Saturday, July 15, 2000

In/Exhale - February 10, 2001 - Part IV

February 10, 2001 - Part IV

The Xanax helped. Jon always thought that he couldn’t love his brother more, or be more proud of him, but Kai always did something that left Jon in even more awe of how strong and brave Kai really was. Everything about today, especially in light of how Kai must have been feeling the past few days--despite his reluctance to share it with Jon--should have left Kai a mess. And yet he’d been strong and stoic, acting disaffected until only just now. Jon’s instinct was to hover and fawn over his brother, but he was learning that what Kai valued most was knowing his brother was there to lean on when he needed it, even if Jon didn’t do or say anything proactive. Kai was stronger than he gave himself credit for, and Jon had to remember that. Even if his dissociations made him feel like a child, Kai was an adult and he could take care of himself. Mostly.
They’d wandered into one of the rooms together, and although Kai was much calmer thanks to the medication, Jon noticed how his brother never let the door out of his peripheral vision. And he’d occasionally meet Jon’s eyes and dart his gaze toward the door as a wordless way of asking for Jon to help him make sure it didn’t close. Nevertheless, even this more spartan, more secure room wasn’t like any psych room Jon had ever seen. Granted, his experience was limited to the public hospital where he’d done his psych rotation way back in medical school, and then the one visit he’d been allowed to Kai a few days into his stay at JMH’s psych unit.
The room was open, with at least a 15-foot ceiling, windows high on the outside wall that let sunlight brighten the space. The walls were painted a calming light blue, and on one of the interior walls there were what appeared, at first glance, to be two plexiglass windows overlooking a garden. Jon drew closer, and he realized they were of course not real windows at all but actually TVs embedded in the wall behind the plexiglass to give a patient the illusion of looking out onto a garden where hummingbirds fluttered from flower to flower. It was enchanting, and when Jon surveyed the room some more, he realized the furniture was actually organized so that a patient could sit in a comfortable-looking chair and watch the “scenery.”
But when Jon tried to share his amazement and joy over this with Kai, Kai only frowned and looked sad.
Jon said nothing, again, trying to give Kai some space while he explored the room. The bed was fixed to the floor and wall, without any harsh edges, making it look like a bunk on some futuristic spaceship. It fit with the modern decor that made the room feel more like something out of an artist’s minimalist home rather than what it really was. This continued in the bathroom, where the toilet was seemingly all commode without any exposed pieces or pipes, as was the sink. The shower was a basic walk-in, similar to a typical hospital shower but with a few modifications for patient safety and that artistic touch that gave it a homey, rather than institutional feel.
Kai was sitting on the bed with an unreadable expression when Jon came out of the bathroom.
Jon joined him, a little worried that maybe the weight of trying to keep everything together all day was finally draining Kai. “What’s wrong? You don’t like this place?
Kai laughed, but there was no humor in it. “It’s too good to be true. Everything has a cost.
Jon’s eyebrows went up. It reminded him a little of what Kai had said earlier, about how he’d expected Jon only wanted him for a sick purpose, because Kai had nothing else but his body to offer anyone. “Yeah. This place costs thousands of dollars a day.
But Kai didn’t appreciate the joke. “Maybe I never belonged in the real world. Maybe I was always destined to end up in an institution. That’s the real reason we’re here, right? So you can convince me that I need to stay behind?
Jon wasn’t sure where that had come from but he did his best to reassure Kai. “If your memory hadn’t improved after your transplant, I wouldn’t have put you in a home. I would have found a nurse to take care of you. Anything so you didn’t feel like I was sending you away. That’s the last thing I want. I want you to be safe. I want you to get better. And if I could have prevented us being separated in the first place I would have. I thought you understood that.
I saw how you all looked at me last night. Like I can’t be trusted. You brought me here to leave me.
Jon’s shoulders fell and he let out a soft sigh. Kai might not be thinking logically right now; he was afraid, and being left behind was one of his biggest fears. “If you decide to stay here, it’s your decision. And I will stay with you. That’s why I picked this place, remember?” Jon felt like he’d said this twenty times already. “I want you to be safe and feel safe.
Kai stared at the bed almost like he wanted to lie down on it and curl up into a ball. “How can you stay here? You admitted that it was hard enough for you to deal with Vicky being across town. You’d panic if you were two and a half hours away and something happened to her.
Jon softened and offered Kai an encouraging smile. “I’ll always worry about you and Vicky and the baby. Worrying is who I am. I’m working on it, on trying to be healthier about it, but it’s part of me. If you decide you need to stay here, whether it’s now or down the road, I’ve already talked to Vicky. She’ll stay with her sister, so I know she’s not alone. And if worse comes to worse, I’ll use some of my adoptive father’s money that I barely touch and hire a helicopter or plane to take me home. OK? If I tell you I will stay here with you, I mean it.” Jon hesitated before admitting, “I’m glad you trusted Renee and went to her this week, but it hurt me that you were too focused on upsetting me to go to me when you needed help.
Kai took a huge breath. He seemed troubled, like he wanted to say something but was worried about what Jon would say. “You hated our mom so much, and I’m worried I’m like her. That if you knew how much you’d hate me too.” Kai’s eyes filled. “I don’t know what I’d do if you hated me.” Kai had expressed this fear before, and despite Jon’s reassurance, still believed it.
Jon pulled his brother into a tight hug, almost as if he could protect Kai from everything bad in the world, including his darkest thoughts and memories, if only he could just keep holding him like this. When Jon was younger, he sometimes thought that as long as he held Kai in his arms, even the hardest night of breathing would pass OK, because he’d keep his brother safe.
Kai finally pulled away. He slowly lifted the sleeve of one arm and Jon could see the bandages, the hint of blood staining them. “I did this this morning. I wanted to keep going. I’ve been thinking about it so much lately, and I hate myself for it, but I can’t . . . it’s just always there. And I know you all say that my death wouldn’t make things better, but I can’t stop believing it would. It feels like I do nothing but cause stress and worry and problems for anyone who gets near me, and if I was dead . . .” Kai’s hands trembled and dropped. A few stray tears fell.
It broke Jon’s heart to see his brother like this, terrified him how many times in the past few days Jon could have lost him. But Kai didn’t need to see Jon’s fear or worry or judgment; he needed support. Maybe if Jon and Bryan could have been more understanding of what Ann was going through she wouldn’t have felt so compelled to try to take her own life time after time.
I’m not going to say I understand what you’ve been through. But trust me when I tell you I need you. I need you to be there to help me raise my son. Hang on for him if no one else.
Kai’s eyes grew wide for a moment, and then he sighed softly. “You know more about being a father than I do. You don’t need me. I’ll just make everything worse. That’s all I do is make things worse.” Kai hugged himself, his shoulders hunched, his head drooping.
Jon wished he knew the magic words or actions to help Kai out of his depression, to get him to realize how much he and David and Renee and even Vicky loved him. But he worried if he told Kai how much of a wreck Renee had been last night when they all believed Kai might be dead would only make Kai feel worse. He took a breath and tried something. “What are you really upset about? Think hard before you answer.
Kai gave Jon a look but took a breath and seemed to consider it. His eyes wandered around the room, as if constantly expecting some threat to appear. “I’m scared I can’t get better. That this will be my life until I die,” Kai said, indicating the room.
Jon thought carefully before he signed, because he didn’t want to mess this up. “You know our father never loved me less because of my diabetes, or you because of your MLS or your bad lungs. All things that you can treat but can’t cure.
Kai rolled his eyes and shook his head. “Being crazy isn’t the same thing as needing to take insulin every day.
Maybe it’s not exactly the same, no, and I’m not trying to minimize what you’re going through, but what I’m trying to say is that even if you are like Mom, if your mental illness is something you have to live with and take medicine for forever, that’s OK. No one will love you less because of it. I won’t hate you. And you shouldn’t hate yourself either.
Kai stared at Jon, almost like he wanted to believe Jon’s words but was struggling to. “Do you think if I can never get completely better that I can teach kids? That Renee will still want me?
Jon reached for Kai’s hand and held it firmly to offer his support before continuing with his other, “After your transplant, it took months to get your anti-rejection medication regimen stable. Where you were in just the right balance, and to find meds that didn’t make you too sick. Maybe you don’t remember well because you were still recovering, but I do. It will take time for you to get stable. To find the medicines that work best for you. And you aren’t alone in this. You have me and David and Renee and Vicky to help and support you. And you have Dr. Miller. Don’t forget how much progress you’ve already made, OK? And if you do need to go back into the hospital for a while, that doesn’t mean you’ve failed or you’re weak any more than it would if you got another infection and had to be admitted to JMH again.
A long moment passed, like Kai was trying to regulate his breathing and get himself in control. Finally, he said, not trying to hide his emotions, “I think I need this. Here. The hospital,” he signed, clarifying. “But I don’t want it. I don’t want to stay. It feels like I’m giving up on my life. Like I’m running away, like I’m not strong enough.
You don’t need to make a decision right now, or even today. OK? Let’s finish the tour and we’ll go do something fun. As brothers. Forget about our worries for a few hours.

“Kai’s really bad right now, isn’t he?” Ms. Evans asked, interrupting Dr. Miller’s examination of some of his records.
Dr. Miller slapped on her stoic, neutral expression so as not to give anything away. “You know I can’t say.”
But Evans nodded as if that were answer enough. “He must be if he gave you permission to come here and dig through his files. At least he’s letting you help him. That’s something. Kai never cooperated with anyone, not unless he wanted to.”
Dr. Miller pulled a few more files she wanted to look at and set them on the edge of the desk. But first, she wanted to ask some questions. “Ms. Evans, would you say that Kai suffered from recurrent depression growing up?”
“Recurrent implies that it went away, then came back. Episodes. Right?”
“That’s correct,” Dr. Miller said, opening her small notebook she’d brought with her and beginning to take a few notes.
“Then no,” Ms. Evans replied with indifference, seemingly more interested in her coffee than this conversation.
That surprised Dr. Miller, and she stopped writing. “So Kai’s only episode of depression was when David aged out?”
“You misunderstand me, Dr. Miller. I said Kai didn’t suffer from recurrent depression because, in my opinion, Kai was depressed from the moment he was brought here to the day his brother took him home at age 18.”
That wasn’t entirely shocking, but it definitely was interesting, and Dr. Miller wrote, history of chronic depression throughout childhood? in her notebook. “So some of these files, they weren’t just blowing smoke.”
“Kai was a very quiet child, and I don’t just say that because he was mute. He mostly kept to himself. He and David were a matched set, and he got in trouble because of that red-haired miscreant, but overall, Kai was a good kid. He was just so sad all the time.” Ms. Evans stared into her mug, frowned, seemingly disappointed that it was empty but too lazy to refill it, and so she set it aside. “I mean, he’d have his good periods, of course, and his worse periods, too. Sometimes he’d crawl under his bed and stay there for days, refusing to eat or take his medicine. Sometimes I’d have to get the orderlies to pull him out and send him to the hospital ward here so he could recover from not eating, and in the process, he’d usually come out of it, more or less. Kai could be sullen and resentful, but I did all that I could for him with the budget I had.” Ms. Evans leaned back in her chair. “I did have one psychiatrist try to convince me to have him institutionalized. Sent to a mental hospital. But I didn’t think Kai belonged there. I mean, didn’t the kid have a right to be sad? Bad enough he was an orphan, but with his health, and being stuck in this place with no hope of adoption? David made him as happy as Kai could be, and so I let them be most of the time. They thought they were getting away with everything. That I didn’t know, but of course I did. As long as they weren’t hurting anyone, I didn’t see the harm in letting Kai have that small sliver of happiness.”
Dr. Miller finished a few more notes. She’d come here to determine whether Kai suffered from dysthymia--a chronic low mood--or recurrent major depressive disorder so she could figure out the best way to manage Kai’s symptoms, especially his suicidality. But based on what Ms. Evans was saying, and on the little bit Dr. Miller had gleaned from her cursory exploration of Kai’s files, it sounded like Kai might actually suffer from both. It was sometimes called “double depression.” These individuals were described as being chronically sad people to the point of which it was considered part of their personality--the dysthymia--and then they’d have major depressive episodes in which they’d sink very far. Especially with Kai’s comorbidities of PTSD and panic disorder, if Kai really was “doubly” depressed, it was no wonder he wasn’t responding better to his medications.
“More coffee?” Ms. Evans said when Dr. Miller didn’t say anything immediately.
Dr. Miller had barely touched hers, so she shook her head. “How often would you say Kai had these ‘worse periods’?”
Ms. Evans leaned back in her chair, apparently deciding it wasn’t worth the effort to get up for more coffee only for herself. “Don’t know if my memory is quite that good. It’s all a blur of one big depression. Let me think.” Evans took a moment. “The worst was when he was eight and he realized his parents were dead. Before then, I don’t think Kai understood that. Like with Kelsey, it’s not uncommon for kids here to hold out the hope that their parents will come back for them or change their minds, even if they’re deceased.” Ms. Evans grew pensive. “That was the first time Kai stopped eating. Refused to go to school or even leave his room.”
Dr. Miller made a note, trying to create a timeline of Kai’s depression. “OK. And once he came out of that, how long do you think he went until his next episode?”
Ms. Evans’ eyes darted to the stack of folders Dr. Miller had placed on the desk. “A couple years. Next one was when he was ten.” Her face closed up and she quickly forged on, “I’d say maybe every two years or so he’d really get bad. Stop eating, refuse to leave his room, grades would suffer, get into trouble. High school was the worst. For his first two or three years I was getting weekly calls about him getting into fights. It was a constant battle to keep them from expelling him.”
That was news to Dr. Miller. Kai had admitted about being bullied, sometimes physically, and that he’d fought back, but he’d spoke fairly generally about the experience. “Really?” Dr. Miller asked as she wrote that down.
“I’m sure some of it’s in his files,” Ms. Evans said, gesturing to the stack on the desk. “Part of the reason the psych visits got more regular in high school.”
Dr. Miller reached for the top folder and suddenly Ms. Evans stuck out a wrinkled hand to stop her.
“Not that one. You won’t learn anything from those. I’m sure his school stuff is in one of the other boxes.” Ms Evans tried to wrestle them away.
“I’m here to get a full picture of Kai’s childhood psychological history. I can’t skip over anything.” Dr. Miller tried to grab the folders back and the pile slid out of both their hands and tumbled onto the floor, spilling papers everywhere.
“Dammit,” Ms. Evans cursed. “I’m too old to pick all this up.”
Dr. Miller sank to her knees and began gathering the folders and papers, and that’s when she saw what Ms. Evans had been trying to hide. The folder reminded her of the kind used in hospitals for charts, where the papers were punched at the top and held in place by a bracket. So this particular thick folder hadn’t gotten disturbed in the fall, although it had opened to the first page. A full-color, 8x10” photo of a horrifyingly thin young boy, lying on his side in a hospital bed, naked except for a diaper. Bruises and sores of different sizes and ages covered his skin, larger ones on his stomach and legs and dozens of smaller ones all along his forearms. Dr. Miller could see nearly every bone in his body, his skin stretched over them like a mummy’s. The boy was so small, so gaunt, his long blond hair falling over half his face, that especially with the diaper, she would have predicted he was an overgrown toddler. But then she saw the date and name stamped on the bottom of the photo, TAYLOR, J. K. 09/15/88.
“Kai was only with that woman for about four months, and that’s what he looked like when social services finally took him away from her.”
Dr. Miller flipped through the file. There were dozens of pictures cataloging Kai’s injuries, including one in which someone held Kai’s hair away from his face, revealing a black eye so severe he couldn’t open it, and so many pressure sores she’d initially thought they’d been the same one taken from different angles until she realized they were labeled.
“He was in bad shape when they found him. His kidneys were failing, he had a systemic infection, numerous fractures, and bedsores everywhere. He was in so much pain, but he wasn’t stable enough for most medications.” There was a hint of both sadness and anger in Ms. Evans’ voice.
Dr. Miller continued to flip and found close-up photos of Kai’s arms. She couldn’t make sense of the bruising pattern on them or what looked like dozens of tiny bite marks.
“He’d developed a habit of biting and sucking his arms. The shrink said as a way to comfort himself. They ultimately had to cast both arms to try to break the habit and let his skin heal.”
Dr. Miller had heard of autistic kids self soothing by sucking or biting their arms or shoulders, but she’d never seen anything like this before herself. She skimmed through some of the notes, written by the woman who had gone to collect Kai. She’d found him locked in an upstairs bathroom, naked and filthy, lying on his side on the floor, sucking on his arm and looking despondent. He didn't respond or even react when she spoke to him from a distance. However, when she grew closer to him, he dragged himself away from her, managing to squeeze himself into the narrow space between the wall and the pedestal of the sink, clinging to it and fighting off anyone who got near. It was sad, but it also helped Dr. Miller know that even at his nadir, he hadn’t totally lost that spark, that fighter spirit that was so essential to Kai’s personality. That was good. That meant even as an abused young boy Kai hadn’t totally succumbed to being a victim, which was something she could use to help him now.
“He needed several surgeries,” Ms. Evans said in a solemn voice. “They tried to put them off as long as they could, because he was so frail they weren’t sure he’d survive. But he was bleeding internally; they had no choice.”
Dr. Miller had seen Kai’s bare torso more than once when he’d shown her his self-harm wounds. She’d seen his post-transplant surgical scars, but no evidence of the kind of scar he’d gotten if he’d had abdominal surgery, even if it was twelve years ago.
As if reading Dr. Miller’s mind, Ms. Evans explained, “Not all his injuries are visible in the photos.” She rose suddenly and went to get more coffee, almost as if she couldn’t stand to be in the room with Dr. Miller right now.
Dr. Miller wasn’t entirely sure what Ms. Evans was suggesting at first, so she flipped back to the intake information, a few pages in. It listed a thorough description of Kai’s injuries, along with lab work. In addition to the expected signs of malnutrition and the beginnings of kidney failure, she found two lines nearly lost amidst the pages of lab tests that suddenly put all the pieces into perspective. In simple, cold typewritten letters it said:


She’d suspected Kai may have been sexually abused, but having it confirmed like this felt like a physical blow. Dr. Miller took a breath and skimmed through the doctors’ notes, including the ones that detailed the repairs Kai had undergone during his first surgery. There was even a photo tucked into the pages; it was a miracle this one hadn’t fallen out. Unlike the ones taken by social services, this was a polaroid, less professional and cold. It was of Kai, in pediatric ICU. He lay on his back in a nest of pillows, naked except for a diaper and a few bandages. His arms and legs were spread so he almost resembled a frog awaiting dissection, although from the bags of blood hanging among the nest of IVs, Dr. Miller suspected he already had been: this was a post-surgical photo. His arms were wrapped in bandages past his elbows and were tied with soft, loose restraints, standard for PICU, even in sedated patients. He was intubated and asleep in the crib-like bed, and the cheerful print of the sheets and the brightly painted walls couldn’t undermine the machines and tubes and wires that surrounded him.
An older man stood by his bed, looking sad and somber, holding one of Kai’s tiny hands and smoothing the boy’s hair fondly. His eyes were totally focused on Kai and not whoever had taken the photo. It took Dr. Miller a moment to recognize the man as Art from Lost Apple.
Ms. Evans returned and leaned in to see what Dr. Miller had been staring at. She sighed softly. “I don’t know why I took that picture,” she said out loud. “That was after his first surgery. I couldn’t leave the kids here very long, so Art volunteered to sit with Kai. Art had been visiting Kai here or in the hospital for a couple years at this point, and I couldn’t stand the idea of Kai waking up alone, in so much pain, not understanding what was going on. So I immediately called him.”
Dr. Miller gestured with the photo, referring to this surgery and the lab work. “This suggests a male abuser.”
Ms. Evans sighed heavily and returned to her desk. “There was more than enough evidence to put that woman away, but she wouldn’t give up the boyfriend. As far as I know, they never did track him down, and Kai wouldn’t talk about what happened. I mean, he couldn’t, but even with an interpreter, he’d just sit there, silent, barely breathing. They tried everything, including that exercise where the shrinks give the kid the paper and crayons and tell them to draw whatever they want? Total crock of shit. No offense. Kai’d ignore it.”
The documentation supported what Ms. Evans had told her, how Kai completely shut down whenever anyone tried to get him to talk about what had happened, even through therapeutic exercises. Kai would shake his head and push the paper and crayons away and go back to staring vacantly.
“Kai missed months of school recovering from that summer. He was never quite the same--not that I blame him. Tried to pretend like he was, but he became even more of a loner after that. Rarely signed to anyone except David. Even at school.” Ms. Evans took a sip of her coffee. “It was months before he stopped having accidents; he wet the bed for years. Never had before, either. Poor kid.” Ms. Evans cracked a shade of a smile. “Kai’ll kill me when he finds out I told you. I don’t think David knew. It was hard to get Kai to go back to school at first; he was terrified of having an accident. That’s not an exaggeration. It was a near phobia, and every time it happened, he was convinced he’d be punished for it.” Based on the little Kai had told her, and what they’d uncovered during memory work, Kai’s reaction made sense. It was also fairly typical for children who’d experienced stressful or traumatic situations to regress--the limb sucking, the bed wetting. But what Dr. Miller found particularly enlightening was the genesis of Kai’s anxiety and PTSD.
“Was Kai a very anxious child?”
Ms. Evans leaned back in her chair as if she were thinking carefully. “Yes and no. After that summer, a lot of little things would send him into a panic, and he’d all but stopped communicating, so it wasn’t always clear why he was so upset. But after a few months, he seemed to ‘snap out of it,’ at least to the casual observer. Almost like he’d found some checklist of what a ‘normal’ kid his age was supposed to do and followed it to the letter, as long as anyone was watching. But that didn’t mean he was OK.”
Dr. Miller took furious notes. “So Kai wasn’t held back?”
Ms. Evans’ eyebrows went up as if to suggest that was a whole topic in and of itself. “He missed the entire first semester. They wanted to knock him back a grade for the spring, but the psychologist working with him and I both worried that’d do more harm than good. David was Kai’s lifeline in a lot of ways, and separating them at that point, when Kai was barely holding a fraction of normalcy together . . .” Ms. Evans shrugged as if the rest were obvious. “Kai’s grades suffered that year, but he caught up, and I think that decision helped Kai get over what happened to him. Maybe it wasn’t the right choice, but it let him return to his life. And he did, for the most part.” It was possible that what may have been best for Kai in the short term had actually contributed to the development and severity of his PTSD. But Ms. Evans didn’t need to hear that. “Back then I was swamped with work; that was the last time the state was really pressuring me to slash the budget or get shut down, and honestly I was relieved he wasn’t giving me too many problems. But I know now Kai was just doing what needed to be done so we’d leave him alone. He never did like being singled out; hated that he was different, even here.”
If Kai forced himself to be “normal” so quickly after the trauma it meant he’d never really processed it. No wonder his PTSD was so severe now. And that didn’t account for one more thing Dr. Miller was hesitant to ask, afraid of how Ms. Evans might react. “Do you think there’s any chance any of the staff here abused Kai as well?”
Ms. Evans gave Dr. Miller the harshest, coldest look anyone had ever cast her way. It rivaled even some of Kai’s best. “I think we’re done here. Visiting hours are almost over and I have things to coordinate. You’re welcome to take Kai’s files with you. Honestly, it’s a miracle they didn’t get dumped when he aged out.”
Dr. Miller wasn’t sure if Evans was simply mad about the insinuation or if there were any knowledge on her part, but either way, it looked like this meeting was over. She rose and started packing the files away, attempting one last-ditch effort to appeal to Ms. Evan’s evidently caring nature. “I just want to do everything I can to help Kai. He’s a good kid with a bright future, and he doesn’t deserve to have that sabotaged because of a few horrible people.”
Evans sighed, leaning on her desk as if for support. She didn’t look directly at Dr. Miller. “There’s nothing about this on file, and if you say anything to anyone I’ll deny it.” Then she let out a soft sigh and her demeanor changed. Dr. Miller recognized the look of frustrated guilt, of impotence, from patients she’d counseled over the years. “It’s very difficult to staff up here. The work is unforgiving and the pay is horrendous,” Ms. Evans said as if it were a prologue to the rest of her confession. “I’ve never found hard evidence of any of my staff doing anything inappropriate with any of my children. But I’ve had my suspicions and let more than one go based on that over the years. That’s all I’ll say.” Then she cast a look at Dr. Miller, suggesting the doctor had better help Kai; it was shockingly protective. It didn’t seem congruent with the aloof geriatric she’d first encountered.
Dr. Miller nodded, smiled tightly. She was determined to help Kai, and she knew she already had, but she couldn’t get the image of that beaten and bruised little boy out of her mind.


The Xanax was kicking in pretty hard and Kai was feeling decently stoned as they toured the most secure rooms, although Dr. Byron insisted that patients were usually only held there temporarily, a few hours at most. These rooms were actually not much different from the ones they’d just seen, the biggest difference being the furniture was sparser--just a bed and a chair--and both were made entirely of foam, with no separate pillows or blankets. Additionally, the bathroom wasn’t attached to the room, and the walls and floor were slightly padded, although it was a far cry from the sterile white isolation cells at JMH. The walls and floor were colored and patterned so it almost seemed like one was living in a giant diorama where a quilt had been used for the walls and floor. The fact that there was a giant plexiglass window in one wall so a staff member could keep constant eyes on the patient inside only added to that effect.
“You’re free to enter,” Dr. Byron reminded Kai as they stood together on the outside of that large window, looking in. Jon was inside, exploring and taking some notes.
Kai smiled and hoped it wasn’t too tight. Xanax or no, his heart had picked up at the very thought of going in that room, no matter how little it resembled the one in his nightmares. Kai swallowed, staring straight ahead because it would be easier if he wasn’t looking at the doctor when he said this next thing. “They gave me too much of the wrong drugs at the last hospital. I freaked out, so they sent me to isolation. They didn’t supervise me properly.” Kai took a huge breath. “I almost died.” I should have died, Kai thought, but he didn’t say it out loud. “After, they dosed me with so much Haldol I got sick.” Kai risked a glance at Dr. Byron. “I’m immunosuppressed.” Antipsychotic medications were popular tranquilizers in hospitals for “difficult” patients, but they also had a side effect of decreasing the amount of white blood cells. Dangerous for someone like Kai, and Jon believed the huge doses Kai was given during his stay at JMH psych contributed to his infection. “The infection nearly killed me and destroyed my inner ears.”
Dr. Byron frowned, but didn’t immediately say anything.
“You’ll read it in my records anyway, but I’m telling you this because I need to know that won’t happen to me again if I stay here. I’m a devious little fuck when I want to be,” Kai said with the shade of a smile.
“We believe in minimal restraints here at Harbinger. Physical and chemical.”
“Yeah, they promised me that at my last hospital, too.”


By the time it was evening, and he and Jon had returned to the hotel to change before heading back out for dinner--Jon wouldn’t say where they were going--Kai was far past “done.” He was physically exhausted from the long day of walking, and all the Xanax he’d taken was lingering and making him groggy on top of it all. And that was without the weight of depression, of the horrible thoughts that swirled through his mind and told him if he took his life now he might save everyone, including himself, a lot of pain later.
Jon was doing his best not to smother Kai, and Kai did love him for the attempt, but he couldn’t completely conceal how worried he was. Jon was trying so hard to cheer Kai up, promising him that he would like where Jon was taking them to dinner. Kai didn’t care. He knew he was hungry because he hadn’t eaten anything all day other than a few bottles of juice or Gatorade, but he just couldn’t muster up the energy for food to matter. If it had been up to him, after getting back to the hotel from Harbinger he would have removed his braces, stretched, taken his medicine, and then crawled into bed and slept until the nightmares tore him awake. Depressing, but that was his life, wasn’t it?
“I know you’re tired, but this is something you can’t have back home and I know you’ll love it.” Jon was trying almost too hard, constantly glancing over at Kai as if he’d--what, throw himself out of the car?
Kai was struggling to keep his eyes open despite wanting to stay alert and take in the unfamiliar sights. Omaha was huge, with massive highways within the city itself like Kai had never seen before, and strip malls and big box stores everywhere. Kai found it all very depressing, like somehow in this city of 400,000 people he was more alone than ever.
It didn’t take long to find the strip mall where the restaurant was. It was brightly lit and busy, which made a flare of anxiety ignite in Kai’s stomach, but he was drugged and depressed enough it didn’t burst into flame. Still, it took Kai probably ten times longer to assemble his chair and transfer into it than it normally would have, because he was dragging, big time. Jon hovered nearby, clearly wanting to interfere but doing his best not to and also apparently excited to share this food with Kai.
The smells inside the restaurant were totally foreign to Kai, meat and spices Kai couldn’t identify. It was a casual place, with a long counter and open kitchen dominating one side of the room and simple tables and chairs scattered around the rest of it. A few of the patrons glanced at Kai and then decided he wasn’t that interesting after all and returned to their food. The counter was low enough that Kai could see through the glass to the food, arranged in neat little plastic bins. Kai couldn’t tell what anything was. There was something that looked almost like thick mashed potatoes, but it was the wrong color, and then beside it was something else that was even chunkier. There was some kind of parsley salad, and another that was made of tomatoes and cucumbers. Then there were these little cabbage roll things but they were dark green and shorter than Kai’s pinky. Looking up, where Kai would have expected just a stove and range there were two strange rotisseries with giant chunks of meat rotating vertically on them, one that looked like chicken and another that Kai couldn’t identify.
Jon waved for Kai to follow him toward the register. There were a few people in line, so Jon handed Kai a menu. “Lebanese food,” Jon fingerspelled, clearly not knowing the sign. “Lots of vegetarian options.
Jonesville’s “vegetarian” choices were typically limited to potatoes, grilled cheese, and soup (which was always made with a beef or chicken broth), but Kai managed. Studying the menu, it looked like 80% of the dishes were actually vegetarian. Kai had never heard of any of these things: hummus, baba ghanoush, falafel, tabbouleh, dolma. And he certainly didn’t know how to pronounce them.
I’d suggest the vegetarian sampler,” Jon said, pointing roughly toward it on Kai’s menu. “That way you can try everything and find what you like.
Kai didn’t want to tell Jon that he wasn’t hungry, although Jon had been totally right and there was nothing like this back home. “OK. Order for me. And water,” Kai added glancing over at the soda fountain and deciding the last thing he needed right now was sugar. “I’ll get a table.
Kai hadn’t been pulled into one long when he felt his phone buzz. It was probably Renee. She’d been texting him all day and he’d done his best to reply when she did because he felt guilty about last night. She’d probably been more upset that he could realize and he’d pushed her away. Right now he was too tired to deal with English or talk to anyone, but he didn’t want her to worry if he didn’t pick up. He took a moment to connect the phone to his hearing aid and answered. “Hey.”
“Hey. It’s pretty loud. Where are you? Can you hear me OK?”
Kai hadn’t even noticed. Proof of how out of it he was. “Since your voice goes straight into my hearing aid, it’s OK. I’m at a Leb--” Kai hesitated. Even his mouth was lazy and he was worried he’d flub the pronunciation. “A Middle Eastern restaurant.”
“Oooh,” Renee said. “Yum. Perfect for a vegetarian. How are you? How was the hospital? I miss you.”
Hearing Renee say she missed him felt strange. No one ever missed Kai. It took him too long to respond.
“Sorry. I’m exhausted. That place is huge, and I walked the whole time.” Kai pushed his fingers through his hair.
“You’re OK, though? I mean . . . you’ll be safe tonight?” Renee was trying not to pressure him, but she loved him, as hard as it was for him to believe sometimes, and she worried.
Kai sighed softly. He’d purposefully left anything sharp at home, though he was resourceful enough that if it came to it, he’d find a way. “I’ll be OK. Jon won’t let anything happen to me,” he said, hoping it would reassure her. “The hospital is nice. They said I could bring my books and do my school work from there if I wanted to.”
“That’s great, sweetie.” She took a breath. “So did you decide to stay?”
Kai sighed and glanced toward Jon, who signaled with two bottles of water that he’d be right there. “I can’t miss our first Valentine’s Day.” It was only four days away. And Renee’s birthday not long after that.
Renee made a sound Kai couldn’t distinguish. “Kai, you are the only thing that matters. Not a silly made-up holiday.” Renee’s words weren’t mere platitudes, either. She meant it. He could almost feel how strongly she loved him through the phone. Remembered that warm, comfortable reassurance he’d felt when she’d laid beside him in bed, not afraid of him even if she should have been.
And Kai found himself smiling. Faintly, but genuinely. “I need a few days to process. To talk to Dr. Miller and give the head guy at the hospital time to review my records. And I have a big surprise planned for that made-up holiday, and I’m not going to let anyone--even me--ruin that for both of us.”
“I love you,” Renee said, and he could hear the smile in it. “If you’re feeling lost and sad tonight, remember that.”
Kai’s smile expanded a little, and some of the darkness lifted.
Jon settled into the seat across from him and gave him a nod to signal Kai could take his time.
“Our food’s almost here, and if I don’t eat Jon will probably tie me down and stick a funnel in my mouth, so I should go.” Kai hesitated a moment. “It was nice hearing your voice. Thank you.”
“Love you. Sleep well. Imagine I’m there with you and I’ll see you tomorrow.”
Kai nodded. Unplugged the cord from his hearing aid and set his phone aside. “She’s worried about me. You’re right. I was too honest with her. I should have gone to you instead of her.
Jon shook his head. “No. I understand why you can’t trust people easily. People like Becca and Nikki haven’t helped that. But Renee loves you. Real love. Nikki cares about you. She still does. Last night made that clear. But Renee is the one who I can tell will stand by you. But not if you hide too much from her. If I’ve learned anything from my own experiences with Jenny and Vicky, it’s that you can’t have a real relationship if you can’t be your real self with the other person. You have me and David and we will always be there for you, but I’m glad you had Renee to go to when you didn’t think you could come to me.
One of the men working behind the counter delivered their food--Jon had gotten some of the meat from the spit and a salad and Kai had a huge sampler platter that was far more food than he ever dreamed he could eat.
I’ll eat some of it,” Jon said as if reading Kai’s mind. “But taste everything. You might be surprised.”
The food looked and smelled totally foreign, and really not very appetizing, but then nothing did nowadays. At least he wasn’t nauseous right now, just not hungry even though he knew he had to be, so he picked up one of the round fritter things and studied it, smelling it.
“Falafel,” Jon said.
Jon repeated himself in English, first at normal speed, then annunciating a little more to help Kai see how to pronounce it. Then he fingerspelled it.
“Fa-la-fall?” Kai tried.
“Close. It’s more like ‘full.’ Fa-la-fel.”
Kai tried again, and this time he got it right, or at least Jon said he did. He took a hesitant nibble. It was freaking delicious. “What is it?”
“Uh, ground up chickpeas and spices, deep fried. I don’t know the exact recipe.”
Kai took another bite. The spices weren’t familiar to him so he couldn’t identify them, but he liked how it was crunchy on the outside but soft in the inside. Normally Kai didn’t really care for fried food, but this was yummy. He set the falafel down and stared at the not-mashed potatoes. “What’s this?” He dipped his finger into it and tasted it. It was . . . not like anything he’d ever had before. Nutty, sort of, but not at the same time, and with a unique texture. He found he liked it.
“Hummus. It’s mashed chickpeas and tahini and olive oil, I think. Tahini is a paste made from sesame seeds.” It was a little loud in the restaurant for Kai to get all that Jon was saying on the first try, but supplementing it with a little fingerspelling helped.
Kai nodded to signal he’d finally gotten it and tried dipping the falafel in the hummus. It tasted really good, and he actually smiled.
Jon returned the grin, looking ridiculously triumphant. “Told you you’d like it!


Dr. Angela Miller followed the aroma of garlic and spices into the kitchen. Lori was at the stove, stirring a simmering pot of something. Angela came up behind her and wrapped her arms around Lori’s waist, inhaling the scent of her hair. “I’m starving. Please tell me there’s wine.”
Lori giggled and turned in Angela’s arms, reaching up to smooth some hair off her lover’s face. “I take it the meeting didn’t go well?”
Angela sighed, kissed Lori briefly before pulling away to find a bottle of wine to open. “I’ve been doing this for twenty years and it never gets easier.” Angela frowned. “There were pictures of this kid. I can’t get them out of my head. That anyone could do that to a child.” Angela never talked about her cases except in very general terms with Lori, always respecting her patients’ privacy, but sometimes it was hard not to bring her job home with her, and honestly, she was really concerned about Kai. She constantly worried that she was giving Kai too much rope and that he might quite literally hang himself with it. He wouldn’t be the first patient she’d lost to suicide; the nature of working with PTSD patients and those who’d suffered abuse made it inevitable. But it still chipped away at her every day. Reminding herself how many people who’d benefited from her treatment helped, but it also sometimes felt like she could never quite do enough.
Lori turned the heat down on the stove. “That’s because you need a vacation. When was the last time we went anywhere, really? You still owe me that second honeymoon.” Lori’s smile turned up in one corner, making her look sly and sexy. It was a look that got Angela every time.
Angela played coy, opening the bottle of wine to avoid eye contact. “That’s because we’re not technically married.”
Lori took the bottle away and set it on the counter, linking her fingers in Angela’s. “Only because it’s not legal in Iowa. Doesn’t stop me from loving you as my wife.” Lori pulled Angela close, kissing her chin and neck and shoulder in that way that always turned her mind to putty. “Let’s go to Hawaii like we always wanted. Last-minute you can get some good rates. I’m sure Glen could find us an amazing hotel with a spa.”
Angela enjoyed her wife’s ministrations for a few more minutes, the way Lori sucked on her collarbone, teasing with her tongue, little promises. But finally, she managed to push her wife away and focus. “I can’t go anywhere now. This one patient is in a really vulnerable place, and I can’t leave him.”
Lori rolled her eyes and scowled, returning to the food, anger in her posture. “It’s always some patient you can’t possibly leave behind. That’s why we haven’t gone anywhere farther than a few hours’ drive in years. Aren’t you the one who’s always preaching to your patients about healthy boundaries?”
Angela reached for Lori, but she pulled away. “Lor, please, don’t do this. This kid finally trusts me. We’ve made real progress, but right now I’m concerned about him. I don’t think he’d react well if I went away right now.” Angela touched Lori’s arm, and this time, her wife turned around, giving in a little, perhaps once she saw how serious and worried Angela really was. “I promise once I get him stable I’ll take a week off and we can go anywhere you want. OK?”


Kai didn’t eat a lot, but he did try everything on the plate. He liked almost everything except for the tzatziki, but then Kai never had liked yogurt. The important thing was Kai actually ate. Jon was pleased to see Kai enjoyed the food so much he started talking about wishing he could make some of it at home. If it wasn’t sweet, Kai had never gotten excited about food in his entire life, so Jon had made the suggestion that they go to a bookstore and buy some Mediterranean cookbooks. As tired and depressed as Kai was today, books were to Kai like candy was to little kids, and Kai’s eyes actually lit up even if he pretended he didn’t care.
Jon pulled into the parking lot of the nearest Barnes and Noble, a giant two-story monstrosity like Kai had never seen before in his life.
“Holy shit. Holy shit, that’s all one store?” Kai said, letting his excitement leak out.
Jon chuckled. “Yes. Maybe someday I’ll take you to New York. There’s some great bookstores there. Bigger than this one.”
Kai’s eyes were huge, and for a moment he reminded Jon of how he’d been as a toddler. “Really?
Jon smiled. “We have a few hours before they close. Let’s go have fun, OK? You can buy whatever you want.
Kai glared, but there wasn’t much heart in it, almost like he resented Jon continuing to act like he was Kai’s father but at the same time the promise of hundreds of thousands of books for him to chose from was too wonderful for him to really be mad.


Kai sat in his wheelchair in the store’s foyer, frozen, taking it all in. Words or signs couldn’t describe the sheer magnitude of this place. If Kai believed in heaven, it would probably look a little like this store, with two stories of books of every possible genre he could imagine. It was bigger than the JU library, or at least it felt like it.
He hardly knew where to begin, even though he probably wouldn’t buy anything. It felt extravagant to buy books he could borrow from the library, and it didn’t seem fair to purchase something here when he could have Art order him whatever he wanted. Still, it wouldn’t hurt to look, and he could pick out one book, right? Something he knew he’d read over and over so it would justify the purchase. OK, one fiction book and one cookbook, and that’s it.


Kai spent several hours pouring over shelf after shelf and book after book, and when Jon finally found him, he was deep in the nonfiction section, surprisingly lost amidst the art and architecture books.
Jon called Kai’s name but he didn’t look up. So he stomped on the floor, and after a moment, Kai finally seemed to realize Jon was there.
He made sure the large coffee-table style book was secure in his lap and then reached up to turn on his hearing aids. “Sorry. I didn’t want to be distracted. Is it time to go?”
Jon couldn’t help the hint of a smile seeing his brother snapped out of his depression, even if it was temporary. “The store closes soon and you’re past due for your medicine. Did you find anything?
Kai nodded. “I picked out two cookbooks and a copy of A Confederacy of Dunces. I’ve never read it and I figure now that I’m dating a New Orleans girl, I probably should. I almost got a collection of Tennessee Williams’ plays but I figured I’ll just borrow that from the library. I also almost got this book, it’s the first of a children’s fantasy series, but I thought maybe I need something light and simple right now in my life. Harry Potter, have you heard of it? But then I thought I could just get that from the library, too.
Jon sighed. “When I said you could get anything you want, I meant it, Kai. You love books. There’s no harm in owning some.” Kai only had a handful of books that were actually his: a dictionary; a beat-up copy of Hamlet that was nearly falling apart; the copy of The Velveteen Rabbit he’d bought last year; an expensive, hardcover copy of The Count of Monte Cristo he’d recently found again; and an equally nice copy of Tom Jones Jon had given him while he was waiting for his transplant. Plus some textbooks. Pretty much everything else Kai had ever read had been borrowed from Art or the library.
Kai shrugged. Even heading into his fifth year out of County House, Kai still hadn’t gotten used to the idea that he could actually own nice things. “I do want to buy this for Renee. She’ll love it, but it’s just so expensive.” Kai heaved the heavy book up so Jon could see the cover. It was some kind of collection of blueprints for different room and house designs, apparently. Kai set the book down because it was too heavy to hold and sign at the same time. “She has this huge project where they have to essentially do the blueprints for their own house design, and she’s been stuck and I know that dealing with all my crap has taken time away from working on it. Her birthday is coming up and I didn’t really get her anything for Christmas, so I thought . . .” Kai suddenly seemed to shrink in on himself. “I know, it’s a stupid idea. Nevermind. I don’t need to get anything. Let’s just go.
Jon sunk down to his knees so he was more at eye-level with his brother. He gently touched Kai’s knee just to get him to make eye contact. “Kai.” Jon met Kai’s eyes and stared into them for a long minute to convey that he was dead serious. “You don’t need to ask my permission to buy something. You know that. And this book isn’t a stupid idea. I think Renee would be happy to see that you were thinking of her.
Kai let out a difficult breath. “It scares me how much I love her,” Kai admitted in sloppy signs. He was beginning to hyperventilate and shake and that could signal he was going to panic, although he was so far past his last Xanax dose that could explain it.
Love is the most terrifying thing anyone can experience, I think,” Jon said. He reached up and cuffed Kai’s neck affectionately, trying to reassure him. “But it’s also the most wonderful.


The brothers were nearly ready to turn in when Kai rolled up to Jon, holding out his car keys and wallet. “I think I’ll be OK tonight, but please lock these in the safe so I can’t leave the hotel easily. I promised Renee I’d be safe tonight and I think it’s best if we do this just to make sure.
Jon took the items from Kai, hesitating. “That won’t make you feel trapped?
Kai sighed. “It may a little, but I’d rather freak out here than take off and risk getting lost or hurting myself.” It clearly wasn’t easy for Kai to admit this, but Jon was proud of his brother for being responsible.
“All right. I’ll put them in with your medicine and my syringes.”
Kai nodded, but didn’t move. Almost as if he had something more to say.
You OK?
Kai attempted a smile and shrugged. He pushed to his bed and transferred to it, but he didn’t move far beyond that. Just sat on the edge of the mattress, hunched over, his expression unreadable.
What’s wrong?” Jon asked once he got Kai to look up.
Kai sighed heavily. “I’m just realizing how much you must have given up for me.
Jon had no idea what Kai was talking about. “Given up?
Kai looked at first like he was going to just let it all go, but then he said, “I knew your adoptive father had money, because it’s the reason I’ve never had to worry about my medical costs, even long hospital stays. But I never really thought too much about it. But today, that hospital . . . and the way they treated you, like you could have whatever you wanted, no questions asked. How rich are you?
Jon shoved his hand through his hair. “When I decided to come back to Jonesville, I also determined that I wouldn’t use any of my adoptive father’s money. It was important for me to live on my own means, even if a fellow and a young attending doesn’t get paid very much.” Jon offered a slight smile. “I only cared that I could use that money to help take care of you.
But that’s exactly my point. Omaha is . . . I feel like such a small-town hick coming here. And it’s a fraction of the size and population of places like New York City or Boston, where you grew up. You left a life of luxury behind so you could live in a shitty apartment in a podunk town with me? You’re rich and smart; you could live anywhere. You could practice at the best hospitals in the country. But you gave up all of that because of me? No wonder your adoptive father was pissed. I’m not worth it.” Kai looked so incredibly sad and yet angry at the same time, it was amazing to see it. He shook his head and planted his hands behind him at a slight angle and pushed hard to heave himself further onto the mattress. Kai started threading his legs under the blankets as if he were getting ready to go to sleep.
Jon asked wordlessly for permission to sit on Kai’s bed and then did, far enough they could still sign to each other. “First of all: you are worth it. The last four and a half years have been stressful and full of worry, but I wouldn’t change a minute of the time I’ve had with you, even if it was at your sick bed. OK?
Kai pulled his legs up to his chest, not looking convinced, but he didn’t say or sign anything else.
And someday, when your anxiety is better managed, I’ll take you to New York or Boston or wherever else you want to go. They’re amazing cities. But I never belonged there. I like Jonesville. I’d never be able to have such close relationships with my patients if I was working in a major hospital on the east coast. Those places--those big research hospitals, especially--they don’t see patients as people. They’re statistics with wallets. That wasn’t the kind of medicine I wanted to practice. Even if you had been dead, like I’d suspected when I came to Jonesville, I don’t know if I’d have ever gone back to the big city.” Jon smiled. “They used to tease me incessantly during my residency, did you know that?
They called you Doogie Howser because you were so young and smart.
Jon rolled his eyes. “Yes. And they also refused to believe that I was going to specialize, and I’d get comments all the time that if I wanted to see patients as people I should have gone into family medicine instead.
Kai wrinkled his nose in disgust.
“Yeah, internists are assholes. One reason I hate training them.”
Kai relaxed a little, leaning against the padded headboard and loosening his hold on his legs. Maybe the sleeping pill was beginning to kick in.
Jon couldn’t resist pulling the covers up around his brother, tucking him in a little even if Kai was still technically sitting up. “Did I ever tell you how I became fluent in Spanish?
Kai’s brows wrinkled and he shook his head.
Not long after my adoptive father brought me to the east coast, he sent me away to boarding school.” Jon had no idea how to sign “boarding school,” so he explained it as a school where you live there all the time, similar to a Deaf school, but fancy.
Kai seemed to understand and nodded. “Boarding school.”
Jon smiled, glad he really was getting more fluent. All that time spent with David while Kai was sick had helped him improve enormously. “Everyone hated me there. They saw me as a charity case, as a hick. They called me names and tortured me and beat me up. They never let me join any of their activities, not that I really wanted to. I only ever saw my adoptive father a couple days a year while I was at that school. It was very lonely.
Kai took a deep breath and sank down a little farther, clearly getting sleepier. “I had no idea.
I don’t talk about it. I used to find out-of-the-way places to hide so I could study without getting beat up. And I made friends with the staff--the gardners, the cleaning women, the cooks--in the process. All the people who were completely beneath my classmates’ attention. Most of the staff was from Central America, a few from Mexico, and I already knew some Spanish at that point, so I spoke to them. It took time to earn their trust--God, those kids treated the staff terribly--but they became like my own little family. I learned a lot from them, and they all insisted I only speak to them in Spanish so I could improve, and I did. Within six months I’d gone from passable to completely fluent, and by the time I graduated, I was about as comfortable in Spanish as I was in English. They were the ones who really convinced me that once I finished school I had to go back home. I had to find out what happened to you. Some had family they’d been forced to leave behind and they still had no idea if any of them were OK. I had the opportunity, unlike them, and I wasn’t going to waste it.
Kai’s head drooped and Jon realized he’d fallen asleep.
Jon smiled and shook his head good naturedly, then got up so he could get Kai settled into the bed properly, making sure his limbs were supported and he was well covered, his stuffed fox tucked into his arm. Despite Kai’s age and size, like this Jon could almost see the image of a five-year-old version of his brother superimposed, and he knew that even years of therapy and a child of his own could never change the paternal feelings he had for Kai.



  1. Wow, that was an amazing chapter! I loved reading it so very much.

  2. Absolutely an outstanding chapter. Really intense and unforgettable.... I am kind of speechless. Thank you for publishing it here.

  3. It was a really good read. This chapter explains a lot about Kai...

  4. I hope you're alright, can't wait for the next chapter!