Health _______ Safety __X_____ Functioning __________ Moral/Spiritual ____________
Session Narrative: Arrived upset, nightmare, memories surfacing, PTSD symptoms surfacing, highly anxious, concerned about impact on work functioning and what memories mean. Appears information is missing, guarded, not yet safe to speak or reveal memory content. May not have access to dissociated memories.
Diagnosis: Axis I: Generalized Anxiety Disorder, R/O PTSD, DID, DD nos
Axis II: None
Recommendations: practical self-care and management techniques will continue to assess, practice grounding, safety mantras, needs support, realistic feedback, psycho-education
Referrals if necessary: _______________________________________________________________
Clinical Impression: Patient is a capable young woman who has been in treatment here for 2 months working on general adjustment and life issues. This appears to be an acute onset PTSD, triggers remain to be fully identified. Patient appears to have trauma history much of which remains unconscious or dissociated. Patient unprepared for new information, unstable and panicky. Patient unprepared for possible threat to job security. Patient concerned about possible real world threat to personal safety. Social supports present but limited. Consider degree of fear/anxiety vs real world threats.
Treatment Plan: Meet 2x week; begin full diagnostic assessment.
Appointment Scheduled: Yes ___X___ No ________
Elisabeth Reinhardt, PhD ________Elisabeth Reinhardt, PhD
Date ____11/3/2012_______________________________________
CHAPTER 8
THE THERAPIST
Elisabeth Reinhardt descended from a large extended family which resided in several hamlets and villages along the German-Austrian border. Having lived through Nazi Germany, the surviving members of the Reinhardt family developed a heightened sensitivity to political persecution, abuse of power and the various impacts that trauma has on the human spirit and psyche. From infancy, Elisabeth, the youngest of 5 children, heard tales of horror from her grandparents, aunts, uncles and of course her parents. Many of them had been hidden by friends in attics, basements or outbuildings to protect them from Hitler’s Reign of Terror. Many of her relatives were killed in concentration camps, while others suffered unspeakable torture at the hands of their captors. The Reinhardt’s were a large, determined family; those who survived the holocaust managed to re-connect with each other after the war and through arduous years of planning and saving, immigrated to the United States, many settled in New York and Philadelphia while others relocated in cities further west. Elisabeth’s parents migrated to Chicago. Once settled, the children were directed toward careers and the education that would get them there. Sisters Stella and Reina became lawyers. Stella opened a small firm specializing in criminal defense and Reina had recently been appointed US District Court Judge, for Northern Illinois. Brothers, Simon and Samuel, identical twins, co-owned S & S Shoes, operating with the tagline ‘Special Shoes for Special Feet.’ They specialized in orthopedic shoes which were distributed internationally. Emmanuel (Manny) owned and operated a company called ‘BE WISE Data Storage’ specializing in internet security. Manny, advanced beyond his peers had several NSA contracts for his work on satellite surveillance and code breaking.
Elisabeth had attained a Doctorate in Psychology. She had a small private practice in the city, specializing in trauma recovery and served as a consultant for the STARNET Program providing assistance to special needs children.
All the Reinhardt children had married, procreated and lived productive comfortable lives. All were devoted to humanitarian pursuits either in their professional or volunteer lives. They were charitable with their money and generous with their time. They served the community in many different ways. They knew they were the lucky ones, they all agreed on that. They felt it was their duty to remember those who were less fortunate. They would never forget those lost in the concentration camps, those who had been so damaged, that their experiences at the hands of the Nazi’s would live forever in their tormented minds. Not one day passed when the Reinhardt children did not give their thanks to G-D for their good fortune and pray for the health and well-being of their people. If they knew one thing for certain, it was that they would fight injustice and abuse of power, of any type, every chance they could, to do otherwise would be a betrayal of their people, their religion, and their belief system. Knowing that injustice and abuse of power took many forms, they felt that it was their personal and collective responsibility to fight for what was right. If that fight meant personal risk or jeopardy, well they would just have to take that chance. The Reinhardt children fully embraced their commitment and it had led them far into distant worlds.
Elisabeth carried her commitment into her work. She was recognized throughout the city for her expertise in trauma recovery and for her willingness to fight for her clients’ rights in every venue she encountered, whether it was a custody battle or a court proceeding, criminal or civil. She knew from her own experiences as a very young child what it felt like to be terrified. She knew what it felt like to hide or run for your life. She knew what it felt like to be betrayed by people you trusted. Her father and his brother were ‘turned in’ by their employer of over fifteen years. Two of her aunts were betrayed by the principal of the school where they taught. They were never seen or heard from again. Terror, fear of betrayal, screams in the night - those were prime elements of her childhood. Elisabeth learned the lessons of life early and never forgot them. Moreover she dedicated her life to helping people in desperate situations. An intelligent, unassuming woman she went about her life’s work with a quiet dignity, treating all she encountered with respect and patience. But beneath her calm exterior burned a fire, a quest for justice that could not be seen and could not be stopped. She would stop at nothing to fight wrong-doing. Through the secret corridors of her life, she fought for those who suffered at the hands of others. After years of fighting behind the scenes, she developed a personal code of justice. It was the one she lived by.
CHAPTER 9
OPERATING ROOM
She thought it was the smell of cleaning products that made her feel a little light headed, as she scrubbed her hands and arms for the fourth time. A tech helped her don her mask, gown and gloves; she entered the OR and approached her patient’s isolette; she remembered how frightened Marla Benning had been sitting white- faced in the waiting room along with her husband and both sets of grandparents. She was glad there was so much family support. It was always a relief to see family members show up at such a difficult time. Dr. Reynolds had developed an especially close relationship with Marla, who had not left the hospital since her baby had been born and her condition diagnosed. They had talked daily and twice had gone to the chapel and prayed together. A few minutes ago, she approached the family, reached out her hands and assured them that she would be at the baby’s side throughout the procedure, although it was neither usual nor essential for her to be in the OR. With her usual warmth and concern she explained the procedure step by step, assuring them the baby had a good prognosis. She joined them as they formed a small circle and shared a prayer:
“Heavenly Father, watch over your child Heather and grant that she may be restored to that perfect health which is yours alone to give. Relieve her pain, guard her from all danger, restore to her your gifts of gladness and strength, and raise her up to a life of service to you. Amen.”
The surgical team was gathered along with several residents, there to observe. The anesthesiologist was reviewing his notes aloud inviting comment; the neurosurgeon kept up a running commentary of the surgical plan, the surgical nurses were arranging instruments in their proper order. Everything was sterilized, perfectly prepped and they were ready to go. Three week old Heather Marie Benning tiny and still lay in her isolette, breathing tube in her mouth, IV’s hooked up to her neck and legs. A nurse examined her monitoring equipment and called out her vital signs as they appeared on the monitors. The
y were preparing for a ventriculoperitoneal shunt on this 2 ½ pound neonate. The baby was suffering from hydrocephalus; ‘water’ or excess cerebral spinal fluid in the ventricles of her brain. While this was not necessarily a difficult surgery, the baby’s age and size presented some challenges. Dr. Gina Reynolds, the ‘primary’ would be monitoring the baby’s overall condition while the neurosurgeon performed the operation. The operation was scheduled to take 2 hours but hopefully it would be done in 1½. The extra time was on the books just in case.
Having performed dozens of similar procedures during the last year and a half, this team was well prepared. It was a good team, mutually supportive, respectful and cohesive, rare in a high stress situation like this one. No finger pointing and ass-covering here. Working with such sick patients was hard enough, but working with infants was even harder. Caught up in the details and pressure of the moment, Dr. Reynolds watched the measurements for heart rate, blood pressure and pulse ox. She was calm and focused. She would monitor her patient’s vitals and support the surgeon and the rest of the team. She was a doctor; she was Gina Reynolds, MD.
The nursing staff draped the baby’s body in blue paper sheets allowing only the surgical areas to be seen. Felt tipped pen traced the course of the incision on the infant’s pale skin. The anesthesiologist indicated that the baby was ‘under’ and stable. Taking a small scalpel, the neurosurgeon cut a tiny incision on the left side of the baby’s head in preparation for inserting the shunt. About halfway through the surgery, Dr. Reynolds leaned over to examine a monitor lead when a stream of arterial blood shot up splattering her face, coating her mask and instantly she was in a flashback. The pounding of her heart thumped in her ears. Her throat closed up, she felt strangled. Frozen, she stared at her bloody hands limp and unmoving near the cardiac lead. The walls of the room closed in on her, the surgical team shrank around her, their voices dim, incomprehensible. They worked to stabilize the patient, talking rapidly to one another, giving instructions, asking for instruments, reporting monitor data. She was faintly aware someone took the clamp from her hands. She heard garbled words in slow motion. Stepping back from the table, she stared at her red hands, stunned. She looked up to see the lights getting dimmer. She felt like she was floating. She stumbled backward out of the room. An image haunted her...a slim blonde girl burst out the door of a shack…the girl was running through the woods… she leapt over fallen logs, pushed through low hanging branches. The girl was covered in blood. Terrified she glanced over her shoulder and saw two young men pounding after her. One of them was screaming, “I’ll kill you, Bitch!” He had blood running down his face. He had long black hair. He seemed familiar but she couldn’t recognize him.
Gina Reynolds, MD stood in front of the mirror disoriented, “I’ll kill you, Bitch” echoing in her head. What had just happened? She stared down at the blood on her hands and looked up at the mirror. She pulled off her bloody latex gloves and tossed them into a biohazard receptacle. She was panting and panicked. She heard voices yelling at her, footsteps thundering after her. She heard a small voice inside her head screaming “Run!” She clamped her eyes shut and shook her head. She removed her mask and gown, tossed them away and splashed cold water on her face. She splashed more water, drank some. She took some deep breaths. In the mirror she saw a terrified face, wide-eyed and ghost-like. Behind her pale reflection she saw two aides standing near the doorway watching her.
“You OK, Dr. Reynolds?” one of them asked? “You need something?”
“No thanks, Ella,” she answered with a wan smile. “I’m okay, just need to clean up a bit.”
“OK, but you look awfully pale. You sure you don’t want to sit down or something?”
“You’re a dear Ella,” she answered “but I’ll be alright, I just need to re-gown.”
She knew they could tell she was upset. She splashed more cold water on her face, drank a bit from her cupped hands. Ella held out a fresh surgical gown for her to put on. Shanna handed her a fresh mask and held out a clean pair of gloves for her to slip into. “You two are the best,” she said gesturing little air hugs, “thanks so much for helping.”
“Anytime, Doc,” Ella said, “anytime.”
After what seemed like an hour, though it had probably been a few minutes, she rejoined the surgery in process wearing fresh surgical garb. She was still shaky but oriented. The baby was stable and the operation was concluding. She stood back watching. The neurosurgeon glanced up at her with a little nod. He seemed fine. He was pleased as he completed the procedure. She didn’t detect anything negative in his look. Her eyes searched the rest of the team members moving from face to face, looking for signs that they ‘knew’ what happened, that they could read her anxiety, her panic on her face. Nothing seemed out of order, but she was terrified, not just from the flashback that had her reeling, but from the fear that her past was invading her present. This had never happened to her at work. She worried that it would keep happening. She worried her team members could tell something was wrong with her, that her past was catching up with her.
CHAPTER 10
FLOODGATES
“Sorry you had to wait so long,” Elisabeth Reinhardt said, as she opened her office door. It was 7pm and ordinarily she would be headed home, but Gina had been so frantic, she had just told her to come in. Gina had been sitting in the Starbucks across the street, watching the Bank Building, drinking lattes and fiddling with her blackberry since 2:45. She didn’t care. She had to be here. She had to see her therapist. She had to sort this out. A whole new memory had come up and it scared her to death. In her mind, she saw herself covered with blood and running for her life. She saw men with blood on them chasing her. She couldn’t remember what had happened before that memory in the woods. Why was she covered with blood? What had she been running away from? Why had they been yelling at her? Had she hurt someone? What went on back then? Saying she was ‘coming down with something,’ she had left the hospital and with shaking fingers dialed a number from memory. “I need to see you, something just happened and I don’t understand it,” she said urgently into the message machine. “Please call me back as soon as you can, okay? I really need your help. I think I’m in big trouble.”
Since leaving the hospital assorted fragments of memory flooded her mind. She remembered the inside of a little chicken coop, the smell and sound of the chickens, bright sunlight, broken eggs, being grabbed and carried roughly through the woods. She remembered pain. She remembered terror. She remembered wanting to run, struggling to get free and she knowing she was going to die.
Dr. Reinhardt had seen Gina as she left the Starbucks and crossed the street for her appointment. She knew that that this could be a turning point in her recovery process. Gina was very secretive about her past. That wasn’t unusual. Many trauma survivors lived their lives in silence. ‘Don’t ever tell anyone!’ was the abusers’ threat. So it was not unusual for the therapist to be the first person to hear their patients’ secrets. But there was something else going on here.
Several weeks before, Gina had been recalling a fairly innocuous story about a time when her older sister called upstairs to ask her sisters to come down and help shuck the corn. She remembered hearing her sister call, “Come on you two! Patty Sue, Re …” and then she had stopped with a stunned look on her face.
Dr. Reinhardt waited a beat then repeated, “Come on you two! Patty Sue…. Re…”
Nothing... The therapist cocked her head, “Patty Sue .... Re…,” she prompted again looking at her patient.
Gina finally raised her eyes and said… “Ah, Gina.”
“What did your sister call you? What was the name you just stumbled on?” she asked.
“It’s nothing,” Gina had said touchily, “forget it.”
“What is it Gina? What are you not telling me?” the therapist asked, “Was there some other name, a nickname perhaps?”
Nothing...
After a few minutes the therapist said, “It’s not the name that’s im
portant, but the fact that you feel you can’t tell me about it, now that’s important.”
“You don’t understand, it’s not that simple,” Gina murmured.
“Okay, set me straight,” Dr. Reinhardt had replied.
“Can’t we just move on?” Gina asked.
“I’m afraid not. Not now,” the therapist had said. “Now we have this giant, unspoken secret between us. That has to be resolved not ignored.”
“Okay,” Gina had said, “How about for now we say I used to have a different name, not the one I have now. But, I’m not ready to tell it to you yet, and I’m not ready to tell you why. It’s too soon. Can we leave it at that? Please? Can I just tell you when I’m ready?”
“Not really,” the therapist had responded. “While I respect your decision about what to say and when and I don’t need you tell me your, I’m assuming here, real name, I do need you to tell me why you have a different name now.”
There was a long silence and Gina said, “I went into a kind of witness protection thing, not exactly but sort of. Can that be enough for now?”
Dr. Reinhardt remembered pausing a moment then nodding her assent, “For now,” she had said.
Now she greeted an anxious Gina at the door, “Come in,” she said, “tell me what happened that’s gotten you so upset.”
Gina began a breathless, disordered account of the nightmare and blood and being in the OR and rushing out of the room and worrying that people knew she was freaked out. Dr. Reinhardt urged her to slow down and take a couple of deep breaths while she made them some herbal tea. When Gina was settled and calmer, taking small sips from a floral mug, Dr. Reinhardt led her through a brief retelling of recent events. Then she said, “We have some decisions to make about how best to use our time tonight. First, there are some practical concerns; you need some strategies to manage situations that may come up while you are at work. Second, your nightmare triggered a series of traumatic memories and they need to be unraveled, examined and processed, not re-dissociated. Can you say how much of what happened during that series of events you have conscious memory about?”
Relentless (Elisabeth Reinhardt Book 1) Page 4
