The Paper Shepherd

by Olivia Landis

  “Mr. McLeod,” Dr. Rogers said condescendingly. “I understand from the nursing staff that you’ve been writing progress notes on this Terra girl.”

  “Tiar, sir,” Pat corrected.

  “Excuse me?” Dr. Rogers asked.

  “Her name is Tiar,” Pat said a little louder. “You only half pronounce the ‘r’.”

  “That’s what I said,” Dr. Rogers stated confidently. “Terra.”

  “That’s right, Sir,” Pat answered politely.

  “Are you aware that Ms. Alfred is not your patient?” Dr. Rogers asked.

  “Well, yes, sir. But…”

  “But, what, Mr. McLeod?” the attending said, finally looking up.

  “With all due respect, sir, I see her with you at rounds every morning. I see her in community meetings while the residents are at their seminars,” the student continued. “I see her more then anyone else on this ward, and I feel like there’s more to her story that’s getting missed.”

  “Trust me, Mr. McLeod,” the attending admonished. “There isn’t. There never is. One thing you can count on with addicts, Mr. McLeod is that they always lie. They lie to hide their motives. They lie to minimize their use. They lie so that medical students like yourself feel sympathetic and want to help them. But what they really need is a good prison,” the older doctor pronounced. “Ms. Alfred is a prime example. She got high and attacked a police office with a broken bottle. She would be in prison right now if she didn’t remind some cop of his daughter or his sister… or his girl friend. They feel bad for her and they don’t want her in jail. So, they dump her in our emergency room and being a state funded hospital, we can’t just boot her out. Take my word for it, Mr. McLeod. All that can come out of you talking to this girl is you getting hurt.”

  “I’m not that fragile, sir,” Pat objected. “I can handle myself.”

  “That’s another thing, Mr. McLeod,” the doctor said, staring over his reading glasses. “I heard about your little performance in the emergency room. I don’t care what you did in your life before medical school. We will have no macho heroics on my watch.” There was silence in the room. Pat wanted to defend his actions but judged that it was not worth it to justify himself to Dr. Rogers, possibly the most cynical and unsympathetic doctor he had ever worked with. It mystified Pat that Dr. Rogers had even chosen psychiatry as a specialty, let alone graduated from a psychiatry residency program and become an instructor at a teaching hospital.

  “You are dismissed, Mr. McLeod.” Pat wasted no time exiting the room. He had barely closed the door behind him when his resident, Dr. Matthews, approached him seeming in a hurry.

  “Hey Pat,” the young resident said. “I have to go to class in a minute. Could you do me a favor and ask if the new girl has any medications allergies and if she’s been on any antidepressants in the past?” Pat smiled genuinely at his resident. I guess I do have reason to talk to her after all, he thought.

  “Yeah, no problem,” Pat said. “You just go enjoy your seminar.” The resident sped off. Pat walked slowly down the non-descript hallway to the patients’ day room where he quickly spotted the new patient, that Terra girl, Tiar Alfred sitting alone staring out the window. He observed her as she watched the world outside and remembered the very strange night they met.

  It was four days earlier, and Pat was on over night call with Dr. Matthews. The young resident, answering a call from the emergency room, slammed the receiver down excitedly.

  “Want to practice your restraint skills?” he asked, his eyes full of excitement. They had practically run to the emergency room of the large teaching hospital. This would be a good break in the monotonous parade of depressed, alcoholic seventy-year-old farmers and anorexic female Brighton undergraduate students they were used to at Brighton University Hospital.

  When they got to the emergency room, they heard a loud crash and immediately headed in the direction from which it had come. Pat prepared himself to tackle some two hundred pound strung out gang member. Instead, when he got to the door, he saw a tiny young woman in a belly dancing costume standing on the bed bleeding profusely from the arm. Her eyes darted around the room to each of the seven assembled medical staff who were preparing to tackle her.

  “What happened?” the resident asked one of the ER staff while Pat read her name of a near-by clip board.

  “We thought she was calming down. We tried to numb up her arm with lidocaine so we could sew it up. She became combative again,” a nurse informed them. Pat picked up a tourniquet off a near by counter and slowly approached the patient. He had never seen someone look so frightened before, as though she had suddenly been transported to another dimension where none of the normal rules of time, sensation, or language applied. He walked toward her very slowly, one step at a time.

  “Tiar,” he said, putting his hands up in front of him. She stared at him apprehensively but did not move. Blood was pouring out of her arm onto the gurney below. He was about six feet from the bed when two orderlies and a male nurse rushed passed him, pulled the girl’s feet out from under her and held her down on the bed. The girl fought back frantically, as though fighting for her very life. Despite her small size, it took all their strength to subdue her. When they finally got her arms pinned, Pat took the opportunity to tie the tourniquet around her arm, then put his torso over hers, holding her down and shooing away the rest of the medical staff.

  “Stop it, all of you!” he shouted at them. “Can’t you see you’re making it worse?” Despite the oddness of his request, his confidence compelled them to obey. They backed off, giving him some space. The patient was pounding on his back with her fists.

  “I want one tech with a suture kit, and everyone else out,” he said, his voice commanding. “And turn off that damned alarm.” Moments later, the room was much quieter. The young girl in the bed was whimpering, but had nearly given up hitting Pat, resigning herself to the fact that he was not going to let her go.

  “Tiar,” he whispered to her, his voice gentle. “Tiar, you’re safe now. You’re safe. We’re here to help you.” The girl’s arms dropped to her side. “You’re safe now.” Pat motioned to the ER technician in the room. He sat down next to the bed and began to work. Pat looked over his shoulder to Dr. Matthews who was standing in the doorway. In the chaos, he had managed to get two syringes of a sedative. Pat nodded at him.

  “Tiar, close your eyes sweetheart,” Pat said calmly. “This man is going to fix your arm. Just don’t move, okay? You’re perfectly safe.” They sewed up the girl’s arm. She didn’t move an inch, remaining perfectly still and silent. A few minutes later, Pat took each syringe and emptied them into the patient’s leg. Within minutes, she struggled to keep her eyes opened and finally succumbed to sleep. The resident and medical student worked quickly to get a full physical exam, wanting to catalogue the patient’s injuries. They were shocked to find that other than the cuts on her left arm, which appeared to have been made with a jagged, irregular object, she didn’t have a scratch. There were no bruises to indicate she was beaten, no track marks to indicate a history of intravenous drug use, and no other cuts, whether from previous suicide attempts or self injurious behavior. She didn’t even have any tattoos or piercings.

  An hour later, the girl was in hospital pajamas with her arm sewn up and she was transferred to the psychiatric ward. Pat and Dr. Matthews were sitting in the residents’ office typing up their notes on the patient.

  “I don’t get it, Pat,” Dr. Matthews said. “She was so agitated already. How did you get her to stay calm while they were sewing up her arm?”

  “Didn’t you notice how her eyes were moving up and down?”

  “Of course,” Dr. Matthews said disingenuously.

  “One of the only things that does that is PCP.” Pat said. “That’s a dissociative anesthetic. She couldn’t even feel her arm.”

  “Then why did she freak out about the lidocaine?”

  “She freaked out about seeing the needle. She thought she was being a
ttacked,” Pat reasoned.

  “How is it that you know so much about PCP?” Dr. Matthews asked. Pat laughed.

  “I was an EMT in New York City as an undergraduate.” Dr. Matthews had initial trepidation about supervising a medical student two years older than himself. He had to admit Pat’s life experience often came in handy.

  “Was that after the army?”

  “No. Right before.”

  “Did you do anything medical in the army?”

  “Just some basic combat life saver stuff. Tourniquets, CPR, that kind of thing. Although, learning how to talk down junkies did come in handy. Especially during desert storm when six members of my unit thought we were under a chemical attack and used their MACH 5 autoinjectors. You think a little girl on PCP is bad, you should see a psychotic two hundred pound infantry sergeant with an M16 high on nerve agent antidote.”

  By her second day on the ward, Tiar was a different person entirely. She was polite and cooperative with all ward activities. She had no complaints. She made no phone calls. She had one visitor—a tall, thin, well-endowed woman who moved with the grace of a dancer in tight jeans and six inch heels who dropped off some clothes and a text book. But, even this life line to the outside world stayed for ten minutes and left without incident. There were no emergency phone numbers to contact. No parents were listed in her contact information. She never volunteered anything about herself. She sat with her robe crossed high around her neck, her modesty in stark contrast to the topless, jingling siren Pat had met in the emergency room just days before. In community group, she sat quietly and said vague, encouraging things to other patients. In art therapy, she sat alone and drew cherry trees. No matter what the question was, her answer was always cherry trees. What is your definition of safety? Cherry trees drawn in pastels. What gives you hope for the future? Cherry trees drawn in colored pencils. What do you put your faith in? Cherry trees in magic marker. There is definitely more to this little girl, Pat thought. But, prohibited from speaking to her, he gleaned what he could from Dr. Rogers cursory daily interviews and watched her from afar. Now, with an excuse to talk to her, he walked across the room and summoned her. He escorted her into one of the small interview rooms. She started speaking before he could even sit down.

  “I think I’m getting much better, doctor,” she recited her rehearsed statement. “I’m hardly depressed at all anymore. I don’t think I’ll try to kill myself, like I did a few days ago. I realize now how stupid that was, and I’m so glad to be alive. And, I’m really looking forward to going to drug rehab. I really want to get off drugs and stay clean this time.” Pat sat down and tapped his lips with his pen.

  “I’m not actually a doctor yet, Ms. Alfred,” he began. “And, I’m not officially on your case, so you can drop the act.” The young woman looked at Pat for a moment as if trying to read his intentions. After several awkward seconds, she forced a laugh.

  “What act?” she said with a disingenuous smile.

  “You’re not depressed, and you weren’t trying to kill yourself,” Pat announced. “And, if I had to guess, I would say you never took drugs before in your life.”

  “Then I can go soon?” she asked with genuine hopefulness.

  “I’m afraid not,” Pat stated reluctantly. “My supervisor doesn’t agree with me.” Renee sighed in discouragement.

  “Then it’s just like last time,” she said quietly to herself.

  “Last time?” Pat asked. “What happened last time?”

  “Oh, it’s so stupid,” Renee reported. “It was just a stupid misunderstanding. You don’t want to hear about it.”

  “But I do,” Pat replied.

  “You really don’t,” Renee protested.

  “I have to be here until the residents come back from their classes at five, and I don’t have any other patients to see. So, unless the emergency room pages me, it’s either talk to you or play poker online.” Renee looked out the window in the door and then at Pat trying to compress the events of her life into as few words and as little emotion as possible.

  “I was hospitalized once before, my senior year of high school. They said it was for attempted suicide. They were wrong, of course. I’m not mad or anything. I understand what the paramedics were thinking. I mean, you find an eighteen year old girl naked and unconscious in her apartment surrounded by a bunch of empty pill bottles. Of course, you’re gonna think she was raped and was so depressed about it she tried to kill herself. Right? Except, that’s not at all what happened.” Pat’s head was spinning. Generally, during a patient’s initial interview, they would ask about previous psychiatric admissions. But, due to the nature of Ms. Alfred’s admission, she could not be asked much of anything at all. Somehow, the situation was not rectified once she was more articulate.

  “Why don’t you tell me what really did happen, Ms. Alfred?” Pat asked.

  “It’s a pretty dumb story,” she said. “You don’t want to hear it.”

  “It sounds like no one has let you really tell your side, though,” Pat said supportively. “Don’t you think you’d feel better if at least one other person knew the truth?” Renee knit her brow, deep in thought. She clutched her hospital robe more tightly around her self.

  “Well, you see…When I was in high school…” she hesitated. She leaned toward Pat and lowered her voice as if sharing a secret. “I did have sex with someone I shouldn’t have. I wasn’t forced to. In fact, it was all my idea. I talked this guy into it. It was pretty obvious later it was a mistake. And, I was upset about it. But, I didn’t want to die. I just… I wanted to sleep. I don’t mean ‘I wanted to sleep and not wake up.’ I really just wanted to sleep. But, I was also nauseated. So, I took some antiemetics. Only, I didn’t figure on how the antiemetics would react with the sleeping pills. Plus, I thought they were the twenty five milligram pills and they were fifties. I had no idea how much I’d taken. A friend found me the next morning and couldn’t wake me up. Everyone was convinced I tried to kill myself. Only, I didn’t. But, it took me almost ten days to convince them I was safe to leave the hospital.”

  “Ten days,” Pat repeated. “That’s a long time to be in the hospital just for a suicide attempt, even if it was real.”

  “I know,” Renee said. “But, I kept telling them I wasn’t raped, and I think they thought I was either lying or I was psychotic and so I didn’t think it really happened to me, or something. Plus, I’d go in every morning to talk to them and they’d ask me if I wanted to kill myself and I’d say no, and they’d be all smiles like they were going to release me. Then, I’d remind them that I never did want to kill myself, and they’d assume it was all a lie, and keep me another day.”

  “Well, what happened?” Pat asked. “I mean, how did you finally get out?”

  “The state insurance would only pay for ten days of hospitalization,” Renee said. “So, after ten days, I was declared cured. I’m sorry if that sounds kind of cynical. It’s hard to feel good about people who refuse to believe you. Near the end they told me they would have let me go sooner, but they don’t like to send people home alone without family or friends or someone to watch them.”

  “You were in high school?” Pat clarified. Renee nodded. “Then, why were you living alone?”

  “It’s complicated,” Renee said dismissively.

  “I’d really like to hear about it if you don’t mind,” Pat said. Renee nodded and gathered her thoughts.

  “My father died of a brain tumor when I was… fourteen, I think,” Renee began.

  “I’m sorry to hear that.”

  “Don’t be,” Renee said. “I hadn’t seen either of my parents since I was nine. That’s when my parents sent me to the states to live with an uncle. He was decent enough. But, he didn’t really want a kid hanging around. So, when I turned eighteen, he kicked me out.”

  “Just like that?”

  “He warned me for a couple of months,” Renee said. “But, I thought it was all just an empty threat. Boy, was I wrong.”

&
nbsp; “Still, it must have come as quite a shock,” Pat said supportively. Renee shrugged.

  “He wasn’t that involved with my life anyway,” she said dismissively.

  “It sounds like a very lonely way to grow up,” Pat probed.

  “It wasn’t really that bad,” Renee said. “There was this family at my church who always looked after me. They took me to church and made sure I did my homework and ate my vegetables and stuff. They had a son two years older than me who was my best friend. It was actually a really great way to grow up.”

  “They sound really great,” Pat echoed.

  “They are,” Renee agreed, for a moment, almost smiling.

  “Then, why couldn’t you stay with them,” Pat asked. “I mean, when you got out of the hospital?” Renee looked suddenly very worried.

  “The Franklins? No, I couldn’t stay with them,” she insisted. “What I did was… it was unforgivable. I couldn’t ask them for help after that.”

  “Don’t you think they would have wanted to help you?” Pat asked.

  “You don’t understand,” Renee protested. “The Franklins are Catholics. Very devout Catholics.” Pat’s brow furrowed.

  “Even if they really thought suicide was an unforgivable sin, Ms. Alfred, don’t you think they would have believed you if you told them it was all an accident?” Renee stared out the window in the door once again, her shoulders slumping forward.

  “That’s not what they wouldn’t forgive me for,” she said almost inaudibly. Pat traced back over the story. Oh! He thought silently to himself.

  “The boy you weren’t supposed to have sex with…”

  “Was their son, Max,” Renee finally filled in. There was a short silence.

  “I can only begin to imagine how awkward that would have been for you,” Pat said sympathetically. “But, don’t you think they could put that aside to help you?”