by Barbara Ebel
Eventually, Annabel realized, the best match for her would be someone in the same or a related field but, in the meantime, she wanted and hungered for her sexual flings. It was just too bad that Robby Burk still stuck in her head like cotton to crazy glue. Heck, she didn’t stand a chance at dating him let alone join him in the sack.
Annabel scrolled through new male profiles knowing that the pictures posted highlighted the individuals to their maximum benefit. On the app, swiping right meant she approved of the individual based on his few pictures and a short bio. She found two men worthy of further consideration and swiped right on the both of them.
-----
After a shower, Annabel accidentally dozed off with a book in her hands. She yawned, decided to get real sleep, and leaned over to plug in her phone. She put one end of the cord in the outlet and spied at her messages; one of the men, Jerry, had responded to her text.
I notice you’re up the river from me. I’m boating east from Louisville this weekend. I won’t marry you but want to hookup?
Interesting circumstances, she thought, and he’s direct about no relationship. She darted her fingers across the alphabet.
Sure. Ha! Kayak or yacht?
She smiled at their exchange and closed the app.
-----
In the morning, Annabel passed the cafe in the hospital lobby, went upstairs to the psych ward, and into their gathering room. She appreciated the place due to its multifunctional use: an open kitchen, a lounge, and a work area. Not too shabby for a medical student who lived in a place not much bigger than the room.
Since she showed up first, Annabel rummaged through the cabinets and put on the coffee. As it dripped, she refreshed her mind about the side effects of Mr. Blake’s antipsychotic.
Dr. Washington walked in with a to-go cup. “Good morning,” he said.
“Back at you,” she replied. “Coffee’s on but I see you stopped downstairs.”
“I’ll still drink some of yours when this is finished,” he said.
“I can’t promise it will be better than what they eloquently conjure up down there. You know, the names of those coffees on the blackboard are dreamed up by marketing majors and they cost a quarter before you even place your order.”
Joshua laughed. “Pumpkin blitz,” he said, tilting his head at his cup. “I think you’re right. They squirted an eighth of a teaspoon of flavored syrup into it and charged me a resident’s wage for a day.”
“Someday we won’t feel rotten about spending a few bucks on that,” she said as Dr. Keeton and Bob walked in.
“Welcome to another day,” Selina said, putting down her briefcase. She switched her outside coat for her lab coat hanging on a hook and covered up the brown skirt and striped blouse she wore.
“Let’s begin,” she said after visiting the coffeepot and sitting at the table with a filled mug. “There’s a patient to evaluate but we have time while the ER finishes their screening.”
“Dr. Tilson,” she said, “tell us what you learned about risperidone’s side effects.”
Annabel clasped her hands under the table and launched forward with what she knew. “The major issue to consider when prescribing it is metabolic syndrome.” She rattled off the components.
“Why is that so bad? In other words, why should we be concerned about a patient acquiring those things?”
“Because the greater the number of risk factors a patient acquires, the greater chance they come down with a cardiovascular problem.”
“Sure,” she said. “And this is a good time to make a point. Even though you will all segregate into a specific specialty, becoming physicians first with a knowledge base across all fields is fundamentally important. I cannot prescribe a psychiatric drug and be ignorant of the internal medicine effects it could cause. Never think that medical school is superfluous to where you’re headed. I have heard med students mumble, ‘Why do we have to know all of this stuff?’ Learning these things is vital.”
She leaned back, surmising their respectful attention and continued. “I’ll get off that soap box. So, the hypertension, obesity, glucose intolerance, and dyslipidemia are serious health conditions and there are already many Americans with the syndrome before we give any patients drugs that cause it. Isn’t that correct, Dr. Washington?”
Joshua nodded. “Yes, almost thirty-five percent of adults have it.”
“Wow,” Bob said, letting the word slip out.
“That statistic is dismal,” Selina said. “Dr. Palmer, what are the underlying reasons why these Americans are acquiring it?”
“Their obesity and physical inactivity,” he said. He stole a glance at Annabel and smiled. “And besides their cardiovascular risk, they are susceptible to strokes and diabetes.”
“Good,” Selina said. “You and Dr. Tilson will be sharp as a tack when the syndrome rears its ugly head on your medicine rotation.”
“We’ll tell the internal medicine attending that we learned it on psychiatry,” Bob said with a grin.
The crinkle lines around Selina’s eyes formed and she nodded at each one of them. “Now, before seeing all our patients, let’s go see what kind of response Mr. Blake is getting from his 2 milligrams of risperidone.”
Chapter 6
After checking for Victor Blake in his room and toting along his chart, the team searched for him down the hallway.
“He’s in here,” Joshua said, poking his head in the recreation room.
Two other patients sat across from each other at a table but Victor sat on a bench deep in the room looking straight out the window. He tilted his head back and forth as if conversing with someone on either side of him so the team approached him cautiously.
Dr. Keeton sat next to him and Victor slid to the end. “Mr. Blake, how are you this morning?” she asked.
“Those two over there. They hate me. They talk about me all the time.” He glanced backwards at the two patients in the room. “Watch out,” he said in a flat tone.
“Why should we watch out?”
He kept his head down but tilted it toward her. “Their eyes throw protons at me because they want to kill me. The nuclear particles explode and can blow me up. They’re after me but don’t you stand in their way.”
“Why do you believe that?”
“The voices in my head told me that.”
“Are they talking to you right now?”
“Of course! But I know you already. You put the snakes in my room.”
“Don’t worry, Mr. Blake. We just came from your room and there are no snakes.”
“Whoa,” he said. “That was close. They almost hit me.” He got up and twirled the knob of the drawstring to the blinds. “See. This is a big proton which just missed us.”
Annabel felt sorry for him knowing his dissociated thoughts and voices made a halfway normal life impossible. His only chance at functioning better would be prescription drugs.
Dr. Keeton’s cell phone dinged with a text message. “I must make a call to another psychiatrist,” she said. “Dr. Washington and Dr. Tilson, what do you think about increasing Mr. Blake’s medication another 2 mgs?”
Joshua nodded and Annabel imitated him.
“You can write the order. Dr. Tilson, you can take Mr. Blake back to his room. Find out more about what’s going on in his mind.” She turned to Joshua and Bob as she stood. “You two see your next patients.”
Joshua wrote Victor’s order for 4 mgs of risperidone and then handed Annabel the chart. “Give this to the nurses as you and Mr. Blake pass their desk and, after you spend some time with him, write your progress note.”
“Thanks,” Annabel said.
Bob paused before following Dr. Washington. “Those ankles crossed just like you said they would,” he said.
They smiled at each other and Annabel wondered what tactic she’d use to lure Mr. Blake back to his room. She hoped by the end of the rotation she would know how to deal with these mentally-disturbed patients on her own, but sooner would be bett
er. She focused on Victor; he wore blue jeans that his mother had brought him the day before, his skinny legs in there somewhere, and the absence of a belt made them a bit loose. She took a big sigh and clutched the chart.
“Mr. Blake,” she said, “come with me. You and I and your voices are all going for a stroll to your room.”
-----
Annabel mentioned the order for Mr. Blake’s new dosage as she passed the nurses’ station and kept a watchful eye on her wary patient as they went into his room. She sat in the most comfortable chair right inside the door and positioned her legs like her attending.
Victor went from the dresser to the sink to the bed, all the while mumbling softly. Getting him to sit at ease would probably be impossible, so she didn’t try.
“Are you looking for something?” Annabel asked.
“The protons. Their nuclear energy must be avoided. At all costs.”
He lowered himself flat on the floor so Annabel stood up and peered over the bed to observe. One of his arms stretched over the floor tiles under the bed and as he backed out and stood, a collection of dust waved from his hand.
Annabel resumed her spot, waiting for what he may say next.
“No. No snakes right now under there so no protons. Top Gun used to sap them but he almost killed me. I couldn’t take it anymore.”
“Who is Top Gun?”
Victor threw his arms behind his head, landing the wad of dust on the upper side of his head. The dust ball stuck like a fuzzy halo illuminating his delusions.
“You should know that. You aren’t smart, are you?”
“Not always.”
“He’s one of my snakes. My first snake but he’s dead.”
“You have another one?”
“Of course. He’s Cat Man.”
“What an interesting name.”
“Because he would eat cats if he had a chance so I don’t keep any.”
“I see. We hope that the medicine we’re giving you, as well as some therapy, will help rid you of all these troublesome ideas swimming around in your head.”
“Swimming? There are no fish in my head.”
“I’m sorry. I meant to say that we hope you get better by not thinking so much about snakes and protons and other ideas which upset you.”
“Like when Top Gun scared me too much. I couldn’t kill him then but, finally, I made him go away. I had to be the one.”
“What do you mean you ‘had to be the one?’”
“Since I wasn’t ready to kill him, the only way to get away from him was to kill me.”
Annabel froze. “But you wouldn’t do that.”
“I fell off the chair.”
“What chair?”
“The one I stood on while hanging myself.”
“What happened?” she asked, a chill running up her spine.
“I told you. I fell off the chair. And I couldn’t try it again because I broke my toe. My foot hurt. I almost cried and Top Gun was still there.”
“Which toe broke?”
He sat on the edge of the bed and palpated the outer edge of his soft shoe. “This one.”
“Did you see a doctor?”
“I couldn’t leave Top Gun.”
-----
When Annabel left Victor’s room, she ran into Bob and Joshua in the hallway.
“Annabel, what’s wrong?” Bob asked. “You look like you’ve seen a ghost.”
She motioned towards the lounge and they followed alongside her. Inside, she paced back and forth and finally plopped down on the couch.
“I don’t know what to say first. I mean, schizophrenic patients dream up all sorts of scenarios in their heads but Mr. Blake almost had me believing some of his … except, of course, the protons from patients he talked about in the rec room zoomed around again from snakes in his room. But, Dr. Washington, the scariest part, if what he said is true and we didn’t know this before…”
“Spit it out,” Joshua said.
“He may have staged a suicidal incident in the past.”
Joshua frowned. With displeasure, he let out a big sigh as he sat. “Did he give details making it more plausible?”
“Yes, I think so. This may sound crazy but would you mind if we ordered an x-ray of his right foot? If his little toe is broken, it may corroborate his story that he attempted to hang himself.”
“That’s not a big deal. I’ll write the order.”
Bob sat down next to her, studying her face. “Your color has returned. Can I fetch you a glass of water?”
“I’m fine. Listening to him disturbed me, that’s all.”
“Isn’t it amazing?” Joshua asked. “It’s not only the initial blood and guts that medical students encounter, but also the weirdness of the human mind that can chill and shake you up.”
Annabel nodded.
“Nice therapy work, Dr. Tilson,” Bob said. “Or should I say detective work?”
-----
Dr. Keeton’s medical school board of director’s business ended up consuming much of her day so she left routine clinical matters to Dr. Washington. He rounded with the students late and when Annabel arrived home, she sank into her chair, too tired to go back out. During the day, she’d received a text message from Jerry. Now she could read his reply properly. She scanned their last exchange - when she texted whether he’d boat to Cincinnati in a kayak or a yacht.
Neither, he responded. It’s a cruiser…and I, or both of us, can sleep onboard. Docking at marina overnight. Meet at their restaurant Saturday night?
Annabel considered his suggestion. Living in Nashville until medical school, her family used to spend time on the Cumberland River and the nearby lakes, but she had never been on the Ohio River. Flowing through six states, it was about time she acquainted herself with the large waterway. Perhaps they could take a ride … whether she slept with Jerry or not. The hookup sounded out of the ordinary and she liked the idea.
Unique location. I’m game. Send me marina website link for directions.
One additional correspondence and she received more details. With a thin smile on her lips, by 10 p.m. she was able to fall asleep without thinking of her perplexing patient, Victor Blake.
-----
“We’re bumping up Mr. Blake’s medication another 2 mgs,” Selina said the next morning. Even though their patient needed more risperidone, he seemed calmer that morning and slightly more attentive to their questions. Joshua wrote the order and Annabel wrote her progress note for the day.
With anticipation to watch their first schizophrenic group therapy session late in the morning, Annabel and Bob headed into the recreation room. Three outpatients and one inpatient – Victor - were seated in chairs next to each other. Dr. Keeton and Dr. Washington were dragging chairs next to them.
“Dr. Tilson and Dr. Palmer,” Selina said, “each of you bring over a chair and fill in our little circle.”
Bob grabbed both their chairs. After the rough, thin end of one of the legs squeaked along the floor, he picked them up and carried them. “Thanks,” Annabel said as they both sat down.
“Today there are newcomers to our group,” Dr. Washington said. He introduced the two students and then Victor. “Mr. Blake is staying in our hospital ward for the first time after being diagnosed with schizophrenia.”
Next, he introduced the other three patients. It seemed to Annabel that Joshua was the head moderator; Dr. Keeton wore her normal posture and sat with a clipboard, paper, and pen.
“We’ll let Mr. Blake talk after the three of you tell us how your week went. How did each of you feel?”
The young man, Jonah, sitting next to Annabel spoke first. The hood of his sweatshirt covered his head and the side of his face. The only thing she could appreciate was his subdued voice.
“I felt alone a lot,” Jonah said.
Joshua nodded. “Did you do anything that made you feel less alone?” he asked thoughtfully.
Jonah’s foot tapped on the floor several times. “I drew pictures o
f me, another person, and then another person. Even added a dog.”
“Doing that made you feel less forlorn and neglected?”
“Yes. It was like instead of being alone in the world, I had two visitors and a dog to keep me company. I kept my drawing and hung it on my door.”
“That’s excellent, Jonah. Dr. Keeton is writing your method down in our list of things to do to make us feel better.”
Joshua looked questioningly at the next patient, a young woman who went by her nickname, Orange. Her head hung down; shoulder length hair drooped along the side of her face.
“Would you like to tell us how your week went, Orange?” he asked.
“I heard too much noise from upstairs,” she said. “I didn’t like that and I felt scared.”
“What kind of noise?”
“Like furniture or something scratching the floor. I told them to stop it but they thought I was crazy. I know people think that way of me a lot. But I’m not crazy. I’m better than before.”
“You are better than before,” Joshua said. “It’s excellent you realize that. How did you deal with these thoughts?”
She drooped her head a bit more. “I had a package in my closet to make cookies. I mixed the contents with eggs and oil and baked oatmeal cookies. I was happy I created something.”
“Smart thinking,” Joshua said as Dr. Keeton jotted down another entry. “I bet they tasted pretty good, too.”
“Yeah,” Orange added from beneath her draped hair. “They did. I’m buying another mix next time I’m at the store for when those loud noises start again.”
“And Timmy,” Joshua said, “would you like to add to the discussion?”
The third patient didn’t hide his face like the other two. After shaving off his hair during a psychotic event when he believed it served as a vehicle of communication with aliens, he continued to shave his head. He never made it to engineering school right after college graduation because his first major symptoms reared their ugly head.
