And true to my words, I am back with more. Thank you very much for your kind reviews.
Ps: Immi as always thank you
The door in front of me opens a mere minute after I rang the bell. A man in his fifty opens the door, he's surprised to see me but just steps aside to let me in.
"Can I offer something to drink?"
"No thank you, Artie," I refuse.
Arthur Montgomery is my mentor. I met him during my residency in psychiatry and he's taught me everything I know and has become a precious friend with time.
"The last time you came here unannounced was four years ago…"
"A week after Annabeth's funerals," I finish.
"Indeed. How are you?"
"I'm fine, all things considered."
"And how are my four favorite trouble makers?" he asks about Finley, Thaddeus, Keenan and Charlie – my children, well they are teenagers now on the edge of young adulthood.
"Grounded as of today, but otherwise they are doing quite fine, they're finally starting to get their marks again."
He chuckles at my answer then goes to seat down in an armchair that looks like the twin of the one I have in my own office.
"So to what do I owe your visit?" he continues. "We both know that when you come here unannounced it is seldom for a social call."
"Patient, as usual," I give him a tight smile. "I need some perspective."
He waits for me to take a sit on the couch that is facing him. "Talk to me," he simply declares.
I'm used to work side by side with him and each time I felt like I needed a professional advice he's always been my first call, and he has never failed me as a mentor.
"I've been treating patient X for almost three years now. X grew up in an abusive environment, as a result they have a problem with any form of authority. They are in constant control of their emotions, because for them the loss of control implies violence; X has developed destructive habits since early teenage years, i.e. cutting, any form of self harm. As an adult, X has learnt to channel those habits into something healthy and positive, like sports, but in case of extreme emotional distress they embrace their bad habits again."
I give Arthur a moment to process all those information. "Go on."
"Two years ago they faced one of the most dramatic events, self preservation lead to denial; that bubble of denial has been slowly punctured for the past months, yesterday was exactly the two years mark and the awakening has been… brutal."
Arthur frowns. "I assume X gave into their destructive habits."
I rub my forehead. "Yeah they did and they came to me."
Arthur waits for me to continue, however when I don't say anything for a whole minute he takes the lead again. "What's the problem?"
"I…" I clear my throat. "I'm questioning whether I'm a help or and hindrance to the process of X's recovery."
I stand up, I go to one bookshelf and take one the bouncing balls made out of rubber bands that is there, I return to the couch and lie down, throwing the ball in the air and catching it back.
It's something I like to do when I need to clear my head. I like to think about the balls as the parasite thoughts in my head clouding my mind, I throw each one of them out so I can get a clear vision of my ideas.
"How so?" Arthur keeps on tracks.
"I'm questioning my judgment."
I keep throwing the ball regularly. "I knew X was about to break down, I knew they'd most likely hurt themselves and I didn't do anything," I switch hand with the ball.
"X is an adult, unless they are in a facility we unfortunately can't shadow our patient 24/7. You made a choice taking all the facts about X in account, with a rational mind. You can't blame yourself for the things that aren't in your control," Arthur reflects.
I keep throwing the ball for a few minutes then I suddenly stop. "I don't know what to do Artie," I admit. After five throws I stop.
There's a long silence before asks his next question "Have you crossed the line with X?"
"No," I reply honestly.
I did cross a line with Sara but I was never physically intimate with her nor do I have feelings for her. So the sacred line Arthur is referring to is safe.
"Adam," he pushes sensing that there's more.
I stop the ball and stare at the ceiling for a moment. "I stepped on a line and allow myself to comfort them on three occasions," I elaborate. "Each times was when they reached their breaking point. The process was too violent for them to handle and they were in extreme distress," I explain. "It's unprofessional, I know. I also know that you disapprove but I stand by my choices."
"Then, what is it?" he moves on not needing to gives me an earful about my behaviour since he knows I'm well aware of my mistake.
"They are… they're like a Jesse, I think."
I sit up and face him again. I play with the ball in my hand "We must be detached and objective, but it doesn't matter how used to it we are or how much experience we have for the job…" I bounce the ball once. "There are patients and then there are the… Jesses…" I declare.
"They affect you," Arthur states with understanding.
I've had patients after patients, yet I can count on one hand the cases that marked me the most. Jesse Moran was one of them. It was one of the first cases Arthur trusted me to work on my own. I first met Jesse when he was a teenager, in many ways Sara reminds me of him. Except that Jesse had no grasp whatsoever on his emotions and was enable to control his constant rage so he was often violent with others and with himself. Every step in the right direction was draining for me and painful too.
Working with Jesse affected me so deeply that it felt like an iron fist was clenched around my guts and pulling every time I tried to distance myself from everything. And though in the end Jesse had a breakthrough and could finally start working on growing up and building healthy ground around him, I found myself wondering for the first time if I had the backbone it takes for this job or not.
"We must be in control of our own emotions and shut them down completely, but even the best experience doesn't stop you from being human. We're getting inside people's head, it's normal that from time to time they get under our skin."
I lie down again and throw the ball in the air. "Have you considered redirecting X to someone else?"
"I have. It's not an option though. They have had a parade of shrinks before me. They know all the tricks in the book, they have an endless defensive arsenal, and they can build walls with faces so high they make the Great Wall of China look like a joke."
"They get to you, I can understand that, but I don't see why you're questioning your judgment. They did come to you when they were losing their grip. If anything it goes to show that your judgement was accurate."
"They cut themselves."
"But they came to you nonetheless."
I sigh and stand up to put the rubber ball back to where it belongs. I go back on the couch.
"There's something you're not telling me."
I have an intake of breath as if I was about to say something but words fail me.
I close my fist and sigh heavily. "They gave in a few times during all the years I've been treating them. They came to me before cutting themselves or after."
Arthur finally picks up on what's been bothering me. "What was different this time?" he asked with a frown.
"They came… during their cutting," I clear my throat. "I had to patch them up," I explain more clearly.
I exhale and hide my face into my hands. I've been fighting this thought all night when I looked after Sara, I've been looking at it under every angle and I know that I can't deny what happened.
Self harm is an intricate habit to understand. The first thing to understand about it is the fact that it is a completely psychological issue. The logic behind it is displacement.
"You don't think it was about control, do you?" Arthur states.
"I'm 99 per cent sure it wasn't," I confirm.
First there's a frustration because one is not to be able to identify the roots of their emotions or issues. They feel something intense that puts them into distress but cannot explain why nor can they control it. There's a displacement of this feeling by turning it into physical pain. When one hurts themselves they can rationalize it all, 'I'm hurting because I'm bleeding', better yet 'I'm in charge of it all for I can increase the pain or reduce it'.
There's a relief coming from that distorted rationalisation process. That relief is coupled with a perverse adrenaline rush, perverse because it gives them a 'feel good' sensation so that pain turns into a positive in a brand new equation: 'when I feel bad, pain makes me feel good'. Thus begin a viscous circle where pain becomes a new panacea, and before they know it they develop an addiction to their new 'remedy'.
Of course, there is a catch. Since they never work on finding the true core of the problem, they keep increasing the pain they inflict to themselves until it gets to the point where it is ineffective, this leads to frustration which brings them back to square one. The difference is that pain is now a negative, yet they keep putting up with it for one simple reason: it's the only thing that makes sense.
As soon as they learn to identify their emotions properly the need for pain decreases and they are able to find healthier ways to handle everything.
Last night I know it was different for Sara because she knew exactly what the core of her problem was. I know that she wasn't rationalizing her pain, she was trying to put an end to it. I also know that her realizing that much is why she came to me in the middle of things. She came to me to stop herself from committing the irreparable.
I should be watching over her still and I would have been if she hadn't left my office without any warning. In the early hours of morning something came up with Thaddeus and Charlie, I had to leave my office for two hours top, when I came back Sara was gone.
I love my kids and I promised Beth I'd never let a patient come between them and I, a promise I've never broken; early this morning Charlie – my daughter, and Thaddeus – my cadet son right before her, had a little accident, there was more fears than harm but the problem lied in the fact that the accident had occurred when they were doing something I had forbidden them to do.
Once I was sure they were okay we had a long conversation, and sure enough when I came back to my office Sara had woken up and walked away. I didn't think she would to be honest, mostly because the last time she ended up sleeping on my couch she had waited for my return. Since the situation was even worse this time I figured that she'd stay as well, once again I was wrong.
I've been cursing myself ever since. I called her at once when I realize she was gone but I was immediately redirected to her voicemail.
"Adam I've taught you everything and I know from experience that you always make the right calls," he states calmly. "I trust you to do what's in the best interest of X. I also have no doubt that if you thought your judgement was no longer based solely on objectivity and reason you'd step away in spite of eventual protest from X."
There's no doubt in his voice, Arthur is not one to beat around the bush if he thought otherwise he'd let me know without any equivocal.
"Now, let it all out once for all then focus again."
At first I frown but eventually I get what he means.
"I was scared," I admit out loud after a long silence. "I was very scared."
"Your fear was legitimate. Now it's over, so let go of it. You can't second guess yourself because you've had a human reaction. Second-guessing yourself is the root for mistakes," he reminds me. "What could have happened is irrelevant, the only thing that matters is what happened and what you have to do in order to help X work things out and get through this."
Now that I've owned up my fear, I do feel a little more level headed. Arthur is right, I came here because I kept thinking about the 'what ifs'.
I'm still worried about Sara and about the rough sessions we have ahead but I know that she has regained a little control of herself, and that why I'm here instead of turning Vegas upside down to find her. She left my office, yes, but she left a note behind her: 'I'll come back, promise'.
I trusted her words before and if anything last night as scary as it was proved me that my trust wasn't misplaced, I know I can trust her again.
"Thank you," I nod in direction of my friend and mentor, then I turn my heels and leave without another word.
I open my eyes and for a second I feel rested and alright, but then my brain gets back on track and I immediately feel the weight of the world lowering on my chest, making it hard to breathe. Everything flows back with a vengeance and tears starts streaming down my face.
I only need a few seconds to realise that I'm alone. I know that Adam must not be too far but right now it seems like light years away.
My left arm is sore, there are bandages around it, pinkish line are visible on it as blood has been soaking through it, bile rises immediately in my throat as well as pain, suddenly I feel like the walls were closing in on me, I must not think about it, I must not think about it, I must…
I need to get out of here.
Without thinking I grab a piece of paper and scribble something on it then I go to the door and leave. I don't know what to do, I just want to stop thinking; I let my feet carry me away never stopping to think of a destination.
I shakily slip my keys into the locks and let myself in. It's dark, every blind is down blocking most of the sunlight, letting only a few rays filter into the room.
Even with the dim light I can see that the living room is upside down, I walk further in and go to the bedroom. The unobstructed light contrasts dramatically with the obscurity of the living room.
"I meant what I said yesterday," the hoarse voice of Greg resounds in the room.
My ribcage tightens around my lungs immediately. I open my mouth to say something but nothing comes out except a shaky breath.
He's hunched on one side of the bed, facing his window, his back to the door. I didn't want to give him a chance to leave me behind the door so I used my set of keys to enter.
"I didn't…" I say with a weak voice.
There's a long silence, he doesn't move or give any sign that he heard me. I fail to find the proper words to reach out to him and the longer the silence the worse I feel.
"You hurt me, you know," his voice is void of reproach, it's a simple statement.
"I wish there was a way to take it back but there isn't," it's hard for me to speak since a golf ball has lodged itself in my throat. "There are no excuses for what I've said, but… please I'm begging you… I'm begging you…not to give up on me, I'm begging you to find it in you to forgive me… please…" I choke a little starting to cry again. "I won't survive losing you as well…" I choke.
I move closer and climb onto the bed, crossing the distance between him and I, I sit right behind him and wrap my arms around his chest and hold him tightly. "I'm truly sorry… please don't give up on me."
He moves for the first time, brushing his finger tips against the hem of the bandages covering my left arm. "Moon…" he calls in a apologetic sigh.
I hold him tighter to me. That name is enough to let me know that even if things are screwed up and far from being sorted, we are alright. He puts his hands over my arms and hold onto me as tightly as I'm holding onto him.
There's a silence, then he hiccups, his body starts trembling and soon I feel warm tears wetting my skin. For the first time he breaks down in front of me, my tears run free as well, but we hang onto each other drowning into our unbearable grief.
My talk with Arthur helped me admitting my fear and I have since regain my composure. I've returned to my office right after leaving Arthur, waiting patiently; I put Sara's note on the table next to me so that I could see it if I ever my trust in Sara's words was starting to waver.
Hours have been dragging on and on, I've been silently bouncing a ball against the wall for the past hour to settle my mind first and just for the sake of doing something.
There's a knock on the door, my relief last all but two seconds as I realise that it came from the door separating my office from the rest of my house and not the one giving on the outside.
"Come in," I invite whoever's on the other side, securing the bouncing ball in my hand.
"I brought you something to eat," my eldest son informs me before walking to the table next to my armchair putting down the plate he's holding on it. "I figured that you might stay the night here."
He starts to rub his hands nervously onto his thigh. I know that the sandwich he just brought me was just an excuse, there's everything I need in my office. I also have a fair idea of what the cause of his nervousness is, but I don't push him, giving him the choice whether or not to talk about it.
"I think I'm going to go to bed early, so I tell you goodnight," he states.
"Goodnight, son," I grin softly at him.
He goes to the door but then stops himself before crossing the threshold. He turns around and looks at me with a guilt painted all over his face.
"Actually, I wanted to present you my apologies," he says hesitantly. "I knew what Thad and Charlie were up to…" he swallows nervously. "…because I drove them to their thing."
He forces himself to hold my gaze. "I should have talked them out of it but… I chose to wear my 'cool older brother' cap rather than the 'reasonable older brother' one," he clears his throat. "That was very stupid and… it could have ended much worse than them having a few cuts and bruises and broken bikes."
He takes a deep breath, becoming steadier as he goes on. "I apologize for betraying your trust, I apologize for not setting a good example, I apologize for not being as reliable as I should be."
"Apologies accepted," I said after a few seconds of silence.
He nods, feeling slightly relieved, but I know that he'll still have to deal with his guilt for a little while. "Like for Thad and Charlie, I'll let you know when I find the appropriate sentence, in the meantime you're all grounded."
"Okay," he acquiesces. "I'll go to bed now. Goodnight, Dad."
"Fin," I hold him back before he can leave the room. I wait for him to look at me to continue. "Thank you, I appreciate your honesty."
"Sure," he grins sadly then retreats to his bedroom.
It's a quarter to midnight when I open the front door of my office on a fragile looking Sara, she's hunched so much it's like she was trying to shrink herself. Reflexively I look down for any sign of immediate harm but see none. She looks at me apprehensively, before she gets a chance to speak I step aside.
Her face is so grim that it seems like she had aged a few years over night. She sits down on my couch, unfocused and having apparent difficulties to breathe.
She rubs the ball of her left hand on her forehead, her face contorted in a grimace. "I need help… I need help because I can't handle feeling this way, and I know that solution I'm thinking about isn't the good one…" she glances at me nervously to make sure that I hear the rest of her silent statement, and I do. "I need help…" she wails, burying her face into her hands.
I stand from my armchair and go to sit on the coffee table so I'm right in front of her.
Every patient is unique, nothing groundbreaking in that statement, but I know that if I'd have never allowed myself to step on a line with any other patient, had it happened I'd have redirect them immediately to someone else.
Yet when it comes to Sara, I have, in essence come to terms with the fact that I've broken the rules of professionalism on several occasions. I've thought a lot about what Sara had said several months back on the matter, that what mattered was the fact that it was working for her.
For some reason I'm in, and it's not because the ones before me weren't good enough, it's because Sara allowed me through her defences. Maybe it's because from our very first meeting three years ago we agreed to established a 'no bullshit, no beating around the bush' rule, maybe that's what led her to trust me.
I understand now what I had failed to see before, Sara allowed me to bend the rules and step on the line of our dynamic. It is, in a way, a translation of the trust between us; what's more it is comforting her in the idea that her choice to let her guard down wasn't bad and that is why it works for her.
I've spent a lot of time weighing the idea of having her committed at least for a short period of time, because I think she is a danger to herself, and she has just confirmed that a second ago. I've put this idea aside because it seemed to me that it might do more damage than good to her, and now that she's here I finally know what I have to do.
Choosing to put her in a facility, would be like waking away. If there was ever a worse time to walk away from a patient, now would be it. I now know with certainty that all Sara needs right at this moment is for me to be the safeguard she has once compared me to.
"There's a man who fell into a deep hole, and try as he might, he can't get out of it," I start calmly. Sara raises her head to look at me, her eyes humid with unshed tears. I keep on with my story once I have her attention.
"A priest walks by and the man asks 'Father, I need some help', the priest says a couple of prayers, blesses the man then walks away. A doctors walks by and the man asks 'Doc, I need some help', the doctor writes a prescription and throw it down with a bottle of pills before walking away. The man is now asking desperately 'Please, somebody help me', a stranger walks by and without hesitation jumps into the hole. The man says 'Why did you do that for? Now the two of us are stuck, you idiot'. The stranger puts a hand on the man's shoulder and says 'It's okay, I've been there before so I know the way out, you're not alone now'."
There's a silence during which I can see her trying to get the point of my story. I raise a hand and rest it on one of her shoulders; she looks at my hand then back at me, her lips quivers in an attempted smile, a mix of disbelief and gratitude painted on her features. "You're not alone Sara, because I'm not going anywhere."
The words barely leave my mouth that her tears double, she nods and then grips my hand tightly forbidding me to let go, a strangled and weak 'thank you' fights its way through her sobs as she breaks down once more.
It's not about bending the rules, it's about understanding why they need – when the circumstances call for it – to be bent.
There's another version of Adam's story where it's a friend of the man who jumps in the hole. The moral stays the same nonetheless, your true friends will always stuck by you during your darkest hours, or whoever stands by you in your worst moments will prove themselves to be your true friend.
Thanks for reading.