by Barbara Ebel
“One container is for you and one for me,” Annabel said, opening one and then halving the banana. “As you know, I am a perfect weight for my height and you are under what’s normal. So, eating these will only serve to provide you with healthy nourishment. You will not undergo a metamorphism into an elephant. I promise.”
Annabel peeled off the yogurt cover on hers and started eating with a plastic spoon. “Did you get some sleep?”
“Most of the night,” Lillie said. “I was dead tired.” She wrapped her hand around the container and slid it towards her.
“Let me know if you like the flavor.”
Lillie opened the lid, ran the plastic spoon over the smooth top, and tasted it.
“If you haven’t been eating much lately, you have not sampled this Greek yogurt. It’s new and practically pure protein, Lillie.”
She seemed to loosen up while Annabel scraped the container.
“Can you tell me why the orange juice is in the bowl?” Annabel asked.
Lillie put her hand over her eyes as if shielding herself from the question.
“You don’t have to tell me if you don’t want.”
“I pour it then dilute it with water.”
“Why? To decrease the calories and only have half?”
“Kind-of,” Lillie responded. “I can see the entire amount of the container in the bowl so I only drink a little.”
“If you don’t hydrate properly and eat properly, you will end up back over on the other side with more IVs in than before,” Annabel said in a non-accusatory and soft tone. “I know you don’t want that. Your mother would be upset and the team would be disappointed, too.”
Annabel continued even though Lillie had heard this before. At some level, she believed Lillie was listening and contemplating what she told her. Since she was closest to her age and looked normal or better than average, she served as a positive role model.
“I’ll be leaving the rotation soon and there is nothing more I’d like to hear about later than you marching forward as a healthy young lady, advancing your education, and making a smart choice for a job or profession. You can’t do that with anorexia nervosa. Unlike medical diseases, cancer, or other diagnoses, you can overcome this by changing your perspective.”
Lillie kept eating the yogurt until it was gone.
“I brought our breakfast from home,” Annabel said. “I am going to order this yogurt for you from dietary.”
Lillie nodded and although Annabel ate the whole piece of fruit herself because her patient didn’t want it, she sighed with relief as she went to write her progress note and order. Little baby steps with Lillie’s eating were better than nothing.
-----
Victor shadowed other employees for the first few hours at his new job. Learning the cash register was his biggest obstacle and transactions weren’t always straightforward. Sometimes a sale was rung up and then a customer would slap a discount coupon on the counter. They had to delete the sale and start all over to correct the price.
By mid-afternoon when the fast-food restaurant slowed between lunch and dinner, the manager kept close tabs and let Victor handle sales himself.
He realized the nearby school must be dismissed because a mother and kid with books stood at the counter. “A burger kid’s meal and a large cheeseburger, no fries, and two drink cups,” the woman said. She wore a streak of orange hair and her kid wiped thick gob from his runny nose. Luckily, the youngster wasn’t the one forking over the money.
Victor rang up the bill. He pinned the receipt over the food bin chute where the cooks slid the order towards the front, put the woman’s cups on a tray, and went back for her hot items. Before he finished, he gave her a copy of her receipt and change. The manager nodded his approval. When his hours were up, he bought himself what he had served all day, sat down, and congratulated himself for a job well done.
At home, he stood over his terrarium. “We’re in the money, Whatever,” he said and pumped his fists. “You and Mom will earn a live treat when I make my first paycheck.”
-----
Annabel caught up with the team as they approached Noah Goodman’s room. “As my grandfather would say, better late than never.” She handed Dr. Keeton the lab result on Noah which they had been waiting for.
“Perfect,” Selina said and walked straight into his room.
“You’re sending me home, aren’t you?” Noah asked.
“Yes,” Selina said. “We can’t ask for a better lithium level.”
Noah looked down and shook his head. “I can see it coming. You all are finished with me, I go home, and I have no idea what to do with the rest of my life. Medical school and becoming a doctor was all I wanted.”
“We understand your dilemma,” Selina said, “but we’re not finished with you. Far from it. I will see you as an outpatient. Your homework will be to start brainstorming another avenue for your skill set and our department will steer you to resources which can help you.”
“Maybe I can talk to someone over at the med school. If I can get a job around the medical field that would be some consolation.”
“Give it a try,” Selina said. “Dr. Washington will write your discharge orders and please fill your prescription either here in the hospital or on the way home. Taking your medication on a daily basis is your most important task.”
“Where are you going to stay now?” Annabel asked.
“Fred said he’d cut classes if he needs to pick me up. I can stay with him to the end of the month when my rent runs out, pack up my things, and move back home to my parents’ place. Can you imagine how they must feel? They were proud I was going to become a doctor. Now they have a grown useless man with a mental disorder taking back residence with them.”
“It won’t stay that way,” Selina said, giving him solid eye contact as if her comment were an order.
Noah nodded reluctantly and the team headed out the door with Annabel trailing.
“Dr. Tilson?” Noah said.
Annabel stopped as Noah fidgeted with his hands. “I believe I made some overly flirtatious comments to you during my hospitalization. I’m not like that; my bipolar disease caused that behavior.”
“I figured that, Noah.”
“I’m sorry.”
“I accept your apology and I understand. We’ll probably meet again in clinic but, if not, I wish you the best. It’s not your fault what happened to you. It could have happened to any of us.”
Noah’s eyes became teary as Annabel left and rushed to join the team; they waited to start the discussion with her.
“I didn’t mean to hold you up,” Annabel said.
“I’m sure whatever he told you, it was important,” Selina said. “Dr. Washington, enlighten us. Make a comparison between the symptoms Noah had on admission compared to his discharge.”
Joshua pursed his lips in contemplation. He made a better listener than teacher but Selina was right to make him speak up. Someday he would be an attending, too, and communication and observing was everything. He kept taking it for granted that their two medical students were bright and picking up what they needed from Selina.
“Mr. Goodman’s social skills with us are markedly improved since his admission and he’s not showing the excessive involvement with prejudicial remarks towards females. The main symptoms of his bipolar disorder diagnosis are all curtailed.”
Dr. Keeton looked at him in silence waiting for more.
“His self-esteem isn’t as high as the Chrysler building, he sleeps more normal, and his speech pattern isn’t rapid. It was impossible to keep up with him when he first arrived. He’s told us his thoughts aren’t racing anymore and he’s not easily distracted.
“Not even by Annabel,” Bob said. “That’s not normal.”
They all smiled while Bob tapped her arm.
“All important points,” Selina said.
They began walking towards the lounge and Annabel tugged at Bob’s sleeve. “Your new love interest has not hamper
ed your sense of humor.” She fished out the blueberry chocolate box and tipped it into the palm of her hand. “Here. Brain fuel for both of us.”
-----
Victor sulked at his dark, old-fashioned drapes as he stood in front of them on Wednesday morning. He decided not to open them; he had slept to 10 a.m. and was not ready to face all that daylight. Besides, he still paraded around in his underwear briefs from overnight.
He made an instant coffee and sat on the floor to watch Whatever. He wished pet snakes were more active and thrilling to watch besides when they were begging for food – like uncoiling and striking to gobble down cockroaches. Of course, their molting process was way cool. Twice he witnessed his two previous snakes rub against the wooden piece in the terrarium to try and shed their skin to no avail. That’s why he had let them out - so they could find rough surfaces in the room to assist with the removal of their skin.
Victor still felt angry over Cat Man’s death. It wasn’t his fault that he had been ill with schizophrenia symptoms and was negligent about feeding his reptile in a timely fashion. And then he ended up in the psych ward leaving the snake without food even longer. By the time Victor was discharged, the snake was assuredly dead.
This new one was safe from starvation, Victor thought. No way would he forget to feed him and no way would he go back to that hospital. Except, of course, for the therapy appointments. Like today.
Victor liked the interaction of the group session but more than that he hoped Orange would show up like last time. He contemplated her, wondering if she had a boyfriend. Maybe he could entice her to be his girl especially since they both had a mental disorder.
‘You’re handsomer than that Timmy or Jonah anyway,’ he heard.
Victor’s eyes bulged at the snake. Whatever was clever but he didn’t know it could talk into his head. Unless it was Orange. A few minutes elapsed and he didn’t hear anything else. He chugged down the last of his coffee and dressed for his appointment. Maybe he would stop on the way to buy a burger from where he worked. No sense in going to visit his mother. She was probably sitting in her chair watching those stupid television shows.
Chapter 26
“Come on, Annabel,” Bob said. “Let’s hurry to your patient’s group therapy.” He pointed at his watch because she had lost track of time huddled in the corner of the couch. The two of them had eaten in the lounge and quizzed each other in preparation for their exam.
“Victor isn’t only my patient anymore,” she said. “We share those colorful schizophrenic patients with Dr. Keeton and Dr. Washington.”
“I guess, but we don’t add anything,” Bob said. “We’re only second-rate observers during the session.”
“You know better. During lunch you proved how much you know and observing patients has a lot to do with that.”
“I guess,” Bob added. “Going through the old tests helps, too.”
Annabel and Bob took the staircase down and crossed over to the outpatient center. In the second floor group room, they both pulled in chairs to finish out a circle. Annabel grimaced as her chair scraped along the floor. She sat next to Jonah after peering under his hoodie to make sure it was him. All the patients were there except for Victor.
Dr. Keeton came into the room juggling a clipboard and chart. She sat next to Bob, the three of them with their backs to the door.
“Dr. Washington is screening a patient downstairs so he won’t be with us,” she said.
Victor strutted in and sat in the open chair of the circle. He wore a denim jacket and held a disposable cup and some hamburger in a paper wrapper. He rose both of them chest high as a greeting, left his denim jacket on, and sat down. His eyes roamed straight to Orange and he puffed up his posture.
“Nice to see everyone,” Dr. Keeton said. “Victor, maybe you can leave the rest of your lunch on the table over there so we can proceed to our session.”
Victor eyed the last bite of his burger. He wanted to eat it but maybe Dr. Keeton had given him an idea. Perhaps he should save it for Whatever. So what if the reptile had eaten enough for a week, obese people overeat all the time. His snake may approve and gobble it down right away.
‘I’ll devour it if you bring it home to me,’ a voice said to him, ‘but who is she to tell you what to do with it?’
Victor flinched at Whatever’s intrusion in his head while Dr. Keeton waited for him to do as she asked. He walked away, took a sip of iced tea, and left the items on the table.
“Who would like to start?” Selina asked. “Tell us how your week went.”
“I have something to tell you,” Timmy said. “I pulled in a parking lot and two guys in a pickup truck stole the space I was pulling into.”
“And?” Dr. Keeton prompted him.
“I confronted them because when they got out, I told them, ‘You did that on purpose. You better be more careful next time.’ I pointed to my shaved head and said, ‘I’m like the wrestler and actor, The Rock, so don’t bully me.’”
Annabel wrung her hands. Timmy stood less than six feet and was one-third the size of Dwayne Johnson.
“When I first met you, Dr. Keeton,” Timmy said, “my illness made me think my shaved head caused aliens to communicate with me. When I’m on my medicine, I understand that thinking is wrong but, if need be, I can freak people out who are messing with me. I tell them about people from outer space in my thoughts; that shuts them up, and they run the other way.” He pumped his fist.
“You’re not laid up in the hospital so the men in the parking lot obviously didn’t beat you up because you boldly told them those things,” Selina said. “Please be more careful, Timmy. Sometimes let rude events go without comment.”
“What about you, Jonah?”
Jonah’s hand went up and slid his hood back halfway but not enough that it slipped off. “I started an on-line course.” A trickle of a smile crossed his lips.
“Good for you and thank you for letting us see your face more than usual. We appreciate that. What kind of course?”
“There are three sessions about real estate. It prepares you to take an official class to become a realtor.”
“What do you think, everyone?” Selina asked. “We should congratulate Jonah on his educational pursuits.”
The other students, Annabel, and Bob gave him encouragement and Victor gave him a high-five.
“Orange?” Dr. Keeton said.
Orange twisted her hair and smiled mischievously. “I decided I want a boyfriend.”
“Just like that?” Selina asked.
She nodded and scanned everyone. Lastly, her eyes settled on Victor.
“Well, maybe.” She drooped her head and clammed up.
“But the rest of your week went fine?”
“Yes, ma’am.”
“Victor,” Selina said, “we had a session two days ago. How did you perform on your new job?”
Victor beamed. “I handle an assembly line of tasks! Ring up, box up, and hand out. One after the other.”
Selina nodded and looked at the students.
“Sounds like a lot of responsibility,” Annabel said.
“Congratulations,” Bob said. “Your mother must be proud, too.”
Victor glanced at Orange. “You can come by for a burger if you want,” he said. “Any of you.”
“Don’t be like one of our other patients, however,” Bob said, “who was giving out free pizza where she worked. Make sure you charge everyone for what they purchase. Friends or family, it doesn’t matter.”
“Good point,” Dr. Keeton said. She opened the outpatient group therapy chart and looked at her last notes. “So,” she said, “I’ll summarize our topics from the last two weeks. We talked about things you all do to feel better and after that we discussed positively affirming our good points or deeds or attributes. Today the topic I selected is ‘why is it important to come to therapy?’ When each of you share your thoughts, it enlightens your colleagues and gives them more to consider.
“Who woul
d like to start?”
Orange crept up her hand and then used it as a comb through her long, dark hair as Dr. Keeton acknowledged her.
“We’re supposed to come,” Orange said. “In a way, it’s an order; a requirement we’re supposed to follow from the psychiatrists. Because coming here keeps us out of trouble even with the police. People like us with mental illness can rob or steal or hurt people if we’re not well and treated by you. I don’t want to go to jail.”
“Your insight is remarkable,” Dr. Keeton said. “What do the rest of you think?”
Jonah had sunk back into his hoodie but it bobbed back and forth as he agreed.
“She’s right,” Timmy said.
Victor swallowed. Since his hospitalization, a lot of orders had been thrust at him including at work. He had not looked at therapy appointments that way. “Is that the only reason?” he asked.
“No,” Orange said. “I am happier when I come and am freed of those symptoms like hallucinations. When I’m sick, I barricade myself from the outside world.”
“So by participating in this group,” Selina said, “you’re not isolating yourself from us or your family or your friends. You tend to engage in activities you enjoy?”
Orange stopped playing with her hair. “Yes.”
“Would anyone else like to add to that?” Dr. Keeton asked.
The patients stayed quiet so Annabel chimed in. “Orange, even for those of us who don’t have schizophrenia, we tend to isolate ourselves with any kind of medical illness. Maybe being engrossed socially in a positive way is a sign of good health.”
Victor rubbed the stubble on his chin. “So many orders are hard to follow,” he said. “It depends on who they are coming from.” In the past, he thought, he always followed commands from his snakes.
“Appointments with your doctors are imperative,” Dr. Keeton said. “This is a stellar group who understands that and shows up like precision clockwork.”
-----
Annabel and Joshua went ahead of the others to visit Haley Morris before their late afternoon rounds.
“Haley is not making progress, Dr. Washington,” Annabel said as Joshua pulled her chart out of the rack. “She is the only really depressed patient I’ve had on the rotation. Can’t patients like her with such despondency and lack of energy wear off on other psychiatric patients and health care providers? When I visit her, a cloud of negativity washes all over me.”
