by WD Clarke
Clinical Interview #3 09-11-93
Blood levels again stable, 59 and 60 μg/ml. No perceived change in outlook. Missy appears resigned to pessimism regarding the drug’s efficacy. When asked if she feels she is pessimistic by nature, she smiles—wryly—and says to ask her husband. When asked why, she does not respond. She then adds that her husband wonders if a higher dosage might bring about an improvement in patients who prove unresponsive to lower dosages. She is informed that while higher dosages may prove to be more efficacious in some cases at reducing serotonin re-uptake, Alba also appears to produce elevated dopamine levels, levels that are contra-positive to some patients. The kinetics of dopamine and its role as a precursor to adrenaline are then explained to her in layman’s terms. She is reassured that as a possible participant of one of the higher dosage quartiles, her dopamine levels, while presumably increased over baseline, should not prove a hindrance. However, she is also reminded that she must report any feelings of anxiety or panic to the trial’s administrative nurse. She is then reassured that, if she has been selected to receive an above-median dosage, she should see some improvement by the end of the eighth week.
Clinical Interview #4 23-11-93
Blood levels increased: 72 and 76 μg/ml. Missy is quiet but agitated, and taps her left foot repeatedly and rapidly on the floor. When queried as to how she has been feeling, she adopts a ‘thinking’ posture, then looks up blankly and does not respond. Upon the mention of her husband, she breaks down, sobbing heavily. Missy confesses that he and she have been fighting continuously since their honeymoon, and that her husband is convinced that she is a pathological liar. She refuses to say more, except that her husband is waiting in reception, and wishes to have a minute or two of the doctor’s time.
Major Mark Plumtree is calm, considerate, concerned. Missy has been agitated lately, he says, and he wonders if she is suffering from an adverse reaction. He is informed that her blood levels are up considerably, but that this, in-and-of-itself, is not necessarily causally related to Missy’s current mental state. When Major Plumtree is asked if there is something else that might be upsetting her, he relates that they ‘did indeed have a bit of a blow-up’ the previous night, regarding Missy’s sexual conduct. Major Plumtree had been unhappy to discover a letter from a lover that Missy had taken just prior to the beginning of their relationship, whom Missy had abruptly and secretly abandoned upon meeting her future husband. Apparently, Missy had then confessed to a further string of casual lovers that she had taken in the period immediately following her father’s death. She had then run outside in her nightgown, clutching a large, boxed Xmas present that she had bought for Major Plumtree. Major Plumtree had no idea where she might have been heading, adding that he had intercepted her before she reached the end of the street.
Missy is subsequently directed to have her blood levels tested on a twice-weekly basis, as well as to monitor her agitation level and to contact the administrative nurse if she experiences any further anxiety.
Clinical Interview #5 07-12-93
Missy called in sick, rescheduling for Fri. 10-12-93. Her blood tests read 78, 81, and 80 μg/ml. A fourth test has been rescheduled for Fri. 10-12-93.
11
Her Diagnosis
Dr. Ed Arrived at Emerg just before 20:00. Upon seeing him, the doctor who had examined Missy pulled him aside.
—Pete Laframboise. Dr. Ed stuck his hand out.
—Ed.
—How’s Emerg tonight?
—Hopping. Full moon time.
—How is she?
—Physically there’s just a minor contusion to the forehead, above the right eye socket. But, obviously, she’s very … upset.
—Where is she?
—103. Anyhow, this is just the hunch of a non-specialist of course, but I think there’s more going on here than endogenous depression, Ed.
—How so? What are her blood levels?
—94. But check out the husband; he’s in the waiting area.
—Did you speak with her?
—She’s not overly communicative.
—No, she’s not.
—See, I knew her before all of this. She was a friend and a classmate of my wife’s, always a bit shy, but she had these … bright … eyes.
—Eyes.
—She had a mind, a personality. There was always a lot going on upstairs.
—Did she tell you anything?
—She described what happened, if that’s what you mean. The husband apparently called her a ‘slut’ and a ‘liar’, and said that she was ‘slime’. She repeated the word ‘slime’ several times, in fact. Things progressed from there. He left for the day, she called him repeatedly at work, alternatively begging forgiveness and accusing him of being unfair. Eventually he had his secretary intercept her calls.
—But he met up with her after work?
—He called home and said that he was going out for dinner and a movie with friends from the base, and would not be home until late. So she went looking for him….
—And?
—And accosted him outside of the movie theatre, distraught. When he turned away she proceeded to hit her head against a telephone pole, ‘to get his attention’, she said.
—To get his attention?
—I guess she felt there was no other way.
—You believe her?
—The way she described it, it was as if she were merely an observer or bystander. She wouldn’t answer questions, but … well, talk to her yourself, you tell me. I’d say her attempts at self-injury aren’t simply reducible to a … to a mood disorder.
Dr. Ed frowned, said nothing, put his thumb beneath his chin and his index finger beside his mouth so that they formed an ‘L’, to indicate that he was reflecting seriously upon this last statement.
—You tell me, Ed, Pete continued, you’re the Man here. I’m just a bone-setter, but I’d say she needs, they need, marriage counselling more than anything. More than just putting her on anti-depressants, anyway.
—Hmmm.
—I realize I’m overstepping the boundaries here.
—Not at all, not at all, Dr. Ed lied. Tell me, what gives you this impression?
—Talk to the husband, suss him out. I’d say he’s manipulative, like she says. Controlling, but suave. He’s shocked, has ‘no idea’ why she did what she did. No idea, Ed. Like it has nothing to do with him.
—Are you being objective here, Pete? You’re not speaking like a doctor, you’re….
—Getting emotional, yeah, I know. Like I say, Missy was my wife’s friend, before she got married. Listen, don’t take my word for it, just talk to Missy, then the husband. I’d bet that if you listen closely, you’ll find there’s a whole subtextual thing going on between them. He’s getting her to act out a lot of his … negative energy for him.
—Pete. ‘Negative’? ‘Energy’?
—That’s my wife talking.
—I’ll keep her diagnosis in mind.
—But then she’s not usually far off the mark on these things.
—Have her come in for an interview; we could use a clairvoyant on staff.
—I’m serious, Ed.
—So am I, so am I. Now where is Mrs. Plumtree?
—Out in the hall. The husband is in the waiting room.
—Cheers, Pete.
—Yeah, cheers … Um, Ed?
—Hmmm?
—Don’t let anything happen to her, ok?
—Of course. I mean, of course not.
As expected, Missy was uncommunicative. By the time Dr. Ed found her, her gurney had been moved from the overflow hallway into an examination room. She was in 103, sitting on the examination table, hugging her knees. She was short, 5´1˝, and in this position she resembled a sulking child. As Dr. Ed approached, she turned her back toward him, turned onto her left side, and curled up into a ball. He spoke to her gently, but she began humming to herself. He posed several questions, but each went unanswered. When he mentioned that he would be spea
king to her husband, the humming grew louder. He patted her tensed shoulder, then took his leave.
Major Mark Plumtree sat waiting in the decrepit waiting room. He sat with an energetic, erect attitude (with rectitude) reading a near-decade-old edition of Popular Mechanics. Dr. Ed cleared his throat as he approached, and the Major looked up. They exchanged pleasantries. The Major was a bit of a cold fish, but try as he might, Dr. Ed could not read any of Pete Laframboise’s speculations into anything that the Major told him. The Major had been at the movies with a couple of friends from the base, like Pete had said. He hadn’t seen Missy since earlier that morning. They had certainly had an argument at breakfast, he admitted, during which he had questioned her honesty and integrity over a personal matter regarding which she had kept him in the dark, as it were. But you know how it is, the first year of marriage?
Dr. Ed did indeed know.
Yes, the Major had ignored Missy’s calls, but she was making it impossible for him to do his job. He had also ignored her at first when he came out of the movie theatre, but only out of embarrassment—she had made quite a scene. He regretted that this might have pushed her towards hurting herself in any way, but she obviously needed more help than he alone could give her.
Dr. Ed concurred.
Dr. Ed wrote out a prescription for lorazapam and gave it to the Major, asking him to take Missy home and put her to bed. He reminded the Major of Missy’s rescheduled appointment for the following morning, and asked him to bring Missy in himself if she proved too reluctant or agitated. The Major agreed readily.
—We can sort this out, said Dr. Ed. We may need to take her out of the Alba trial and try something else.
—I see, the Major said.
—By the way, tell me, what, exactly, did she say?
—You’re referring to … ?
—As she struck her head against the telephone pole?
—Right.
—She did say—or rather yell something, didn’t she?
—She did. She yelled one thing, over and over.
—Yes?
—‘Feel my heart. Feel my heart,’ she said. ‘Feel my heart.’
12
This Just In
Dr. Ed Sighed. He was at a stoplight, almost home. He was weary, and he was hungry. No, he wasn’t—yes, he was, no, yes. The short-term energy of the doughnuts had evaporated into the ether, leaving him ‘feeling’ simultaneously full & tired, empty & wired: flemty, twired. His digital watch had just chimed only moments ago; it was now well past 22:00.
‘Feel my heart.’ Unfunnily enough, that was just what Agnes had said when he’d finally summoned the courage—after she’d come back (empty-handed, so to speak, from her involuntary stint at the convent)—to up and leave her, after much indecisive gnashing of teeth, after plenty of guilt-ridden hemming & hawing, oh, what?—27 years ago now. But: ‘Feel my heart’, wow. Spooky. That’s for sure.
—Ahh, there she be.
His wife’s Suburban was docked asymmetrically in the driveway, which should mean that Max would be back, too. Time for our bedtime walk, Maxxy, our l’il constitutional, eh boy? Just Max & he, he & Max. The wife would stay at home. Gladly. And watch TV.
She’ll be deep into a manic microcycle, he ‘thought’. Always happens after a shopping expedition. Not after every shopping expedition (of course—just after the successful ones—which worked out to about 7 out of every 8 trips, or 87.5%), but shopping’s always the trigger (of course). She’ll be like this for at least 36 hours. Then she’ll be helpless for 48–72. Christ. It was to be expected, he supposed. But if it was to be expected, at least it was also fairly predictable, both quantitatively and qualitatively speaking.
Her periodicity was far too compressed to qualify her as bipolar, or manic-depressive. The classic bipolar cycle is measured in terms of weeks, not days, and, when graphically displayed, appears something like:
Her oscillations, on the other hand, looked more like:
So, while (needless to say) that particular label was a definite no-go, as far as his wife was concerned, there were other exciting new developments on the pharmacological front. The identification of psychiatric disorders sometimes spurs pharmacological research, but sometimes it also happens the other way round.
And so it goes: just last month, he’d gotten wind of a new drug (code-named Equinox) being developed at Nexceutica Laboratories (one of the Nexus family of companies—Nexchem, Nexgen, Nexcom, etc.—‘Where Mother Nature Meets the Mother of Invention’) down in Boston. Nexceutica were concurrently sponsoring SUNY Watertown’s push to verify a potential new mood disorder that matched his wife perfectly, and for which Equinox was the answer. And if Equinox survived the FDA gauntlet (after which a Health Canada rubber stamp of approval was a for-sure gimme) it would answer the prayers of them all—i.e., Nexceutica, Dr. Ed, and, quite possibly, even his wife. Dr. Ed had purchased 1000 shares of Nexus (which trades on the NASDAQ, symbol: NXS) the previous April at 39½; it had recently closed at 62¾.
For the record, Dr. Ed did not currently hold any shares in Eumeta PLC., the makers of Alba. Eumeta trades out of the U.K. on the FTSE. Its symbol is EU.
She wasn’t home. Max wasn’t home. The lights were off. He didn’t bother to look for a note: there wouldn’t be one. As he made his way next door instead, to see his wife’s best friend (and fellow tv addict) Margaret, to pump her for information, he was momentarily aware that, in his haste to locate Max, he was forgetting something of considerable practical import. But any knowledge of such forgetting was well forgotten by the time he rang his neighbour Margaret’s doorbell. He didn’t like Margaret, and did not like the fact that his wife did.
For her part, Margaret Murphy, a 55-year-old 33-year-old (or was that the other way around?), looked considerably displeased to be called to the front door in her fluorescent pink track suit at such a primetime hour as this. Dr. Ed had interrupted a particularly engrossing made-for-tv docudrama (The Price Is Right Models: Their Tragedies and Their Triumphs) and his wife wasn’t there, and was there anything else he wanted?
—Do you have a moment? he asked.
—Nuh-yeahhhhh. Uhhh, Ray’s n’t here, if’s him yer after. Ray, her invisible husband, was a lawyer.
—Working?
—Sort of. Whatever. Pop-Tart?
Saying this, she peeled open the heavy gauge plastic/foil composite wrapper off of a pair of dewberry frosted pastries, and moved one of them half-heartedly through the air, in his direction.
—No thanks. Uh, Margaret … ?
Only Dr. Ed addressed her using her proper name. Everyone else used one of 2 nicknames that she had picked up at the Cruelty Masterclass otherwise known as high school. Her first nickname, ‘The Midge’ dated from 11th grade biology, and owed itself both to the skeletal, gnatlike appearance (replete with piercing mouth parts) of the family Ceratopogonidae, as well as to their insatiable appetite. The second came later, in Grade 13: her older brother’s friends, the O’Gallivan boys, had come from university for a weekend visit, and by Sunday dinner ‘Smurphetella’ (a portmanteau word which combined 2 of her obsessions: a certain gooey, chocolate spread from Holland, and her impressively vast collection of plush toys) had been engraved upon her forever.
—Hwa? she said, her mouth already full.
—Margaret, do you know anything about Max, did anything happen?
—Bax, she said.
—Yessss….
—Bax’s Bozrate, she said, simultaneously swallowing.
—Prostate, Dr. Ed corrected.
—Knees Tess.
—Needs Tests.
Smurphetella took another gobble from the pop tart, finishing the first one off, then morphed into The Midge, screwing up her eyes in a cataclysmic effort to remember something that Dr. Ed’s wife may or may not have told her.
—Or ripes day, she said hopefully, putting a good half of the second pop tart in her mouth.
—Overnight stay, yes yes, go on.
—Top we pee to
bee, she whined, sputtering moistened poptart crumbs in his direction.
—Stop re—Uh, Margaret, is it serious?
She swallowed, with gusto, a shockingly large mouthful, while raising her index finger as if to say ‘One moment please, due to an increased volume of calls all of our lines are busy; you have been placed in queue and a customer relations associate will be happy to serve you shortly.’ She then clutched at an English pint glassful of coffee and poured two-thirds of it down her throat (a trick that she had taught, much to Dr. Ed’s embarrassment, Dr. Ed’s wife to perform with beer) and let out a tremendous belch. She then gave him the look that always scared him the most (because it telegraphed the message that she was entirely at home in her body, and could easily take on three times a man as Dr. Ed was): a gee-shucks, gosh-golly, isn’t-life-just-the-best-thing-ever, shit-eating grin.
—Is what serious, lover-boy? You know I’m not the serious type.
—Max, Max. I was asking about Max. Is it serious, whatever it is he’s got?
—Oh, him. He’ll be fine, she said, showing so many mercury amalgam dental fillings that he was temporarily blinded. She then waved her hand in emphasis, like she was jus’ one-a-tha-fellahs. Her hand waved ‘G’won. C’mon. Re-lax, g’way, geddouttahere.’
—Where’s your husband, Margaret? Dr. Ed asked, feigning interest. He looked toward the door.
—Yeah, he was, like, helping at Lions Club Euchre—or was that Kinsmen Tv Bingo? Anyway, by now, what time is it, oh he’d probably be at the Oddfellows Hall or the Legion for a couple of beers. Unless….
—Unless?
—Unless, what day is it?
—Wednesday.
—Which Wednesday?
—Which? What do you mean, which? he said, backing away from her slightly.
