The Patient

by Steena Holmes

  “Should I pick up where we left off? For, say, five minutes?” Nothing calmed Ella like being read Alice’s Adventures in Wonderland.

  “But I don’t want to go among mad people,” Alice remarked.

  Despite the uplift in my voice, I stopped and looked at Ella from the corner of my eye. I should have skipped this part, but then, knowing Ella, she’d call me on it. Most days, as I read, her lips moved as she said the words with me.

  “Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”

  “How do you know I’m mad?” said Alice.

  Another glance toward Ella, and sure enough, her lips were moving.

  “You must be,” said the Cat, “or—” I stopped and hesitated long enough to see if she’d finish the sentence for me.

  “Or I wouldn’t have come here,” Ella said, changing a word to make it personal. “I cross-stitched that onto a sampler and framed it.” Her childlike smile was contagious when she finally spoke to me. “It reminds me that I’m no different than anyone else. We’re all just on different paths.”

  I set the book down on the table and picked up my notepad. It was a rare day that Ella was ready to talk so quickly.

  She held her teacup between the palms of her hands and blew at the steam. The look on her face was one of the reasons I’d bought the set of cups from Sabrina. Her smile was full of warmth, and her eyes glittered with happiness. “Did you know, I’m actually reading this to our preschoolers during our reading hour at the library?”

  “Then it’s good they have a librarian like you,” I praised her.

  She beamed with a confidence I rarely saw, her cheeks a nice rosy shade.

  “Being lost in books is my sanctuary, and . . . I’d die if I couldn’t do this anymore.”

  This wasn’t the first time this train of thought had come up, but it had been a while.

  “Ella, you live a full life, and you’ve been through so much. It would be hard, but you would survive.”

  Her lips compressed into a frown that also wrinkled her forehead.

  “You survived ten years in prison. I doubt there is very much that would destroy you now.” I needed to remind her of where she’d been and how far she had come since those days.

  She swallowed more of her tea, her back straighter than a ruler.

  “I only survived because of the books.”

  The tap-tap-tap of my pen against the notepad brought a flush of red to her cheeks. It wasn’t a loud sound, but it carried a message that said I knew she wasn’t being truthful—with me or with herself.

  Ella didn’t like to discuss her time in prison. Each time we skimmed the surface, she retreated, withdrew from me, from the life around her, and lost herself in a book.

  She liked to become a character within the story she read, and despite our twice-a-week sessions, there had been times when it was a week before I saw her again.

  She would say the world she lived in now, our world, our present reality, was fictional, a facade she maintained in order to live with freedom, but her reality was found within the pages of any book she read.

  “You don’t understand, Dr. Rycroft,” Ella said. “The person I was before I started to work in the library at the prison was horrible.” She shuddered. “Evil. Bad. I didn’t like being her, but I was lost. It was like I was waiting to be reborn, to become new, but all that anger and hatred continued to build until I—the real me—was brought into being.”

  Ella stared off into the distance, not seeing me, the wall, or anything else.

  This was the most she’d revealed on a personal level about her emotional displacement, and I wasn’t about to interrupt.

  “Spending hours each day alone in that library, poring through the books on those shelves, discovering help through the nonfiction section . . .” She pinched the bridge of her nose. “It saved my life. Literally.” There was a naked truth in her gaze. “I would have ended up dead or killing anyone who got in my way. Instead, I found healing.”

  Fixated on death. I jotted that down.

  “I swore I would never be that person again.” Ella’s voice turned whisper soft. “I can’t.”

  Her smile was mixed with both sadness and sympathy, except I wasn’t sure who the sympathy was meant for. Herself? I couldn’t imagine her being the way she described herself in prison. Evil? Bad?

  Not my Ella.

  Regardless of her past, the person she was today—so different.

  Her revelation surprised me, and I was filled with pride. For her. For her growth.

  “Ella.” I needed to bring the conversation back, to retain the flow of truth between us. “You’ve used a lot of destructive words today.” I glanced down at my notepad and repeated the ones I’d made note of. “Destroy, death, evil, bad, killing . . . Would you like to talk about what was wrong earlier?”

  Ella went through the motions of pouring herself a fresh cup of tea, added in a sugar cube, and stirred it round and round and round.

  “Have you been watching the news?” she asked. “It’s horrible, isn’t it?” She continued to stir. “Parents murdered in their own beds . . . and their children so close by? How is anyone safe anymore?” She hugged herself, squeezing tightly, her eyes closed.

  “You’re safe, Ella.” I waited until her hold loosened, her eyes opened, and the scared look on her face disappeared.

  “I need to tell you a secret,” she whispered, her voice barely audible, “but you can’t tell anyone. You can’t.”

  I remained silent, not giving voice to the anticipation that built like a stoked fire. I expected this would lead back to her time in prison, to the reason she’d been sentenced, and a nervous expectation settled in my stomach as the seconds ticked on.

  If she told me what I hoped she would, I’d be thrilled. She held so much guilt and condemnation while at the same time attempting to pretend those feelings didn’t exist.

  Except they did.

  I squashed down the excitement, gave her time to think about her words, to build up the courage to face a truth that had always been there, right beside her, just waiting for her acceptance.

  “I have a confession to make.”

  Chapter Seven

  WEDNESDAY, AUGUST 7

  PATIENT SESSION: SAVANNAH

  Some days I just wanted to crawl back into bed—covered in blankets, lights off, curtains closed—and hear nothing but silence. Sweet, blissful silence.

  Some days the pain was too much, too draining, too strong.

  For the past six months, I’d had more headaches than I could count. Some days the pain was generalized, like a regular headache, one that made me cranky and irritable, but given enough coffee and water, I could plow through.

  Today, the pain was more than I could handle, but it was the one day I needed to ignore the pain the most.

  Savannah was coming. I had once made her a promise that I would never reschedule our sessions. I hadn’t broken that promise in the past nine months, and I didn’t plan to.

  With a glass of water in hand, I people-watched from the window in my front office. It was a gorgeous summer day, and the park was full of those taking advantage of the weather. I didn’t blame them.

  Looking out at the park, you wouldn’t know a killer was terrorizing my town.

  From my window, I watched families with little ones who crawled around on blankets. Older couples walked hand in hand through the gardens. Teenagers zipped through the bike lanes on their skateboards, not caring who was in the way.

  My phone buzzed with a text from Tami, her third check-in this morning. She’d just left, not twenty minutes ago, with fresh soup from the deli.

  Cancel your session.

  I’m fine. I even added a smiley face that proved my point.

  No, your not.

  You’re, and yes, I am.

  Stop correcting my texts.

  Use proper grammar and I will.

  O.M.G. Just promise you’ll go back to bed af
terward then, Tami replied.

  If not for the pain pulsing in my head, I would have rolled my eyes.

  Yes, Mom.

  Despite my sarcasm, I appreciated her looking out for me.

  By the time Savannah arrived, I was on my third glass of water. Hydration was supposed to help when it came to headaches. My poor bladder might say otherwise.

  The front door opened.

  “You around?” Savannah called out.

  She asked that every time, and every time I wondered if she secretly hoped I wouldn’t answer.

  “I sure am,” I replied, and held my office door open with a warm smile. I noticed her clothing along with the soft smile on her face and knew today would be a good session.

  One thing I’d learned early on with Savannah was her outfit tended to indicate her mood.

  We used a number system.

  Goth was a three, angry and on edge.

  Normal teenage attire was a five. That would be a mixture of tights and a baggy sweater or ripped jeans and tight shirt.

  Nightwear was a one. Depressed, exhausted, and once upon a time, suicidal.

  The safety plan we’d put in place had helped her to move past suicidal thoughts to depression.

  Today, by the look of it, she was a four. Tight, ripped black jeans, hair in two braids, skull earrings, black plaid top, but with a gray tank beneath.

  “You look like shit.” Disgust mixed with pity spread on her face.

  She definitely was not one to hold back, which was something I’d learned to appreciate.

  “I’ve got a headache.”

  If I wanted honesty from her, she expected it in return. Even if it meant she knew I wasn’t at my best.

  “I hear green tea is supposed to help.” She made her way to my side counter and turned on the kettle. I watched as she made us a pot, something I normally took care of before she arrived.

  “Have any whiskey?” Her eyes twinkled with mischief as she glanced at me over her shoulder. “I hear it goes nice with green tea.”

  I smothered a snort and winced in the process.

  “Doesn’t hurt to try.” She played with the end of one braid, the hair twisted in her fingers, as we waited for the kettle to boil.

  Once the tea was made and she was comfortable on the couch, I asked the question she’d waited for.

  “Why would a seventeen-year-old know about adding whiskey to green tea?”

  The smothered grin of hers told me more than her words would.

  Nothing about Savannah surprised me anymore.

  All our sessions started with casual talk. She led. I followed. There was never a set destination to our journey, and our only time frame was the clock. The goals were understanding, strength, and moving one step forward.

  Some weeks we retreated more steps than I cared to admit.

  But we always regained that ground.

  She fiddled with her hands, played with the cushion on the couch, and made small talk about finally reading the latest Stephen King novel before she handed me a letter her school had sent about a fight she’d gotten into last month following an exam.

  “How come this is the first I’m hearing of this fight?” I asked.

  The look on her face was one hundred percent teenager.

  “It wasn’t that big of a deal, and you didn’t need to know,” she mumbled. “I don’t get why everyone is making such a fuss. Mom said I had to show you. She didn’t say anything about me talking about it.”

  I laid the letter on my lap. “Savannah, if she asked you to show it to me, I’m pretty sure she’d like us to talk about it.”

  “I don’t see why.”

  “Why don’t you tell me about the fight, and I’ll decide if we need to explore it a little deeper.”

  Her sigh almost resembled a growl, but I ignored it.

  “Community service in exchange for charges tells me this isn’t something we should be ignoring.” Did it surprise me Savannah had gotten into a fight? No. What surprised me was her unwillingness to discuss it.

  “I was just defending myself, okay? No big deal. I don’t deal with bullies, and now she knows it.”

  I didn’t say anything. She hadn’t really given me much of a reply. In my experience, the less you said to fill the silence, the more the other person let slip. In my line of work, being uncomfortable in a place of safety was a good thing for the patient to experience.

  “Fine,” Savannah said as she rolled her eyes. “The bitch told me to fuck myself and said my parents must have been drugged out of their skulls to not abort me. She called me a psycho and said I’d be the first in our class to land in jail for being a terrorist and killing schools full of kids.”

  Her hands balled into fists at her sides. The anger was still there from the altercation. What part of it was she angry at the most?

  “Like I’d kill kids. That bitch had it coming.” Savannah spat out the words like spitballs through a straw.

  “Says here,” I said as I looked down at the letter, “you caused a cornea laceration from the skull ring on your finger, a broken nose, permanent loss of her two front teeth, broken fingers, and other bruising and cuts.”

  “I went easy on her.”

  I covered my laughter with a cough that had bells ringing in my head.

  “What type of community service will you be doing?”

  “Weeding in the park gardens and around the library. It’s lame, but whatever.” She tapped her long black fingernails on her leg.

  I thought about saying more, but I had a feeling it would come up later and didn’t want to push it.

  “Savannah, how are things at home? Last week you were at a two. We discussed ways we could bring that up to a four, which, by the look of things, you were able to do. How did that go?”

  Our number system wasn’t just for clothing. We used it for everything in her life she struggled with.

  The scowl on her face, along with the way her hands clenched as she hid them beneath her legs, hurt. It felt like a brick had dropped on my heart.

  “Out of all the things we discussed, which did you find worked the most?” I didn’t need to look at my notes—I’d memorized everything in her file—but I still reached for it.

  “None of it,” she answered before I even started to ask the questions. “I didn’t call a friend and see if we could hang out. I didn’t leave the house when I should have. I didn’t call you like you told me to. I didn’t do any of the things you suggested.” She pulled her hands from beneath her legs and slapped her knee. “I didn’t do any of those things you suggested for one simple reason. I. Didn’t. Want. To.” She slapped her knee again with each word. Hard.

  “Well then.” The click of my pen ricocheted. “Maybe we should come up with some ideas that you’d like to suggest? If I remember correctly, we came up with those together, but . . .”

  “No,” she grumbled. “I just didn’t want to do any of those things.” Her lips turned into a pout. “It wasn’t that I didn’t need to—I just didn’t want to.”

  At least she was being honest. Savannah could be a brilliant-but-petulant toddler some days.

  “What did you do instead?”

  Again with the shrug.

  “So . . . you just stayed in the situation? Did you keep quiet or mouth off? Did you state your opinion or say what was expected?” I could probably ascertain the answers myself, given what I knew about her, but she had the capacity to surprise me when I least expected it.

  “Yeah, right,” she scoffed. “Have you seen my parents when they’re both drunk? When my mom is higher than a kite thanks to the antidepressants her doctor has no idea she’s buying on the side? She’s either pissing herself from laughing at the imaginary ladybug who talks to her or she’s crying in bed because my dad didn’t kiss her goodbye before he left for work.”

  “Savannah.” I fought hard to keep the exasperation out of my voice but apparently failed, judging by the sudden fold of her arms. “Your mother isn’t on drugs.”
<
br />   She snorted. “She’s a good liar.”

  Savannah claimed to hate her parents based on imagined offenses, whether it was drugs, physical and emotional abuse, neglect, or any other type of charge she imagined.

  I pulled out a drug test from the file I’d recently received.

  “Like I believe that.” She kicked out her legs and crossed her ankles on the table as if to prove she couldn’t care less about anything I said.

  “You haven’t trusted any of the tests she’s taken, correct?”

  Her right brow rose to the edge of her hairline, but she didn’t respond.

  All right—a different tactic, then.

  “What would it take for you to believe your mom is telling the truth?”

  Her face transformed from an average teenager’s look of disgust to one of raw hatred. “I know what I saw. I know what I experienced. Your question tells me one thing—you think I’m lying.” She unfolded her arms and leaned toward me. “Perhaps the question isn’t what it would take for me to trust her, but what will it take for you to believe me?”

  I dipped my chin toward my chest, not wanting to feel the hurt her words caused.

  “You know better than that,” I said.

  I knew that Savannah trusted her warped truth to be real. Those were lies she believed to be true. There are terms for this: Delusions. Pathological liar. Narcissist. Pseudologia fantastica.

  “What happened during the week? How about we start there?”

  Savannah’s paranoia could hit extreme levels. To her, everyone was out to harm her, one way or another.

  She’d even gone to the police with accusations of physical harm at the hands of her parents. I had been asked to step in after child services found no such evidence; otherwise, she’d have been put under psychiatric care within a facility. Thankfully, with our weekly sessions, we’d been able to keep her at home.

  “I don’t want to talk about it.”

  “Sometimes it’s better to talk things through,” I said, repeating the words I’d said to her countless times. One day she would hear them.

  At least I hoped so.

  “Why? Why is it better?” She popped to her feet and walked around my office. She ran her fingers along the spines of books I’d collected and bought for patients to read. “You say that over and over, just like my mom. What does talking do? Nothing. It’s never done a damn thing.”