Tuesday, July 25, 2000

In/Exhale - November 24, 2000 - Part II

November 24, 2000 - Part II


Even though Kai had joked, during their last meeting, that he would never sit in the recliner again, he’d insisted upon it, climbing into it with both his brother’s and Dr. Miller’s help, but only after turning it so he could still see the entrance leading to the waiting room, which meant Dr. Miller had to switch to another chair to keep line of sight. At Kai’s insistence, Jon left the door open behind him, propping it open with a chair, and assuring Kai he’d be in the waiting room if he needed him.
   
Kai had shifted his body so that he was lying sideways, his legs tucked, his head lazily draped on the arm cushion. As long-limbed as Kai was, it didn’t seem like a very comfortable position, though it was defensive and defeated and perhaps projected more about Kai’s current mood than anything he could have told her. She also noticed he was dressed in baggy sweats, the giant hood masking most of his face, his golden hair uncharacteristically brushed so it covered his eyes. Kai was hiding himself with his hair and clothes and posture, whether he realized it or not.
   
“How are you feeling this morning, Kai?”
   
“Medicated,” he said flatly, his voice coming out a little muffled.
   
Dr. Miller suspected today’s session was potentially going to be as difficult as their first. “Does the Valium help?”
   
Kai shrugged.
   
“Kai.”
   
He sighed. “No. Give me enough to kill a normal person and it knocks me out for a little while. It controls some of the physical anxiety symptoms, but it doesn’t stop my brain from having a crazy party, if that’s what you’re asking.” Kai’s voice was tired, but not in the sense of exhaustion or weariness from the drugs. Rather, it was more exasperation. She remembered how initially he’d been convinced he couldn’t be helped, and she wondered if he was thinking that now, too.
   
She didn’t bother to chastise him for using the word “crazy,” though she did find his phrasing--kill a normal person--interesting. “Kai, have you hurt yourself since I saw you Tuesday morning?”
   
She heard the leather squelch as he shifted, lifting his head, peering at her through his hair. “Technically, no,” he said, and she saw the hint of a grimace, as if he hadn’t intended to be that forthcoming.
   
“Technically?”
   
He sighed, as if he knew she wouldn’t let him leave it at that, even though he didn’t want to go into it. “Jon and I got into a fight Tuesday afternoon. He told me I was selfish and needed to get over myself and that he was moving out.” Dr. Miller couldn’t see Kai’s face, but she could hear the subtle tremble in his voice, like he was trying to speak dispassionately but failing.

“Yes, he mentioned that to me yesterday.”

Kai reached over to push his hair out of his eyes, to see Dr. Miller more clearly. “When?”

“Yesterday afternoon, he brought you home and you had another flashback, and he had to give you more diazepam because you were getting hysterically violent. Do you remember that?”

Kai pushed himself up some more. “I’m not sure,” he said, confusion and surprise in his voice. “Everything’s all fucked up in my memory.”

Dr. Miller tapped her pen on her notebook. “He was very worried about you, concerned some of the things he’d said had pushed you . . .” Dr. Miller corrected her wording. “Had been hard for you to deal with.”

Kai seemed shaken, pushing himself up so he was sitting, though he gathered his legs to his chest again. “Why am I not strapped to a hospital bed right now?”

Kai’s perceptiveness never ceased to amaze Dr. Miller, even heavily medicated and not fully himself. “Jon was worried you’d think he had betrayed you.”

Kai took in a harsh breath. “When I got home and saw he’d moved out, I . . .” Kai dropped his forehead to his knees, his voice coming out a muffling echo. “I wanted to grab a knife and just cut until that was the only hurt I could feel.”

“But you didn’t?”

She saw a subtle shake of his head in response. “Instead, I got drunk. I spent Tuesday night and all Wednesday drunk.”

Dr. Miller scribbled some notes furiously. Kai had admitted to physically harming himself from time to time, but never anything substance related. Considering the veritable pharmaceutical bonanza that had to exist in Kai’s medicine cabinet at home, this revelation was concerning. “Is that something you’ve done before?”

“What?”

“Drink yourself into oblivion?”

Kai shook his head again. “I don’t like alcohol. But it was that or risk doing worse with the knife, so . . .”

“And what about drugs?”

Kai hesitated a long moment before finally replying with a defeated sigh. “No . . . not .  . . not really . . . but . . . it’s been on my mind lately.”

Dr. Miller took a deep breath, set her notepad and pen down for a moment so she could give Kai her full focus. “Kai, have you thought about suicide?”

Kai trembled, which she heard in his breathing more than saw with that cavernous sweatshirt. “Yes. I don’t want to, but it keeps popping into my head.” He released his legs, slipping his hands into the pocket of his hoodie.

“Why?”

Kai shook his head. “I guess . . . I guess, especially yesterday--today--fuck, my last freak out was only a few hours ago.” His shoulders trembled again, as if he were trying to keep his control but it was struggling to break through anyway. “It feels like . . .” Kai shook his head.

“Like what, Kai? It’s OK.”

Kai took in a breath, as if it were a struggle to get the air to enter his body. “Like I’ve lost whatever bit of sanity I had left. Whatever ounce of control I still had. Like there is no light at the end of the tunnel, and whether I want it or not, I’m going to hurt myself.” Kai was surprisingly calm, and despite his insistence that the Valium didn’t work, Dr. Miller suspected it was responsible.

“It’s not uncommon to feel depressed and even suicidal after a crisis,” Dr. Miller said, choosing her words carefully. “But a flashback--which is what you’ve experienced--is not psychosis. It may feel like you’re losing touch with reality, but it’s really a dissociative experience. Think of it almost like a particularly vivid daydream, only these visions are from your memory. Does that make sense?”

Kai swept his hair off his face for a moment, and she saw his eyes were raw and desperate, like he might have broken down into one of his sobbing fits if the drugs weren’t restraining him. Still, he looked particularly defeated. And not terribly convinced. “I don’t remember most of what happened yesterday, between losing myself in these . . . flashbacks and all the drugs. And you’re telling me that’s normal.”

“Normal for someone with PTSD, yes.”

“Sometimes, when I’m in a bad panic attack, like the one I had at the diner, I think I’m going to die, and I welcome it, because it’ll mean it’s over. Why do I keep thinking about it now even when I’m . . .” Kai seemed to search for the word. “Fine?” He laughed bitterly. “Dammit, if I’m fine, then the Pope’s Jewish.”

“What are you thinking about right now, Kai?”

Kai was still a long moment before he finally pulled a hand from inside the pocket of his hoodie. He opened his palm, revealing a large shard of glass.

A surge of dread reflexively shot through Dr. Miller’s body as she quickly rose to take the glass. It was clean, though Kai had cuts on his left fingers and palm. They weren’t fresh, though.

“Kai?”

He held up his left hand. “That happened early this morning, during a flashback,” he said, waving it away. “That,” he said, indicating the glass, “broke a few hours ago and I’ve been wanting to use it ever since.”

“But you didn’t,” Dr. Miller said, staring at it. With Kai’s strength, even on the muscle relaxant, if he had wanted to, he could have done some serious harm to himself.

He sighed heavily, almost as if he were disappointed with himself that he hadn’t used the glass, that he’d given it up. Telling. “No. Other than the alcohol and some questionable judgments, and whatever shit I do to myself when I’m lost in a memory,” he said, his voice dripping with scorn on the final word, “I haven’t hurt myself.”

She knew he wasn’t lying, so she finally returned to her seat. “Have you given any more consideration to hospitalization?”

Kai hesitated, then finally nodded. “It probably makes me even more crazy that the appeal of being drugged unconscious is greater than my fear of being locked up?”

That made Dr. Miller frown sternly. But she let herself focus. The theme here, between Kai’s suicidal and self-harming thoughts and magnetism toward chemical assistance was escape (which she’d recalled he’d said he had used sex for in the past). “What are you so afraid of, Kai? It’s more than the flashbacks. I know you better than that.”

Kai looked at her, surprised again, perhaps at the shift in direction. “I don’t understand.”

“I think you do.”

Kai was silent a long moment, contemplating, staring longingly at the confiscated glass, almost as if he wished he hadn’t relinquished it.

“What are you so desperate to escape right now? Did something other than the flashbacks happen yesterday?”

Kai reached up and fiddled with his hood, as if he were debating pulling it down farther and further hiding in it. “I ran into Nikki yesterday morning,” Kai said on a sigh.

Dr. Miller’s eyebrows went up reflexively. “And?”

“She tried to pretend like nothing happened, like we could just pick up where we left off.”

“And?”

“I told her I was with Renee, but . . .” Kai shook his head.

Dr. Miller waited for Kai to finish.

“I’m still attracted to her. But I told her off and then I went and threw up, and then I broke down and sobbed like a fucking kindergartener.” Kai’s voice rose in his usual self-directed anger.

Dr. Miller scribbled a few notes. “Do you remember what happened before your first ‘freak out’--to use your words--that prompted you to come to me initially?”

She saw Kai freeze. “No,” he tried, though what she could see of his face revealed he didn’t expect her to believe the lie.

“Kai.”

He sighed heavily, rubbed his arm with one hand. Could the sedating effects of the diazepam be wearing off already? “Becca.”

Dr. Miller nodded, added her name to a list in one portion of her notes. “And do you remember one of the main topics of our last meeting?”

Kai hesitated, not that he had to think, but more like he didn’t want to answer. “Re,” he finally replied resignedly.

Another name for the list. “So you have your first major panic attack and series of nightmares in recent memory after Becca reappears in your life. Then Nikki leaves you and you have another major breakdown. Renee goes home for the week and you have a panic attack in public, coincidentally after your first sexual experience with her. . . .” Kai looked like he was going to interrupt, but Dr. Miller kept talking. She wasn’t going to let him derail her. “And Nikki shows up again and that afternoon you have your first flashback. I don’t believe in coincidences.”

Kai pushed his hair off his face, toward the top of his head, where it stayed for a few seconds before slowly creeping back down. Still, it gave her enough time to see how stricken he looked.

“Becca left you when you were vulnerable. So did Nikki, even if she supposedly had good intentions. And you’re convinced that Renee is going to leave you, too, again, when you’re vulnerable, once she figures out the ‘real’ you. Add to the fact that your brother, the one person--except perhaps your friend David, while you lived at County House--who has been a certainty in your life before and since those twelve years might suddenly be not so constant.” Dr. Miller fixed her gaze on Kai. “That’s a lot of stress, Kai.”

Kai’s eyebrows furrowed threateningly, but there was no malice in his voice when he spoke. “What are you saying?”

Dr. Miller softened her tone. “You were abused by your aunt, and you are re-experiecing memories of that abuse. You never really dealt with that before, just did your best to bury it and pretend it didn’t affect you. But the past few months have brought everything back to light, and I think Becca was likely the trigger.” Dr. Miller looked at Kai earnestly, though it was impossible to see his eyes between his hair and the hood. “I think part of the reason you’re struggling so much with nightmares and flashbacks is because of your overarching fears of abandonment and self-esteem issues, feelings of worthlessness and helplessness. Those memories are a perfect echo of the inner turmoil you’ve been going through since your transplant.”

Kai laughed, though it was defensive, hollow, forced. “You couldn’t have sounded more like a shrink in those last sentences unless you’d thrown in ‘Oedipus complex’ or something.”

Dr. Miller chose to ignore his snark. “What do you remember of your life before your parents died?”

Dr. Miller wasn’t sure if it was the effects of the drug dimming Kai’s normally sharp-as-steel, cut-through-bullshit mind, but she’d totally thrown him off guard, again. “What?”

“What memories do you have from before you went to County House?”

Kai rolled his neck, which cracked loudly. “Not many,” he admitted. “I remember Halloween 1983, because it was the only time I went trick-or-treating. I remember bits of that winter, because I was sick with pneumonia for a long time. Most of my memories are less concrete, like, bits and pieces I couldn’t say when they were from. I remember Jon feeding me and playing with me and signing with me. I remember him pounding my back and helping me cough. I remember him bathing me and holding me when I was having trouble breathing. I remember him reading to me. Stretching and massaging my legs when they hurt.” Kai took in a breath, his eyes rolled back as if he were searching the ceiling for answers. “I remember my sister, vaguely. I think she had dark hair, unlike Jon and me, but bright blue eyes like mine. I remember she was always whining that Jon treated me different and that he would yell at her and not at me. I remember her complaining it wasn’t fair that I got more attention than she did. I remember being jealous of her, that she could talk and I couldn’t, and that she didn’t have problems walking or breathing. That her legs never hurt her. That Mom loved her more.” Kai blinked, as if he seemed surprised at what he’d said, like he’d been following some trail in his mind, not realizing where it would take him.

“Do you notice a trend in these memories, however fragmented and non-specific they may be?”

“I’m sure you’re going to tell me,” Kai said wearily. Kai definitely wasn’t himself. Exhausted physically and mentally, probably partially because of the Valium, partially because of the last twenty-four hours.

“You haven’t mentioned your parents at all. All of those memories involve Jon. And not just Jon, but Jon acting in a parental role. How much older than you is he?”

Kai rubbed his face, as if he were trying to stay awake. “Almost eight years.”

“So, in 1983 you were how old? Five?”

Kai nodded.

“For the sake of argument, let’s say your memories start then, though I’m sure some of them are older. That would have made Jon thirteen?”

Kai shrugged.

“And I’m assuming that you needed more care as a young child than a typical kid of your age did.”

Kai scowled.

“I don’t mean that in a judgmental way, Kai. You know this is a judgment-free zone. I’m just trying to lay the facts out.”

Kai sighed. “Yeah. I had major breathing problems until I was about seven, when they leveled out a little for awhile. And I don’t remember, but according to Jon, I didn’t really walk until I was three, and that was only after a lot of physical therapy and with orthotics. And of course, I didn’t talk, and apparently had problems eating for my first few years.” Kai sighed. “I’m not normal; we know that. Do we have to talk about this?”

Dr. Miller decided to ignore his use of the word “normal” for now. “I’m trying to make the point that Jon is a ‘protector.’ It’s fairly typical for the oldest child in an abusive family to grow up quickly, become a ‘little adult’ and assume the roles that the parental figures aren’t serving. Making sure everyone’s fed, that the clothes are washed, the other children are cared for. . . .”

Kai pushed himself up, his back straight, his hood falling off. “You’re saying our parents were abusive? That that’s why I don’t remember them, because of repression or some shit like that?” Kai was getting angry, which Dr. Miller actually saw as a good sign, because the relative apathy of the rest of the session, combined with his admitted suicidal ideations, had concerned her. Anger meant he was engaged.

“Not necessarily, at least not intentionally. But they were obviously absent in some way if your brother felt compelled--even at age thirteen, perhaps younger than that--to step in and take care of you.”

Kai blinked.

“My point is that you remember Jon, not your parents, because potentially he was the only significant parental figure in your life, for whatever reason.”

Kai seemed to let that sink in. “So I was fucked up before I even got to County House, let alone my summer of fun.”

Dr. Miller scribbled a note about Kai’s sardonic reference to the time he spent with his aunt, but nodded. “The fact that one of your memories from that time is being jealous your mother cared for your sister more than you is telling, don’t you think?”

Kai’s forehead wrinkled, just barely visible beneath his hair. “I always believed they didn’t love me because I was . . . broken,” Kai said in a small voice. “Jon says our dad did, but I don’t remember him at all.”

“Do you see yourself as broken?”

Dr. Miller heard Kai swallow, turn his head, look down, clearly ashamed. Without a word, Kai brushed his bangs back over his eyes, resecured his hood, and settled himself down into his original position from the start of the session, making himself as small and invisible as possible, which spoke volumes.

Still, Dr. Miller worried she was losing Kai again, as he seemed to be shutting down fast. “Tell me what you’re feeling right now.”

Kai didn’t answer, but she realized he was crying softly.

“It’s all right, Kai, but I can’t help you if you don’t talk to me.”

“Please,” Kai pleaded. “Please don’t make me talk about this.”

That struck Dr. Miller. If Kai didn’t want to talk about something, he didn’t. He got angry. He got snarky. He artfully changed the subject. This was Kai more like he’d been that day in the hospital, when he’d been suffering from Valium withdrawals. She added that to her notes. “What do you want to talk about, then?”

The question surprised Kai, and she heard him sniffle, take a breath. “Why is this happening to me?”

“What, Kai?” she asked, pressing him to be more specific.

“Why am I losing myself?” Kai’s voice was full of such raw despair it pushed through Dr. Miller’s shields and made her even more determined to ensure Kai left her office feeling at least a little better. She remembered Kai talking before, briefly, about how he didn’t know who he was anymore, post-transplant. It wasn’t a topic he talked about much, but she’d gleaned that he definitely had identity issues. She wrote, Self and identity dysregulation? and boxed it in, hoping it was something she could tackle more later.

“What do you mean?” Dr. Miller queried, hoping to get Kai to elaborate before he shut down again.

“It’s like . . . I’ve never been able to control my body. It does what it wants. Always has. But my mind? That’s always been mine, and I feel like lately . . .” Dr. Miller heard more quiet tears before Kai finally explained, “It’s like I’ve lost it, in more ways than one. Like I’ve lost myself. . . . That’s why this is so . . . why I’m so . . .” Kai was breathing a little faster.

“It’s all right, Kai. Remember, it’s OK to express your emotions. How does ‘losing yourself’ make you feel?”

“I’m scared.” She heard the shudder in Kai’s voice, saw him grip his legs tighter to his body. “I’ve never walked well, I couldn’t talk most of my life, and that’s why . . .” Kai hesitated. “I was weak, and people took advantage of that. I don’t want to be weak, but . . . I can’t control my body. I can’t control that I’m probably not cured, and that not only affects me but others. Jon. . . . This patient of his who won’t get a transplant because of me. He’s just a fucking kid, Dr. M.” Kai paused, the only sound his ragged breathing as he struggled to collect himself. “That’s why Jon and I fought.” A long pause, where Kai didn’t even seem to be breathing, and when he finally made a sound, Dr. Miller realized he’d been attempting to prevent himself from breaking down into more tears, quiet weeping sounds seeping out despite his attempts to stop them. “And now . . . I can’t even control my consciousness? Whether I hurt someone? Myself? What the fuck is left of me? I can’t even trust what’s real and what isn’t.”

Feeling weak--broken, as he’d indirectly admitted to earlier--out of control, and guilty were all pretty par for the course with someone with a history like Kai’s, but it was good to see him admitting to some of it at least, instead of avoiding the subject, as he had earlier. “I can understand why you find this frightening, but you know no one is fully in control of themselves at all times--”

“I’m so scared of losing everyone. Jon.” Kai’s voice broke. “I really thought . . . I’d never seen him angry like that before, not at me. And he took all his insulin with him. . . .” Kai let out a short sob. “David. What the fuck have I ever done for him, other than interpret from time to time? All I do is use him. All I do is use everyone. Jon. Nikki. Re. . . .” Kai broke down in earnest now, either giving up on trying to contain his tears or losing the battle. He buried his face completely in the hood, his hair, and his knees, crying for a long while. “I’m so, so scared of ending up alone. All alone.”

Dr. Miller was beginning to wonder if Kai’s fears of abandonment and isolation were more than symptoms of his history and the abuse he’d suffered, certainly pathological. He hadn’t given her any indications that he had the desperation of preventing said abandonment in the same way someone with BPD might, but she wondered if part of his fears about “losing himself” were an extension of that same terror of aloneness. Madness, even if it wasn’t true insanity in the sense of psychosis, was certainly isolating, especially if it forced Kai to relive the moments in which he felt most alone, the most helpless, in his life.

“Do you know what a self-fulfilling prophecy is?” she asked, hoping to dig a little deeper into the issue.

Kai let out a sound of confused surprise.

“It’s when you believe something so strongly that you make it true.” Dr. Miller shifted in her seat. “I see it a lot in patients who’ve suffered abuse. You’re convinced that bad things will happen. That people will leave you, so, consciously or not, you sabotage.”

Kai pushed himself up, partially, so he wasn’t one with the recliner, which was potentially good. The hint of anger in his voice was good, too. “So, what, I’m so pathetic that I have to create drama, like yesterday, to keep people from leaving me? Like, I was so afraid of losing Jon forever I went crazy just to get him back and keep him close? So now you’re going to tell me I’m fucking Munchausen or something, like I make all this shit up because I’m so fucking scared of being alone?” What Dr. Miller could see of Kai’s eyes were angry, though a few stray tears traced down his cheeks anyway. “Or maybe, I do this shit so people will leave me, so I can blame them instead of me?” His eyes widened with realization, though she could only see one eye clearly through his hair and hood. “That’s what I did with Becca and Nikki, didn’t I?” His gaze was directed downward as he continued, speaking almost to himself. “I was going to do that with Renee, too.” Kai suddenly became very agitated. “Fuck. Fuck. Fuck.” She saw one of his hands dive into his pocket, and she jumped up, worried that he might have another piece of glass, but then he let out a harsh sound of frustration, as if he’d forgotten he’d given it to her. “It would be easy to use all this shit to push her away.” Kai crumpled. “Dammit. I love her,” he said, surprised as the words spilled out. It surprised Dr. Miller, too, who, knowing the limited details of his relationship with Becca, hadn’t believed Kai would be capable of admitting love so soon. “But what we have isn’t real.”

That got Dr. Miller’s attention. “What do you mean by that?”

“It can’t be real. It can’t last,” Kai said, his breathing quickening. “Look at me. I’m a fucking mess. I pissed myself last night because I was so fucking . . .” Kai grunted as if he didn’t want to admit it. “. . . scared, lost in another fucking waking nightmare. Re deserves so much better. Someone who isn’t such a needy, insecure little bitch. Fuck. Dammit. Fuck.” Kai was hitting the chair, as if he were desperately in need of throwing something, his chest jerking like he wanted to sob again but couldn’t quite get there because of his anger. He let out a frustrated scream, reaching up to pull at his hair, breathing heavily.

Dr. Miller inched toward her desk.

“Maybe I should let her see me like this, so she can get scared off for good and . . .” Kai was rambling, as if his thoughts were just spilling out uncensored. “And that’s exactly what you mean, self-sabotage, right?”

Dr. Miller found her stash of Xanax and tapped out a single pill, a small dose. “You admitted to me that Renee makes you happy, that she makes you feel free, alive. Safe.” She headed for her mini fridge to grab a bottled water.

“She does. God, she makes me feel like no one else ever has, not even Becca, not even Nikki. . . . Sex with her was even something completely different. With Becca it was . . .” He hesitated, shook his head. “A way for her to control me, I think,” Kai said, his words full of disgust, his hand on his stomach as if he were going to throw up. “Dammit.” He took a few steadying breaths. “And Nikki was about escape. Forgetting. But Re. With Re. . . .” Kai sighed. “I almost didn’t care about getting off. How fucked up is that? I just . . . I just wanted to be with her and make her feel good, make her not regret being with me.” Kai’s agitation was growing, his hands searching for something to keep them occupied. “With her it’s just.” He sighed, frustrated he couldn’t explain himself. “When I’m with her, everything is . . . peaceful. Like, I dunno, like it can’t be real, because it’s too perfect. Life isn’t like that.” Kai shook his head, almost violently, as if doing so could toss the thoughts physically out of his head. “This is so stupid. I’m so stupid.” Kai whacked his head with the base of his fists. “I let her trust me and I’m just going to totally destroy her.” Kai’s anger didn’t ebb, but he soon dissolved into tears. “All these memories . . . all these years I told myself it wasn’t true,” Kai said, almost babbling to himself, cupping his hands over his eyes. “What if . . . everything she ever said . . . everything the bullies in school ever said . . . what if they were right about me?”

“Kai,” Dr. Miller soothed, snagging one hand and offering him the bottle. “Drink some water. Have you ever taken Xanax before?”

Kai obeyed, sniffling, eager to take out some of his frustration on the bottle, swallowing a few gulps greedily. “Yes. Once that I know of. My first freakout Nikki gave me some.”

“And it worked for you?”
    
Kai seemed confused, but not so much by the question, more at having been derailed. He nodded.
    
“Here,” she said, offering him the pill. “I think this’ll help you right now.”
    
Kai took it, stared at it a moment, checked her eyes as if he didn’t trust her, but finally, he swallowed the pill. Then he let some of the tension go out of his body, sinking back into his defeated, secure position.
    
“I know you don’t think so,” Dr. Miller said, retaking her seat, “but flashbacks can be a sign of recovery. It means you’re ready to face your traumas head on and move past them.”
    
Kai sighed heavily. He was shaking, almost shivering, wrapping his arms tighter around his legs.
    
“Some therapists like their patients to deal with the flashbacks without drugs, but I believe you’re also dealing with depression, something I think you’ve been struggling with since your transplant. Would you agree with me?”
    
Kai let out a long sigh. “Is now the time you tell me my ‘suicidal ideation’ is an extension of my ‘inability to accept my continued survival,’ or something like that?” Kai’s words were mocking, as if he were quoting his previous therapist, but he just sounded tired. The reality was, Dr. Miller suspected part of Kai’s problems did arise from that, from a combination of twisted survivor’s guilt to what essentially amounted to Adjustment Disorder--Kai’s struggle to accept his new life, post-transplant.
    
“What do you think?”
    
Kai grunted. After Dr. Miller said nothing, though, he finally spoke. “I spent most of my life being told I wasn’t going to live, or I was going to die young. I didn’t really expect I’d make it to eighteen, and I spent most of the time between then and now actively dying. I never expected to be here, to go to school and meet a girl who could be . . .” She could hear Kai’s breathing slow as the medicine began to work. He shook his head, and looked away, as if he were shutting down again.

“Could be what, Kai?” Dr. Miller prompted when it didn’t seem like Kai was going to continue on his own.

Kai sighed heavily, wiped his eyes with his sleeves, then dropped them, staring down at them to avoid her gaze. “It’s gay as fuck, I know, but . . . I just . . . wanted someone to love me.” Kai let the words hang in the air for a moment as Dr. Miller wrote that down. It wasn’t a surprising admission based on Kai’s history and the types of things he’d revealed to her before, but it was good for him to say it out loud, blatantly. Kai looked up through the curtain of his hair. “Not because they were obligated or forced or dared or wanted to fuck around with my head. I thought I had that with Becca, but I was stupid and naive. . . . I’m pretty sure Re loves me, though how, I have no fucking idea.” Kai’s voice hitched, like he was going to break down again, but he didn’t. “I never really planned for my future, because I never thought I’d have a future. And now I have Re, and . . .” Kai did break down now, but it was a quiet intensity, perhaps mediated by the Xanax. “. . . I want everything with her. I want it so bad it terrifies me, because it’s easy not to care about something you know you can never have. Right?” He pushed his hair out of his face, revealing red-rimmed, desperate-looking eyes. “Like, I’ve never walked normally, so it’s not something I miss, right? How can you miss something you’ve never had, that you’ll never have?” Considering Kai’s issues with feeling “broken” or not “normal,” and lacking control, and his admission, earlier, that the labels (such as “freak” and “fucked up” and “worthless”) given to him by his aunt and others might be “true,” Dr. Miller wondered how honest Kai was being, not just with her, but with himself. Dr. Miller didn’t interrupt, though, making a note to explore the concept later.

“But . . .” Kai wasn’t bothering to hide his tears, looking through them toward Dr. Miller like the last puppy in a litter staring out, alone, from the glass of a pet shop, certain no one would ever take him home. “I want forever with Re. Dammit. How fucking sentimental is that? I haven’t even fucking known her that long. I’m such a fucking idiot.” Kai’s swearing always increased when he got particularly angry with himself. He shook his head as more tears fell. Wiped his nose with the back of his hand. “I want it, but I don’t even know if I can survive today. I don’t know if I deserve it, even if I can.”
    
Dr. Miller took her own deep breath. “First of all, Kai, thank you for being so open with me. I know that wasn’t easy for you.”
    
Kai breathed out noisily, sunk down into the recliner, his eyelids drooping. The Xanax, probably.
    
“Second, no one can give anyone ‘forever.’ That’s one reason marriage vows are until ‘death do us part.’ Third, desiring love is normal for anyone, but especially someone who grew up largely without parental affection. You’ve told me about County House; you didn’t exactly have a mother or father figure there. You talk about that experience as if it were incarceration. So it’s understandable for someone like you to crave the intimacy you never had growing up.” Dr. Miller took a deep breath. “But most importantly, wanting something you’re not sure you can have is part of life, Kai. And you’ve been blessed with life, whether it’s a week or a decade or more. Life is scary, but have you ever really let fear stop you from doing what you wanted?”
    
Kai shrugged. Either the drug was combining with the Valium in his system and making him groggy, or he was simply psychologically exhausted. Both were legitimate possibilities.
    
“Death is easy. The dead have no problems, no fears, no doubts. I think it’s very possible that part of you wishes you hadn’t been transplanted, that you had died last year, so you can fantasize about not needing to deal with any of the difficult emotions that have plagued you since then.”
    
Fresh tears spilled out of Kai’s eyes, but he said nothing.
    
“I think there’s a reason why you find talking about your last couple years pre-transplant harder than talking about the summer you spent with your aunt.” Dr. Miller grabbed the box of tissues from the nearby table, rose, and offered them to Kai. “But think of all the things you have gotten to experience in the last year. Yes, you’ve had heartache, but you’ve also had happiness and love. You won’t say the word, but I know you’ve wanted to. You see Renee as ‘the one,’ and maybe you’re wrong, but how many people at twenty-two--or even at any age--can say they’ve found that kind of love in their life? And that doesn’t count your brother, who I know would insulate you from every hurt in the world if it was in his power, he loves you that much. He got angry with you because he loves you. Does this make sense?”
    
Kai blew his nose, coughed for several minutes, wheezing, then coughed some more. Kai nodded.
    
“I consider myself pretty conservative when it comes to prescribing for my patients, but I would like to propose two additions to your medications, if you’ll hear me out.”
    
Kai grabbed more tissues, coughed more, wiped his face. The Xanax really did seem to work for him; he was far more serene than he was before, and it wasn’t the stoned, dead look of the Valium, either. He nodded.
    
“I’d like to consider offering you Xanax, to take on an emergency basis, like yesterday, when the hydroxyzine and mindfulness aren’t enough.”
    
Kai used another tissue to wipe some gunk out of his eyes. “I know you just gave me some, but can I really take Xanax and Valium together?”
    
“I’d prefer, under normal circumstances, you didn’t. But you can, if you’re careful. But I think it’d be best if you kept only a dose or two on you at a time, and let Jon hold onto your benzodiazepines for you. Especially at a time like this. Do you understand?”
    
“So I don’t kill myself,” Kai said flatly.
    
Dr. Miller decided there was no reason to sugarcoat it. “Yes. Especially since you might not even do it entirely intentionally. You might simply be hoping to turn off your pain, and when one pill doesn’t work, you’ll take another, and another. . . . The Xanax clearly works for you, Kai,” Dr. Miller said pointedly. “That was only half a milligram.”
    
Kai laughed. “I think yesterday I had like, 14, 20 milligrams of Valium at once, combined between pills and shots. Probably would’ve killed a normal person.” Ten milligrams was usually considered the maximum dose, but Kai had a tolerance from taking the drug for so many years.
    
Dr. Miller frowned. “If you don’t think you can trust yourself, be honest with me, Kai.”
    
“I don’t trust myself,” Kai said without hesitation. “But I do trust Jon. He won’t let me hurt myself, not if he can help it.”
    
Dr. Miller nodded. “I also want you to consider an antidepressant called Celexa. It’s very effective for anxiety. I’ve seen patients respond within only a few days; most within a week or two. It may also eventually help with your mood. I know you’re happy when you’re with Renee, and it’s good that she helps with your anxiety, too. But you know you can’t rely on other people to make you feel good about yourself.”
    
Kai laughed derisively at that, but nodded.
    
“I’ll talk to Jon, and you two can discuss whether it’s something you want to try or not.” She smiled faintly. “How are you feeling right now?”
    
“A little better,” Kai admitted. “But that’s like asking the guy who barely survived a T5 tornado, which destroyed his house around him, if he’s fine.”
    
Dr. Miller nodded. “Try to wean off the Valium and take the Xanax four times a day in its place for the next couple days. Relax. I can’t promise you won’t have any more flashbacks, but you can try some of the techniques you use for your anxiety to moderate them. Stimulating your senses when you suspect one might be coming can help. It won’t always prevent the memory, but it can help shift your focus so you’re watching them instead of living them.”
    
Kai nodded weakly. “Would you . . . would you be disappointed in me if I used rubber bands again for a little while?”
    
“Kai,” Dr. Miller said gently, “you don’t need my approval.” Though it was telling he felt he did. “I’m not here to judge you, remember? If you think you need a way to release your self-harming urges in a way that is relatively harmless, then go ahead. Are you feeling that urge right now?”
    
Kai looked so ashamed, like a young boy who wanted nothing more than for his parent to be proud of him. Which, in some ways, even as an orphan, Kai still wanted. “The past few days, it hasn’t really gone away. . . . Before the first flashback, I was looking for something to hurt myself with, anything I could find in my friend’s bathroom, but there wasn’t anything. And this whole time, it’s been hovering in the back of my mind, kind of like . . . kind of like when you’re too busy to eat, but you’re really hungry, and it keeps trying to pull your attention away. If that makes sense?”
    
“Let’s try an exercise before we go. I wasn’t sure you were ready for this quite yet, but it’s not something you can ‘master’ overnight; it can take weeks, even months, but you might find it helpful. It’s called the Circle of Forgiveness. It’s a mindfulness exercise.”
    
Dr. Miller had expected Kai to resist, at least say something sardonic, as he professed an outward scorn for therapeutic exercises in general, though later, he often would (reluctantly) admit they were helpful. Instead, he simply said, “OK.”
    
“Close your eyes, and imagine you’re in a beautiful park in early summer. It’s warm, but not hot, and the birds are chirping. Somewhere, in the distance, you can hear the laughter of a party, or maybe a game, people having fun. You can smell the grass . . .” Dr. Miller half expected Kai to interrupt here, as he sometimes would, to say that fresh-cut grass made him wheeze, but he didn’t. He seemed to be cooperating, and she thought, however inappropriately, that maybe she should drug him with Xanax before sessions more often. “Someone, maybe at the party, is grilling, the scent of charcoal floating in the air. You’re peaceful. Content. You’re alone, but you’re not lonely, you’re not scared. You don’t ache anywhere; your muscles are loose. You’re breathing slow and deep and relaxed.”
    
“It’s a beautiful day,” Kai added sleepily. “The sky is bright blue, and clear, with only a few clouds, and there’s a warm breeze that feels like a delicate touch on my skin.” Kai sighed softly. He normally was never this cooperative.
    
“That’s good,” she encouraged. “In the distance, you see people approaching you from all sides, but they’re not threatening. You’re not scared at all. In fact, you’re happy they’re coming closer. Once they get about ten feet away, they form a circle around you, and you can feel hope and love radiating from them. These are people who you need to forgive, or who you want to forgive you. Who do you see, Kai?”
    
Kai let out a long breath. Again, he answered genuinely, surprising her. “My mom and dad. Jon. Becca, Nikki, Renee. David. Art. Ms. Evans. Jake. Jo. Vicky. Jenny. Troy. Dr. J. Martin.” Kai’s voice broke on that last name, and though he named a few other people, Dr. Miller couldn’t distinctly tell all of them until he finally said, “My aunt.”
    
“That’s good, Kai. Now, I want you to imagine going up to each person you need to forgive, look them in the eyes, and I want you to call them by name and tell them, ‘I forgive you for hurting me. I release you. You have no power over me any more. Go in peace.’ Take as much time as you need, Kai, and don’t be afraid of the emotions that might arise with each person. You might find it hard to say those words, even in your mind, to some of these people. It can take time. But I want you to try, OK?”
    
Over the next few minutes, Dr. Miller coached Kai through the exercise, which did bring up some strong emotions--particularly with his parents--though perhaps not as strong as if he hadn’t been on the benzodiazepines.
    
“I can’t,” he said, though, at one point.
    
“What can’t you do?”
    
“I can’t picture my aunt. I can’t believe she’d be there.”
    
“That’s OK, Kai. That can be something for you to work on. This isn’t something that can be done right or wrong; it’s a process, and it takes time. I want you to watch the people you forgave walk away. You feel their relief and happiness; it’s also yours. Now the circle is filled with those people whom you may have hurt and who need to ask you for forgiveness. Do you see them?”
    
He laughed, but it was tinged with tears, his voice emotional. “There’s more of them than the other group.”
    
Considering how much guilt and shame Kai carried around with him, that didn’t surprise her at all. “There’s one person that might not be there, but I want you to picture him. Can you do that? Can you picture yourself, looking at yourself? Like you’re one of the group, but you’re also still in the center of it.”
    
Kai took in a wheezy breath. “I can’t look at myself,” he admitted, his voice pained.
    
She knew he didn’t mean he couldn’t picture it in his mind, like with his aunt, but rather, that he couldn’t meet his own gaze. “Why, Kai?”
    
Kai seemed reluctant to respond initially, finally admitting, “Because you need to respect someone to look them in their eyes, right?” He sighed.
    
Dr. Miller jotted that down. “I know he’s probably the hardest person to face, but I want you to imagine him approaching you. I want you to picture him telling you--in sign or English, whatever is easier for you--that he forgives you. Telling you, ‘Kai, I forgive you for hurting me. I release you. You have no power over me anymore. Go in peace.’”
    
Kai started to sob, his eyes still closed, his hands held up in front of him, moving in what she knew had to be signs, though she would never have been able to make out anything more than some pointing and blurred fingers.
    
Kai then opened his eyes. His face was a grimace, almost as if he were in physical pain. “Please don’t make me do any more,” he said softly.
    
“It’s all right,” Dr. Miller said, speaking soothingly. “Forgiving yourself is going to take time and effort, but I think that may be more important than anything else. I want you to do this exercise once a day, every day. You can skip the people who you don’t feel ready to confront, like yourself, or save them for the end. Try. I want you to write down how you feel with each person, anything that stands out, and I want you to genuinely work your way toward confronting yourself. OK?”
    
Kai sighed, but he nodded. Tired, defeated.
    
“I also want you to start thinking about characteristics you think of when you imagine a ‘good’ mother or father. People you might know, in real life or in fiction, that you think of in these roles.”
    
“I smell another exercise,” Kai said wearily, but with a faint sly smile. Perhaps, as difficult as the exercise was, it had helped him as she’d hoped it would.
    
“Yes, but that’s for another day. I just want you to start thinking about these things. If you could have a genie grant your wish for parents, what would they be like? They don’t need to be ‘perfect,’ because no one is. Just give it some thought.”
    
Kai let out a long breath. “Thank you, Dr. Miller. I feel . . . I don’t want to say ‘better,’ but . . .” Kai passed his hand over his face. “More hopeful, I guess? A little less lost.”
    
Dr. Miller smiled, relieved. “That’s good to hear. Use the Xanax, and even rubber bands or other distractions for your hands if you need them. Let Jon support you. If your self-harming urges become overwhelming, you can call me. But I’d still like to see you again tomorrow morning.”
    
“Re flies in tomorrow afternoon.”
    
“How does that make you feel?”
    
“Scared. Confused.” Kai shoved his hair off his forehead. “I want to see her so badly, but at the same time, I’m afraid. It’s not even so much about her seeing the crazy part of me, though that’s part of it. It’s . . .” Kai cradled his face in his hand. “I’m not ready to tell her about my aunt. I’m not sure if I’ll ever be ready. And how do I explain the past day without it?”
    
It was a very valid point, but she was happy to see Kai being so self aware. That he was beginning to recognize, and even want (though that was probably too strong a word) to let Renee into this final major corner of his life. “Why don’t you give that some thought, too. Talk with Jon about it, if you feel comfortable. And we can try some role playing tomorrow, which might help.”

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2 comments:

  1. Wow--Very powerful writing. Fantastic job. Thanks.

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  2. This is so amazing. I just love reading it. What a fantastic writer you are

    ReplyDelete