September 18, 2000
Dr. Miller pretended to be making some final notes in paperwork as she let Kai get settled in for their second session. In reality, she was observing him surreptitiously. He looked simultaneously worse and better than he had a week ago. Clearly, he’d been sleeping, the purple bags gone, and he was clean shaven. But he seemed weary, groggy, his hair a little disheveled, his eyes droopy.
He sat in a compact blue wheelchair, dressed in a faded long-sleeve T-shirt and loose gym shorts; his feet were covered in what looked like two or three layers of socks, but no shoes. His left leg wasn’t as muscular as his right, on which he wore a bulky black knee brace. He slouched, one hand on a pushrim, as if that was all that was keeping his upper body upright.
“You’re welcome to the couch. Stretch out, lie down, if you’d like,” Dr. Miller offered, setting down her pad and sipping some of her coffee.
He glanced over at the couch he had parked himself beside and shook his head. “I’ll stay here for now,” he said quietly.
Dr. Miller nodded. “So, how have you been feeling since we last spoke?”
Kai let out a weary laugh that almost sounded like air being released from a tire. “What do you think?”
Dr. Miller kept her gaze fixed on him, an eyebrow raised, patient.
After a moment, Kai sighed, started to lean forward, forearms on his legs, then winced and pushed back. “You talked to my brother?”
She nodded. Jon had called her Friday afternoon to explain, succinctly, why Kai had missed his Tuesday session, and to schedule today’s visit. “He told me you were in the hospital last week.”
Kai smoothed both hands over his face, covering it, elbows braced against his chest. He nodded slowly.
“Do you want to talk about it?”
Kai didn’t respond for a long while, not moving except for the slight rise and fall of his shoulders with each breath, his hands still masking his face. “No. Maybe,” he hedged.
Miller contained her sigh, shifted her legs so the opposite was crossed over the other, her ankle bobbing. “How has your mood been since I saw you last?” she asked instead, hoping shifting gears would help.
She heard a harsh breath of air blow against the palm of his hands, and he let them fall away. “I’ve been drugged up the ass,” he said. His face was almost devoid of expression, but unlike a week ago, it didn’t seem intentional, but rather, as if he were simply too tired to show any emotion there. Like it was too much effort.
Miller nodded, giving him a chance to elaborate.
Kai sighed, realizing what she was doing. He closed his eyes for a moment, as if thinking, before opening them again. “But I’ve been all over the place,” he admitted finally. He glanced over at the couch, leaned slightly, flicked off his brake, and wheeled himself backwards until he lined up roughly parallel. He shifted the brake back on, took a breath, and lifted his body carefully out of the wheelchair and onto the couch, taking extra care with his injured leg, his skin paling and face scrunching up subtly as he moved.
Miller noted the brace kept Kai’s right knee locked at a ninety-degree angle, and that the tone in his left leg was low, his foot floppy at the ankle, his knee loose. It took Kai several more minutes to arrange his legs, tenting a pillow beneath them before lying back with an audible sigh.
“Please don’t make me move for an hour,” Kai said in an indeterminate tone.
Miller chuckled softly and sipped more coffee. “Tell me how your mood has been the past week.”
Kai swallowed; his eyes drifted closed. “I freaked out my first day awake.” Miller could see Kai was gritting his teeth, the hinge of his jaw working. “I was fucking terrified, panicking, and I let it show.”
Kai took a breath, and a finger moved to a strap on his brace, dragging his nails on the velcro. “I don’t remember that well. They put me out with milk of amnesia, and I was already pretty stoned.”
“Kai, I think this is important. Tell me what you remember. Even if it’s only how you felt.”
Kai scraped his nails on the velcro repeatedly, and Miller realized Kai wasn’t wearing a rubber band; his hands apparently weren’t sure what to do with the nervous energy. “One of the drugs . . . it makes me really sick. Dizzy, nauseous. And . . .” The velcro ripping sound grew as Kai started tearing off part of the strap and replacing it, his breathing increasing, his anxiety blooming.
“Relax, Kai. Safe space.”
Kai forced himself to take a few slow breaths, buried his hands under his butt. “My legs started spasming again. I . . .” Kai swallowed. “I can handle pain. I haven't gone a single day of my conscious life without pain. Mostly without drugs. I know pain . . ."
Dr. Miller noted how Kai seemed so proud of his pain tolerance, yet clearly defensive. But it was telling: chronic pain, especially over a lifetime, could cause depression, anxiety. Dr. Miller doubted it was the root of Kai's problems, but it certainly could exacerbate it. She wrote chronic pain, underlining it.
"But . . ." Kai squeezed his eyes tightly shut. "I was in so much pain. Pain like I've never felt before. . . . And it pushed me over the edge." Kai's chest heaved as his breathing grew more ragged.
"It's all right, Kai. No one's judging you here. Tell me how you remember feeling."
"Hurting. I was hurting so bad. And I was so nauseous. And dizzy, like the room was spinning around me. And confused. And . . . terrified. So fucking terrified." Kai stumbled on the final words, hyperventilating now.
"Kai, relax. Stay with me. You're safe here. Deep, slow breaths. Come on. In," Miller counted in her mind a slow five seconds, then prompted him to exhale. She repeated the process a few times, until he seemed to have relaxed a bit. "Why were you so afraid?"
Kai shook his head. "I don't know. It was like the day before I came to you the first time. Overwhelming. Pure fear and panic." Kai's nails scraped against the velcro again, almost as if he had an itch he were trying to scratch through the thick fabric of the brace. "I--I was terrified they'd put me out and Jon would leave me. Fuck. It doesn't make any fucking sense." Dr. Miller could hear the creak of Kai’s teeth and jaw as he ground them. “I freaked. I acted like a fucking child."
Dr. Miller scribbled a few lines, making notes about Kai’s sense that emotions were overwhelming. She wrote, fear of being alone? control?? and boxed it in, hesitated a moment, then added, BPD? It was far too early to say, but so far Kai seemed like a potentially classic case of Borderline Personality Disorder. “Those seem like legitimate fears. That’s a scary situation.”
“You don’t understand,” Kai ground out, turning his head toward her. “I don’t . . .” He took a few breaths as he struggled to figure out how to express himself. “Do you know how many times I’ve been hospitalized?” Without giving her a chance to answer, he continued, “Neither do I. I lost count years ago. Point is. None of this is really new. I’ve dealt with severe MLS flare ups before. Alone. My first two years of high school were basically one long attack.” Kai cradled his left wrist on his stomach, his right fingers picking at the skin as if trying to find an outlet for his anxiety, as if searching for the rubber band that wasn’t there.
Miller rose, went to her desk, and fished out a couple foam stress balls. Crossing to the couch, she offered them to Kai.
He stared up at her, confused.
“Take them. Pull them apart if you want. I’d rather you do it to these than yourself.”
Kai looked at his wrist, which was red, scratched and irritated from his nervous tic. He frowned, accepting the balls, squeezing them in each hand before letting one rest in the curve of his stomach and proceeding to tear apart the other.
Dr. Miller retook her seat, watching as little bits of foam snowed down on Kai’s belly. “You went through all that alone because you had to. But you’re not alone anymore, Kai. You have your brother. And you have friends?”
“No,” Kai said in a distant voice. His eyes staring up vacantly at the ceiling while his fingers continued to work on destroying the ball.
Kai sighed. “Growing up, my only real friend was David, my roommate at County House. But he was a year-and-a-half older, even though we were in the same grade, and when he aged out, he disappeared. We didn’t go to the same school anymore, and I didn’t exactly have the ability to go searching for him. I haven’t seen him in probably six years.”
“And there’s no one else?”
“Jake. My friend from the hearing high school. He stayed in town for college and was there for me during a lot of the time pre-transplant. But he’s in med school now in Chicago. We talk on the phone some, but I miss signing with him. It’s not the same.”
The chunks of foam Kai was pulling off the ball were growing larger. A few more minutes, and the first ball would be unrecognizable.
“What about a girlfriend?”
Kai let out a laugh that sounded more like a sob and turned his head away, toward the back of the couch. “Nikki. I kicked her out. I haven’t seen her since.”
Interesting. Dr. Miller scribbled that down, noting relationship problems?, also boxing that in. “Why?”
Kai shook his head, squeezed the remaining intact ball hard in one fist. “I was in a lot of pain, and angry. So angry, because of my leg.”
“What about your leg?” Dr. Miller probed. The brace suggested he’d injured it, but it would be good for Kai to talk about this, his body language--fist clamped tight around the stress ball, tension in his shoulders--suggested lingering frustration.
“My right leg has always been my ‘good’ leg. I spent the months after my transplant getting my strength back, building up my muscles, working with the control I do have so I could walk almost unaided.” Kai closed his eyes, threw the intact ball hard against the far wall. “Fucking worked against me. My hamstrings and quads fought, and because my hamstrings were stronger, they won.” Kai’s breath grew a bit jagged; he blinked furiously. “I may not walk or stand ever again. And I know it shouldn’t bother me, because I could be dead right now and the glass is fucking half full and all that, but Nikki’s gone, and I can’t talk to Jon about any of this and I’m just so . . .” Kai broke down, covering his mouth so the rest of his words came out muted. “Fucking alone. And I fucking hate myself for feeling like this, because ‘alone’ is all I’ve known for most of my life. Fuck.” His palms covered his face, his chest jerking as he cried, swearing at himself.
Dr. Miller pulled some tissues from the box on the table beside her and stuck them in Kai’s hand, not saying anything immediately, giving him some time. She observed how shame and guilt rode along with nearly all his emotions. As if he couldn’t allow himself to express any emotion too strongly, and if he did, he felt as if he’d failed some ridiculous test. It was likely there was more in Kai’s past that she didn’t yet know, perhaps relating to the other nightmare he’d been shell shocked about during their last meeting, and which she still needed to probe him about later if they had time.
“Why can’t you talk to your brother, Kai?”
Kai sucked in a few steadying breaths, blew his nose and wiped his eyes. “Because Jon has a messiah complex. He thinks it’s up to him to save the world. He . . . cares too much.”
“How can you ‘care too much’?” Dr. Miller asked.
“Jon takes failure personally, even if it’s not in his control. Everything that happened to me while we were separated? He blames himself for. And he doesn’t fucking know the half of it,” Kai said bitterly. “This attack? He hasn’t said it, but I know he’s been feeling guilty about it. He hasn’t worked, other than to treat a few inpatients, in more than a week. Even when I was waiting for my transplant, I know he worked part time.”
“It’s not good that he’s taken time off to help you through this?”
Kai sighed, frustrated. “Of course it is. Fuck, I don’t like to admit it, but I don’t know what I would have done without him these past few days. But--”
“Everyone needs someone sometimes, Kai.”
“It’s not that. It’s--” Kai struggled to explain himself. “You weren’t there. You didn’t. . . . I screamed and cried and pleaded for him like I was still six-years-old, terrified I’d never see him again. I . . . I don’t let Jon see me like that.”
“Because . . . because I’m not a kid anymore. Because I don’t want him to think I am. Because . . . because I don’t want him to worry about me.”
“You don’t want him to treat you like a child, yet you’re treating him that way.”
Kai pushed himself up awkwardly onto his elbows so he could see her better, his face confused and surprised. Bits of stress ball floated to the ground.
“Would you want your brother keeping things from you to ‘protect’ you? Wouldn’t that be patronizing? Condescending?”
Kai blinked, baffled.
“I do think you love your brother and genuinely want to shelter him. But do you want to know who I think you’re really protecting?”
Kai dropped back down, staring up again at the ceiling almost unblinking. Finally, he nodded.
“The nightmares. Have you had any the past week?”
Kai swallowed. “Too drugged up in the hospital. They started again once I got home and my dosages were paired back.”
“As bad as before? You seem tired, but not as desperately sleep deprived as you were last week.”
Kai laughed, flicked the remaining bits of foam off his stomach. “Drugs. Drugs to keep my muscles from spasming. Drugs to keep them from locking when they do. Drugs to keep me from throwing up because of the other drugs. Honestly not sure how I’m even awake right now, and not hurling on your couch.” His tone was light, self-deprecating, but weary. “When they wear off, that’s when the nightmares come. The same ones. I woke up screaming the other day, a few hours after I got home from the hospital. Thank God Jon didn’t ask what I’d dreamt about.”
Dr. Miller shifted her weight. “I want you to tell me about the other nightmare. The one you didn’t want to talk about last time.”
Kai took in a breath, held it. She saw a few tears trail down his cheeks he didn’t bother to hide or wipe away, though he kept his gaze fixed on the ceiling. “Sometimes I wish I could get high instead of sick from drugs like morphine or Valium. Only drug that ever really made me that way is the patch.”
Kai pressed the heels of his palms into his eyes. “I begged for that, in the hospital, the day Nikki and I fought. The pain was that bad, but . . . but after she left I needed to get out of my head for a while. I don’t remember the rest of that day. I nicknamed her ‘Forget,’ you know? It’s a sign language thing. Sometimes all I want to do is forget. Forget the last twenty-two years and just . . . start over. But there is no starting over, is there? Ever?”
Dr. Miller took a careful breath, then responded, “We’re all a product of our pasts. Bad and good.”
“What if there’s more bad than good?”
“Tell me about this other nightmare, Kai.”
Kai choked out a laugh. “I guess better to do it when I’m doped up on muscle relaxants so I don’t go full-out panic attack on you, huh?” He smoothed his hands over his arms, dragging his fingernails over them, almost like a junkie hungering for his next fix.
Dr. Miller set down her pad and pen, rose, and crossed to her filing cabinet. She opened the bottom drawer, sorted through it, before finally pulling out what she’d been looking for. It was an old, worn, thin T-shirt she’d originally intended to tear up for cleaning cloths. She offered it to Kai.
He stared up at her, warily, the fingers of one hand teasing at the edge of the fabric. Dr. Miller found a loose string and pulled; it made a satisfying tearing noise. Kai didn’t quite smile, but a relieved look passed fleetingly through his eyes and he seized the material.
Dr. Miller returned to her seat, watching as Kai wrapped the fabric around one hand, pulling it tight, before releasing it again and repeating.
“For almost three months, the summer I turned ten, I lived with a woman named Julia Taylor.” Kai pulled the fabric through his hands, giving them something to do that wasn’t self destructive. “She said she was my father’s sister, that she’d been out of the country for years and had only just learned of my parents’ deaths.” Kai stretched the fabric and picked at it, his eyes still staring up at the ceiling. “It was kind of nice at first. Living in a real house, being the only kid. Even if she didn’t know sign language. I was used to that, since only one staff member really knew it at County House, and only a little.” Kai paused for a long while. “My breathing was good, then, relatively. My MLS, not so much, but . . .” Kai shook his head, clasped his hands together; they were trembling subtly. “I can’t.”
“I’m not trying to force you, Kai. But I think this is important. Why don’t you tell me about the nightmare itself. Maybe that would help.”
“It’s so real, though,” Kai said in a whisper. He took a few breaths, clearly trying to calm himself. He’d tied the fabric around one wrist, pulling on the other end. Occasionally, it’d rip. “In the nightmares, it’s like I’m ten again. Living in her house. I’m terrified, because she’s angry at me. So, so angry. That part of the dream changes, but usually it’s because I threw up on her shoes.” Kai laughed snidely.
“Did that really happen?”
Kai twisted the shreds of fabric around his fingers so tightly he threatened to cut off the blood supply. “Yes.”
Dr. Miller scribbled a few notes, but gave Kai time to elaborate.
"It's . . . I don't . . . I don't talk about this. Ever. To anyone."
"I'm not here to judge you, remember. And this is all confidential."
Kai choked out a weak laugh. "It's not that," he said, tearing at the fabric. "It's . . ." He took a deep breath, bit his lip, struggling to explain. "In the nightmares, I'm ten. Everything that terrified me then is real again. Sometimes, it takes me thirty minutes to come out of it, to escape the panic, and realize I'm not that scared kid anymore. And when I do, when I think about it now, it's . . . embarrassing."
"Why is it embarrassing?"
"That I let her do what she did. That I was so scared . . . not of her, but that she--" Kai's breathing suddenly shifted into nearly full hyperventilation, his eyes squeezed tight. A few moments passed, and then he admitted, "I want to cut myself so bad right now." He began tearing the fabric in earnest, his hands shaking. "And I hate that I can't even talk about this without feeling that way, and that makes me want to cut more, and--" Kai was gasping for air now.
Dr. Miller offered him a paper bag she'd left out in case he needed it.
After a few minutes of breathing into the bag, he calmed, though he was still shaken up. Dr. Miller wasn't sure what exactly had triggered the mini panic attack--if it was the memory of the nightmare, of whatever things he had gone through with this woman, or his obvious overwhelming shame of how deeply it had all affected him. Likely, it was some combination.
"It's all right, Kai. Talk to me."
He nodded, took a few steadying breaths. "She starved me." He winced, clearly ashamed to admit it.
Kai turned his head away to hide his face. "I couldn't talk, not until I hit puberty. Not wouldn’t, couldn’t. But many people assumed I was just stubborn. Or retarded." Kai paused for a long time; when he finally spoke again, his words were tinged with tears, even if he still had his face turned away. "Every day, she'd ask me, 'Are you hungry?' When a nod wouldn't suffice, I'd sign, 'I'm hungry.'" Kai signed as he spoke, as if to demonstrate, pulling his C-shaped hand, fingers inward, down along his torso. "She'd slap my hands down and tell me to ask for my food, to speak, like a 'good boy.' But I couldn't. I couldn't, so she made me sit and watch her eat. Every meal. Every day." Kai wrapped his arms around himself, as if trying to hug away the bad memory.
"She never let you eat? How did you survive a whole summer?"
"At first, I was always hungry, so I raided the pantry and fridge while she was at work. David and I used to do that at County House all the time. He'd go for salty food, I'd go for anything that could remotely pass for dessert."
"And that worked?"
Kai finally turned his head toward her; his eyes were red and puffy. "No. She got pissed. That was the first time she locked me in the bathroom."
Dr. Miller scribbled a few notes, especially noting how seemingly disaffected Kai spoke the last few sentences. She recognized one of his coping strategies: minimize what happened, act like it wasn't a big deal, and maybe he could convince himself that was true.
"I learned my lesson; I was supposed to clean up after her, so I ate whatever she left when she wasn’t around. I learned what I could eat during the day that she wouldn't notice, like a slice or two of bread from the middle of the loaf, once a week. A handful of cereal a day. A slice of cheese. Stuff like that. After a couple weeks, I stopped being hungry most of the time. I also stopped trying to communicate with her; she'd ignore my signing, or even my gestures, berate me for not talking. So I just . . . stopped."
"Let's go back to the dream," Dr. Miller said, scribbling, "I just stopped" in her notes, boxing it in. "She was angry because you threw up on her shoes?"
Kai held the tattered T-shirt spread out on his belly, picking at it with one hand. "She was always angry at me for something. Because I didn't talk. I was too quiet. I cried too much. I fell too often. Because I was disgusting and annoying and . . ." Kai shook his head. "I threw up a lot. My stomach has always been . . . testy, and eating so little all the time. . . . It got used to being empty, I guess."
"What happened when you threw up?"
Kai shrugged. "I'm an idiot. For letting this upset me. It's not that big a deal." There it was again: minimizing the situation as a way to avoid talking about it. Basically, the "I'm fine; nothing to see here. Move along" defensive strategy. Coupled with his fears about opening himself to his brother, Dr. Miller presumed it was Kai's modus operendi. She jotted that down.
Kai pushed himself up, partially using the back of the couch to pull his torso up. He gripped it with one arm while he used the other to slip the pillow out from under his legs, wincing slightly as his bad leg was jostled. Then he used his hands to lift his legs, one by one, off the couch, until he was sitting facing her.
"Kai, fear isn't rational. It can sometimes help to talk about it that way, but telling someone with arachnophobia 'spiders aren't a big deal; they can't hurt you' isn't going to change the way their heart races out of control every time they see one."
Kai deflated, his shoulders sinking, recognizing she'd seen through him.
"This woman--your aunt--may have invalidated your feelings, and now, as an adult, with all your life experiences under your belt, it's easy to look at that boy and be ashamed to have ever been him, to have felt his fears. But you've said so yourself: in these nightmares, you are him. His fears are your fears. They're real. Just as we were once afraid of the dark, and it can be hard for us to remember and understand it as an adult, doesn't mean we were stupid for feeling that way then. And just as we learn to forget what it was like to be terrified of darkness, we need to find a way to help you move past everything that scared that ten-year-old you, that's still giving you nightmares and panic attacks."
Kai nodded weakly. His chin trembled. "I believed her, when she said I was stupid, or worthless, or lazy. That I was bad. I let her yell at me and starve me and take my mobility." He swallowed, hung his head. "Because I was so afraid. So paralyzingly afraid, that I would have nowhere to go, that no one--" Kai's voice broke, his shoulders shook. "--else could possibly want me if she decided she didn't."
Dr. Miller was almost thrown back in her chair. She hadn't expected to get to the heart of the matter so soon, especially at the end of a tough session. But there it was: fear of abandonment, of being alone--perfectly legitimate considering his background--but that inched her one step closer to the diagnosis of BPD.
"It's all right," Dr. Miller said in an encouraging voice, offering Kai some tissues. "I think you made some really good progress today."
Kai nodded, wiped his face, his fingers playing on the ratty T-shirt in his lap, which had stuck to the Velcro of his brace. "I must look like I cried for the last hour," Kai said, peeling off the rag and laying it aside in a strange, almost reverential way. He pulled his wheelchair closer, transferring into it, arranging his legs and feet with his hands. "Jon must think I'm insane. . . . I guess I am."
"I get the feeling your brother cares deeply about you, and nothing you could say to him would change that. Consider what we discussed earlier in the session. Talking to him might help."
Kai smiled, one of his contrived grins that looked deceptively genuine. "We'll see."
Continue to September 22, 2000, Part I ------>
Continue to September 22, 2000, Part I ------>