by Barbara Ebel
Annabel and Bob nodded at each other. “Thanks,” they both said. “We’ll take the sample test and holler if we need help,” Annabel said.
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One by one, a nurse handed Selina all their in-patient charts. She stacked them on the rolling cart and then Joshua pushed it down the hallway.
“Mr. Blake,” Selina said in his room, “did you go to the dining room to eat already?”
Victor repeatedly swiped a comb through his hair as they all took positions inside the door. “Yeah,” he shrugged. “Too many people in there today and they’re crazier than me, doc. Do you think I can finally go home?”
“Give me a few minutes.” She checked all the notes that the nurses and aides had written since their last rounds. No one had recorded any misbehavior by Victor and there was no indication he was acting psychotic.
“Are there any creatures lurking in your room?” she asked.
“Nah. I feel better and they all left.”
“In what way do you feel better?”
“I can think clearer because the voices in my head went away so they’re not clamoring for my attention.”
“Are you positive about yourself? Like the decent mood of our other patients in group therapy?”
“Yes,” he beamed. “As much as them; and I do want to look for a new job.”
With his optimism and plans for his immediate future, Selina didn’t bother asking him about suicidal thoughts.
“Why don’t you call your mom and either she can come pick you up today or tomorrow morning. I want to see you one-on-one once a week for a short time and also in the weekly group therapy. Can I trust you to comply?”
Victor put his comb in his back pocket and nodded.
“Do not stop taking your medication, risperidone. Take it every morning like clockwork. Consider it the most important chore you must do every day. All right?”
“Okay, Dr. Keeton.”
“We will go over your discharge instructions again and, to be on the safe side, I’ll repeat them to your mom when she gets here.”
“I like my mom a lot. You can do that.”
“Treat her carefully, Victor. Don’t mess around with her oxygen tubing again.”
“I goofed up. I won’t do that again.”
“I know you didn’t mean to,” she said.
Selina turned to Joshua. “Keep tabs and interrupt me when Mrs. Blake arrives today or tomorrow.”
A pang of sadness came over Annabel when they left. She would see Victor again but, as an inpatient, he had given her firsthand insight into his diagnosis and course of treatment. Her paper on schizophrenia, she hoped, would be interesting to anyone in or outside of the field of psychiatry.
In her scant research already, she was surprised to find out about well-known or important people who carried the diagnosis or were strongly suspected of having it.
Annabel was aware of John Nash, the Nobel Prize winner for mathematics, because they made a movie about him but she had no idea about some others. Her father’s most respected historical figure, Albert Einstein, had a son presumed to be schizophrenic, and James Watson, the DNA co-discoverer and Nobel Prize winner, also had a son with the same history. Since schizophrenia may be a heritable trait, it made her wonder to no end about Albert Einstein’s genius mentality and his association with the passed down DNA. Schizophrenic patients may have some bizarre behavior; however, there were also traits which made them geniuses.
It was also reported that Abraham Lincoln’s wife had schizophrenia as well as a host of celebrities, including the famous actress Veronica Lake.
Annabel respected all the psychiatry patients so far and, in a way, she thought that all ‘normal’ people weren’t ‘normal’ anyway. Many people exhibit a peculiar habit, a strange fastidiousness, or an explosive, narcissistic, or compulsive personality. Her list went on and on.
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The team searched for Noah and found him in the rec room peering over a backgammon game played by two patients.
“Dr. Tilson,” Selina said, “before we go in, please give us this morning’s update on Mr. Goodman?”
Annabel straightened her posture and started. “Mr. Goodman is oriented times three with no signs of psychotic behavior or pressured speech when I spoke to him earlier. He also slept a few hours last night.
“The labs we ordered late yesterday are back and his lithium level is perfect. I did notice a slight elevation in his white blood cell count. Since his situation stabilized, our plan is to continue the present dosage of medication and therapy.”
“What are you thinking about the elevated white count?” Selina asked.
“Dr. Washington and I discussed that finding; it’s most likely a benign and not uncommon occurrence under his circumstances. Also, it seemed as if he had a slight tremor this morning which he never had before.”
“Ah ha,” she said, “a lithium side effect. At least he hasn’t shown any others which are worse.” She shifted her gaze to Dr. Washington. “What is your plan if he does have tremors?”
“Maintain the present therapeutic dose,” Joshua said, “and consider treating the tremors with a beta blocker. Propanolol is the drug of choice.”
“Let’s go face the music then,” she said taking a step. She waved Noah to the other side of the room and they all sat down at a table.
“I want to tag along on your rounds,” Noah said. “No, I’m not acting weird like when I arrived, but I do want to learn since I’m here. You mentioned they may put a halt to my education but my going back will be fine. You fixed my problem.”
“I am sorry, Noah,” Selina said. “The medical school board has decided the acuteness of your illness prevents you from continuing. Plus, you need to focus on getting better and controlling any signs and symptoms which you have … both now and in the future. It’s going to be a steep learning curve.”
Noah registered surprise and then drooped his head. “But I already proved I can do medical school.”
“Yes, you did, for a little while. You earned a seat with your entrance exams and resume of activities and recommendations. Life is not static, however, and things change in a heartbeat. Your diagnosis is a crushing blow and a life-altering one. One thing we will talk about in therapy is support from others. Are you close to your parents?”
“Kind of,” he said. “But this changes everything. My whole life.” He wiggled his finger at them like it was their fault and, to their dissatisfaction, his hands briefly shook when he stopped.
Annabel felt so sorry for the crestfallen student, she wanted to sit next to him and console him. “Noah,” she said, “once the dust settles, you may learn about other jobs associated with medicine. Some doctors employ close helpers in their offices. Maybe with a little more medical exposure or training, you could do something like that.”
“You’re just trying to help but I wanted to be like you or them,” he waved.
“I wanted to be a pilot,” Joshua said, “but after I started training, I had a problem with one eye and needed to stop. My eyesight would have prevented me from passing the practical exams and physicals so my parents suggested medicine instead; maybe it was a blessing in disguise.”
“Dr. Tilson and Dr. Washington are giving you practical advice to be helpful,” Selina said. “Also, your lithium level is perfect but we’re starting you on another medication for the hand tremors which are a secondary side effect.”
“I thought the mania had settled in my hands,” he said with a big frown. “I guess one more medication won’t kill me.”
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Jamie Harris walked the halls to expend her pent-up mania and when the group gathered in the hallway after seeing Noah Goodman, she came rushing over.
“So what’s it going to be?” she asked while tugging at Dr. Keeton’s sleeve. Other than an appropriate V-neck top, she wore a skirt with ankle socks and a turned around baseball cap.
“Hold on, Ms. Harris,” Selina said. “We want to hear from Dr. Palmer
about any new developments in your case.”
Jamie let go but stayed close.
“You can be brief,” Selina said. “Ms. Harris is listening and wants to be an integral part of our decision making.”
“As we would expect, her lithium level is not normal yet,” Bob said. “And last night staff reported she began visiting patients. She wrote entitlement passes out for free pizza at the restaurant she works in and woke patients up to hand them out.”
Selina looked at Jamie. “Even though your homemade coupons won’t function the way you think, your boss isn’t going to be happy if he hears that. Call Dr. Washington next time you’re thinking about behavior like that. He will make you understand why it’s not appropriate and stop you. We want you to hold onto the same job after you’re discharged. Okay?”
Jamie took off her baseball cap. “You mean I can’t use these?”
A few square pieces of paper coupons fell to the floor and several stayed in the hat. Bob picked one up.
“No. No more pizza paper deliveries.”
-----
“What’s the latest development from the internal medicine service on Lillie Carter?” Selina asked as they stood outside the doorway of her medical ward room. Doctors, students, and staff brushed by them on patient visits. An orderly with a patient in a wheelchair tried to pass on the way to radiology so they opened up their circle to let them go by.
“Lillie’s lab work is close to normal and she’s better hydrated,” Annabel said as they huddled back together again. “Yesterday I had a lengthy talk with her and she confided in me that her bones hurt. I jotted her complaint in my progress note and medicine went ahead and ordered her a bone scan. The radiology reading is not normal. She does not have the slight bone thinning of osteopenia; they found full-blown osteoporosis.”
Annabel shook her head with disapproval. “I can’t believe it. A sixteen-year-old girl with osteoporosis.”
“I echo your concern,” Selina said. “This is one of the worst anorexia cases I’ve seen. She’s an example of what happens when someone only eats an apple and a handful of pulverized oat cereal pieces a day. Her body has been deprived of calcium and all the daily food requirements from dairy products, vegetables, fruit, and meat at a critical age.”
“They are going to start her on osteoporosis treatment,” Annabel said.
“A not uncommon plan for a sixty-five-year-old woman but not a sixteen-year-old. What’s the outlook for this poor girl’s body when she’s only thirty?” Selina flinched. “Let’s go in,” she said.
Within a few steps, they caught Lillie in a routine ritual as she stood a few feet back from the large mirror over the sink, her head scanning up and down.
Joshua was quick to comment. “Can you tell us what you see?” he asked.
Lillie startled but continued staring at the mirror. “A whale. Blubber meat like what they hunted in ‘Moby Dick.’”
A shattering silence permeated the room. The magnitude of her response cut into Annabel’s mind like a train smashing into a concrete wall. How could a human brain from a skeletal person conjure up a thought even remotely close to her response?
Annabel gulped a breath of air. Selina’s normal countenance also returned so she asked Lillie to sit in the chair.
“Dr. Washington or Dr. Tilson, why don’t you both do a little physical on Lillie this morning since we’re overseeing her entire care?”
Annabel took her stethoscope off her neck and crouched down. They all sensed Selina was going to forego psychiatric talk and save it for therapy; what Lillie had said was too appalling to discuss on rounds.
Lillie’s heart rate was not as high as when she’d been admitted and Annabel found her lungs to be clear. She checked her IV site which looked clean and functional but noticed for the first time her parched and cracked skin. As Annabel straightened up, she saw thinned-out areas of hair, dry and course, on the top of her head. My God, she thought, even a lot of her hair had fallen out.
“Lillie,” Dr. Keeton said, “you and I are going to be seeing each other for a long time but, for now, you still need the medicine doctors.”
She turned to leave. Whatever the team discussed further, it could wait until they were outside.
Selina paused and turned. “Lillie, you must conquer anorexia before it conquers you.”
Chapter 18
Outside Lillie’s room, Dr. Keeton wrote a note acknowledging the medicine service’s plan to treat her for osteoporosis. She placed the chart back down and sighed heavily.
“I may have told Lillie I will be seeing her for some time, but I didn’t tell her she’s going to be staying in the psychiatric ward for months. Her whole thought process needs to be overhauled with a great deal of cognitive behavioral therapy.”
“Do you think she will ever be normal?” Annabel asked.
Selina shook her head. “The prognosis of anorexic patients is one of the worst in psychiatry and she’s a severe case. Estimated mortality is six to eighteen percent due to complications or suicide. I’ll try my best and I’m counting on Dr. Washington to make an impact on her as well.”
“Bob and I won’t be here as long, but if there’s anything over and above our role of students that we can contribute, we’d be happy to.”
“In your future practices, if you are ever suspicious of a youngster with anorexia, please send them to psychiatry right away. Sometimes primary care doctors dismiss these young girls as going through a phase. The illness must be taken seriously.”
“I sure won’t forget,” Bob said. “I barely knew about the illness.”
“That’s partly because anorexia affects mostly females,” Selina said. “Society can take some of the blame. Skinny runway models and Hollywood magazine stars make developing young girls think it’s glamorous and healthy to be beanpoles.”
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Following morning rounds the next day, Annabel finished writing progress notes in the lounge and then stuck the sample test in her pocket. She waited for Bob but finally headed to lunch without him. Downstairs, many of the cafeteria visitors and health care workers vied for the ravioli special and salad bar. She waited for the same entrée and then skimmed the room for an empty table.
After placing her tray down, Annabel noticed Karla Weaver and Bob sitting at a table in the middle of the room. Bob wore a smile as Karla pulled back her dark hair in a ponytail.
Annabel looked back at her plate, took a swig of ice tea, and stabbed at a pasta. She must have misunderstood him. They were supposed to meet during the day to look at Dr. Keeton’s sample test; most likely at lunch. But Karla and Bob must have made specific plans to break away to eat. She couldn’t fault him for not doing study work with her at lunch time but she felt left out.
When she glanced over again, the two of them burrowed their heads close over the centerpiece like two kids sharing a secret. Maybe he was telling her a joke, she thought. He does have a super sense of humor and, after all, he is pretty good looking with a round face and perfectly cut blond hair. Plus, like most med students, he was smart and came from a good family; his mother was a nurse and his father an electrician. What female wouldn’t be interested in him? But why was he falling for an older woman? He could at least pick someone near his own age.
Darn, she thought. All along, Bob had shown interest in her but he couldn’t wait forever for her to reciprocate. Even though she wasn’t interested in a close relationship, if she were, Bob would be a wise choice … that is if she weren’t head over heels hooked on Robby Burk. In a month or two, she would surely see him. The FDA, a drug company, and the surgery and anesthesia departments would have to meet to wrap up a drug issue from her last rotation so her involvement with that problem would warrant an invitation to the meeting. Robby Burk has to go, she thought. His presence was imperative - for her to feast her eyes on him as much as for his medical input and attendance.
For the time being, she needed to focus on her studies. Get these two men out of her head but also res
pond to the last text from the high school basketball coach from Findar. Their messages had continued in a steady fashion and, although not as original as meeting on a boat on the Ohio River, the plan was tentative for tomorrow night. She opened up the app off her phone and wrote a brief two-liner:
Yo, Tristan. Keep those kids shooting hoops today!
Still on for tomorrow? 7 p.m.?
She sent the message, put her phone back, and took out the test and placed it beside her plate. As she ate, she glanced at the first several questions.
“Hi, Annabel,” Bob said.
She looked up to see Bob and Karla standing beside her holding their trays.
“I forgot about the test,” Bob said. “I bet you’re acing it and wish it were the real thing.”
“I forgot to make a copy for you so I’ll do it when I get back. But I thought we were going to work on it together at lunch time.”
“I would appreciate a copy,” Bob said as Karla glanced away. “See you upstairs” he added, ignoring her second remark.
Karla and Bob walked away. Annabel made a disgruntled face but then focused on a test question - one that zeroed in on the side effects of antidepressants. Knowing the answer lifted her spirits away from the tinge of jealousy she felt for her best buddy on rotation.
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Only a fraction of sunlight still beamed over the Ohio after Annabel changed at home and headed out for a run. As she walked through the flower garden and between the benches of her neighborhood park, her phone alerted her to a text. She stopped, brightened the settings on her phone, and read Tristan’s return message.
Hey, Annabel. That will work. Meet you at corner of Brimstone and Market off of exit 453 – Murphy’s gas station. Lots of restaurants around there … we can first grab a bite before ‘committing’ to anything else. ☺
My treat. Tristan
She could always pay for herself, she thought. But in any case, the fling tomorrow night would be a nice way to start the weekend before studying.
I’ll be driving a red SUV, she wrote.
I’ll wear blue jeans and a cowboy hat, he responded.