by Barbara Ebel
Annabel’s eyes watched Selina’s demeanor. She seemed to care about her patients so much … more than the team realized. Annabel bet Selina’s own advice of maintaining a professional distance with patients was difficult for her to follow.
“Let’s go in. We’ll think about discharging Noah in a day or two so order one more lithium level today. Among our bipolar patients, it’s probably Jamie Harris that we can discharge first. We’ll see her next.”
“Wait,” Joshua said. “Here comes Noah up the hallway now.”
A tucked shirt was pushed nicely into Noah’s blue jeans and strange socks were not peering out from below. He stopped abruptly after a fast pace. “You all coming for me?” he asked. “Come into my spacious abode. I am so bored, I was playing chess with myself in the rec room.”
“How did that work out for you?” Selina asked as they walked into his room.
“I play from one side of the card table and then switch to the other side. But I know what went into the other guy’s move because it’s me. So knowing that, the second guy must be doubly crafty. He has to outsmart guy number one because he knows what the other is thinking. It’s a cat and mouse affair or a king and queen liaison. The whole castle is involved and I can’t tell you which one of me is going to win.”
Annabel grew upset wondering if he was acting out some kind of psychosis like when Victor heard voices in his head.
“Miss Annabel,” he said, “you have a worried expression. I’m not crazy and there are not two of me. I would much rather play the game with a real player.” He shrugged his shoulders. “There’s a lot of crazy people around here, though, and I think they’d fold fast if they played me. By the way, I hope I didn’t offend you by that cat comment this morning.”
“Not at all,” she replied.
“One more blood test for a lithium level today,” Selina said, “and I think you will be going home soon.”
“Home? I was living with my roommate, Fred, because I was in medical school.” He slumped to the edge of his mattress. “I may have to go back and live with my mother and father,” he said with newfound awareness.
-----
The team huddled inside the door of the rec room where they spotted Jamie Harris scrolling through her iPhone screen and Bob gave a short presentation on his patient.
“What’s your impression and plan?” Dr. Keeton asked.
“Her lithium level is perfect and she’s appropriate with normal affect and demeanor. I think she should be discharged today.”
“Dr. Washington?”
“I concur,” Joshua said.
“Let’s say good-bye to her,” Selina said.
Jamie peeled her eyes off her phone when the team walked to the front of the couch.
“Dr. Palmer and Dr. Washington plan on writing your discharge orders in a little while. How do you feel about that?”
Jamie wiggled both her short legs as if dancing. “Better tell me what time so I can arrange a ride. Maybe I can stop in to see the restaurant manager later today and confirm my return to work. He wasn’t happy with what I did, but he’s a reasonable guy.”
“Tell him you plugged his pizza while you were in the hospital,” Joshua said.
“We’ll come by one of these days and give him some business,” Bob said.
“I would appreciate that.”
“We’ll see you in clinic,” Dr. Keeton said. “No skipping your medicine.”
“I promise,” Jamie said.
Chapter 23
Victor Blake’s mother, Marilyn, listened with disinterest to the weatherman’s forecast. Pretty much the same old thing day after day, she thought, while sitting in her threadbare recliner. She wore one of her three flannel house dusters while she nursed a cup of tea. Watching TV always killed the first few hours after getting up. Then she’d have her second cup when she took her morning meds and made sure Victor took his risperidone.
“Have your umbrella handy when you leave work later today,” the announcer said. “Chance of rain? Seventy percent.”
Marilyn kept the oxygen cannula attached to her nose as she squirmed to the edge of the chair. She then pulled off the tubing, draped it on the canister, and rose with a steady effort. After leaning her crooked back over, she picked up the mug. With the other hand, she steadied herself with her cane, and walked a few feet to the kitchen.
Her blue plastic days-of-the-week pill box sat next to the pot with warm water and she flipped open the lid with an “M” on it. When it came to her meds, and Victor’s too, she kept an orderly routine. She steeped another tea bag and then took her medicines one-by-one knowing her emphysema was under control as well as her high blood pressure and heart disease. Once every six months she saw her primary care doctor whether she needed to or not, unless she was acutely sick. Inevitably, he had to adjust at least one of her pills. Dosages went up and dosages went down. She counted on the manipulation every time.
Marilyn looked over at the clock knowing Victor needed his medicine by now. She opened his pill box – his was green – and spilled the vitamin, allergy pill, and antipsychotic on a napkin. They had their schedule down pat. Either Victor would come up the stairs by 10 a.m., visit a little bit with her and take his pills, or she would go the cellar door and yell down to remind him to come up. Going down the flight of stairs, or worse, coming back up was too much of a physical challenge for her. The only way she rarely saw her son in his basement man-cave was if she walked outside down the tolerable hill to his side door which only had two steps.
Marilyn used her inhaler, puttered over, and opened the door. “Victor, you have a therapy appointment today at one o’clock,” she said, her words frail and slow. “Are you up and about? Come take your medicine.”
She heard what sounded like a cabinet door shut. “I know, Ma,” he yelled up. She stood perched with her cane and then Victor appeared and came up the thin carpeted steps.
Marilyn took a moment to give him enough room to pass and then followed him. It was one thing she didn’t appreciate about her son. He could have given her a good morning kiss but, ever since he became an adult, he passed on doing that. Maybe because he didn’t want to get that close to her. After all, she looked like a decrepit old lady but that still wasn’t an excuse. Maybe it had to do with his personality due to the mental illness he carried around like extra non-checked baggage. Yes, that’s probably the reason, she thought.
“Here you go,” she said, pointing to the pills on the napkin.
“Thanks, Ma,” he said and swallowed them with a glass of water.
“Did you have something to eat yet?”
“I’m going to get a burger or something before seeing Dr. Keeton. What about you?” He glanced around the counter and spotted a bag of bagels. “Do you want me to put one of those in the toaster for you?”
“Let’s split one.”
He cut a bagel, slid the two halves into the toaster, and buttered them when they popped out. Marilyn sat down and perched her cane against the table.
“Here, Ma,” he said and sat next to her.
“Thanks. What a blessing you made this for us.”
“I can do some stuff for you once in a while.”
She gave him a weak smile. He didn’t really do much for her especially since once a week a housekeeper came in and ran the vacuum cleaner, dusted, and added another chore or two like making her bed or doing a small load of laundry.
“I’ll be sure to call you,” Marilyn said, “like I just did if you’re not up here by ten o’clock.”
“Yeah, I know Ma. You told me that before.”
Marilyn took a bite. She wished she had a third cup of tea to accompany the buttered bagel but it was too much trouble to rise and make it.
Victor stayed as a courtesy to his mother and they both ate in silence. When he went back downstairs, he thought more about lunch - his mind and stomach were both settled on eating a burger - but he had also seen a ‘help wanted’ sign in the fast-food window. His job before his
psychiatric hospitalization was a thing of the past so maybe he could land the position and flip burgers or manage money at a cash register.
He frowned at how unkempt his living quarters were as he stepped over a pile of old newspapers and empty boxes and grabbed his jacket draped on the ottoman. As he put it on, his thoughts turned to his upcoming appointment at the outpatient unit. It felt like a heavy burden had been lifted from his psyche by not having to hear voices battling over nonsense in his head. He would be sure to tell Dr. Keeton and that female medical student about that. They deserved to take some credit.
Victor put his car keys in his pocket and turned to the table in front of his shelves. A terrarium took up the width of the sturdy, long table. As he peered through its glass side, he saw his new pet snake. So new, he hadn’t yet given him a name.
The snake prowled around the cage like on a hunt. Not only did it exhibit more activity than normal, but its tongue flicked more than usual as well.
“Whatever your name is,” Victor said aloud, “I think you’re thinking about lunch like me.” He knew the actions of the snake were signals that it wanted to be fed. That made sense because he had not needed to feed it since bringing it home from the pet store. That was one thing he liked about taking care of the snakes he acquired – they only needed feeding once a week.
Victor cocked his head still looking at the reptile. That’s it, he thought. If I had two snakes before you with weird names like ‘Top Gun’ and ‘Cat Man,’ I can just as well name you ‘Whatever Your Name Is.’
He put a smile on his face and went to the refrigerator and opened up the small freezer door. Although small, the shelves lacked any order and he had to dig around in the bottom container. He opened up a big freezer bag and took out another bag inside. The pre-killed prey in a bag practically froze his fingers so he quickly dropped the frozen rat bag in the sink to thaw out. It should be soft enough by the time he returned later in the day, he thought, to feed it to ‘Whatever Your Name Is.’
-----
Victor gave the overhead menu a once-over and pulled out his wallet. “I need a cheeseburger, fries, and a medium cola,” he said, “and one of those job application forms.” He handed the aproned young man a bill and the employee slapped down a paper cup and the necessary paper.
“Drinks are over there,” the man said, pointing. “And here’s a pen.”
Victor filled out the form as he polished off his lunch and returned to the counter. A skinny manager, who obviously didn’t eat regularly from the restaurant’s menu, waved him to a table and took the form.
The man went through the two pages in a thorough manner. “Interested in putting the drive-through orders together including ringing up the sales?”
“You bet’cha,” Victor said.
“You available to start as soon as possible? It’s part-time. Like twenty-four hours a week. No benefits.”
Victor nodded positively. Better than nothing … but he must make sure not to skip out on his psychiatry appointments. “Sure. Just not Monday or Wednesday afternoons.”
They shook hands and Victor went out to his black sedan and eyed the dented fender. Maybe he could earn enough money at his new job to get it fixed, surprise his mother with flowers, or buy his new snake a live prey treat from the pet store.
-----
Annabel waited for Dr. Keeton to enter the second floor room in the emergency psychiatry building. She wrapped her fingers under the rim of the plastic chair and scooted it a few inches away from the door. The thin, tapered ends of the chair had no rubber tips on the metal so it scraped along the tiles making a grating noise. Annabel winced. Surely the facility could add rubber ends on the bottom, she thought, for half the chairs needed them. The annoying noise could give psychotic patients a reason to hallucinate.
Victor came in first, greeted her, and sat down. Annabel figured Selina may want her to write an outpatient progress note so she scrutinized him with a keen eye based on what she had learned already. He was dressed neatly in blue jeans and a denim shirt and he looked well-nourished like usual; she even noticed a fresh dollop of ketchup on one blue sleeve. For his young age his hair was thin but, since seeing him last, he had grown the beginnings of a mustache and beard. They filled out his face and Annabel thought the addition enhanced his average looks.
Victor looked around from time to time but, overall, he seemed calm, his attitude towards her friendly, and his posture relaxed. Annabel was just about to ask him questions when Dr. Keeton pushed the door fully open and walked in.
“Mr. Blake,” Selina said, “how has your mood been?” Her eyes were on him like a marksman eying a target and she backed into a chair and sat on the other side of Annabel. She had his chart in her hands and a pen between two fingers.
Victor wiggled his head back and forth and Annabel took note. It meant he had variation in his affect which was a positive sign.
“On a scale of 1 to 10,” Dr. Keeton said, “with 10 being the happiest you’ve ever been, what do you think?”
“I like numbers so I can do this. I’m smack in the middle. I’d make it a 6.”
“You’re in a better mood than the 4 or 5s you reported before,” Selina said.
Annabel made a note on her notepad. She wanted to cover as many aspects of Victor’s mental status exam that she could think of. Patients were not aware of what mental health experts watched for while being evaluated and that was half the beauty of it. She wrote, ‘Patient’s speech appropriate with a normal volume, rhythm, and rate.’
“What are you writing there?” Victor asked her.
Selina used his question to Annabel to ask him, “Do you remember this young lady’s name?”
As Victor thought for a moment, Annabel realized Selina was checking his recent memory.
“You’re the medical student,” Victor said. “In the hospital I heard someone call you by your first name and I remember it was a southern girl’s name. Other than that, you’re Dr. Tilson.”
Annabel grinned. He was right about that. “Only because I’m a student,” she said, “I’m writing down pertinent points for this field of medicine.”
“Then write this. Victor Blake applied for a job today.”
“Tell us about that,” Selina said. She crossed her ankles the other way and gave him a smile.
“They need someone part-time at a fast-food burger place near where I live. I could do that. Talk to people at the car window and hand them stuff. But they have to pay first.”
“Good planning, Victor. A part-time job while you’re in therapy would serve you well. Are you and your mother making sure you take your medicine every day?”
Victor sighed. “Don’t worry, doc, we have it covered.”
Annabel wondered if Victor still had full and appropriate insight into his illness like he had when discharged. “May I ask a question?” Annabel asked.
“Yes, we’d like to hear from you,” Selina said.
“Victor, why are you taking that prescription every day?”
Selina nodded her approval.
“For schizophrenia,” Victor said. “Which is what I have.”
Annabel smiled. “Correct,” Selina said and leaned forward. “Now, tell us more about your background. Can you remember being involved with team sports or having many friends five or ten years ago?”
Victor raised his eyebrows in surprise. “I had a skateboard when I was little but stopped riding it. Later, I watched other kids play basketball. At first I wanted to shoot baskets like them but then I was unmotivated and they pretended I wasn’t on the spectator’s bench.”
“What about friends outside of basketball?”
Victor twitched one shoulder. “Nah. Over time, I was different from everybody at school. It was easier to go home where my mother let me buy turtles at first. Afterwards, I had two gerbils. Of course, I switched later to other things.”
Annabel made another key point for her ongoing paper project. ‘Progressive social isolation.’
&
nbsp; “Having pets taught you to care for other living things,” Selina said, “so I’m glad you mother allowed you to keep them. Perhaps through the group therapy sessions, you can talk more at ease with patients like yourself. It’s a start … to be less withdrawn. Engaging in some activities with family or friends is productive and keeps patients like you centered in the real world.”
“Okay, doc.” He stood up. “I want to come back on Wednesday for that. Can I go now?”
“Yes, Victor, you may take off. Keep up the good work.”
“Good bye,” Annabel said. “Thanks for helping me with my education.”
Victor smiled. “As long as you don’t make fun of me,” he said.
“Never,” Annabel replied.
“You can write the update,” Dr. Keeton said when Victor left, “and I’ll sign the progress note if it meets with my approval. Our star paranoid schizophrenic is managing his illness.”
Annabel felt confident her note would be worthy of Selina’s signature.
Chapter 24
Marilyn Blake expected her housekeeper and, sure enough, by late morning a knock came at the front door. She leaned forward to part the curtains to make sure it was her. The woman, Anna, was the same age as Marilyn but appeared a decade younger in comparison.
Marilyn opened the door and stood for a second taking full breaths. “How are you, Anna?” she asked, heading back to her chair to string her oxygen back on.
Anna walked in and put her purse on the counter. “No, the question is how are you?” She slipped off her jacket, went to the stove, and put water on to boil for Marilyn’s tea.
“I tolerate myself,” Marilyn said.
“That’s a strange way of saying you’re fine.” She opened the storage space under the sink, took out a few cleaning materials, and began spraying and wiping the counter top. She worked in silence as the water started bubbling.
“Here,” Anna said after she prepared the tea. “Drink up. I’m going to check how much food you have in your refrigerator and I’ll pick you up any essentials when I leave.”
Anna rubbed her hands together satisfied that Marilyn had dairy products, a week’s worth of cold cuts, and more than enough soup cans. “Your son eating any of your food?” she asked.
