February 3, 2001 - Part I
Darkness. It surrounded Kai. A darkness so deep, so penetrating that it was almost sentient. Malicious. He flailed, trying to find something. Someone. Light. But there was none to be found. He screamed, panic beginning to overtake him, but no sound escaped, and that darkness, thick and inky, began to slip into his nostrils and his mouth like some foul viscous liquid. Kai choked and thrashed, trying to fight it, but the darkness, the aloneness, this creature filled him, cutting off his air completely. Wrapping around him like a cloak of death.
Kai screamed, and his eyes shot open. He could still feel the darkness, as if it lingered in his throat, and he had to force himself to stare at the crack in his ceiling to remind himself that it had been only a dream. But he couldn’t escape the tightness in his chest, and he forced himself to sit up, his T-shirt sticking to his back with sweat, reaching for his inhaler. He took a couple puffs, struggling to hold on to this reality, to be mindful. He sat, his hands supporting him, breathing effortfully. I feel the sheets beneath my hands. They’re soft, but damp from my sweat. Which I can smell in the air. The air is cool. I can feel the cold emanating off the wall by my bed. This is real. This is real.
Kai’s chest was so tight. He should cough himself. He’d feel better if he coughed.
So he did. Hard. Pounding his chest to help loosen the gunk. It was part of his morning routine, yet it felt like that icy grip of the darkness from his dream still clung to him, like he was coughing it up instead of mucus. It freaked him out. Like he was half caught between dream and reality. What if this was all part of his dream, too?
“Jon!” Kai called, desperate. “Jon!” God, what if Jon wasn’t here? What if this was a dream and he was all alone? Kai could almost swear he saw the darkness seeping in around the edges of the light he always left on in his room, like the shadows were growing, crawling, creeping toward him like they did in the story he’d refused to turn in yesterday. “Jon! Please!” Kai called out. He pulled his knees to his chest, holding them there with one hand while the other helped support him; he didn’t want to touch the wall, because the wall was where the cold and the dark came from. “Please. Please be here, please,” Kai mumbled to himself.
Kai dropped his head to his knees, still breathing hard, but if he hid his face, if he didn’t see the darkness expanding, then maybe he’d steal its power away. He was shaking now, partially from the chill of cold air on damp skin, partially from fear. It’s not real. It’s not real. I feel the sheets. I feel the air. And it’s just air. It’s just air. It’s just air.
Kai was breathing short and fast, his shoulders working hard. His hands were numb, but he clung to his legs, pressed his other harder into the mattress. I feel the mattress. I feel my shirt sticking to me. I feel . . . Jon isn’t coming. No one is coming. No one will ever come for you. No one cares about you. No one ever cared. . . . That’s why everyone leaves you.
Kai felt tears forming, and he dug his fingers into his legs. If he cut. If he hurt himself, that would be real, right? That would bleed away the lingering darkness. You couldn’t hurt yourself in a dream, could you? Couldn’t feel pain the same way you did in real life? A spike of fear hit Kai as he imagined his wheelchair was gone. Taken. Swallowed up by the darkness. He forced his head up. But it was there. By his bed, just where he left it.
Kai took a huge breath. His limbs still felt numb, like they weren’t fully part of him, like gravity was weighing him down. He needed to move, but he couldn’t. What was the point? Renee hated him now. Hated him because he couldn’t tell her about his aunt, about . . . other things that had happened to him growing up. Even David didn’t know the full truth.
You’re so fucking worthless, his aunt’s voice screamed in his head. Maybe she was the darkness. Or part of it. Where was Jon? Kai wanted to be independent, he wanted Jon to have his own life, but he also needed him right now. That made a spike of self-loathing stab him like a physical thing. You’re so fucking self absorbed, Jon’s voice yelled next. The world doesn’t revolve around you.
Kai let himself fall sideways, not bothering to fix his legs, letting the sadness, the darkness, take him. And he sobbed. He wasn’t better. Today was like so many other days since he got out of the hospital. Waking to a nightmare that bled into reality, then the crushing weight of depression and hopelessness. Worthlessness, his thoughts reminded him. Why did he get to live when good people, people like Martin, would die? And it’s your fault.
Jon never came. Kai finally dragged himself out of bed, mostly because he’d opened up all his cuts from the day before in the hopes of pulling himself out of his funk and silencing the negative voices. He cleaned his wounds, made a few more, and bandaged everything again, feeling completely, totally hollow. It was like watching himself go through the motions of his routine--checking his skin for signs of irritation or any cut he didn’t inflict himself that might need treating. Taking his medications, making notes in his little notebook about his lung function and his temperature and his blood pressure and his PO2. Showering, brushing his teeth. Stretching. None of it felt real. Maybe this was all still a dream. Probably just dissociation, another type, different than his flashbacks. Something Dr. Miller called depersonalization that she’d warned him to watch out for. It was kind of nice, though. Like putting his body on autopilot.
In the kitchen, Kai found a note from Jon. Here’s your meds for the next 24 hours. I’m working all day. That was it. Nothing else. Not even signed. The emptiness expanded, and again, the logical part of Kai’s brain knew he couldn’t begrudge Jon for going to work. He took care of sick people, many of them kids younger than Martin, including that Deaf boy. Dammit, Kai thought. You’re such a selfish asshole.
Kai checked the clock on the microwave. He wished he had time for a swim, though like this, there was a good chance he’d end up with a repeat of Thursday and miss his session with Dr. Miller, and he needed it. Really, really needed it. Kai wished his hearing was working so he could call Renee. He couldn’t fully remember what happened last night--when he was sleep deprived, his brain stopped storing memories properly, and everything got a little fuzzy. But Kai knew he’d been an asshole. God, wasn’t that his default state? Hadn’t even David accused him of as much at the bowling social the other day?
Kai’s brain threatened to spin off again into more negativity, so he pushed to the fridge, yanking it open. He didn’t have knives, because Jon wasn’t here to unlock them, but he had some pre-chopped vegetables in the freezer. He’d cook something, and that would distract him until it was time to go to his session with Dr. Miller. And it would keep him from doing something stupid.
Kai said nothing to Dr. Miller when she welcomed him into her office, simply pulled up to the couch in his wheelchair and transferred, tucked his knees to his chest and wrapped his arms around them. Some of his long hair slid down, shielding his eyes, but what she could see of them was sad. And guilty.
“I’m sorry I ruined your weekend,” Kai said in a quiet voice.
“You didn’t ruin anything. It’s my job to be available for you in an emergency.” She noticed Kai was staring at her intensely. Was his hearing out? Was he struggling to understand her?
But he replied as if he had. “We wouldn’t be here if I hadn’t skipped my last session.” His shoulders hunched, and he kept wanting to hide his face, but then he’d catch himself and look back up at her. He obviously needed to see her lips.
“You don’t know that, Kai. Not that I’m encouraging you to skip sessions, especially without notifying me first, but it’s possible you still may have needed to see me today.” Dr. Miller shifted in her seat. “Besides. I’d rather spend an hour with you today than see you back in the hospital, or worse. Especially if we can avoid that, OK?”
Kai flinched when she said “hospital,” but he nodded. Though he still looked guilty.
“Why didn’t you show up for your session with me Thursday, Kai?”
Kai dropped his gaze, looking a lot like a chastened puppy, but he didn’t answer.
“Kai?” She had to say it a few times, louder each time, before he looked up. “Talk to me.”
“It’s stupid. I’m so fucking stupid. And selfish. And an asshole, too.” Kai shoved his hair behind his ears on both sides. It was obviously taking him effort to keep looking at her, and she sensed his anger, which had been leaking through more and more since his stay in the psych ward, was taking hold. Dr. Miller suspected it was covering his other emotions, things like sadness, fear, and shame, that Kai still struggled to admit to, even with her.
“Kai, we’ve talked about this.”
Kai looked away, grit his teeth, and finally met her eyes again. “Fine, I’m a fucking prince. Happy?”
“Kai, what are you really angry about?”
Kai bit his lip and stared at her, almost defiantly, but then his shoulders fell, and she saw some of his anger melt away. “I had trouble coming out of my nightmare this morning.” Especially since his fever, Kai’d had some issues with reality. Dr. Miller wasn’t really comfortable calling them psychotic episodes, especially because of his PTSD, but he would often wake up not fully realizing he was awake, and it could take him some time to “come back,” in his own words.
“Which nightmare was it this time?”
Kai shuddered. “The darkness.” That was the name Kai gave to a variation of one of the dreams he’d begun having after his most recent stay in ICU. He claimed he’d had post-ICU nightmares before in his life, but never like these.
“Do you want to talk about it?”
Kai wrapped his arms around himself. Shook his head. “It happened Wednesday, too. Vicky was supposed to take me home from the hospital--” Kai froze. “Oh. You don’t know what happened.” He looked so ashamed.
“I do,” Dr. Miller said, needing to repeat herself a few times before Kai finally lifted his head again. “Dr. Trent called me before and after he spoke with you.” The psych resident had asked for Dr. Miller’s input on Kai’s condition, explaining about his panic attacks, and Dr. Miller had advised him it was in Kai’s best interest not to be admitted back into the psychiatric unit.
Kai nodded, as if to show he’d understood her. “I liked him. He was . . . nice. He listened to me even though I had to use an interpreter. He didn’t lock me up even though I probably deserved it.” Kai gripped his legs tighter, the muscles in his upper arms and shoulders straining the fabric of his T-shirt.
“Do you think the psych unit is a punishment?”
Kai sighed and dropped his eyes before forcing them back up. Then he avoided the topic and got back to what they’d been discussing before. “Vicky was the only one who could take me home, but she brought me to her house instead. I think she was hoping to convince me to move in. I don’t know. But when I woke up, I was so confused. And scared. I freaked out.” Kai dropped his eyes again, and his hold on his legs loosened, almost like he was giving up. “It took Jon a long time to pull me out of it.”
“Do you remember what happened?”
Kai hesitated, then shook his head. “I just remember what I felt. And I remember, as I slowly came back to myself, worrying I hurt someone, or that I could have hurt someone.” Kai’s eyes filled. “What if Vicky had tried to wake me instead of Jon? What if I’d killed her baby?” Kai held his gaze on Dr. Miller as long as he could as his eyes spilled over before he finally dropped his forehead to his knees and gave into sobs.
Kai couldn’t hear anything Dr. Miller said, apparently, so she could do nothing but wait until his tears subsided. Finally, when he looked back up, completely wrecked, she said, “You’re OK. No one was hurt. Remember, ‘what if-ing’ isn’t healthy.”
Kai stared at her hard, then wiped his eyes and nose with his sleeves and blinked a few times. “My hearing is out right now. If I can’t see you, it’s almost impossible for me to understand you. Can you say that again?”
Dr. Miller nodded and repeated herself, trying to speak clearly and loudly, hoping that would help him.
Kai’s nose wiggled. “You said as I got better the . . . confusion would stop,” Kai said, obviously choosing his words carefully.
Dr. Miller nodded. “I also said that recovery would be a long road, and sometimes it would feel like you were going backwards. That’s part of dealing with PTSD.”
Kai stared at her and said nothing. He looked like he was processing, either figuring out what she’d said or deciding how to respond, or both. “What if school is making me worse?”
“We talked about how, especially the first couple weeks, going back to class would be stressful. That you might have flare-ups.”
After a slight delay, Kai laughed bitterly. “Flare-ups? I’ve had at least two panic attacks every single day this week. I’ve--” Kai cut himself off. His nose twitched again. “I’ve thought of quitting school.”
“Does that have something to do with why you didn’t show up Thursday? Can we talk about that?”
Kai shook his head. “It doesn’t matter. Nothing matters.” Despondency, especially considering Kai skipped a session--which wasn’t like him--and the way he called her yesterday, desperate, despite his hearing loss, was concerning.
“Talk to me, Kai,” Dr. Miller said, repeating herself until Kai seemed to hear her.
Kai sighed heavily. “Jon was supposed to go swimming with me. He canceled. I was angry.” Kai hesitated. “And hurt. I was really fucking hurt. Because this was the one thing we were supposed to do together. As brothers. And he’d promised. And fuck.” Kai’s hands fisted his jeans. “That sounds so stupid.”
“Kai,” Dr. Miller said in a mildly castigatory manner.
“What? It is. I’m not six years old anymore. I don’t need my older brother to hang out with me. I don’t need anyone.” Kai spoke angrily enough, but his voice broke a little on the last part.
“That’s not true. Everyone needs someone.”
Kai let out a frustrated scream. “Ugh! I’m so fucking angry.” Kai’s hands had shifted away from his legs, which looked like they would fall if he moved too much, to the edge of the sofa cushion. He gripped the fabric tight, almost like he wanted to tear a hole out of them. But then he deflated a little. “I’m so scared I’m going to lose everyone I care about because I’m so fucked up. I was such an asshole to Jon. I know how important his work is, and the fact that he chooses it over me shouldn’t hurt so much.” Kai used one hand to guide his legs down, his feet on the floor, since he wasn’t holding them up and they were about to fall.
“But it did. It does. And you don’t need to apologize for that. Emotions aren’t logical, and you shouldn’t be ashamed of how you feel, Kai.”
Kai said nothing for a long moment, just breathing. He had dropped his gaze to his thighs, as if he would find some answer to all his problems there. Finally, he looked up at her again. “What if I’m ashamed to be me?” he said, his voice and face so bleak.
Dr. Miller frowned, but in a sympathetic way. “Kai, why do you feel that way?”
Kai stared at her for a long moment before he began to blink furiously, trying and failing to keep back the tears that leaked out anyway. He dropped his head and went back to studying his thighs, smoothing a hand over them but not speaking.
“Kai,” she had to say it several times before he looked back up. “Have you been doing your mirror exercises?” They were something Dr. Miller had started with Kai while he was an inpatient as an attempt to improve his self esteem and body image. Kai was supposed to start and end each day by looking at his reflection and talking to himself, saying positive things about his body and his emotions. To focus on at least one good thing that would happen or had happened that day.
Kai’s nose wiggled again, and Dr. Miller was beginning to suspect it was a new tic Kai had developed, something that became more pronounced the more irritated or upset he got. “It’s stupid. And pointless. Telling myself I’m good enough and smart enough and all that shit isn’t going to change how pathetic I am.” Again, Kai was outwardly angry, but it was a thin shell over the raw pain underneath.
“Why are you pathetic?”
Kai stared at her, broken, like it was obvious, before wrapping his arms around himself, tucking his head, and shutting down on her.
Dr. Miller sighed, not worrying about holding it in since Kai couldn’t hear it. She tried calling out to him, but it was no use. At least one good thing about it being a Saturday was she could spend more time with him without worrying about bleeding into another patient’s session. Dr. Miller was determined that she would not let Kai leave without ensuring he was stable first.
She tried to give him a chance to look back up at her, but after five minutes, Kai began to cry softly, pull in on himself even tighter, and she knew she couldn’t let this go. So she rose, crossing to the couch, sitting beside him but still giving him space. She could tell he felt the shift in the cushions, because his posture stiffened, but he didn’t look over at her. Normally, Dr. Miller resisted touching her patients unless they asked her to hold their hand during memory work, because she treated too many abuse victims, like Kai, for whom touch was a trigger. But with Kai’s hearing out, and with his eyes shadowed by his curtain of hair, she had no other way to get his attention.
She reached out and touched his shoulder, just enough for him to feel it and no more.
He flinched, and his breath caught, and she could see his muscles tighten, straining the fabric of his shirt. But he finally picked his head up, shaking his hair out of his eyes. They were red-rimmed, and his cheeks were stained, but she saw a hollowness in his gaze that was dangerous. His nose twitched several times. He blinked slowly. But he didn’t say anything, and he didn’t drop his arms from where they were crossed over his chest, as if they were protecting him from some unseen threat.
“You need to talk to me, Kai.”
The space between Kai’s eyes wrinkled, and his eyes grew glossy again, but he didn’t speak.
“Whatever it is, you know I’m here to help you get through it.”
Kai shook his head; maybe he hadn’t understood her, or maybe he didn’t believe her. He dropped his head, his nose wiggling frantically, though he was otherwise still. He swallowed thickly. “If you knew what I’ve done to myself . . .” But then he sighed and didn’t finish his sentence. Tears leaked out, and Kai blinked furiously, hugging himself even tighter.
Dr. Miller suspected Kai had hurt himself yesterday. Perhaps seriously, and although he’d assured her last night he wasn’t suicidal, it was her responsibility to look out for his well being. Even if it meant hospitalizing him again. But she knew she had to be very careful in what she said and how or Kai would shut down completely, maybe even leave. Ultimately, Kai was here because he wanted help. So she had to work with that instead of spooking him. Finally, she took her notepad and turned to a blank page.
Where’s your fox? she said via a note.
Kai stared at her blankly for a long moment before finally using his chin to point to his wheelchair.
Can I get it for you?
Kai wiped his nose on the shoulder of his shirt, handsfree. Finally, after another long stare, he nodded.
Dr. Miller knew Kai usually kept the fox in the top pocket of his backpack. It was his comfort object and reminded him that not everything about his past was traumatic, that he had people in his life who loved him, and he often used it during memory work. So she rose and went to his wheelchair, trying her best to only touch that zipper and nothing else, not even the wheelchair itself, knowing how sensitive Kai was about it, and managed to extract the stuffed toy with minimal disturbance. She realized Kai had been watching her, holding himself tensely as he did, and when she finally stepped back from his wheelchair, the fox in hand, he seemed to let out a relieved breath.
For the first time in probably fifteen minutes, Kai dropped his arms, stretching out for the toy. Once he had it, he hugged it to his chest, burying his face in it, as if inhaling its scent. Dr. Miller had discovered Kai responded intensely to having his senses stimulated, especially smell and vision. She suspected Kai, despite his issues with touch since Thanksgiving, was also very tactile, and she wondered if part of his struggles since had been that he longed for touch but was afraid to ask for it. A phenomenon that wasn't uncommon in abuse victims.
“You won’t want me anymore when you see what I’ve done,” Kai said in a small voice, partially muffled since he still held the toy so close to his face.
“Judgment-free zone, remember? And I told you Tuesday that I wouldn’t drop you as a patient. Come on, Kai. We’ve been through too much together for you to think that I would. There are no failures here. That’s not how recovery works.”
Kai inhaled a difficult breath. “No failures?” he asked, almost as if he were confirming what she’d said.
“No failures,” Dr. Miller said with a nod and an encouraging smile.
A sudden sob took Kai and he shielded his mouth, trying to hold it in, taking deep breaths and nodding. Then he secured the fox in his lap, reached behind his head, and pulled off his shirts.
Dr. Miller let out a gasp, but Kai couldn’t hear it to her relief. Both of Kai’s arms were heavily bandaged, as was his entire torso. Even his normally prominent transplant scars were barely noticeable because of the bandages everywhere. Blood, fresh blood, had soaked through at least half the bandages, likely due to re-opened wounds caused by movement. This was definitely evidence of a serious escalation in Kai’s self harming behavior, at least outside the hospital, and she couldn’t even see his legs, which she suspected were probably in as good of shape as the rest of him.
Kai read her concern in her face and dropped his head. “I’m so sorry. I’ve tried cooking and swimming and rubber bands and cold showers . . . but it was never enough.” Kai squeezed his eyes tightly shut. “Nothing was ever enough.”
Dr. Miller was extremely concerned, and needed to take a better look at some of his wounds. Again, she lightly touched Kai’s shoulder to get his attention. “Can I see your arm?”
Kai stared at her, clearly worried and scared, but he finally nodded, holding out his left arm.
Dr. Miller could see the bleeding was particularly bad in his elbow, and she wanted to remove the bandages, but she also didn’t want to put either one of them at risk by doing so if he had open wounds.
“I have a first aid kit, including gloves, in my bag,” Kai said as if reading her mind, but his voice--and his gaze--was flat. Distant.
Dr. Miller again went to Kai’s bookbag and opened the main compartment, digging in it until she found a small zippered fabric case with a cross on it. She returned to her seat and opened the case, shocked by how organized it was, and how complete. There were gloves, antimicrobial hand gel, bandages of all kinds, antibiotic ointment, alcohol swab packets, hospital-grade wound cleaner, gauze, and even a couple rolls of tension bandages, like what Kai had wrapped around his arms and torso.
Dr. Miller cleaned her hands and gloved up, setting the case nearby. Then, with another visual confirmation from Kai, she slowly unwound the fabric bandages around his left arm. With the bandage out of the way, she could see some of the cuts had scabbed over, while others had strips of gauze stuck to them, a few taped in place, nearly all with fresh blood soaking through. The worst was the crevice of his elbow, which didn’t look like it had ever had a chance to scab. Either Kai had cut there this morning, or, as she suspected, it was simply deep enough, and in a place where Kai moved a lot so that it wouldn’t stay closed.
“I think this needs stitches,” she said, reminding herself to look up at him when she spoke.
Kai looked at her impassively, even when she began to manipulate some of the wounds to check for infection, which she knew had to hurt. It was like he wasn’t even there, which he may not fully have been, if he was dissociating, and that was frightening, too.
“I’m going to clean everything and re-bandage your wounds, OK?” Dr. Miller said, although Kai gave no response other than a few twitches of his nose. She sighed. This was the kind of thing she hadn’t done in years, but even though it looked like Kai had done a fair job of caring for the cuts, as immunocompromised as he was, it wouldn’t hurt to treat them all again, and it would give her a chance to get a full survey of the damage.
It took her nearly thirty minutes to clean every cut, all one-hundred something of them--she’d lost count--and put fresh gauze and bandages on, encouraging Kai to put his shirt back on. Throughout it all, Kai never flinched, never said a word, just stared off into the distance.
Once Dr. Miller had cleaned up the old bandages and put everything away, she touched Kai’s arm lightly to get him to look at her. “Kai, does anyone know about this?”
Kai’s nose wiggled, and he blinked, but he didn’t respond.
“About your cutting. Does your brother know? David? Renee?”
Kai blinked slowly, and it was almost like she could see him pulling away from wherever he’d been and returning his attention to what was going on. “I don’t advertise it. It’s not something I’m proud of,” he said, his voice flat. Then he took a breath. Pressed his hands into the cushion on each side of his legs and pushed up, shifting his weight. Dr. Miller imagined all the wounds she’d just tended to reopening, and couldn’t help wincing, even if Kai seemed totally unfazed by any pain he had to be feeling. Then he dipped his head, staring at his knees, leaned forward a little. “David knows, but he has no idea how bad I’ve gotten.” Some emotion finally leaked into Kai’s voice there.
Dr. Miller had to touch Kai to get his attention again. “This is very serious, Kai. I can’t just ignore it.”
Kai swallowed. Nodded. He was trying not to react, but he shivered, and his breathing ratcheted up a notch. “You’re going to call my brother, aren’t you.” He didn’t say it like a question, and again, he just stared straight ahead, though his fingers gripped the cushion edge tight once more.
Dr. Miller laid her hand on Kai’s.
His gaze flew to their touch, then up to her face, confused.
She took her hand away. Kai’s wounds, with the exception of the one in his elbow, were consistent with self-harming cuts--dozens of small slashes, mostly horizontal or diagonal--rather than an attempt at suicide. But she had to ask. “Were you trying to kill yourself?”
Kai’s eyes widened before he forced his face back to neutral. “Kill myself?”
Dr. Miller nodded. “It’s my responsibility to ask you.”
Kai’s eyes grew sad, and his shoulders fell. “I don’t cut to help me die. I cut to help me live.” But then he took in a ragged breath. “But I thought about it,” he said, cradling his left elbow.
“Is that why you called me last night?”
Kai didn’t nod, but something in his features suggested that was part of it. “I was scared. Of myself. I never should have skipped Thursday. I was just so . . . angry.” Dr. Miller could see Kai’s attempt at stoicism was weakening. He took a difficult breath. “I don’t know what to do.”
Dr. Miller handed Kai his fox. “It’ll be OK. You’ll be OK.” She smiled encouragingly. “Would you be open to trying a different antidepressant, Kai?”
“What?” Kai asked as if he hadn’t understood her.
“There’s a medication called Zoloft,” she explained, pausing to write it out so he could see the word in case he couldn’t lip read it. “It’s in the same class as the Celexa you’re already taking.” She paused to see if he was picking up what she was saying. When he gave her a nod, she continued. “It’s approved for both PTSD and panic disorder, and of course, it can also be used to treat depression. Would you be receptive to switching, see if it helps you?”
Kai swallowed. His face clouded. “I can’t just stop taking the Celexa. And it’ll take weeks for a new medicine to work. I don’t want to end up back in the hospital. That’s why I’m here. Please, Dr. Miller,” Kai said, speaking more rapidly, more desperately, with each word.
Dr. Miller held up her hands to calm him and reassure him. “That’s the advantage of switching to a drug in the same class. We can wean you off the Celexa while we build you up on the Zoloft, simultaneously over a couple weeks. Since they’re similar medications, it shouldn’t take eight to twelve weeks for you to benefit. You might start feeling better within a week.”
Kai’s eyes brightened with hope for the first time. “You think it’ll help me? With the anxiety and the panic attacks and the nightmares and my mood? Maybe even the flashbacks?”
“We’ll still need to meet for psychotherapy and memory work, therapy exercises, etc., but I think it’s time we try it. I think the Celexa got you over the first hump, but it’s not always a good long-term option.”
Kai nodded, but he seemed lost in thought. After a few minutes, he looked back at her. “What about . . . side effects?”
“Well,” Dr. Miller admitted a little reluctantly, “it can cause nausea. I’d expect it probably would for you. But you can take your antiemetics.”
Kai frowned. It seemed like there was more he wanted to say, but he was holding back.
“Have you had any side effects from the Celexa?”
Kai blushed, then lowered his head. Swallowed.
Dr. Miller tapped the couch lightly to get him to look up again. “Have you had sexual side effects? Celexa is less prone to causing them, but all the SSRIs carry that risk.”
Kai’s blush deepened. He never talked about sex with her, except in the most general sense, like when he’d admitted that he and Renee had gotten intimate, or that he and Nikki were “fuck buddies,” to use his terminology, or to hint that his sex life with Becca may not have been healthy. But no matter how often Dr. Miller tried to probe a little deeper, suspecting there might be a reason for Kai’s hesitancy beyond simple embarrassment, she’d never succeeded, and she hadn’t wanted to risk the fragile trust they had, figuring Kai would open up about that part of his life when he was ready.
“This is a safe space, Kai. You can tell me anything, and I will not judge you.”
The redness had seeped down from Kai’s face onto his neck and the part of his chest exposed by the collar of his shirt. “I can’t . . . I . . .” Kai cradled the back of his neck. He kept dropping his eyes, and then forcing himself to look back up at her. “I can’t . . .” Kai swallowed. “Orgasm.”
Dr. Miller nodded. It was a risk, with SSRIs. And Zoloft had the same potential side effect, although Celexa was more associated with dry ejaculations while Zoloft tended to produce delayed ones. “You’re unable to ejaculate, or you’re unable to climax?” Some men didn’t realize there was a difference, since normally, they were connected.
Kai hesitated. It was clear this discussion made him uncomfortable. He stared at Dr. Miller a long time, then, perhaps decided that he could trust her, and responded, “I can come, sometimes, but it’s . . . nothing comes out. It hurts. I come in my sleep, though.” Kai’s blush flared up again. “I’m so horny, all the time, and I can’t do anything about it. I think it’s part of the reason I’ve been so . . . crazy,” Kai said, hesitating, knowing that she didn’t like him to use that word.
“That’s definitely a side effect. Zoloft can cause similar issues, though it tends to be more like you'll be able to ejaculate, it'll just take longer. It's a different drug from Celexa, so it’s possible you might not have any sexual side effects at all if you switch.” Dr. Miller wondered how long Kai had been dealing with this and hadn’t felt comfortable enough to tell her. Or maybe it’d only been recently that his depression had lifted enough that he was interested in sex again.
“You really think this will help me?”
Dr. Miller nodded. “I think it’s time we tried it. And I’d like to try to wean you off the Xanax once you’re fully switched over to the Zoloft. I never intended for you to take it regularly.”
Kai looked terrified. “If you take the Xanax away, I won’t be able to function. I’m panicking so much already!”
“Hey. I won’t stop the Xanax until I know your anxiety is better controlled with the Zoloft. OK?”
“I haven’t abused it. You can ask Jon. David. They’ll tell you.”
“I trust you, Kai. It took a lot of courage to show me your cutting wounds. But Xanax is addicting. Much more than Valium. You need to trust me. We will get your symptoms better managed so you don’t feel you need to cut so much. So you don’t feel you need to quit school.”
Kai sniffled. He shifted, then reached for his wheelchair, pulling it closer. At first, Dr. Miller thought he was going to transfer, that he was going to leave, but instead he turned it so he could reach the backpack more easily, and fished out a crumpled bunch of papers. Smoothed them out. Then he handed them to her. “That was for my writing class. But I took a zero instead of turning it in. I should never have even written it.”
Dr. Miller glanced at the papers. The first was an ad from a magazine, followed by a very short story that didn’t take her long to read. From what little Kai had told her of his more abstract nightmares, especially the “darkness” one he’d had this morning, it was clear where his inspiration came from. The story was actually beautifully written and was essentially about a boy who lived in a group home who was terrified of the night and the dark, because the shadows would come to life and haunt him. Each night he always managed to find some source of light to fight them off, but at the end of the story, the power went out. The story ended just before the shadows seized him.
“I thought . . .” Kai took a deep breath and tried again. “I thought if I read it out loud, if the teacher read it, then everyone would look at me and they’d know.” Kai let out a choked sob and bit his fist, hard.
That was the kind of language Dr. Miller had heard before in her line of work, treating abuse survivors. Usually those who’d experienced sexual abuse or rape, but it applied to any kind of abuse in which the survivor felt intense shame as a result of what happened to them. She laid a hand on his shoulder just long enough to get him to look up. “Thank you for sharing this with me, Kai. I know that wasn’t easy for you.”
Kai took a deep breath through his nose and nodded. He pushed his hair out of his eyes.
“I know how you feel about group, but I think you should consider this one.” Dr. Miller pulled a flier out of her notebook and handed it to him. “A lot of my patients have really benefited from it. Read this. Think about it. OK?”
Kai smiled in a way that showed he was relieved she wasn’t forcing this issue. Either the group therapy or pressuring him to talk about the story itself.
“I don’t want you to hesitate to call me any time if you’re afraid like you were last night, OK? And that number works for text, too. I don’t use that feature much, I’ll confess, but I’ll figure it out for your sake. OK?”
Kai bit his lip and nodded enthusiastically.
“I don’t want you to let your shame or your hearing keep you from trusting me. OK?”
Kai swallowed thickly. “Thank you. Thank you for listening. For not just locking me up.” He was looking down at the fox in his lap, holding the ears, smoothing them between his fingers.
Dr. Miller touched his arm. “I promise you, Kai, that if the time comes where I feel you needed to be hospitalized again, it won’t be at JMH. Your brother has already found a private hospital in Omaha that we’ve vetted. And we both think you’ll feel a lot more comfortable there. For one, they won’t drug you like they did here. And for another, they will let Jon stay with you just like he can in the regular hospital, if that’s what you want. OK?” She had to repeat a few things before Kai indicated he understood what she was saying. “But I still promise you that we’ll only do that if absolutely necessary. OK? And I’m sure Jon would take you to visit this facility if you wanted to see it for yourself.”
Kai’s eyes filled, and he suddenly threw his arms around Dr. Miller, enveloping her in a hug.
She was caught off guard, knowing this wasn’t exactly keeping patient/doctor boundaries, but also aware that it was Kai’s way of thanking her without words. She patted his back and then pushed his shoulders to urge him away.
“I want to see you every morning for a little while. Just until the new medicine works. Can I? I think . . . maybe if I did . . . maybe I wouldn’t have to hurt myself so much.”
Dr. Miller nodded. “Of course. I take it you’re feeling better? More hopeful?”
“Good. I’ll give you written instructions on how to start the new medication and wean off the old one. I’m also going to give you something non-addicting to take for the next two weeks to help you sleep. OK?”
Kai looked hesitant. “But what about the confusion. In the morning? Won’t that make it worse?”
“How many hours a night do you think you sleep?”
Kai swallowed thickly. “How much do I sleep?” he asked in confirmation. When she nodded, he replied. “Lately? Maybe two or three hours.”
That was what she’d suspected. This wasn’t the first time she’d seen Kai sleep deprived, and she knew from what he’d told her in their last few sessions that he felt like his nightmares were interrupting his sleep more and more. “These will make you a little groggy and confused when you first wake up, but it’ll wear off quickly if you take them and go to sleep early enough the day before. Sleep deprivation is far more likely to contribute to dissociation of any kind during the day.” It took a while for Kai to get all of that, and she had to simplify her language a few times to help him read her lips, but he finally got it.
Kai seemed relieved. Maybe he was looking forward to getting a decent night’s sleep, or maybe he was hopeful that sleeping better would decrease his daytime symptoms. “OK. I’ll take them.”
“Good. We’ll get you through this.”
Continue to February 3, 2001 - Part II ------>