. The phone slips from his grasp. Dr Shaw remains silent, though she can hear the sound of Richard’s low distant whimpers through the receiver.

  “Mr Galinski? Are you okay?”

  Dr Shaw was breaking many of her rules. She was already too involved in James’ case. Now she was about to divulge confidential information. Most importantly, she had broken her golden rule. Don’t ask questions you already know the answer to. She knew Richard was not okay. This was a direct a result of James not being okay. The reaction said it all. A grown man only weeps in this way when his child’s welfare comes into question. Dr Shaw learnt this from her other patients. This time she asks a question she does not know the answer to.

  “Which hospital is James being held at?”

  Richard picks up the phone. He wipes his face and presses his back against the polished passenger door.

  “Mr Galinski, where is James now?”

  Dr Shaw is now frantically pacing around her office. She collects her handbag, keys and cashmere coat from her desk.

  “Mr Galinski! Which hospital?”

  It is no longer a question, but a desperate demand.

  “Wesley Long. ICU.”

  “Thank you. I’ll be there in 10 minutes.”

  There is no reason for Dr Shaw to rush. James condition was neither worsening, nor getting any better. Even so, she speeds through several red lights to reach him. She even receives a ticket for parking in a loading zone at the hospital. When she walks past reception, she spots Richard in the corridor. His face looks bored and expressionless as he sits alone. If she did not know any better he would seem carefree. There are no signs of agitation or restlessness, but Dr Shaw tries to look beyond his body language. Despite her better judgement, she likes to give people the benefit of the doubt. Richard is a caring father, here to be with his son. People handle shock differently she tells herself. A large proportion handle it with outward indifference. As she approaches Richard, she studies him more closely. She cannot help but notice his broad shoulders and strong jawline. His thick brown hair is held in place by a generous portion of gel. His deep-blue gaze narrows in on the vacant wall opposite. Despite his less-than-zealous state, he is in a word, handsome. Dr Shaw composes herself, patting down her knee-length skirt and matching grey cardigan. She clears her throat and straightens her glasses. Her eyes fix onto Richard’s mouth to read his reaction as she prepares her introduction. It needs to be caring, yet clinical.

  “Mr Galinski I assume? How are you coping?”

  Richard is startled. He turns his sunken eyes to face her. He can only remember their first meeting vaguely. Now standing confidently before him, he admires her curvaceous figure. He had failed to remark upon this the first time around. He finally shrugs in response to her question.

  “You’re James’ therapist. Dr Shaw, right?” he finally adds.

  “Luanne Shaw, yes. It’s nice to see you.”

  “Thanks, you too.”

  “I’m terribly sorry to hear about James. I had no idea. When was he admitted?”

  “6 days, no 7 days ago. Sorry, I can’t really recall. I’m a little exhausted Ms Shaw. Sorry, Dr Shaw.”

  “Please. Just call me Luanne.”

  “Sorry Leanne.”

  “It’s…”

  She thinks again about correcting him, but decides instead to let it slide. There were more pressing issues.

  “Look, the nurse is in there running some tests now,” Richard says. “the doctor should be back any minute,” he continues. “He can explain the situation much better than I can.”

  At that, a slick-haired, fresh-faced doctor struts into the room. He stops and smiles, sympathetically to Richard, then appealingly towards Dr Shaw. His eyes droop clumsily towards Dr Shaw’s breasts. Her already-ample cleavage is further accentuated by her top three buttons malfunctioning. Richard had already noticed, but was polite enough not to stare. The doctor quickly shakes off his hypnosis, greeting Richard before turning his attention back to Dr Shaw. This time his medically-trained mind allows him to maintain eye contact.

  “I don’t believe we’ve met. My name is Dr Carson. Are you James’ mother?”

  It seems Dr Carson forgot to properly check the family’s medical history. Richard flares his nostrils as he hears the question. Without so much as looking, Dr Shaw can sense his disdain. She herself feels equally angered by the absent-minded doctor. She places a hand to her glasses and frowns with annoyance.

  “My name is Dr Luanne Shaw. I am James’ psychiatrist. I’d like to know why I wasn’t informed by the hospital of my patient’s condition.”

  The doctor recoils. He mumbles a confused explanation of the hospital’s policies and procedures, before ushering both of them away from prying eyes and into James’ room. Here he explains the nature of the accident, citing head trauma and multiple limb fractures. Richard leaves the room. He has heard his son’s prognosis enough times to know it isn’t changing any time soon. Dr Carson’s beeper sounds and he excuses himself. As he leaves, he passes Richard in the corridor. Richard curses under his breath. The doctor pauses, turns and faces Richard.

  “I’m sorry. Did you just say something?”

  “Sick. I’m feeling sick.”

  “Oh,” says the doctor. “I’ll have the nurse come see you, Roger.”

  “It’s…” begins Richard.

  Dr Carson is already gone, bouncing down the corridors in his polished black shoes. He clicks his fingers, whistles a tune, and continues with his rounds. Richard imagines his fist plowing into the doctor’s face and the immense joy it would bring him.

  CHAPTER 21: Disassociate

  They stare at James silently. It is not an awkward silence, more one born of guilt. For their own reasons, they had both been consumed by their work. The sight of James’ broken body made them realise their situations paled in comparison. The issue was clear. She had neglected
her patient. He had neglected his son. James was guilty of many things also. They glance at each another, hoping one would finally speak. Dr Shaw nervously looks away, reaching down for her handbag. Her cheeks blush as she she finally notices her unintended cleavage. Discreetly she faces away from Richard ad buttons up her blouse. She retrieves James’ file, licking the tips of each page to locate her most recent notes. Richard watches in awe as she wades through the sea of paperwork. There’s something strange, yet alluring about her face. She looks slightly weathered, though the sparkle of youth is still there. He imagines her hazel eyes yearning to escape their square frames. Too busy to notice Richard’s admiring gaze, Dr Shaw brushes her golden fringe across her forehead. The subtle flick sends her perfume wafting towards him. His nostrils filling with a sweet floral scent.

  “Did you want to talk about James then?” Richard suggests hopefully.

  “I would, yes. But only if that’s alright with you, Mr Galinski.”

  “Please, call me Richard.”

  “Okay, Richard. Firstly, I have made the decision that I can no longer be James’ therapist going forward. I have a referred him to a colleague of mine once he…”

  “Wakes up?” Richard finishes. “He is going to wake up, isn’t he?” he adds.

  “Of Course. The thing is Richard, me simply being here is already crossing the line. I am talking to you now simply as James’ friend. I would greatly appreciate it if this conversation stays between us. Do you understand what I’m saying?”

  “Yes. Of course.”

  “I’m sure you are already aware of this, but James has been quite troubled for some time. He is a rather unique individual.”

  “Unique how?” Richard asks.

  Both parties seem surprised by their conversation’s lack of cohesion. He dared not verbalise it, but Richard was clearly perturbed by the fact that this lady clearly knew more about James than he did. At the same time, she used the same term as he did to compartmentalise his own son’s quirks. Troubled. He wants to suggest a more flattering diagnosis to counter the attractive doctor’s diagnosis. But as his lips move to form a series of words, the creases in his forehead betray his unease. Dr Shaw is quick to pounce upon the new-found silence. She speaks so quickly and with such precision that her lips do not need to foresee the words like Richard’s. They simply arrange themselves in perfectly constructed sentences and spill across the room. Richard is quite impressed. He is also daunted by the prospect of keeping up with her.

  “When James first came into my care, he was in a clear state of emotional turbulence. From what he said and the way he acted he was suffering very clear symptoms of PTSD. You are aware of this condition?”

  Richard is offended. Though he may be threatened by Dr Shaw’s intelligence, he certainly is no man’s fool. Of course, he knew what PTSD is. He was recently watching a Dateline episode about returned Iraq War soldiers. The reporter kept using the acronym PTSD. Having a vague guess at what it meant, he had to Google the term to be sure. At the time, he did in fact feel rather foolish. With the benefit of hindsight, he is now conveniently well-informed.

  “Post-Traumatic Stress Disorder,” he confidently proclaims.

  “Exactly.”

  Richard settles further into his seat, now content for Dr Shaw to commandeer the conversation.

  “James’ behaviour was very consistent with this condition. His detachment from other people, his avoidance, his lack of commitment. They all suggest he has not properly dealt with a traumatic event form his past. I’m sorry to bring this up, given the circumstances. But I believe this particular event concerns the death of his mother. Your wife Christine.”

  Richard snaps to attention. The very mention of her name shocks him. No one at the office dared to even broach the subject. He looks closely at Dr Shaw, but offers no response. He wants no recognition that his interest is now piqued. She continues unabashed.

  “There is a fundamental difference with James. In previous cases I have dealt with, patients do remember the traumatic event, even if they can’t recall specific details. They simply choose not to deal with the fallout. James however, has removed himself entirely from the memory. At first, I thought this was consistent with his avoidance behaviour. Over the course of our sessions however, I came to realise he honestly could not recall being in the car with his mother.”

  “How did you know he was in the car?”

  “You told his previous therapist that’s how she died. That’s about all I had to go on. The rest I had to pull from James’ scattered recollections.”

  “Oh. Right. So, what’s wrong with him? Is it amnesia or something?”

  “Well that is part of it. It’s more like selective amnesia. He still has a patchy understanding of what happened. But the memory is fractured, or incomplete. James feels responsible for his mother’s death. He is unable to process that emotion, so he has simply transferred the responsibility onto others. And by others, I mean yourself, and Hal.”

  Richard sits back in his chair, a confused look washing over him. He attempts to respond but Dr Shaw ploughs on.

  “When this issue came to light, I had to broaden my approach to better understand why James was exhibiting these behaviours. While he was in my care, and as I’m told from his previous therapist, James suffered multiple episodes. They were almost psychotic in nature. He has created an imaginary world, with people and objects that he perceives as real.

  “Are you talking about his nightmares?”

  “It’s more than that, I’m afraid. This extends far beyond a sleep disorder. It’s a culmination of everything. The nightmares, the seizures, the night terrors, even his sleepwalking. He has severe anxiety. He cannot handle intense emotions or stressful situations. His mind has deteriorated to the point that he genuinely believes that his dreams are real. He can no longer distinguish between his dream world and the real world.”

  “So, what? He’s schizophrenic?”

  “I believe he is suffering from a dissociative disorder. Have you ever heard the term Depersonalisation?”

  “Um…”

  “In a nutshell, it means that he has disconnected from himself. Through avoiding the traumatic event, he has divorced the emotions and thoughts that arise about his mother. This has leeched its way into all facets of James psyche. He feels like the world is distorted, and his memory loss is getting worse. He is literally losing his grasp upon reality.”

  She stops to let the last sentence sink in. The concern is not lost upon Richard. He again sits forward, scratching both his ears as he looks at the light flickering above them. He puffs his cheeks as he lets out an anxious breath. Dr Shaw twists her head to read his expression. She smiles softly and loosens her shoulders as she begins to speak again.

  “While I hope he recovers physically, the longer he is in a coma, the further his mind will slip into this alternate reality. If your son does wake up Richard, he may not be the person you remember.”

  Despite the softer delivery, the words hit hard. Richard feels himself becoming frustrated. How can she, James’ therapist and someone who supposedly cares about him, give such an egregious outlook? How can she be so insensitive?

  “Surely there’s something you can do,” he begs. “Some form of medication?” he continues. “I don’t know about this stuff, but he’s going to be okay, right?” he pleads.

  Dr Shaw attempts to steer the conversation toward a more positive note. She puts on a smile, and places a comforting hand upon his thigh.

  “I am hopeful,” she begins.

  “We were making progress before his accident. But I can’t force him to remember. Just because the trauma did not unfold the way he imagined it in his mind, doesn’t make it any less real. His feelings of distress and guilt are real. His memories are real, to him at least. You need to understand that Richard.”

  “Am I supposed to just pretend he wasn’t in the car?”

  “It’s best not to focus on the accident itself. You need to empathise with James. Y
ou must have very similar feelings about Christine’s death. Feel what he feels. That is the connection he needs. It will bridge the divide between the two of you.”

  “I know we’ve not been that close since she died. But I love James. Surely he knows that.”

  “I’ve learnt not to assume anything when it comes to James. He sees himself as an afterthought. That’s not to say that you’re to blame. But James needs to understand he is not the only one who feels the way he does. He needs to reconnect with himself, to reconnect with you. The rest will fall into place.”

  “I’ve never seen him cry, so I just though he had a thick skin. If it did affect him, he never let it show. At least, not to me.”

  “Don’t blame yourself Richard. I don’t think he gave himself a chance to grieve her death before he denied it ever happened. It was easier to imagine she was never there in the first place. As painful as it is, you need to talk to him about Christine. He needs you.”

  Dr Shaw returns to her notes, separating each section with bright pink and yellow sticky notes. She places each section face-down on the floor in front of her. Multi-tasking to the best of her ability, she licks her fingers, rips, sticks, and stacks the papers, all the while nodding as Richard begins to speak.

  “It’s just hard,” he says.

  “Mm hmm,” she says with a paperclip in her mouth.

  “I mean, when I look at him I feel this horrible guilt. I look at his face and I imagine you know, Hal. Then I start to think about Christine and it starts to play over and over again in my head.”