Friday, August 4, 2000

In/Exhale - September 23, 2000

September 23, 2000


Ringing. Ringing. Ringing. Vicky's eyes opened to a dark, unfamiliar room. A warm body stretched out along her side, bare skin touching her bare skin. Her eyes adjusted to the light, recognizing Jon's sleeping form. He was sprawled on his stomach, one arm hanging off the edge of the bed, the other draped over a pillow, cradling it for his head. His hair stood up on all ends. The sheet spread over his back, leaving his pale skin mostly exposed. The alarm clock displayed the time in neon as 3:14. Yawning, Vicky stretched and snuggled down beside him, wrapping her arm around his waist. He murmured happily in his sleep and drew toward her.

I could get used to this, Vicky thought as she closed her eyes to slip back into sleep. She'd just started to drift off when the phone rang again. Jon slept through it, seemingly oblivious. He normally had so much trouble falling asleep, but once he did, he slept like the dead. She figured it was his body's adaptation to years of long shifts in the ER and ICU; you needed to sleep deep when you could.

Vicky finally realized his phone was in the middle of the floor, buried in the midst of the clothes they'd discarded the night before. She could hardly believe they'd had sex. Jon had been drunk, and though he'd insisted he wanted her, he was a man. If he'd been honest about how long it'd been, which Vicky was sure he was--Jon wasn't the best liar even when he wasn't drunk--it was possible he was just inebriated, horny, and had a willing woman. Maybe he'd wake up and realize last night was a mistake. They were a mistake.

And his fucking phone kept ringing. Jon wasn't on-call, so it might mean bad news about Kai. Dammit. Vicky finally found the phone. All the missed calls were from the same number, and though she didn't recognize it exactly, she knew it was one of the Jonesville Memorial numbers. She rose, heading back to bed, Jon's phone in her hand. It rang again, the same number, so she answered.

"Dr. Taylor's phone."

"I need to speak with him," a harried female voice said.

Vicky's stomach knotted nervously, but she forced herself to keep her voice level. "What is this regarding?"

"His brother. Kai Fox. Is Dr. Taylor available? I need to speak to him."

"What happened? Is Kai OK?"

"I'm afraid I need to speak to Dr. Taylor."

"Of course," Vicky said, hiding her frustration; the nurse was only doing her job, respecting patient privacy. "Let me wake him." Vicky's mind raced with possibilities. A series of frantic calls from the hospital regarding Kai, at three in the morning, couldn't be good news.

Kneeling on the bed, Vicky grabbed Jon's shoulder and shook him hard. "Jon. Wake up." He groaned, but otherwise continued to sleep. "Jon! Wake up!"

No matter how hard she shook him or how loud she shouted, he didn't wake. She pulled him onto his back, flipped on all the lights, and finally, he blinked his eyes open.

"Kai," Vicky said, thrusting the phone in his face.

Jon was immediately awake, shooting up in bed, phone pressed to his ear. "Dr. Taylor."

Vicky watched as Jon rose, listening intently to whatever the woman on the other end was saying, picking through their discarded clothes. He was hopping into his boxers when he suddenly shouted, "No. No! I will not authorize that." Jon bent and snatched the scrub pants from the floor. "And I don't care. I'm his medical proxy. I have power of attorney. You're not doing anything until I get there. Understood?" Jon hung up violently, tying the scrub pants to keep them from falling.

"Is--is he OK?" Vicky asked hesitantly, taking his cue and pulling on her own clothes.

Jon huffed, pawing through drawers until he pulled out a faded T-shirt Vicky was pretty sure belonged to Kai and slipped it on. "I should never have left him," Jon said, clipping his pager to his waist and shoving his wallet and phone in his back pocket. "Where are my keys?"

Vicky spied them on the floor and bent to pick them up, offering them to him, concerned. Jon's face was unreadable for any more info beyond guilt and worry. "Jon?"

Jon sighed. "He's OK, and he's not OK." Satisfied he had everything, he jogged out to the kitchen. Vicky followed, carrying half her costume over one arm. Jon was pacing, his glucose monitor in one hand, apparently waiting for the reading. He saw Vicky and looked up, apologetic. "I'm sorry. I have to go to him." Jon abandoned the monitor on the counter and started searching through the cabinets.

Vicky shook her head, crossed to the other end of the room and extracted two glycemic meal bars. Then she laid a hand on Jon's shoulder, offering them to him. He accepted with a reluctant smile.
"If we're together, this is how it'll be, won't it?"

Jon kept looking around, as if he felt he were forgetting something. Finally satisfied, he headed toward the door. She followed.

"I mean, you'll always chose him."

Jon paused, locking the door behind them, but said nothing.

"It's OK," Vicky said. "Just drop me off on your way to the hospital. Eat some real food later. And call me?"

Jon pulled her close, leaning in to whisper in her ear. "I regret last night only because Kai needed me. Not because of what we did. Thank you." He kissed her, chaste but intense, before jogging off to his car.

#

When Jon arrived on Kai's floor, a nurse was arguing with a young, ragged-looking guy who had all the markings of a resident. She happened to glance up and see Jon, a look of relief rushing through her.

"Dr. Taylor?" she asked hopefully.

Before Jon could finish nodding, the resident turned. "We can't sedate your brother because of his blood pressure, so we restrained him. But he should be moved to a psych--"

"No. I'm talking to him. Now. Then you and I are going to talk," Jon said, practically jabbing his finger in the other doctor's eye.

Jon signaled to the nurse to follow him down the hall. "What happened?" Jon asked as soon as they were out of the resident's earshot.

"He started acting irrationally. Throwing things. Screaming. Trying to pull out his IVs . . ."

"Did he hurt anyone? Himself?"

The nurse inhaled, then shook her head. "Not exactly. But we had to move him to a private room, because he was scaring the other patients."

Jon nodded. Kai's behavior worried him, but he wasn't going to let them put his brother on a psych hold until he'd had a chance to talk to him personally. Maybe the low blood pressure was to blame.

Kai lay in the bed, staring blankly at the ceiling. Every now and then, he'd jerk his arms, tugging at the restraints that bound his wrists. His legs were elevated, but they hadn't bothered to tie them, since Kai's ability to move them was so limited right now anyway.

"Kai," Jon said, so many emotions swirling he couldn't begin to parse them all out.

"Jon?" Kai said, trying to push up to see his brother, but he couldn't. Frustrated, he pulled at the restraints again, screaming.

"Shh, easy, Kai. It's OK. I'm here now."

"Jon--" Kai choked out. Jon could see Kai's eyes were red, and his chest was heaving.

Perplexed, Jon maintained his calm and smoothed Kai's forehead. "I'm here."

"She left."

"Nikki? She'll be back later."

"No. No." Kai's fingers curled over and over, like they wanted to sign away some of his anxiety. "She's gone, Jon." Kai's eyes found Jon's, so round and full of despair. "She left me a note."
Jon had never seen Kai like this; it terrified him, because it reminded him too much of their mother--especially in light of some of the things Kai had said earlier, about the transplant being a mistake. Her lows could last for days, and sometimes she'd lock herself in the spare bedroom, alternating between sobbing and throwing things.

Hesitantly, Jon freed one of Kai's hands, shifted the guard out of the way, and perched on the edge if the bed, cradling his brother's head in his lap.

"Why?" Kai asked. "Why does everyone leave me?" Kai began to sob, murmuring names Jon could barely discern, although he was certain his own was among them.

"Shh, Kai. I won't leave you again. I promise. I will always be here for you. Always." Jon added in a whisper, "I shouldn't have left you tonight; I'm so sorry."

"I wanted to hurt myself. So bad. Still do." Kai reached for Jon with his free hand. "Help me, please, Jon. I have to stop it. I can't think. Everything's too loud." Kai was trembling, hyperventilating, on the brink of a panic attack.

"It's OK, Kai. Come on, deep breaths for me. Try to relax." Jon smoothed Kai's hair with one hand while he called the nurse with the other. "Tell me what I can do," Jon said, hoping getting Kai to talk would help.

"Rubber band." Kai could barely speak now as his breaths came in panting gasps. "Can't breathe. Jon. Help."

The nurse Jon had spoken to earlier came in, looking nervous. Her face paled when she saw Kai was partially loose.

"I need a nebulizer and albuterol. Now," Jon commanded. Kai was wheezing, a pained, desperate sound Jon hadn't heard since before Kai's transplant.

"But--"

"Just get it!" Jon barked, wishing he had Kai's inhaler on him. "And rubber bands."

The nurse blinked, but had learned her lesson and didn't question Jon's orders, rushing out the door. Jon released Kai's other hand from its restraint and gripped them both tightly.

"Kai, focus on me. Breathe. Come on. In. . . . Out. . . . In. . . . Out."

Kai's shoulders bucked as he worked hard for each breath, in full panic. The minutes stretched, until finally, the nurse returned with the nebulizer. While she connected it and started the compressor, Jon fixed the mask on Kai's face.

"Come on, Kai, breathe that, relax," Jon cooed.

Kai's eyes drifted shut, but the mask fogged with each breath, and after a few seconds, his breathing grew quieter, less panicked.

"Uh, the psych consult wants to talk to you," the nurse said, dumping the rubber bands in Jon's hand.

Jon grunted, but nodded, adjusting the bed slightly so he could help Kai shift to his side. It was better for him to be upright, but Jon didn't want to risk causing a sudden plunge in Kai's BP that could make him pass out. Next, Jon slipped several rubber bands onto Kai's right wrist, since his left had the hospital ID bracelet.

Kai still seemed out of it, but having to focus on breathing and the soothing effect of the albuterol seemed to have ameliorated the panic attack. Kai's fingers slipped under the bands, then he tested them, flicking each in turn, then in unison. Soon, he settled into a rhythm, the sound of rubber hitting skin making its own staccato beat. It twisted Jon's stomach to see the vacant look in Kai's eyes as he flicked and flicked and flicked, like a child rocking in place.

But he was calmer. That was what mattered.

"It's OK," Jon said, smoothing Kai's hair and glancing at the monitors to check Kai's vitals.
Flick. Flick. Flick.

Jon pulled out his phone and dialed Dr. Miller. It was early; not even five AM, but Jon figured he'd leave her a message, and hopefully she'd get it first thing.

Jon had just finished explaining, succinctly, that Kai was an inpatient because of his blood pressure, but had had a breakdown, and could she call him back ASAP. Kai had curled into a kind of fetal position, still flicking the bands in a slow, steady rhythm, moaning quietly. Jon realized the position wasn't ideal for his injured leg, and it must be hurting him. Jon slipped the mask off, setting it aside. Kai barely reacted, focused on the rubber bands.

The resident from earlier entered, scowling when he saw Kai's position, clearly free, his frown deepening with each flick of the rubber band.

"Dr. Taylor, your brother was trying to harm both himself and others. Showing signs of psychosis. For his safety, we should move him to a ward where the staff is trained to deal with a patient like him." The resident glared at the abandoned restraints. "And he should be restrained until we can medicate him safely, for his own protection."

"We're not doing anything until I speak to his psychiatrist."

The resident looked indignant.

Kai started muttering, "Please. I'll be good, I promise." He grabbed his legs, trying to pull them into a tighter tuck, but screamed as the movement irritated his bad leg. Now he was hyperventilating again, clearly terrified and confused.

Jon tried his best to calm Kai, not enjoying the smug sense of satisfaction on the resident's face. "Go away," Jon told the psych resident, "now."

"I'm calling my attending," the resident responded, almost like a little kid whining he was telling his mom as he strode out the door.

"You do that," Jon said dismissively, all his focus on Kai, who was struggling to breathe again, his flicking wavering as his hands shook uncontrollably.

"Please don't let her lock me up," Kai said, his voice small and strained, filled with pure fear.  Was he talking about Dr. Miller committing him? "I'll be good. I won't throw up. I won't fall. I promise."

Jon sighed, worry swirling in his gut. Low blood pressure, even as low as Kai's had gotten, even as tenuous as it was right now, couldn't explain this level of confusion. "Kai, it's Jon. I'm right here. No one is locking you anywhere."

Kai turned his head and looked at Jon, blinking a few times. "Jon?"

Jon nodded, relieved Kai's breathing had regulated and that his brother recognized him. For a nervous second, Jon had feared Kai might not. Jon smoothed some hair out of Kai's face. He was soaked in sweat, his skin clammy. Jon glanced up at the monitor; Kai's last BP reading wasn't bad, but in this position, it wasn't necessarily accurate.

Just then, the cuff began to inflate. It seemed to catch Kai by surprise, and he flailed his arm. The monitor beeped an error, tried again. Kai started to panic as the cuff tightened, reaching to pull it off, screaming. Jon jumped in to try to subdue Kai, but God, even still recovering from the major attack and all those drugs, he was strong. Maybe I should take up Kai's offer to work out with him next time he asks, Jon thought as he struggled to hold Kai's arms.

"Kai. Calm down. It's OK."

Kai was crying hysterically now, only half-heartedly fighting Jon, as if he'd been lost in his panic and forgotten what he had been struggling against. His cries turned back to sobs, dissolving into despair again.

"Everyone leaves me. Everyone."

Jon took a deep breath, relieved to see a slightly calmer Kai, even if it meant a return to the beginning. Jon lay down beside his brother, cradling him tightly against his body as he had when Kai was a child.

He put his mouth near Kai's ear, struggling to remember the words to an old lullaby he used to sing to Kai years ago, when his breathing or MLS were particularly bad. "Close your eyes. . . . Try to sleep. . . . Though the dark is scary. . . . And tries to creep. . . . Your brother is with you. . . . He'll keep you safe. . . . From the darkness. . . . Till you wake."

Kai continued to cry, but he linked his free hand in Jon's and squeezed.

They lay like this, Kai clinging tightly to Jon, sobbing quietly, for a long time. Jon drifted.

He woke up about thirty minutes later, when the timid nurse from earlier shook him. "Dr. Taylor, it's shift change.” Then she added, clearly amazed, “You calmed him."

Jon nodded, carefully extracted himself from Kai, and stretched.

"I need to turn him; I should have done it half an hour ago, but . . ."

Jon nodded, glanced at his brother. Jon could see where tears had left tracks on Kai's cheeks, and even in sleep, he seemed anxious, tense.

"I'll deal with him if he wakes," Jon added. "I'll help you."

Together, they moved Kai onto his back, buffering him with pillows, making sure his legs were elevated, his right leg supported. As an added precaution, they secured his left wrist. Kai woke suddenly as they were finishing, in clear panic, obviously confused.

Jon gripped Kai's free hand tightly. "Kai, it's OK. You're in the hospital. For your blood pressure. Do you remember?"

Kai tugged at his restrained wrist, looking down at it, frantic, then desperately tried to pull his hand from Jon's grip.

"Kai. Look at me."

Kai jerked his wrists again, but obeyed.

"You've been confused. Having panic attacks. You were trying to hurt yourself." Jon spoke slowly. He noticed the nurse edging out toward the door in his peripheral vision, so he nodded to signal she could go.

"Jon . . ." Kai's eyes were glossy, like fresh tears were ready to bubble up. In this moment, Kai reminded him so painfully of their mother. "She left."

Jon took in a cautious breath. "Yes."

"But you're here."

"Yes."

"You sang to me."

Jon laughed, a little embarrassed. "I did."

Kai squeezed Jon's hand. "I still want to hurt myself."

"I won't let you."

New tears slid down Kai's face. "I'm crazy, aren't I? They . . . wanted to lock me up."

"You've been confused. And angry. And scared. But you'll be OK. You'll get better."

Kai shook his head, and went back to snapping the rubber bands, as if trying to calm himself that way.

Jon watched him. He'd wait for Dr. Miller's assessment, but if this was a sign Kai was like their mother. . . . Jon struggled to remember his psych block. He knew schizophrenia often manifested in the early twenties. Was it the same for bipolar disorder? Would Kai, if he continued to have issues with hypotension, be able to take any kind of mood-stabilizing or anti-anxiety drugs?
Snap. Snap. Snap. Snap.

Kai was focused on his rubber bands, so he didn't notice when the second nurse arrived. But Jon did. A male nurse. Built. It made Jon nervous. He'd learned first hand how strong Kai could be when he was panicking. It was likely this nurse had been assigned to Kai for a reason.

"Kai? I'm Josh. I'll be your nurse today."

"Don't take my rubber bands. Please."

Josh looked from Kai to Jon. "They give him an outlet for his anxiety."

Josh nodded, approached slowly. "I'm going to give you something. It should help." He held up a syringe, his other hand, fingers splayed, in a pacifying gesture.

"What are you giving him?"

"Diazepam. Valium. A low dose. Dr. Miller's orders."

"Jon?" Kai looked at his brother, his voice that small, scared one.

"It's OK. Let him inject you. It'll help you relax."

Kai gripped Jon's hand tight.

Josh lifted the blanket and quickly injected Kai in his thigh. "All done. You should start feeling it in a few seconds."

Josh busied himself checking and recording Kai's vitals. By the time he finished, Kai's grip had weakened, the tension in his body eased, and his lids dropped.

Nervous, Jon checked the monitor, but Kai's blood pressure held.

Before he could say anything, Josh spoke. "I'll be back a little later to give him his morning meds. Dr. Miller should be by soon."

#

"Benzodiazapene withdrawal. I should have thought of that," Jon said, pulling his hand through his hair. He was standing just outside Kai's room with Dr. Miller, who had explained most of Kai's erratic behavior was likely the result of his body's physiologic dependence on the Valium he'd developed over the past few weeks. "He was fine when I left him twelve hours ago, though."
Dr. Miller nodded. "Benzodiazapene withdrawal can set in within only a few hours in some people; in others, it can take days. Twenty-four to forty-eight hours is typical, but every patient is different." Dr. Miller frowned, glancing into Kai's room before returning her attention to Jon. "Dr. Gates had Kai on very high dosages, and even though he'd weaned him down, and it wasn't a very long period in which he was on those high dosages, it was enough, especially since Kai's taken diazepam in some form nearly his entire life. Cutting Kai off so abruptly and completely was a mistake."

Jon peeked in the room. They'd decided to leave Kai's wrists secured for now, until they were certain he wouldn't wake in a panic. Once Dr. Miller had been sure that a low infusion of diazepam would not lower Kai's blood pressure significantly, she'd started him on one, and it was keeping him calm enough that he'd been sleeping for the past hour.

"I was concerned he might . . ." Jon sighed. "Our mother was bipolar. She . . ." Jon looked around, lowered his voice. "She attempted suicide several times."

Dr. Miller took in a breath. "Kai never mentioned this."

Jon pushed his fingers through his hair, gripping the strands tightly. "He doesn't know. In light of everything, I've been meaning to tell him, but . . ."

Dr. Miller folded her arms on her chest and leaned in the doorway. "I don't think telling him, not at this stage, would be advisable. But Kai isn't bipolar." She turned back to Jon, gesturing with two fingers. "Bipolar disorder is characterized by two primary moods: mania and depression. During a mania, the patient is filled with euphoria, a sense of invincibility, often engaging in risky and impulsive behavior. During lows, the patient experiences intense despair, sometimes anger. These highs and lows last days, even weeks or months.

"Kai’s problem isn’t so much with mood instability as his inability to accept his often healthy, normal emotional reactions."

Jon fidgeted, rubbed his eyes. His blood sugar was low. He could feel it. He pulled out one of the meal bars he'd brought with him and started nibbling on it. "So what are you thinking?"

"There’s little doubt he’s suffering from PTSD. Initially, I was considering Borderline Personality Disorder, but he doesn’t fulfill all of the diagnostic criteria. Assuming today was truly a result of withdrawal, anxiety is Kai’s primary problem."

Jon sighed, chewing. "It's been a long time since my psych block."

“Kai struggles with his emotions; he often feels they're overwhelming, or that he's wrong for feeling them. That's where most of his urges to self-harm come from. His anxiety exacerbates the situation. For example, something upsets him, and he feels guilty for feeling upset. The guilt makes him want to self-harm, and wanting to self-harm makes him feel ashamed. Feeling ashamed makes him want to self-harm even more, which leads to feelings of self-loathing, and his anxiety ratchets up, spinning him into a vicious cycle, often developing into a full-out panic attack.”

A dull hypoglycemic headache began to throb behind Jon’s eyes. It was a relief to hear Kai wasn’t taking after their mother, that today’s episode was a fluke, but Jon had seen the self-inflicted wounds riddling Kai’s torso, and his panic attacks and nightmares must have been bad enough to push him toward voluntary therapy with Dr. Miller. God, how bad had things been for Kai all those years they were separated? Years Kai never, ever talked about.

“His therapy is going well, but it will take time. Because of his blood pressure, pharmaceuticals are almost entirely off the table, but I'm going to try him on hydroxyzine as something he can take, symptomatically, to help with his anxiety.”

"An antihistamine?"

Dr. Miller smiled faintly. "It's been shown to be effective as an anxiolytic, it won't affect his blood pressure, and it has almost no side effects. It can also work immediately, and he doesn't need to take it regularly to get benefits from it. I'm hopeful getting his anxiety managed will help with some of his other symptoms." She glanced over her shoulder. "I'm going to talk to him.” Dr. Miller hesitated. “Fear of abandonment is another issue Kai really struggles with. Your support is essential to helping him through all this.”

“Of course. Kai is the most important person in my life; anything I can do to help him, I will.”
Dr. Miller held out her hand; she had a surprisingly strong handshake. “I know Kai isn’t the most naturally forthcoming person, but reminding him that you’re there if he needs you is important. Validating his emotions--assuming he doesn’t try to disguise or suppress them around you--can also really help.”
#

"Kai?"

Kai blinked groggily at Dr. Miller. His blood pressure had stabilized some, so he was able to sit up a little, though his right leg was kept bent. "Dr. Miller?" He seemed to realize his wrists were restrained, but instead of panicking, he just looked at her, his eyes sad. "You're here to commit me?"

Dr. Miller offered a small smile, shaking her head. "You had a bad reaction to having the Valium suddenly cut off. How are you doing now?"

He blinked a few times. "I didn't hurt anyone, did I? I remember being scared. Angry. Upset." He took in a breath. "Nikki left me."

"No, you didn't. And I heard about Nikki. I'm sorry. Do you want to talk about it?"

"She said she loved me."

"Do you love her?" Dr. Miller worked on freeing Kai's wrists.

Kai shook his head. Once his hands were free, he used the bed guard to pull himself onto his left side, curling into as much of a fetal position as his right leg would allow. "I just want to go home."

"Soon. How's your mood?"

"I want to curl up in a ball and sleep forever."

"Because if you're sleeping, you don't have to deal with your problems?"

Kai hesitated, first shrugged, then nodded weakly.

"But you feel calmer than before? Less anxious?"

Kai nodded. "I'm tired."

"Get some sleep. I want to talk to you later. Once you've gotten some rest and are a bit more settled."

"Jon?"

"He's outside. I'll send him in. Consider talking to him. He really cares about you. Going through all of this might be easier on you both if you'd let him in."

#

"Hey, little brother," Jon said with a smile, perching on the right edge of the bed.

Kai reached back blindly for Jon, who slipped his hand into his brother's.

"I should be able to take you home in a few hours, if Dr. Miller clears you."

"Thank you," Kai said in a weak voice.

"Thank Dr. Miller--"

"No." Kai tugged on his brother's hand. Jon didn't understand. "I want to sign."

Jon rose, crossed to the other side of the bed, so he could see Kai's face.

"Thank you for taking care of me." Kai signed slowly, whether a side effect of the Valium or to help Jon understand, Jon wasn't sure. "Bad stuff happened to me when we were separated."

Jon hesitated, then awkwardly finger spelled Dr. Miller's name, continuing in sign, "Dr. Miller told me you have PTSD, but she didn't . . . tell me everything. You don't need to tell me. It's OK."
Kai smiled tiredly. "I struggle talking even with Dr. Miller. But we're all we have, right? Today proved I need to trust you."

Jon took in a breath, looked around. Then he lifted up his shirt and pushed down the waist of his scrub pants and boxers, revealing the scar along the edge of his psoas muscle. He knew faint white circles, evenly spaced, were visible on both sides of the scar, the remainder of the numerous stitches he'd needed to close the wound.

Kai's fingers reached toward the mark, but stopped short of touching Jon's skin. His eyes tracked up to Jon's.

Jon dropped his shirt. "After we were separated, I thought you were dead. I blamed myself." Jon sighed. "You and I may have different reasons for why we did this, but I know what it feels like, thinking cutting is the only way to make the dark thoughts stop," Jon signed, finger spelling when he couldn't think of the sign. "I haven't since I was a teenager, but I've thought about it. Especially when you were so sick last year."

"Jon . . ."

"I should have told you before. I'm sorry."

Kai's eyes were glossy. "Thank you. Knowing I'm not alone really helps. Because I feel alone so much."

Jon grinned, took Kai's hand and squeezed it. "You're never getting rid of me again," he said, blinking away his own tears. "I'll always be here for you. Always."

#

A few hours later, Kai was sitting up in bed, his eyes on the TV that hung from the ceiling, though Dr. Miller sensed it was merely something to focus on, and he wasn't really watching, especially since the volume was muted.

"Kai. How are you feeling?"

He smiled sadly, blinked rapidly a few times, swallowed, all without turning his head. "My blood pressure's finally stable, so now it's up to you to decide how crazy I am."

Dr. Miller grabbed a chair and dragged it to Kai's bedside. "Kai, we've talked about that word."

Kai sighed and turned off the TV, finally looking her way. He seemed defeated, tired, worn; not much better than a few hours earlier, though he was more of himself. "Call it whatever you want; give me a bunch of fancy acronyms. I'm still crazy. If it weren't for Jon, I'd be in the psych ward right now." He let his eyes slide shut.

"And you think you belong there?"

Kai shrugged. "You're the expert."

Dr. Miller gave Kai a moment, processing her own thoughts. "Jon told me that earlier, when you were suffering from the withdrawals, you kept begging him not to let 'her' lock you up. He assumed you meant me, but that isn't what you meant, is it? Do you remember that?"

Kai barely breathed over the next few seconds. "You're really good," he said, almost as if to himself. "You've seen through me since the moment I walked through your door. First shrink who has."

"Seeing me was also your choice, remember that. That's made a huge difference. But you're avoiding my question."

Kai cracked a half smile. "See: good." He sighed, finally opened his eyes again. "I don't remember this morning that well." He turned to face her. "Really. That's not an avoidance strategy. I remember how I felt more than what I said or did."

Dr. Miller nodded. "Earlier this week, you mentioned your aunt sometimes locked you in the bathroom."

Kai sucked in a breath. "Sometimes?" He blew air harshly out of his nose. "At first, it was just for when I was really bad. But then she got more and more disgusted with me, and it happened more often." Kai's fingers bunched the sheet into a tight knot. "'Dirty things belong in the bathroom,' she'd say."

Dr. Miller observed the casual, almost bored way Kai spoke, though, as usual, his hands betrayed his tension. Definitely his "tell."

"It wasn’t so bad, most of the time. I didn’t have to worry about making her mad if I was there, and it meant she wasn’t yelling at me. And it meant she wasn’t getting rid of me.”

"How long did she leave you there, Kai?”

He shrugged without looking up. “A few hours. Sometimes overnight.” Kai rolled his head back to neutral, staring vacantly ahead.

“It’s OK, Kai.”

Kai coughed out a laugh. “It wasn't usually scary. Being locked up. I mean, hospitals and institutions aren’t exactly bastions of freedom. Especially if getting up and walking out isn’t an option." He pulled on one of the wrist restraints still attached to the bed before tossing it aside, continuing in a disaffected tone, "And the room was small enough I could manage even when she took my braces or crutches."

"Did that happen often?"

"Regularly. I fell a lot that summer." Kai shrugged, though Dr. Miller noticed he hadn't even glanced sideways at her in the last ten minutes. "Builds character, right?"

Kai was silent a long time, but Dr. Miller observed his heart rate on the monitor spiked. Not enough to set off an alarm, but enough that Dr. Miller could confirm his calm exterior was just that: a facade.

"Kai, you keep saying things like 'most of the time' or 'not usually.' That implies that it was scary some of the time."

Kai didn't respond, but he lowered his gaze, staring at his hands, which continued to twist the sheets in his lap.

"Remember what we talked about? Not being ashamed of our emotions, even if they are a decade's-old fear?"

Kai inhaled sharply, kept his eyes cast downward. “One night, I made her really mad. Really, really mad. I can’t remember why. Maybe I threw up on her. Maybe I fell and broke something of hers. I don't know." Kai closed his eyes tightly; his breathing faster and shallower, but not nearing panic. “She was so angry. I thought she was going to beat me. I wanted her to hit me. It would have been better.” Kai’s breathing became more erratic, though he seemed otherwise calm, apparently trying to get himself under control. His fingers went to the rubber bands he still wore on one wrist, but he didn't snap them.

“Why would that have been better?”

Kai shook his head. His breathing had slowed, but not his heart rate, though he still stared vacantly. "Because hitting me would have meant she cared enough to hurt me." Kai fell silent, and Miller gave him the time. She'd have to question him more about that statement later. "That night, I was convinced she was finally going to get rid of me. I cried so hard I could hardly breathe, until I finally fell asleep."

Kai lowered the bed, then pulled himself onto his left side, hissing reflexively as he shifted his right leg, resuming the semi-fetal position of earlier, his back to Dr. Miller. I want to curl up and sleep forever, he'd told her. Especially with the way the position hurt his bad leg, it was obvious to her he hadn't chosen it for physical comfort. She could imagine a scared ten-year-old Kai, curled up much like this on the floor of a tiny bathroom, crying himself to sleep.

"If you think I'm too crazy to go home, just tell me. Now that my blood pressure's stable, they can zonk me out." His voice was calm, but she saw the subtle shake of his shoulders.

Dr. Miller rose, crossed to the other side of the bed. She saw tears tracing down Kai's face. He looked up at her for a brief moment, a mere fraction of a second, and in that instance she saw the fear and anguish of the young boy he remembered being, whom he still felt like more than he was willing to admit, even to her. Then he ducked his head, burying his face.
"Please don't look at me."

She contained her sigh. "Kai, I know you want to go home today. I think it's important for you to talk about this before you do." She retook her seat, taking her time, giving Kai the chance to formulate his thoughts.

“It was dark and cold and claustrophobic in that bathroom," Kai finally admitted in a small voice. "I woke up in the middle of the night in the midst of an attack, struggling to breathe." Kai pulled his left leg in tighter, almost hugging it to his chest, as if trying to make himself as small as possible. "At night, with the light off and door shut, that room was pitch black, and I panicked. I had been breathing well the last few months, and I’d never had an attack when I didn’t have my medicine."

"What happened?"

Kai's calm facade began to crumble.  “I couldn’t breathe, and I was trapped, and it was so dark, and I was so cold. And so alone.” Kai sucked in a harsh breath, his words tinged with emotion, jarring after his monotone of earlier. "It was the first time death became real."

"Real?" Dr. Miller asked, hoping Kai wouldn't freeze up on her; she sensed they were on the verge of a breakthrough.

Kai's heart was racing; Dr. Miller was shocked a nurse hadn't yet come in to check on him. But he cleared his throat, tried to find his calm again. "'Because I could not stop for death, he kindly stopped for me,'" Kai quoted. Then he used his arms to roll himself onto his back, carefully arranging his legs, almost as if it gave him an excuse to stall.

After several minutes, Dr. Miller conceded reluctantly, "If you're not ready to talk about this now, we can pick up next time."

Kai inhaled, shook his head. "Death has always been my co-pilot," he said sardonically. “But I didn't understand it, not really, till that night. For years, I believed my parents were alive; they’d simply decided they didn’t want me. Not being able to breathe was always scary, but I didn’t really fully, consciously understand what would happen if I stopped breathing.” Kai breathed slowly, deeply, for a few minutes, one hand on the side of his neck, as if trying to still his rampaging heart. "That night, it hit me. Trapped in a small, dark place, alone, fighting for air, trying to scream and not being able to. It was like . . .” Kai searched for the words, speaking slowly as realization hit. “. . . being buried alive. Oh. Oh. Fuck.” Kai let his head drop to one side, a hand over his mouth, that vacant stare reappearing.

Dr. Miller had to give the kid some credit; that was the kind of connection even an experienced therapist might not make instantly. “The fact that you’ve been able to find some origin for even your more abstract nightmares is a good way to try to overcome them,” Dr. Miller offered.

“Yeah,” Kai said, skeptical. “Because I figured out being buried alive is my brain’s fun metaphor for nearly asphyxiating in a dirty bathroom when I was ten, I’ll sleep soundly from here on out. Thanks, doc.”

“Kai--"

He took a deep breath. “. . . I'm sorry." Kai rolled his neck to look at her. "I'm just . . . I’m tired of being scared. I’m tired of being panicky and anxious. I’m tired of the side effects of one drug making me take another, which has more side effects, and none of them really work. I’m tired of my blood pressure being unstable. I'm tired of feeling like I can never get my life on track, because some new surprise pops up. I'm tired of feeling out of control." He swallowed. “I miss Nikki.”

"But you don't love her?"

Kai hesitated, as if giving the question serious thought. "No. But I . . . I could be myself with her, even as fucked up as that is. I could escape with her. Forget. She helped me deal."

Dr. Miller nodded. "I want to see you first thing on Monday. I'd like to meet with you daily this week. I want to start implementing some behavior modification therapy in conjunction to what we've already been doing to work on getting your emotions and anxiety better managed."

Kai stared at her for a long moment, studying her. "If you think I'm going to hurt myself again, why are you letting me go home?"

Dr. Miller couldn't help letting a slim smile escape. Apparently, Kai could see through her, too. "Because I think holding you could potentially do more harm to your recovery than good. Take the hydroxyzine to manage your anxiety. Talk to your brother. And call me if you need to." She rose. "Sleeping with a light on, if you don't already, may help with the nightmares. Feel better. I'll see you Monday."

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Continue to Interlude: From Kai's Journal #1 -------->

8 comments:

  1. Wow!! Intense isn't really a strong enough word. Really great chapter!

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  2. Amazing, revealing, gripping, superb -- what else can I say?

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    1. Thank you, Pepper!! Your comments always mean a lot to me.

      (And thank you to everyone else, too, who commented. I'm glad you enjoyed this episode!)

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  3. Thank you for not keeping it to yourself. Thank you thank you for sharing.
    a.k.a.

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  4. Oh, this chapter was really emotional. Poor Kai and what he had to endure...
    Anyway, thanks again for sharing, you are an excellent writer!

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  5. gut-wrenching, I lost my breath

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  6. Predictably -- Kai's in trouble again, I hope 'Season 2' sees a change in luck for him and your chapter format. Still great writing but its just kind of the same stuff over and over.

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    1. lol. Yes, S2 will feel very different, I think. I appreciate your sticking with us.

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