by Barbara Ebel
“I felt pretty good since our last session.”
Joshua smiled. “Did you do anything different?”
“I talked to my sister every day. She helps transport me away from my mental agony and I love the way she treats me. Like I’m a real person. And I’m helping her out in her gift shop every afternoon.”
“So your sister is a perfect relief for you. And it sounds like you have a little job. Congratulations.”
“It is like that,” Timmy said and smiled.
Annabel thought about Jonah, Orange, and Timmy. The outpatients had more insight and were more functional than Victor – which made her realize how the prescription drugs and therapy were controlling their schizophrenia.
“Victor,” Joshua said, “you can share with us and speak up. Since you’ve been in the hospital, is there anything that helps you get away from all the troublesome thoughts you experience? Is there anything you’re doing which is making you feel better?”
Victor shook his head. “I’m not a big talker with people,” he said. “Especially when protons are in the room. They might spontaneously combust.” He frowned and twisted his hands together in his lap. Joshua kept quiet as Victor then slowly eyed the three other patients.
“But maybe I can talk here because you all understand what I’m saying and I don’t want policemen taking me away anymore.”
Chapter 7
“We don’t want the police picking you up anymore either,” Dr. Washington said. “So think about positive experiences here in the hospital. Maybe something in particular helped you have a sunnier outlook.”
Tapping his feet on the floor, Victor said, “Sometimes I like looking under the bed to make sure nothing is there which will spring or crawl out and harm me.”
“That’s a start.”
“Maybe next time,” Orange said, “I’ll bring you one of my cookies. They help me.”
A few seconds elapsed. “That was nice of Orange to offer, wasn’t it?” Joshua asked.
Victor nodded.
“You all did wonderful today,” Dr. Washington said. “Dr. Keeton is going to go over what you accomplished.”
Selina leaned forward. “Without our help, you all came up with mechanisms to cope when you’re having difficulty with the uncomfortable thoughts or feelings which spring up mostly due to your schizophrenia. Like I always tell you, we can’t make the illness disappear but we can do our best to control it. This list can be shared: Jonah drew pictures; Orange baked cookies; and Timmy talked to a family member. Victor scans under his bed but I bet next time he will come up with a better idea.”
Orange looked up and Annabel saw her eyes for the first time. “Is group therapy scheduled again for next week?” she asked.
“Yes,” Selina said. “Same time. Same place.”
“Victor,” Timmy said, “these doctors helped me a lot. Sometimes it’s best to be in the hospital. Good luck, bro.”
-----
Annabel walked with Victor back to his room. “How did you like that experience?” she asked him.
“I don’t like talking about personal stuff,” he said. “But I’ve been talking with you students and doctors so I’m getting used to it. Back there I was with others with my same illness and they talked about their feelings, so more people is better. It’s kind of a relief to talk with others about how I feel. Maybe I can get better.”
Annabel couldn’t believe her ears; Victor’s awareness had skyrocketed. Each day his schizophrenic manifestations were less acute.
“I’m glad to hear it. And congratulations. Your ability to interact with others was the best yet.”
Victor kept his head down. A yellow plastic sign diverted people from a mopped-up slippery area on the floor. “Thanks,” he said. “I held it together because I didn’t want to spontaneously combust.”
Annabel chuckled to herself. Although cognizance of his psychosis had improved, he still had a long way to go.
At the doorway, Victor peered into his room. “When is lunchtime?” he asked.
“They’ll be calling you in a little while because today you start eating with other patients. More enjoyable than being by yourself.”
Annabel proceeded to leave the ward. She went to the back of the first floor’s radiology department and spoke with a woman at the desk.
“Is the x-ray ready which was taken late yesterday on my patient, Victor Blake?”
“Blake,” she said, thumbing through x-ray jackets. “Here you go.” She handed Annabel the brown envelope.
“Thanks.” She opened up the radiologist’s reading and her mouth fell open. “So he did break his toe.”
“Pardon me?” the woman asked.
“Oh, nothing,” Annabel replied. “Can I check this out?”
“Sure. Sign here.”
Annabel wrote her name and hurried back upstairs. The door to the ward opened before she asked to be buzzed through. Dr. Keeton and Dr. Washington walked out and held the entryway open for her.
“See this?” she asked. “Victor Blake does have an old small toe fracture.”
“I’ll be,” Joshua said, holding the film up to the light. “It doesn’t look new. No telling how old it is.” He handed the film to Dr. Keeton and read the report.
“Can one of you please fill me in?” Selina asked.
“Oh, sorry, Dr. Keeton,” Annabel said. “Victor mentioned to me that he broke his toe, or he thought he broke his toe, when he fell off a chair trying to commit suicide.”
She squinted her eyes at the film and looked at Annabel. “Nice work. His account of what happened along with the x-ray sounds quite plausible. Mr. Blake came to us none too soon. If we have any influence in the matter, he won’t be pulling that stunt again.”
-----
“Our two upper level docs just went to lunch,” Annabel said, finding Bob eating at their lounge table. She frowned. “My priorities aren’t straight. Where’d you get pizza anyway?”
“It’s up for grabs and in the refrigerator. Leftover from some celebration yesterday.”
She piled two small slices on a plate and after microwaving them, she sat down across from him.
“There are two patients in the ER we’re probably admitting,” Bob said. “At least that’s what I heard.”
Annabel bit her lower lip and paused taking a bite.
“What’s wrong?” Bob asked.
“My second dermatology follow-up appointment is today after my malignant melanoma diagnosis and surgery. I’m her last patient … around five o’clock.”
“I can vouch for you needing to leave on time. After all, I was your PACU chaperone the day of your excision. I still feel terrible they diagnosed that lesion on your arm to start with.”
“Not to worry. Dr. Burk did a good job digging it all out.”
“Annabel, don’t talk about your body so harshly.”
“Okay, I’ll be nice and talk respectfully about it.” She took a bite and thought about her heartthrob, Robby Burk. He had also been the surgeon to excise the dark malignant mole on her upper arm. That made her dream of him even more.
“I see you are sporting a heavenly glazed look in your eyes,” Bob said, butting into her thoughts.
“I don’t know what you’re talking about.”
Frowning, he ran his hand through the top layer of his hair as if figuring out a response.
“Your far-away dreamy Robby Burk expression.”
“What? You know about my stupid crush?”
“How could I not? When we were doing surgery, sometimes it would be stamped all over your face.”
“No! You’re kidding.”
“I wish I were. I wish there was a little room for me in that head of yours.”
Annabel’s cheeks flushed for two reasons. Maybe her feelings on the previous rotation were more obvious than she ever realized and secondly, Bob’s comment about wanting space in her thoughts made her feel worse. He always treated her kindly and made her feel special but now he was sincere and mo
re forthright than before about voicing his attraction for her. She treasured him as a close friend and didn’t want to mess up their relationship. Annabel liked him but not that way.
“There is reserved space in my thoughts for you,” she finally said. “Because you’re my very best friend right now. When we’re out practicing years from now, we’ll remember each other from psychiatry but we may not remember some date or a passing infatuation stuck in our brains for someone of the opposite sex.”
“I’ll buy that for now,” he said, wiping his hands with a napkin.
“Good. And if need be, I’ll take you up on your help to leave on time today.”
“You would do it for me. And let’s hope we see those new patients from the ER,” he added. “I’m ready for a new admission who is as interesting as your Mr. Blake.”
-----
Annabel and Bob finished lunch and a nurse walked in. “Dr. Keeton just called the desk with preliminary orders for patients she’s admitting. She told me to tell the both of you to head to emergency psychiatry.”
“Thanks,” Bob said. Annabel and Bob grinned at each other and headed out with enthusiasm. Across the way, their excitement ramped up when they entered the atrium. Two paramedics were talking with two police officers and the regular security guard stood listening. A stretcher was propped against the wall.
Annabel slowed down to figure out what they were doing there. “I’m going back,” Bob said and continued walking behind the reception desk to the emergency care section.
One of the officers spotted her and briskly walked towards her. She recognized him from Mr. Blake’s admission but didn’t remember his name.
“Student-doctor Tilson, I believe,” he said.
“I can’t believe you remembered.”
“Some people I don’t forget,” he said. “I’m Officer Lowe. Dustin’s my first name.”
“Nice to meet you again,” she said while noticing the dimple in his chin. It shined like an uncirculated penny when he smiled. “Why are you and the paramedics here?”
“Because of a 911 call, we all showed up at a mall for a young man who filled an entire shopping cart with electronics and tried to leave without paying. But the store clerk told the operator to send EMS because he wasn’t your typical shoplifter. He acted loonier than a horned lizard and had to be strapped onto a stretcher. He needs help. Psychiatry help. But anyway, we had other business down here so we gave EMS an escort.”
“Maybe he’ll be my patient. As a student, I need all the patients I can get.”
“Since we’ve been here, another patient came in, too, escorted by a family member. Suicidal.”
“When it rains, it pours,” Annabel said.
“So true.” Dustin glanced around at the different doors. “Is that other doctor here from last time?”
“You mean Dr. Keeton?”
“Yes.”
“Most likely she’s in there,” she said, pointing past the reception area.
“My partner and I were wondering. How about you and Dr. Keeton meeting me and Officer Banks some day after work for scrambled eggs and coffee?”
Annabel smiled. “Like a breakfast date in a 24/7 diner which serves eggs all the time?”
“Yup, just like that.”
“That’s a very different kind of offer. Creative.”
“I have your interest, anyway. Why don’t the two of you discuss it? Here’s both our numbers. Just text me and let us know.” He put the numbers on the back of a card and handed it to her.
“Okay,” she said. “I better go inside now.” She didn’t really want to go out with him, but killing his proposal right off the bat wouldn’t be fair to Selina. The two officers wanted to double-date them so if her attending wanted to go, she’d oblige. It did not have to be a big deal.
She smiled and took one last glance at the atrium. The paramedics grabbed the stretcher and headed out the entrance and the regular security guard went back to standing in his usual spot.
After Annabel went inside, she figured out where everyone was from the bulletin board. Another psychiatrist was there seeing a patient as well, so the acute unit staff had enough to do. She passed a partially closed door and saw Dr. Washington.
“Dr. Tilson,” he said, “come in. This is Noah Goodman.”
She stepped inside to find a young man in his mid-twenties wearing a bright yellow top and green slacks. His long legs paced the room and he talked loudly and rapidly.
“I don’t think I can introduce you at the moment,” Joshua said. “But Bob is with Dr. Keeton and another patient so you can pick this patient up to follow.”
She nodded and looked at her new patient’s mismatched shoes as he hurried from one end of the room to the other.
“Why don’t you sit down?” Joshua asked him. “And tell me about your mood.”
“I feel great!” Noah said. “But I’m not going to sit.”
“We’ve called his roommate,” Joshua said, “and he’s on his way. So I haven’t gotten much history yet.”
“Is he the one that came in with EMS and the police?”
“The same one,” he said while Noah didn’t pay them any attention.
“Noah,” Joshua tried again, “do you have any allergies to medicines?”
“No allergies to anything,” he practically sang.
“Are you taking any medicines?”
“No. Not at all. But someday I’ll study them.”
Joshua went straight forward with his questions. At least he had the patient’s attention.
“Do you take any drugs?”
“I don’t like drugs so I’ll never use them.”
“Drink much alcohol?”
“I shouldn’t tell you but I’ve been guzzling down after-dinner drinks but sometimes I don’t wait until after dinner.”
“Like liqueurs?”
“Yes, dark, tasty stuff!”
“Thank you for letting me know. And have you recently wanted to hurt yourself?”
“Why would I do that? I’m on the top of the world.”
“Any medical problems now or in the past?”
“Medical, medical, medical. They asked me that already. Those men that drove me here.”
“What did you tell them?”
“No medical problems.”
“Have you ever been depressed or seen a therapist or a doctor for depression?”
Noah now circled the exam table and waved off his question as Annabel went through a differential diagnosis in her head. Based on Noah’s scant history, his behavior, and her cumulative studying of psychiatric illnesses, she guessed her new patient had the other major psychosis other than schizophrenia. She wouldn’t be happy for his bad luck but, for her education, she hoped he had bipolar disorder. Sensing a thorough work-up would be involved, she knew as good clinicians, however, they had to rule out other possibilities.
A knock sounded at the door. “Dr. Washington,” a tech said quietly, “Noah Goodman’s roommate is here.”
“I’ll be out,” he said. “Mr. Goodman, we’ll be back in a little while. Someone will be here to take a small amount of blood from you. It’s just to check if you’re okay.”
Annabel and Joshua stepped out. “Besides normal electrolytes and blood counts,” Joshua said, “we must check his blood alcohol level and do a urinalysis for drugs.”
“Is it possible he has bipolar disorder?” Annabel asked.
“Nice deduction,” Joshua said, smiling at her. “Yes, more manic right now than a hyperactive kid on Christmas morning.”
After spotting a man about Noah’s age by the sitting area, they walked over. The young man wore a worried look and extended his hand when they approached. “Are you with Noah Goodman?” he asked
“Yes,” Joshua said. “I’m Dr. Washington and this is one of our medical students, Dr. Tilson. I understand you’re his roommate?”
Unlike their patient, the man’s grooming and behavior seemed normal. “Yes,” he said. “You can call me F
red. This is really terrible. Noah’s a first-year medical student like me.”
Chapter 8
Annabel and Joshua stood dumbfounded.
“Here in Cincinnati?” Annabel blurted out.
Fred nodded.
“Let’s sit over here,” Dr. Washington said. They went to the corner chairs and Joshua rested his forehead in his hands for a second. “You’re right, this is a game-changer. Let’s start from the beginning. Speak up, too, Annabel. You are just two years further along than Fred and Noah.”
“Thanks,” Annabel said. “I’m dumfounded at his presentation. If Dr. Washington doesn’t mind, what kind of behavior does Noah exhibit at home?”
“Now I feel terrible,” Fred said, “because I didn’t realize the severity of his behavior. I attributed his recent craziness to the fact that we’ve been dissecting our cadavers in gross anatomy since school started. We bring home an awful formaldehyde dead-body smell on our clothes and skin every day and it makes us feel grossed out. Lately, Noah barely sleeps a few hours a night and he zips through the apartment constantly cleaning and doing repetitive loads of wash. Again, I thought he was getting rid of the unpleasantness of our corpse but, in retrospect, it was way overboard. I mean, I don’t act the way he does.”
Annabel leaned on her knees and agreed with Fred’s thinking. Perhaps Noah’s lack of sleep and the stark reality of medical school were giving him profound anxiety.
“Noah tried to leave an electronic store,” Joshua said, “with an unpaid cart load of high-ticket equipment. Are you aware if he’s ever done anything similar to this before?”
“Never, and I’ve known him since premed classes. But recently he has money trouble from all the crap he buys. He even went out and bought a motorcycle. He’s never ridden one and it’s sitting in our driveway untouched. What if he drives it? He’ll get himself killed.”
Joshua’s mind raced on the last comment and he realized Noah could be a danger to himself.
“His room is overflowing with new clothes and weird stuff,” Fred continued, “like vinyl records and duplicate textbooks. And I know his credit card is maxed out.”
“Other than this phase he’s going through, did you notice any periods when he seemed depressed?”