Sunday, July 16, 2000

In/Exhale - February 8, 2001 - Part II

February 8, 2001 - Part II

Dr. Miller had been concerned and surprised that Kai had shown up for his morning appointment with Renee. More so by his body language as he’d slowly crutched into her office, Renee following behind him. He’d sat in his usual spot, more stiff than normal, lowering himself with some difficulty like he was in pain. Maybe what she’d taken for a bad mood was his MLS acting up, although that didn’t account for Renee’s presence. He’d insisted she sit beside him, too, and had immediately slipped his hand into one of hers once she did. The hand holding, regardless of why Kai had asked Renee to sit in today, was huge progress for him, though.
“How are you feeling today, Kai?”
Kai stared at her like he wasn’t going to answer, almost looking guilty.
Renee squeezed his hand, and when he looked over at her, she signed something. It looked a little like she was taking something from her forehead and giving it to Dr. Miller.
Kai didn’t respond right away, but he finally nodded. “My mood was really unstable yesterday. And then last night . . . I was with Re, and I don’t know what happened. We were kissing and it was like . . .” Kai chewed his lip, his forehead furrowed like he was trying really hard to figure out how to explain it. “I don’t know.” He turned to Renee as if for help. Ah, so that’s why she was here.
“Almost like he was possessed. Kai’s always been so . . . gentle with me. Understanding about my past, and he grabbed me and wouldn’t let go. He wasn’t listening when I told him no. I got scared, and he snapped out of it a little, but it was almost like he wasn’t himself.”
Kai hung his head and tried to pull away from Renee’s hand, almost like he was ashamed, but she wouldn’t let go. She tugged and shook her head and made eye contact with him, not saying anything, just wordlessly reassuring him. After a moment, she nodded, as if to encourage him to continue.
“Before that, I was . . . my thoughts were racing. I couldn’t sit still. It was like I was full of energy, but then I almost hurt Re and it was like my bubble burst and all these negative thoughts came spilling out.” Kai dropped his head again and shook it like he couldn’t bring himself to continue.
Renee squeezed his hand again. “It was like if ‘normal’ is here,” Renee said, drawing an imaginary line in the air in front of her, and normal for Kai is probably a little lower than that, then he went from here,” she said, showing a point way above the normal line, “all the way down here,” she said, indicating a point way below even Kai’s normal. “Like this,” she said, snapping her fingers. “And he was like that all day. Maybe not so extreme, but . . .”
“I wasn’t that bad all day,” Kai said a little grumpily.
“You brought me here so I could tell Dr. Miller things you might not realize or recall. Remember?”
Kai sighed and nodded.
Dr. Miller contained a sigh. She asked Renee a few more questions about Kai’s mood over the past week--had she seen more of this sort of “revved up” state? Had Kai been particularly irritable? Anything that might help Dr. Miller figure out if the new antidepressant was pushing Kai into a mixed or hypomanic mood--which would mean Looney was right after all, and Kai was bipolar--or if it was simply Kai’s PTSD, or his natural moodiness. But as helpful as Renee was, once again, Dr. Miller couldn’t be sure. Kai’s moods tended to shift too rapidly for bipolar disorder, which made her think again of borderline personality disorder, but Kai didn’t have the emotional manipulation of others, the extreme black/white thinking, or the complete lack of self that was typical of BPD. Of course, she could try Kai on a mood stabilizer--which Looney had wanted from the beginning--and see how he responded to it. But the truth was, Kai was already on so many medications, she hesitated to add another if she wasn’t sure he needed it. It was possible that the sugar could have affected his already unstable mood; Kai seemed to be sensitive to subtle triggers the way many people with bipolar disorder were, but that wasn’t uncommon in PTSD patients, especially if their PTSD was a result of childhood abuse. It could also be that he was in the worst part of the shift from one antidepressant to the next, and that he might need a higher dose. But she didn’t really like to increase that until he had weaned off the Celexa entirely.
She didn’t get stumped often, but she wasn’t entirely sure how to proceed. She just knew she had to do something. Two major suicidal episodes in less than a week. Any other patient she’d already have convinced to commit himself, or even started the paperwork for an involuntary hold, if she felt he was really in danger. But Kai was definitely one of her most complicated cases, and her normal strategy wouldn’t work here.
Buying herself some time while she processed, she said, “I’m proud of you for going to Renee, for opening up to her and letting her help you ride out the crisis. I don’t know if the Kai of last week could have done that.”
“I’m better than last night,” Kai said, “but . . .” He took a deep breath. “I’m not OK. And I realize it’s OK to not be OK,” he said with a glance at Renee, who smiled encouragingly at him, “but I was so proud of myself yesterday, before everything fell apart, and now I wonder if that feeling wasn’t real. Sometimes it feels like nothing positive I feel is real.” Kai pulled away from Renee and covered his face with both hands. His shoulders shook, but he was quiet.
“I can understand why you feel like that, Kai, but I promise that your positive emotions are just as valid as your negative ones. Kai. Look at me. Kai.”
It took a while for Kai to look up, his eyes red. “I’m a worthless little shit. That’s all I’ve ever been and all I’ll ever be.” He said it like he was quoting someone. His aunt, maybe. “I have to go to my nutritionist after this, get bad news. Get bad news from my brain neuro after that. Yesterday, there were moments when I felt like I could do anything, and now I don’t even know if I could get off this fucking couch.” Kai glanced at Renee, and his face and posture changed, almost as if he’d forgotten she was there. “Maybe you should go.”
Renee hesitantly placed a hand on his arm. Signed something.
Kai shook his head. “I don’t know what I want.”
You do,” Renee said and signed at the same time.
“I’m scared, Re,” Kai said, almost as if Dr. Miller weren’t there. “I’m scared of myself. That I’ll hurt someone. You. Myself. Scared I can’t get better.” Tears traced down Kai’s cheeks and he tried to blink them away, but they were falling too fast. “Scared these bad feelings are all there is.” Those were dangerous words, signalling hopelessness, never a good combination in someone with suicidal ideation and a history of self-harm and suicide attempts.
Renee pulled Kai into a hug, but her eyes were on Dr. Miller. Pleading with her to help Kai.
Dr. Miller waited until Kai was looking at her again. “Kai, I know you haven’t had a chance to visit the Harbinger Clinic yet, but I think we need to talk seriously about another hospital stay.” Dr. Miller did her best to use language that wouldn’t spook Kai, keeping her face open and non-threatening.
Kai sighed heavily. He nodded slowly, like he knew she was right, but everything about his posture suggested he was anything but open to the topic.
“We’re just talking right now, OK? Take a few deep breaths. It’s my job to help you, and we’ll figure out the best way to do that, all right?”
More tears leaked out, and he hurried to wipe them away. He found Renee’s hand again and held it in his lap. “I can’t. I can’t go somewhere I don’t know anything about. Not again.” Kai covered his mouth with his other hand. “I feel sick.”
“Deep breaths. Slow. Focus on your breathing. On Renee’s hand in yours. You’re safe. Renee and I won’t let anything bad happen to you.”
Kai nodded. Closed his eyes and just breathed for a few minutes. That didn’t seem to be enough to control his nausea, though, and he bent forward, tucking his head between his legs.
Renee rubbed his back soothingly the entire time. It was really amazing to see them interacting like this. The last session they’d had together, several weeks ago, Renee had left in tears after Kai kicked her out, and it had taken the rest of their hour to talk Kai off the ledge and convince him he owed her an apology.
Kai finally sat back up, wiped his face. “I go visit the hospital in two days.” Kai let out a long breath. “It won’t make a difference, anyway. What will they do for me there? There’s no magic spell that will make me better.”
That was true, but Kai’s depression was also making him even more pessimistic than he was naturally inclined toward. “Harbinger would be a safe environment where we could give the new antidepressant you’re on time to work. It would be low stress, and that might be enough to help push you out of this low.”
Kai started picking at one of the knees of his jeans. “I’m finally starting to figure school out, though,” he said. “I dropped writing and took an ed class, and I got interpreters, and it was like night and day. I was excited about school for the first time in a long time. I know I said it doesn’t feel like the good emotions were real, but when I think about losing days, weeks, of class in the hospital. . . . It makes me scared and angry and frustrated. It’s like I know I need the hospital but I don’t want to need it.” The fact that Kai cared enough to worry about school was a good sign, but that could turn bad, too. She knew Kai often despaired that he’d never finish school, never achieve anything, and so while school could give Kai a reason to live, it could also be used by his poisonous brain against him.
Dr. Miller took a deep breath. “Kai, I have to ask you some important questions. You’re probably not going to like them, and if you don’t want Renee to sit in on this part, she can wait outside.”
Kai was gritting his teeth; Dr. Miller could see his jaw moving. His shoulders were hunched, and he glanced over at Renee before looking back at Dr. Miller. Like he was a child about to get chastised for bad behavior. “You want fuel for your involuntary commitment case,” he finally said in a defeated voice.
“Kai, since that first day you walked into my office six months ago, my first priority has always been your safety. That’s what these questions are about.”
Kai sighed and nodded reluctantly, clinging to Renee’s hand as his wordless signal for her to stay. That shocked Dr. Miller more than anything, but then if he had let her stay with him last night the way Renee had explained he had, if he’d shared with her details of his attempts while an inpatient, then that meant Kai had made huge strides in opening up to her, which was a very good thing when it came to ensuring his safety. It was one more person Kai might feel comfortable calling if he needed help.
“I know last week you thought about it, you even came close, but you stopped yourself,” Dr. Miller said, indicating on her left elbow to emphasize her point. “But what about last night? I know Renee was with you, and you said you were having suicidal thoughts, but how far did they go? If Renee hadn’t been there, what do you think would have happened?”
It took Kai a minute to understand everything she’d said. “Can I plead the fifth?” Kai asked, but he never managed a smile.
“The more honest you are with me, the more open, the better we can decide--together--how to handle this. OK?” Dr. Miller knew it was essential that Kai felt like he had a level of control over his situation, and so she made sure to reassure him that she wasn’t unilaterally making decisions for him.
Kai let out a shaky breath, but her strategy seemed to work. He looked at Renee for a long moment, as if trying to convey something Dr. Miller wasn’t quite sure of before he spoke. “If Renee hadn’t stayed with me, I think . . .” His forehead furrowed deeply. “I’m sorry,” he murmured, as if to Renee. “I would be dead.”
What Dr. Miller had expected, but it was always difficult to hear. She gave him a nonverbal signal to elaborate.
Kai pulled his hand from Renee’s and rubbed his palms on his jeans. “I had a plan. I was going to go to Walmart, bypass the problems with the safe, but then I thought I didn’t even need to do that.” Kai cast a sideways glance toward his girlfriend, almost like he was reluctant to speak in front of her, but he didn’t ask her to leave. “I was going to take my sleeping pill, then wind plastic wrap around my face, covering my nose and mouth as tight as I could. So even if I was awake enough, even if I lost my nerve, there’d be too many layers . . .” Kai swallowed. His hands fisted his jeans. “I wouldn’t be able to get it off in time.”
Renee started rubbing his back. It was clear hearing Kai’s plan, which left no doubt as to his intent, upset her, but she was trying to be strong for him.
“I couldn’t stop thinking how relieved everyone would be when I was gone. How much better their lives would be without me. I know, logically, that isn’t true, but last night, fuck, I believed it anyway. I could almost feel Jon’s relief at not having to worry about me anymore. And I could see David having a better future without being tied down here, to me. And Re--” Kai grit his teeth again and looked at her. “I know I’m not supposed to talk like this, but every time I look at you I think how you deserve someone not just better, but so much more than me.”
“I love you, Kai,” Renee said, cradling his face. “You treat me like your partner, not a trophy, not something to conquer. You let me see a part of you that not many people get to. The only one I deserve is you.” Renee started to tear up here. “I know you can’t control your negative thoughts, but please. Please. Losing you would never be better for me, OK?” Tears escaped Renee’s eyes and her chin began to tremble. “Last night you told me your biggest fear. Do you know what mine is?”
Kai shook his head. He wasn’t crying, but he was breathing raggedly.
“That I won’t have an entire lifetime with you. That you’ll be taken from me too soon.” She sniffled, and Kai turned with some difficulty--his back was obviously tight--and grabbed her the box of tissues. She blew her nose and then took a deep breath. “This morning, before Jon came home, I was having a nightmare that I was at your funeral, standing over your coffin. It was one of the most horrible dreams I’ve ever had, and I can’t explain the relief I felt when I woke up and found you asleep beside me, safe. There is no world in which I would be better without you.” Renee took his hands in hers. “Can you say that for me? Please?”
Kai swallowed. It seemed to take time for him to find his voice. “There’s no world in which you’re better without me.” He took a shuddering breath. “I’m sorry.”
“Don’t be sorry. Just promise me you won’t try to take your life.”
Dr. Miller was impressed with Renee once again. She was telling Kai everything he needed to hear right now, and trying to get him to make a kind of life pledge, which inspired Dr. Miller to suggest something she realized she should have done weeks ago. She got some papers out of a file in her desk and handed one to both of them before returning to her seat.
“What’s this?” Kai asked.
“It’s a ‘no harm’ contract,” Dr. Miller explained. “It’s an agreement between us that you won’t try to hurt yourself or end your life. That you’ll call for help if you need it.”
Kai stared at the paper a long time. “What happens if I fail?” he asked in a broken voice. And Dr. Miller suspected he didn’t mean attempt suicide, but rather, self-harm. As of yesterday, Kai had been proud he hadn’t cut at all since Friday, but he was still occasionally making himself throw up or avoiding food, and he admitted honestly that he could over exercise without realizing it until after the fact.
“Don’t think about it like that,” Dr. Miller encouraged. “Think about this more as a promise to yourself and your friends and family. To me. That you will call for help before you can do something to hurt yourself.”
Kai smoothed a hand over the paper as he apparently re-read it. “If I call 911, they’ll lock me up in JMH again.”
“If you like Harbinger, that will be where you stay. Yes, you’ll initially be held at JMH, but I’ll have you transferred as soon as possible. JMH will be completely temporary, just to keep you safe until we could get you to Omaha. I know it sounds scary, but does that seem fair?”
Kai took a breath and looked at Renee.
She smiled sweetly and nodded.
He took a pen from his bag and filled out the paper, then he read it out loud, presumably at Renee’s urging. “‘I, Kai Fox, hereby agree that I will not . . .’” he hesitated. Breathed deep. “‘. . . harm myself in any way, attempt suicide, or die by suicide. Furthermore, I agree to take the following actions if I am ever suicidal: One. I will remind myself that I can never, under any circumstances . . .’” Kai paused again, looked at Renee, then at Dr. Miller. It was clear he was worried about failing the self-harm part, but he obviously hadn’t talked with Renee about it since he didn’t say anything out loud.
“No failures here, remember, Kai? Nothing you could ever do would disappoint me.”
Kai’s eyes filled and he looked at her with gratitude, but he nodded, cleared his throat, and kept reading out loud. “‘. . . never, under any circumstances, harm myself in any way, attempt suicide, or die by suicide. Two.’” Kai took a huge breath. He trembled a little. This next line was also difficult for him. “‘Two. I will . . .’” Kai’s breathing started to come a little faster.
“It’s OK, Kai. You can do this.”
Kai nodded. “‘I will call 911 if I believe I am in immediate danger of harming myself. Three. If I’m having suicidal thoughts but not in immediate danger of harming myself, I will call: the national suicide hotline, Jon, David, Renee, or Dr. Miller,’” Kai said without reading the actual numbers out loud. “Four. I will continue talking with as many people as necessary for as long as necessary until the suicidal thoughts have passed.’” Kai was shaking a little, but he took the pen and signed the bottom.
Dr. Miller rose and took it from him so she could add her own signature and make a copy for his file, then returned it to him. “I’m proud of you, Kai. I know this was difficult. Keep this paper somewhere you can always find it. Just looking at it might help you sometimes.”
Kai nodded. Folded it as small as he could, then took out his wallet and put the paper there before sliding his wallet into his back pocket again. He seemed like he didn’t know what to do or say next.
“How are you feeling right now, Kai? Are you still having suicidal thoughts?”
Kai took a deep breath. “No. They . . . they don’t hit me all the time. They’re worst after I do something . . . after I almost hurt someone. Usually. I get so ashamed, so angry at myself, I start thinking if I were dead I wouldn’t be able to hurt anyone. And then I start thinking how I’m already on borrowed time, how I should be dead, and that makes it worse.”
“Be honest with me, Kai. If I let you leave this office, will you be safe?”
Kai took a moment, but he nodded. “Yes. I’m . . . I’m OK now. I feel a little better than I did earlier, and . . . I’ve been trying to focus on the fact that I won’t end up in JMH in a worst-case scenario, that it’s OK to call 911 if I need it.”
Dr. Miller smiled faintly. “It’s been five days since you started switching to the new antidepressant, right?”
“Yes. Tonight will be the sixth day. Why?”
Dr. Miller hesitated. Lithium was normally used for bipolar disorder, but she’d read a few studies that showed it could be just as effective in preventing suicide and decreasing suicidal thoughts (up to 90%) in patients with recurrent major depressive disorder. The more she thought about it, the more her instincts told her that lithium might be the final piece of the puzzle Kai needed, and it would have the bonus of helping to regulate his mood if he was a bipolar patient who hadn’t yet had a manic episode. But she didn’t want to start him on that until he was on the full dose of his new antidepressant. And it wasn’t a decision to be made lightly because of its potential toxicity.
“Dr. Miller?”
“Sorry, thinking,” she said with a smile. “I want to see how you do over the next week or so. Once you’re on the full strength of the new medication, we’ll re-evaluate. Sound fair?”
Kai shrugged.
“There is one more thing I would like to talk to you about, but I really think Renee should step out while we do.”
Kai’s brows furrowed, but he said, “OK.”
“It’ll only be a few minutes. Then you’ll be free to go.”
Renee stood and kissed Kai, her hand brushing over his cheek before she disappeared into the waiting room.
“I’d like your permission to go to County House and get a copy of any of your records that I can,” Dr. Miller said once Renee was gone.
That seemed to take Kai by surprise. “What?”
“You mentioned to me more than once that you were treated by a barrage of psychiatrists, psychologists, social workers, counselors, etc., growing up. I think it might be helpful to me if I could read some of their notes.”
Kai scowled. “Why?”
Dr. Miller sighed softly. “Dr. Looney is convinced, largely because of your mother’s own psychiatric history, that you’re bipolar. But so far I haven’t seen any indication to support that. However, I do suspect you may have recurrent major depressive disorder, which is a fancy way of saying that you’ve had major depressive episodes repeatedly throughout your life. Do you think that may be the case?”
“Probably,” Kai said on a sigh.
“Knowing more about your past than you’re able to tell me may help me get a better picture of you now. So I can treat you more effectively. I know you believe you can’t get better, but it’s possible we just haven’t found the right medication regimen for you yet.”
“Does County House even keep our files once we age out?” Kai asked, almost like a rhetorical question. “You think those records could help you help me? I want to get better. I want to stop feeling like I did last night, this morning. I want to stay out of the hospital if I can.”
Dr. Miller nodded. She was relieved to see Kai really was better than he’d been even an hour ago. That he was cooperating with her. It made her more reassured about not forcing a hospitalization just yet. “Yes. There’s a type of chronic depression in which you never really come out of an episode. It’s kind of like your MLS, where it’s always there, always giving you symptoms, but you only have a few major episodes that pop up from time to time. Then there’s another kind, the one I was describing earlier, where you do get periods of normal mood interspersed with depressive episodes. I suspect you have one of these, and which could make a huge difference in which medications we choose for you going forward. Because it’s very possible that the Zoloft may be a big piece of the puzzle, but it may not be enough to manage all your symptoms.”
“OK,” Kai said without hesitation. “If you think it’ll help me, I’ll sign the release form.”


Renee immediately tossed the magazine aside she’d been flipping through when Kai emerged from Dr. Miller’s office. She waited until he was looking at her, and she smiled huge to show her love and support, not that it was difficult. It was hard not to smile at Kai.
He returned the grin, though it was a little tired. But she also knew his MLS was bothering him today, his muscles stiff, and she still didn’t fully understand why he’d opted to walk if his back was hurting him so much.
How you feeling?” Renee hoped Kai wouldn’t be angry at her for asking. She had work, but she was willing to call in sick if he needed her today.
They weren’t alone in the waiting room, so Kai crutched a little closer. It took him more time than it usually would, and he seemed reluctant to trust himself to stand without at least one crutch, so he released his left hand and used it to sign, the cuff still on his arm, so he didn’t try to move his arm too much, “OK.
I’m proud of you. I know that session was difficult.
Kai sighed. He signed something it took her a moment to figure out since he couldn’t bring his hand to his chest, but she finally realized he’d said, “I want to live.
I know. You really can call or text me any time. I mean it. Work and school aren’t as important as your life.
Kai shifted his weight a little more onto his right crutch and extended his left arm for her, asking for a hug. He embraced her with one arm, hugging her close to his chest and stomach for a long moment before releasing her. “Thank you.”
Do you need me today?
Kai took a deep breath and seemed to consider it. “No. I think I’ll be OK,” he signed again in that awkward way, but she managed to get it, because he exaggerated his mouthing of the words to help. “But I’ll call if I need to. I promise.” And Renee could tell that wasn’t one of Kai’s hollow “I promises,” but that he genuinely meant it. She’d earned his trust last night in a whole new way. Maybe he felt like she understood him, including his isolation phobia. Whatever it was, if it meant he’d call her before he hurt himself, that was the only thing that mattered.
I love you.
Kai smiled at her now, soft and genuine, almost as if to say, “me too.” “Come on. Let’s get you back to your car. I don’t want you to be late for work and I have my appointment, and I’m not exactly Mr. Speedy today.”


“So, Kai, do you want to try the regular scale today, or the accessible one?” Amanda, the petite nurse who was charged with doing his weigh-in asked.
Kai adjusted his weight on his crutches, eying the scale. He could manage on a good day--and he had in the past more than once. If he was wearing his braces, it was a matter of balance, then subtracting the weight of the orthotics, but some days the feat was easier than others. It was difficult for him to pull himself up on the scale, harder still to make sure both feet were properly placed, and then he couldn’t hold onto anything until his weight was registered. Kai was generally pretty good at keeping his balance when he was standing still, but that usually was on a flat surface where he could plant his feet appropriately, not on a tiny square that was several inches off the floor. But today he could barely walk. He knew he’d made the right choice--his legs were much looser already than they had been when he woke up--but that didn’t change the fact that he really wished he could have taken a safe dose of Valium and slept the day away. His mood definitely played a role in that. Though he was much better than he had been. Dr. Miller was a partner in his recovery, and Renee, too. It wouldn’t be easy, and he wouldn’t always be OK, but he would be fine in the end. He just had to focus on that. Remember that.
Kai forced a smile. “I never like to pass up my chance to feel like one of the livestock in Jurassic Park,” Kai joked, indicating he’d go with the disability-friendly option for his weigh-in.
“Since when does Kai Fox quote movies?” Kai had been seeing the same nutritionist off and on since the summer after his adventure with his aunt, and more regularly since his transplant and his switch to vegetarianism. So the staff knew him. Amanda had been doing Kai’s weigh-ins for the past couple years.
“Since I’ve been hanging out with Martin Gomez every week,” Kai said. “The kid has some master list and is insisting we go through every movie on it before--” Kai cut himself off abruptly. He was about to say, “Before he dies.” “Anyway, we’ve watched Jurassic Park, Beetlejuice, The Matrix, and a couple others. I think Ghostbusters is on the roster for today.”
Amanda chuckled. “Well, I hate to disappoint you, but we have a new scale. I think you’ll like this one better. If you’re in your wheelchair, you don’t even have to transfer out of it.”
Kai followed her into a room which was dominated by a large contraption he assumed was the weighing device. It was square, with four bars rising up at each point, connected on three sides to handles and a bar which supported the display. The base was black non-slip material with a wedge strip to make egress from the floor easier for those who couldn’t simply pop a wheelie up onto the frame. In addition, there was a small bench that looked removable, presumably so one could sit while being weighed. Definitely a vast improvement over other devices Kai had experienced in the past.
“Can you manage to get on without your crutches?”
Normally it wouldn’t be a problem. Today? It would be more difficult, but he was worried that the tiny Amanda wouldn’t be the one helping him, and after what happened with the male nurse at his derm last week, Kai didn’t want to take his chances. He’d manage, so he nodded. Slipped out of his crutches, leaving them nearby but out of the way. He reached for the padded grips, using them to pull each leg onto the scale. It shifted with his weight, and even though he was holding on with both hands, it made his stomach plunge. “Can I hold on? Or will that throw off my weight?”
“You can. Or you can sit, if you’d prefer. Do you need help?” Perhaps she sensed Kai’s anxiety.
He didn’t like how the scale shifted slightly beneath him. It was supposed to, of course, but he didn’t feel secure. Especially with how bad his balance was today since his locked up back meant he didn’t have the core control he normally did? “No. I’m OK,” he lied.
She glanced up at him, clearly skeptical, but she left him be. “It’ll only be a few seconds. This one works pretty fast.” She hit a few buttons. “Try to hold still.”
Kai felt the edge of irrational panic, and focused on slow, deep breaths to try to forestall it.
Ghostbusters is one of my favorites. Especially the giant marshmallow man.” Amanda was obviously trying to calm Kai down with small talk.
Kai felt his arms shaking, and he knew it wasn’t from fatigue. No. This couldn’t happen here. “Giant marshmallow man?” Kai asked, grateful his voice didn’t shake as well.
“Yeah. I won’t spoil anything, but it’s a big part of the movie. OK, all set, you can hop off.”
Kai never hopped anywhere, but he nodded, sucked in a difficult breath and got off the thing as fast as he could while still being careful. He focused on his breathing as he finally slipped back into his crutches.
"You OK, Kai?"
“What does a giant marshmallow man have to do with busting ghosts?” Kai was ignoring her question, but now that he was on solid ground again, with both his crutches, in control, he’d be fine. Hopefully, he wouldn’t throw up.
The nurse probably sensed Kai wasn’t OK, but she knew him enough that if she asked him again he’d snap at her, so instead she asked, “And your orthotics and shoes haven’t changed since your last weigh-in, right?”
Kai shook his head.
“Good. OK.” She scribbled a few things in Kai’s chart. “Follow me. Molly wants you to do a BIA today.” BIA stood for Bioelectrical Impedence Assessment, which basically used electricity to give a more accurate picture of how much body weight was due to fat and how much was due to other tissues, like organs, muscles, and bones. It could also be used as a way to predict how healthy someone was, and whether or not they were malnourished. Kai didn’t have the test done every time he saw Molly, but it made him nervous, because even if his weight in pounds was in a decent range for his height, the BIA would reveal the truth about Kai’s eating habits over the past few weeks.
Amanda led Kai down the hall to another room. There was a long table, sort of like an exam table, covered in a sheet, and there was a gown and blanket folded on top of it. Nearby, a cart with complicated computer equipment and a monitor stood by. “OK, you know the drill. Take everything off. You can leave your underwear, but your medical alert jewelry has to go.” Kai knew he didn’t have to strip completely for the test, but Molly didn’t like anything to interfere with the results, so she always had Kai take off his clothes, just to be sure he wouldn’t have any metal on.
“What about my hearing aids?”
Amanda’s brows went up, perhaps since Kai had never asked before, and they weren’t visible, so she probably didn’t even know he used them now. “I’d take them off to be safe. I know they aren’t cheap, and I’d hate for the electrical impulse--even if it’s small--to damage them.”
Kai nodded.
“You know where the bathroom is, if you want to use it before you get undressed. I take it you’re hydrated and you didn’t exercise this morning?”
Normally, Kai did swim on Thursday mornings, but because he had this appointment, the only thing he’d done was see Dr. Miller. “I’m good.”
Amanda nodded. “All right. Go ahead and get undressed, put the gown on and lie on the table.”
“I won’t be able to hear you once my hearing aids are out,” Kai said. It might have been obvious, but he figured it was worth saying something.
“OK. Why don’t you keep them in and you can hand them to me right before I start the test?”
Kai nodded and sat down on the edge of the table to start getting undressed. It would have been a lot easier if he’d come in his chair, but the routine of removing his braces (and putting them back on again after the test) would give him something to focus on to keep his mind from spinning back off into the darkness. He could almost feel the weight of the suicide contract in his wallet, his promise to himself, Dr. Miller, and Renee that he was going to try to keep. Besides, Kai wasn’t looking forward to what Molly--his nutritionist--would have to say to him in a few minutes.


The BIA test was simple enough; Kai lay back, Amanda attached electrodes similar to the kind used for a heart monitor to Kai’s feet and hands, and then the computer did the rest. A small electrical current was sent through his body--so small Kai couldn’t even feel it, except for the tiny spasms it triggered--and then it was over. It took longer for Kai to get undressed and get dressed again (because of his braces) than it even took for the computer to compute the results.
Now he was sitting in one of the exam rooms waiting for his nutritionist to rip him a new one. Well, it wasn’t a traditional exam room; it was more like a consultation room. And Molly was far too sweet to yell at him, even once she realized how little Kai had been eating over the past few weeks.
Kai liked her, even if he hated how she’d been forced to “snitch” on his progress back before he aged out. Molly was a nurse practitioner, so she had years of medical training plus the heart of a nurse. She treated a lot of the more complex cases that came through the hospital, both children and adults, and managed the nutrition and enzyme replacement therapy regimens for many of Jon’s and Dr. J’s CF patients.
There was a soft knock on the door, and a moment later, it opened. “Hi, Kai. How you doing?” Her full name was Molly Guttenberg, but she preferred her patients simply call her Molly. Perhaps a remnant of her early nursing days.
Kai shrugged.
Molly took a seat across from Kai, his chart in her lap even if she didn’t consult it yet. She always liked to start off by just talking to him first. “Things are going well with Dr. Miller? She’s helping you?”
Kai’s anxiety wasn’t bad right now, just that low hum in his chest that never seemed to go away, but his stomach was roiling. “Yeah.”
“And your anxiety and everything? Is it better managed?”
Kai let out a dry laugh. “Recovery is a process,” he said, repeating a phrase Dr. Miller told him at least once during every session.
“It is,” Molly said, obviously trying to get Kai to open up more. “And what about your GI tract?”
Kai shrugged.
“You’ve been having normal, regular bowel movements?” Questions like that didn’t make Kai uncomfortable, because he’d spent too much of his life sick, too much time around doctors and nurses. And Deafies were far less squeamish than hearies anyway. But this question did make him a little uneasy. His GI infection had devastated his system to the point that Kai’s intestines had actually shut down completely at one point, causing excruciating pain and blinding nausea like Kai had never felt before. He’d needed to be readmitted and spent an extra week in the hospital until his plumbing started flowing and he’d been able to go again. Kai was better, but he hadn’t been the same since, and a combination of not eating, throwing up too much, and wheeling more than he should meant things still weren’t working as well as they were supposed to.
Kai shrugged, but he wouldn’t meet her eyes.
Molly sighed. “You’re not tracking that? You know it’s important for us to make sure your intestines are still healing.” It could have been a reproach, but Molly’s voice was gentle and kind, like always. But she moved on. “How has your appetite been?”
Kai shrugged and started fiddling with his fingers in his lap.
“What about the nausea?”
Kai resisted the urge to shrug again. “My ears were damaged by the antibiotic. I’ve been having vertigo on top of everything, but the hearing aids are supposed to help.” Kai held up his hair and leaned so she could see one of them.
“And the vomiting?”
Kai studied the floor like it was the most interesting thing he’d ever seen and didn’t answer.
“You have your notebook with you?”
Kai pulled a small planner from his back pocket and handed it over, pointedly not looking at her as she flipped through it.
“Most of the last few weeks are blank. You stopped tracking your calorie intake?”
Kai’s nose twitched, and he continued to look down.
“Look at me, Kai. Please.” Molly was again speaking softly, gently, and Kai was grateful for the quiet room and expensive hearing aids so he didn’t need to worry about understanding her.
Reluctantly, Kai looked up.
“What’s going on?”
Kai shrugged. Picked at the strings around the hole in his right knee. “I never got anywhere close to 5000 calories, so I figured there was no point.”
“Are you at least keeping down one meal a day?”
Kai shrugged.
Molly seemed to realize she wasn’t going to get Kai to talk, so she flipped open Kai’s chart instead. “You’ve dropped five pounds, and even though on paper your weight is acceptable for your height and age, that’s not what the tests show. The BIA and your bloodwork tell me your body is starving. You’re malnourished, your blood chemistry is off, and there’s far more myoglobin in your urine than there should be, even with your MLS.” Molly paused, as if waiting for Kai’s reaction. “That means your body is breaking down muscle more than it normally would due to your natural activity and your spasms. We have to fix this, or you could have kidney problems or other very serious issues.” She glanced down at the chart again for a moment. “How often are you having panic attacks?”
Molly’s question threw him. She’d already asked him about his anxiety. “Why?”
“Kai, every question I ask you is for your own good. This isn’t an inquisition. You don’t need to be afraid to tell the truth.”
Kai sighed. “At least one a day. Sometimes as many as four or five.” Kai shivered and rubbed his arms, even though he wasn’t cold.
Molly pointed to something in his chart, not that he could see it. “Your potassium and magnesium levels are extremely low, which is pretty common with chronic vomiting or diarrhea.”
Kai figured she was going somewhere with this, but he decided he’d keep up his disaffected persona, because she was still building up to her big “you’re a total failure, Kai,” speech that was coming later. “So?”
“So,” Molly said pointedly, “these levels can make your MLS and constipation worse, or even cause heart problems if we don’t correct them. But that’s not why I brought it up.” Molly paused like she was giving him the chance to say something, but then when he didn’t, she softened a little. “Studies have shown a correlation between low levels of potassium and magnesium and an increase in anxiety and the frequency of panic attacks.”
Wait. What? “So you’re saying a banana a day keeps the panic attack away?”
It was Molly’s turn to shrug. “What I’m saying is that diet and nutrition can impact mental health.”
Kai hesitated. “Like how you and Dr. Miller told me to cut out sugar.”
Molly nodded.
“Sugar affects anxiety, but what about mood?”
Molly didn’t immediately respond, as if waiting for him to elaborate.
Kai sighed. “Yesterday I binged on Oreos. Other than a slice of pie, that was the first time I’ve had that much sugar in months. And I went crazy. I was on top of the world one second, and the next, I crashed. Got really depressed. Don’t worry. I already talked to Dr. Miller this morning. I’m fine. But do you think the cookies were to blame?”
Molly was studying him carefully. “How many cookies we talking?”
“Uh . . . an entire package?”
“What size package? Two or three cookies? Twelve? Thirty?”
“I dunno. Twenty? Thirty? I’m not sure. I ate them so fast,” Kai said, feeling ashamed. “I was hungry. I never feel hungry, and it’d been so long . . .”
“It’s possible they could have contributed to your mood swings. Some people are very sensitive to sugar, and especially if you’d been avoiding it for so long, it may have had a particularly powerful impact. Honestly, though, a little sugar is OK. It’s when you go overboard with anything that it’s not healthy. Do you do that often? Binge?”
Kai felt like slime that someone stepped in on the street. He knew where she was going with this. After all, it was well documented he threw up a lot, so why not binge, too? “No. This was a one-time lapse in judgment.”
Molly sighed. Closed the folder and gazed at him sincerely with her friendly, open face that told him she wasn’t the enemy. “We need to figure out if this,” she said, indicating his chart, “is because there’s still a problem with your GI system, or if there’s something else going on.” It could have been how Kai heard with his new hearing aids, but it seemed like she was putting particular emphasis on the last few words.
God, why did he still feel so guilty? So dirty? So ashamed? He wanted to throw up, but now was definitely not the time. “Like what?” Kai said, starting to get a little defensive.
But Molly wasn’t fazed. Her voice didn’t get any harsher, though she remained serious. “Why haven’t you been eating?”
Kai didn’t answer.
“Is it because you don’t have an appetite?”
“Because you’re nauseous?”
“Something else?”
Kai didn’t answer.
Molly was patient, though, and her voice never lost that dulcet tone. “Kai, do you ever make yourself throw up?”
Kai’s stomach contracted, and the web of anxiety in his chest expanded. Dr. Miller had told him to own his emotions, even the negative ones, but Kai wasn’t sure if he’d ever get used to the shame that sometimes hit him, seeping out of him like it was the darkness from his nightmares. He swallowed. Finally, reluctantly, he nodded.
“Why?” Again, there was no accusation there, just someone who had known Kai for a long time, who was familiar with some of what Kai had been through, and just wanted to get to the bottom of things.
Kai shrugged. “Try to feel better.”
“And do you? Feel better?”
Did she mean mentally or physically? Kai didn’t answer right away. Instead, he took a deep breath and looked up. “Dr. Miller says that there’s all kinds of ways to self harm. Like drinking, or doing drugs, or hurting yourself, or even stuff like working out too much.”
Molly set his folder and his notebook aside so she could give him her full attention. “And do you do some of those things?”
Kai nodded tightly. His nose twitched. “I think . . . I think maybe . . .” Kai hadn’t brought it up with Dr. Miller yet, partially because they’d had so much to cover, but he took a breath and said what he thought, worried what it meant, but knowing he could trust Molly. Probably any other nutritionist would have taken one look at Kai’s results and decided he was anorexic or something and sent him back to the nuthouse.
“It’s OK, Kai. Take your time.” If Kai hadn’t known for sure that Molly had been a nurse before she went into nutrition, he would have been certain she’d been a therapist.
“I think maybe throwing up and not eating . . . it’s . . . it’s like that other stuff. A way to try to make me feel better about myself. To feel like . . . I have control over something.” And wasn’t searching for control something Dr. Miller had told Kai many people with eating disorders suffered with? Why she’d sent him to the inpatient eating disorders group therapy sessions while he was in the hospital, despite his antagonism toward the whole thing?
“It’s good that you were able to admit that, Kai. I think that might be part of it. Remember, we’ve discussed that before?”
Kai sighed. Nodded. Once Kai’s feeding tube was pulled after his summer with his aunt, Kai had all but stopped eating entirely. Partially out of habit from being starved so long, but partially because he was so incredibly fucked up by that whole experience. He’d been brainwashed by his aunt to believe that he didn’t deserve food, and maybe a remote part of Kai still felt that way.
“Are you taking your vitamins?”
Kai nodded. He saw them as part of his medicine, and especially if he’d been throwing up, he always made sure to take them because he knew from past experiences how bad chronic vomiting could be on his body.
“And keeping them down? Because I really don’t like your numbers, and it’s possible it’s making your mental illness symptoms worse.”
Kai couldn’t look at her.
“It’s all right,” Molly soothed. She grabbed some papers from her desk. Kai recognized them as the kind used to order bloodwork. “I’m going to have the nurse come in when we’re done and give you a few vitamin shots to boost your levels quick. And I’m also going to order you some new vitamins. These are going to be in liquid form. They’ll come in a dropper and you’ll basically take a few drops a day for the first week, then switch to every other day, etc.” Molly glanced up from where she was scribbling furiously. “Don’t worry. I’ll give you a printed instruction sheet so you don’t need to remember. The liquid is absorbed quickly, but try to take them when you’re least likely to throw up. If that’s in the morning, great. If that’s at night, great. The point is, we need to get you back in balance. I think you’ll feel better, and if you feel better, that will help you eat.”
Kai was skeptical, but he nodded anyway.
Molly stopped and looked him straight in the eyes. “We need to see how we can get your daily caloric intake up so your body can stop eating itself. You understand why that’s so important, right?”
The shame hit Kai again. He knew he wasn’t trying hard enough. But even when he wasn’t nauseous, he had no appetite, and then he spent the time worried that if he did eat it would make him want to throw up, so it was easier not to bother. And then there was that disgusting feeling of accomplishment when he did feel hungry and resisted eating, a feeling he’d never admitted to anyone because he was afraid of what it meant.
“I think you should consider seeing a psychologist here in the clinic who specializes in treating people with eating disorders. I don’t think you have something in the traditional anorexia/bulimia spectrum, but you do have an unhealthy relationship with food and your body that I think she could really help you with.”
Kai gave her a nod and a look that said he’d think about it, which really meant he wasn’t interested. He had Dr. Miller, whom he trusted, and he didn’t really feel like seeing yet another doctor.
Molly smiled faintly like she’d expected that reaction. “We can also change your diet plan to 2500 calories a day as a minimum goal. I’d still like you to try for 5000, but if it’ll be easier for you to think about it with the lesser number, then that could be helpful. You might even try several 500-1000 calorie meals per day so that it seems less of a daunting challenge to meet. You can celebrate the fact that you ate three meals, let’s say, even if they were only 500 calories, rather than feeling like you were a failure for not eating your 5000 max.”
It was ridiculous, but perception was everything, and Kai actually thought Molly might be onto something. If, like Dr. Miller had taught him, he could focus on the positive instead of the idea of failure, maybe eating would feel less daunting. Maybe he’d feel less like there was no point in bothering if he knew, at the end of the day, he could look back and say he had eaten. “I like that idea.”
“Good. I want you to start tracking your intake again, but if it helps to focus more on the quantity of food rather than the amount of calories--for instance, to write down you ate breakfast or you had three snacks--then go ahead and do that. The point of the notebook is to help get you into the habit of eating again.”
The habit of eating. It sounded even sillier than measuring his day in small achievements, but Molly was absolutely right. A huge part of Kai’s struggle with food so many times in his life was that he’d had long stretches where he was fed via a tube or IV, or he starved himself (intentionally or not) that even remembering he had to eat was a challenge. He got used to not doing it. “I’ll try,” Kai said, feeling a little less ashamed and more hopeful.
Molly smiled. “You might also try making yourself a meal plan each day, or even for a week at once. Write down what you’re going to eat and when, like a schedule. That way you don’t have to think about food, just look at your list, go to the fridge, grab what you’re scheduled to eat, and go. So it might say, ‘7AM: Cereal and whole milk. 9AM: fruit and nut snack. 10AM: protein shake. Noon: Cheese sandwich and fruit.’ Etc. You could even spend the night before putting together your meals and snacks so you always have something you can grab with little prep. I know you like to cook, but if you’re having trouble forcing yourself to eat, having the planning part already taken care of can help, and then you’d have the satisfaction of being able to cross off meals from your list to make you feel like you’ve accomplished something.”
Once again, Molly had a great idea. If Kai planned ahead, especially when he was thinking clearly and wasn’t nauseous, it would make things easier later, when he was depressed or sick to his stomach. He nodded. “I think that’s a good idea.”
Molly smiled encouragingly at him. “You could even try scheduling a meal every hour, and set yourself a goal to eat at least one of those a day. If that works for a couple days, you can say, ‘Today I’ll eat at least two meals,’ and if that works, bump it up to three, etc. This will help it feel less daunting, less like you failed if you don’t eat everything you’re scheduled to eat. Plus, if you really feel you can’t eat at one point in the day, you can tell yourself you have more meals scheduled later, other chances. Think of it as goals you’re working to achieve, a habit you’re trying to get into. Hopefully, if you can do this over the next few weeks, eating will become part of your routine again, like taking your medicine or exercising. And you don’t have to look at it as something you’re failing at or have to feel ashamed about. Because that’s really important. OK?”
Kai nodded.
“And if you’re still not gaining weight when I see you again, we can talk about putting you back on an appetite stimulant.” Molly had prescribed one for him a few times in his life when he’d been dangerously underweight and struggling to eat--after his aunt and his transplant, for example. “Something that’ll help, at least for the short term, get you back eating regularly again.”
Kai nodded.
“All right. I want you to come in for a weigh-in every week for the next six weeks, at which point I’ll see you again and we’ll do a follow-up BIA to see where you are. But feel free to come in sooner if you need to. You’re still on a strict vegetarian diet?”
Kai nodded.
“I know you’ve been eating that way for awhile, but Amanda is going to give you another packet of high-fat vegetarian recipes. It’d be good for you to try to eat one of those a day. And I want you to keep eating the yogurt, and keep track of your bowel movements. You should have one every two to three days, at least, and if you’re not, especially if you’re eating, you may want to go see your GI. OK?”
Molly smiled. “We’ll get you through this, Kai. We always have before. Just take it one step at a time. One bite at a time.”



  1. Thank you for the update. Once again a really intense chapter with lots of emotions.

  2. I really love your story. Especially because it is like a TV series. There is no end (I hope). Different characters are coming and going. Their personalities are growing and changing. It is just so much fun to read it and you are a really great writer.

    1. Thank you so much! That's exactly how I think of it. I'm really glad you enjoy it. There is plenty more to come. :)

  3. Fascinating, educational, and the characters draw you into their worlds. Amazing!