September 9, 2000 - Part II
Dr. Miller pushed the door that led to the waiting room opened with one hand, juggling her cellphone and coffee mug in the other. She was surprised to see a tall blond man struggling in the door, leaning heavily on a pair of forearm crutches. He kept one leg straight, and seemed to be using his upper body to pull himself forward. It was awkward, yet obviously practiced.
“Mr. Fox? I was just getting ready to call you,” she said, waving her cell phone.
He looked at her, his face an unreadable mask except for a slight frown and crease of his brow. “I’m sorry I’m a little late. I haven’t been moving real fast today.” He nudged a chin toward where his hands gripped the crutches and shifted his weight.
Dr. Miller blinked, then caught herself and smiled. “Of course. My office is just through here.”
She held the door open for him, and as he squeezed past, his eyes met hers briefly in a look even her years of training and experience couldn’t quite determine. She knew very little about him, since the appointment had been set up with such short notice. He’d mentioned he’d had a double-lung transplant a year ago, that he had some other health issues, and that he’d been “shrunk” before--to use his words. Other than that, she was going into this pretty blind. She knew he’d be a challenge, but she wondered if perhaps he’d be a harder shell to crack than even she had anticipated.
“Thanks,” he said, then added quickly, “for squeezing me in.”
Her brows furrowed, but she smiled and nodded, opening the second door, this one to her office, and walking around to hold this one for him as well. “Take a seat wherever’s comfortable,” she directed him.
Once they were inside her office, she left her coffee mug on a side table near the chair where she usually sat during sessions, then crossed to her desk. She left her phone in a drawer, grabbed a pad and pen, and looked up at Kai, who had settled into the large couch, his crutches propped against one of the arms, one long leg stretched out, the other bent. He had his eyes closed, but his face was devoid of any discernible emotion.
She took a moment to study him. Deep purple bags marked his pale skin beneath each eye, and several days’ worth of stubble coated his cheeks, creeping onto his neck. His body seemed stiff and yet sagged into the couch, and he absently massaged one palm with the thumb of the opposite hand.
He had some faint bruising on the inside elbow of one arm, and he wore a rubber band on his left wrist. His arms were muscled and lightly freckled, but the loose, overly large polo he wore masked the rest of his body. Objectively, he was handsome and attractive, but it seemed evident he didn’t consider himself as such. Despite his best attempts to mask his emotions, he struck her as weary and filled with doubt. Or perhaps that was just her intuition.
“Can I get you something to drink? Coffee?”
His eyes fluttered open drowsily, and he wiped a hand on his cheek. “No. Thank you.”
She nodded and took her seat, crossing her legs at the ankle and holding the pad in her lap. Smiling, she said, “It’s probably already obvious, but I’m Dr. Miller. Why don’t we start by you telling me what brought you in today?”
Kai let out a faint laugh, scratching under his nose with one finger. “It’s still kind of hard for me to believe I’m here of my own volition.”
“You mentioned you’d seen therapists before.” Dr. Miller asked in her carefully cultured neutral tone. She knew psychiatric treatment was pretty standard for the first months after transplant surgery, but preferred not to assume and let Kai’s response speak for itself.
Kai held out a hand and started counting off on his fingers. “When I was six, when I was ten, when I was thirteen. Before and after my transplant.” He dropped his hands and shrugged.
That explained something, at least. It was clear Kai was experienced with how counselors worked, and was likely--if his manipulation of his body language and facial expressions was any indication--very good at revealing only what he wanted. Or rather, only what he knew the therapist wanted.
“So what changed this time? You seemed pretty upset when I spoke to you yesterday.”
Dr. Miller didn’t normally see patients on Saturdays, but after hearing Kai’s panicked voice on the line yesterday, she’d made an exception. It seemed hard to reconcile the harried man she’d talked to the day before with the stoic one sitting on her couch.
Kai’s placid mask slipped for a moment, and he fingered the edge of his shirt. Then he brought his left wrist to his right, slipping fingers under the rubber band there.
“I don’t like to pressure my patients,” Dr. Miller said carefully, “but you called me. You showed up. I can’t help you if you don’t talk to me.”
Kai swallowed, nodded. His eyes drifted around the room, finally fixing on her framed diploma that hung over her desk. “Can I ask you something first?”
Dr. Miller nodded. “You can ask anything you like, and unless it’s inappropriate or not relevant to your therapy, I’ll answer it.”
Her eyes went to his wrist, where he began absently snapping the rubber band against it with the fingers of his right hand. “If you have a patient who tells you--hypothetically--that they’ve been thinking of taking their own life, or hurting themselves, how would you react?”
She shifted in her seat, her eyes fixed on him, but keeping her posture and face non-threatening, welcoming. “If they’re serious about suicide, I’d want them to let themselves go on a 72-hour hold, for their protection. It’d also give us a chance to help them through the crisis safely.”
Kai nodded and flicked the rubber band a little harder.
“As far as self harm goes, if I’m certain the patient doesn’t have suicide as their intent, I’d likely encourage them to call me whenever the urge became overwhelming, and increase the frequency of our sessions while we worked to figure out why they have these feelings and ways in which they can address their issues without physically hurting themselves.”
Kai pursed his lips and nodded again. After a moment, he took in a deep breath, then pulled up the hem of his shirt. Dr. Miller saw the end of his sternal scar from his transplant, but what drew her eye were the bandages and gauze that covered large patches of his abdomen. After a few seconds, he dropped his shirt again, and he didn’t meet her eyes when he spoke.
“That’s why I’m here,” he said, his voice quiet. His entire demeanor seemed to have changed, his shoulders a little droopier, his body language suggesting shame and embarrassment, bracing himself for harsh judgment.
“You did this yesterday?” Dr. Miller asked, scribbling some notes on her pad but trying her best to keep her eyes on him as much as possible.
Kai inhaled sharply, then nodded.
“Would you like to talk about it?”
Kai lifted his head, looking a little surprised, before dipping it to mask his face. He reached back and cradled his neck, not saying anything.
“When you’re talking to me, I want you to consider it a safe space, OK? I won’t judge you for what you say or do. I want you to feel comfortable being open and honest with me so I can do my best to help you get through whatever it is you’re dealing with.”
Kai looked up at her, obviously skeptical.
Dr. Miller stifled a sigh, slipped on an easy smile. “I don’t know what your other counselors were like,” she said softly, “but I’m here for you. I’m not going to try to force you to tell me anything you don’t want to, and I’m not here to criticize you or trick you or manipulate you. I’d like to help you.”
Kai’s eyes drifted away, and she saw him shifting back into the faux calm of the beginning of the session, shutting down. This was going to be more difficult than she’d thought.
“This wasn’t the first time you’d harmed yourself,” Dr. Miller said, trying a different tactic, offering him an easy yes or no response. She normally preferred to keep her questions more open-ended, less guided, but different patients required different strategies, and at least until they could establish a comfortable rapport, it was likely Kai would keep her on her toes.
Kai took in a deep breath and let it out slowly. Finally, he shook his head.
“Before yesterday, how long had it been?” Dr. Miller dropped her hands on the pad, leaning back in her chair, doing her best to seem non-threatening, more like a friend and less like a doctor, hoping it might prompt Kai to be more forward.
Kai started to flick the rubber band against his wrist again, but stopped himself. “Since before I got really sick, before my transplant,” he said, his voice small, his shoulders hunched, again, as if bracing for chastisement.
“How long ago was that, do you think?”
Kai leaned back on the couch, closing his eyes. His fingers toyed with the rubber band, but he didn’t flick it against his skin. “More than a year. Eighteen months, maybe. At least.” He shook his head. “The last few months leading up to my transplant are a little fuzzy in my memory, to be honest.” He smiled, but it was more of a wince than anything else. So he wasn’t nearly as well adjusted to the transplant as the previous psych must have been lead to believe.
Kai pressed the heel of his hands into his brows, as if trying to push away a headache. “But I’ve wanted to. Lots of times.”
Dr. Miller nodded. “Is that what the rubber band is for?”
Kai froze, then glanced at his wrist as if seeing it for the first time. “Yeah,” he finally responded in a quiet voice.
“It’s good that you’ve tried to channel a less harmful way of dealing with things, but ideally I’d like to see if we can get to the heart of why you hurt yourself so that maybe we can work together to stop it entirely.”
Kai’s fingers curled on his jeans as if gripping something beneath the fabric. “I’m fucked up,” he said, and when he looked up, she saw the skepticism in his face. He didn’t believe she could help him. No, that wasn’t right.
He didn’t believe he could be helped.
She pushed away the reflexive frown. “Why do you say that?”
He shrugged, and there went the mask again.
It felt like fishing. You bait the hook, lower it into the water, get a few tentative nibbles, occasionally a bite. But half the time when you reeled it in, there was nothing, and you were back to square one. All she could do was keep trying different baits and exercise her patience.
“Why don’t you tell me a little bit about yourself?”
Kai blinked at her, but otherwise, his expression was unreadable.
“Normally, I have patients fill out paperwork, forward me any medical files they feel might help their therapy, that kind of thing, before our first session.”
Kai nodded, as if understanding, and took a deep breath. “What do you want to know?” There was a hint of challenge in his tone.
“I suppose anything you think might be relevant to your therapy. Anything you think might help me help you.”
He grunted, and his fingers toyed with the rubber band on his wrist, but otherwise, he said nothing, his face revealed nothing. Jesus. She was going to have to go with specific, directed questions if she wanted to pry anything out of him, apparently.
“OK. Why don’t you tell me about your family?”
He stared at her a long while, and his mouth opened as if to speak, but then he seemed to think better of it and began to fidget, flicking the rubber band against his wrist, his eyes searching the room as if for an escape.
She gave him space, not pressing him to answer.
Finally, his face soured, and he looked at her. “My instinct is to respond sardonically, but that wouldn’t be ‘conducive to my therapy,’” he responded, ending in a mocking tone, as if regurgitating something he’d been told before--likely more than once. Before she could speak, he apologized. “I’m sorry. I--I have to remind myself I’m not being forced into this.”
“No. Like I said before, I’m not here to trick you into telling me anything you aren’t comfortable sharing.” But if even a little question like “Tell me about your family” wires your mouth shut, this isn’t going to be easy.
Kai’s face changed again. It was unreadable, though this time it didn’t seem to be an intentionally feigned neutral mask; it was simply too complex to parse out its exact meaning. It was possible this kid would give her ulcers, but damn, he was fascinating.
“My parents were killed in an auto accident when I was a little kid. My siblings and I were separated. I grew up in the system.”
Ah. “Foster homes?”
Kai laughed, but there was no mirth in it. “Kids like me aren’t fostered. Or, at least we weren’t. Things are changing, now, apparently.” He shrugged.
Dr. Miller couldn’t suppress a frown.
He flicked the rubber band hard against his wrist. “First, they separate boys from girls. You start in a group home, then they foster you out. If you’re like me, then you got sent to Calhoun County House for Crippled, Diseased, and Feeble-Minded Children. Or just County House.” He tilted his head. “And you stay there, until you die, or age out and are either on your own or sent to an institution for adults.”
Dr. Miller shifted in her seat, studying him. His face had slipped back to his mask, but his body language spoke differently. A tension in his shoulders, and the snapping of the band had become almost a nervous tic.
“So you never lived with a foster family?”
Kai’s eyes blinked rapidly, and he looked away. “Like I said. County House kids weren’t fostered. Except in rare situations, and that was usually for the money, since the state paid extra for us, because of our ‘special needs.’”
Dr. Miller observed Kai’s breathing had increased, and his hands were trembling. “Kai,” she spoke softly to him, but he didn’t seem to hear her. He closed his eyes, shook his head, as his breathing grew rougher, harsher, more frantic. “Kai.”
She stood just as he pulled an inhaler out of his pocket and hurriedly took a couple puffs after managing a moderate deep breath between each. The trembling hadn’t abated; in fact, it had spread, and his breathing sounded worse. Calmly, she crossed to her desk, removed a paper lunch bag from a stack she kept in one drawer, then took a seat on the couch beside him, making sure to give him a cushion’s worth of space.
She opened the bag, twisted the top, then pushed it into his hand. “Breathe into this for a little while. It’ll help.”
He looked at her doubtfully for a minute, his shoulders jerking with the effort of keeping up with the quick, short breaths, but he obeyed.
After a few minutes, he relaxed, dropping his hand to his knees. His breathing had calmed, but tension still hovered in the air.
“How long have you been having panic attacks?”
Kai hesitated a moment, then finally pushed himself away from his knees. A fleeting grimace crossed his face, like his back was stiff, and he sank back into the couch, looking more tired and defeated than when he’d first come in. “I used to have them sometimes when I was younger. When my parents first died. When I was . . . ten. Lately, it’s only been a few days. Almost always after a nightmare.”
Dr. Miller nodded, put out her hand. He placed the crumpled up bag into it, and she rose, returning to her seat across from him. “Tell me about these nightmares.”
“They started a few days ago. Every night.”
Dr. Miller observed Kai’s right leg bouncing nervously. Restlessness, panic attacks. Some kind of anxiety disorder? Or maybe PTSD? The recent anxiety attack had been triggered by talking about the environment in which he grew up, and nightmares were often associated with posttraumatic stress. If she had more time with him, that might lead to something. But no. It wasn’t a nervous gesture. His leg was spasming. Apparently, it wasn’t enough for him to reveal that he noticed, and the braces he was wearing under his pants--she’d seen hints of them leading out of his pant legs--must have been keeping the spasms from getting too wild.
He saw her staring at his leg, and he braced it with his hands, calming it a bit. “They do that. It’s worse when I’m stressed. I haven’t slept in days.”
She nodded. From what little she’d learned about Kai in the last hour, she could tell he had been through a lot of life and knew, generally, how to handle himself. Maybe not always in the healthiest ways--as the rubber band and the cuts on his abdomen testified--but there were a lot worse ways to deal with trauma and stress than that.
“Until last night, I’d dream I was buried alive. Literally. Not in a coffin. Just in the ground. And I can feel and taste the dirt in my mouth and my nose. And I can’t breathe. It’s dark, and I can’t breathe, and I’m trying to climb out, but no matter how hard I struggle, I don’t seem to get any closer to getting free. And I wake up, struggling for air.”
Dr. Miller jotted a few things on her pad, particularly noting how Kai had started in past tense, then shifted to present. How his breathing had increased again as he spoke. “It’s OK, Kai,” she spoke softly, “you’re safe here. Try to relax.”
Kai nodded, closed his eyes, and took a few steadying deep breaths.
“So, last night you had a different nightmare?”
Kai’s entire body stiffened, and she could hear him swallow. He nodded once.
“Want to talk about it?”
There was a long pause. “No. Not--not today.”
Dr. Miller scribbled a note to remind herself to probe him about it at their next meeting. “OK. Yesterday, when you called--”
“It was kind of like a panic attack that wouldn’t go away,” Kai said in a small voice.
“Did the cutting help?”
“At first,” Kai admitted. “But then the pain faded, and I felt even worse.”
“And so you called me.”
Dr. Miller tapped her pen on the pad for a moment, thinking. “Do you take any medication for your spasms?” Normally, she’d have a full medical history sheet, including medications, allergies, etc., but there hadn’t been time for that.
He shook his head. He seemed to have given up trying to mask his emotions, and now looked tired and, honestly, a little scared. No, that wasn’t right. It was more the look on a person’s face after they’ve been through a frightening or traumatizing event, like they’d just seen their house burn down and were standing in the street, huddled in a blanket, trying to process that all their worldly possessions were gone, and that they’d just barely escaped with their life.
“I don’t like to take it. It doesn’t help that much. Mostly makes me groggy.”
“I want you to take half your normal dose if you feel a panic attack coming on. It should help. Then take one-and-a-half your normal dose at night to help you sleep. We’ll try that for a few days and try something else if that isn’t working.”
He nodded and grabbed his crutches.
“I’d like to see you again. Soon. Monday?”
Dr. Miller rose and checked the large calendar she kept on her desk, where she kept track of her appointments. “I have an opening at ten.”
Kai nodded, then carefully pushed himself to his feet. He looked ready to fall over at any moment from sheer exhaustion.
“Call me if you feel the urge to hurt yourself before we see each other again, or if you desperately need to talk to someone. OK?”
Nikki opened the door, surprised to see Kai, leaning heavily on his crutches. When he looked up at her, she saw a deep crease in his forehead, his lips pressed tightly together. His breathing was quick and shallow, though she could see he made the effort to control it. His smile was pained and forced, his eyes a deep, glossy blue.
"Can I come in?"
Nikki nodded, studying him as she stepped aside, holding the door open for him. She noticed he moved stiffly, with effort, pulling his legs along primarily with the strength of his upper body, his legs straight and stubborn. He said nothing as he maneuvered to her bed, sinking down with a barely masked grimace. She watched as he unlocked each knee, his hands working the joints to relax.
"I have work in a few hours," Nikki said, watching as he bent awkwardly to undo each shoe.
"I know," he replied, seemingly with effort.
Nikki had known Kai casually for years, intimately for months. She'd seen him in all kinds of moods, wearing an assortment of masks, but it was rare for him to offer a raw glimpse of who he really was. Yesterday had been a scary sample into Kai's obviously damaged psyche. Today--though it was clear he worked to hide it--she saw something else.
She knew, vaguely, that Kai's muscles were unpredictable; she'd even witnessed minor spasms before, his foot or leg jerking against his will. She'd seen him stiff, grumpy. But this was more than that.
Nikki frowned and crossed to help him remove his jeans. It was obvious he was holding his breath for long stretches of time, like a swimmer, surfacing for air only when he absolutely had to. He couldn't keep the mask up as she helped strip off his pants, grimacing.
"Kai, maybe this isn't a good idea."
"I need to get them off," he said, his voice strained, already working to undo the straps on his thighs before Nikki had even gotten his pants completely off. His legs were unyielding, his feet twitching subtly.
She nodded, tossed his pants aside and focused on freeing his lower legs. After a few minutes, Kai lifted each leg from its brace, massaging the back of his knees, focusing on where the tendons stretched from muscle to joint. Nikki heard him hiss more than once as she gathered his braces and crutches, setting them aside but near enough for him to reach. When she returned to the bed, he'd pulled himself back, not bothering to remove his brace socks, underwear, or T-shirt. His eyes were shut, his lips pursed, his breathing ragged, recovering. The pain had to be bad if he couldn't hide it. But she didn't understand: why was he here?
She carefully crawled onto the bed from the opposite side, stretching out alongside him, observing the way his jaw worked as he clenched his teeth, the faint wrinkles around his eyes he was too young to have, the movement of his eyeballs beneath the lids. Nikki reached for his hand and linked her fingers in his. He didn't squeeze it, but he didn't pull away, either.
He opened his eyes halfway, but she could see the glaze of pain there.
"What's going on." It wasn't a question, Nikki's face soft with concern.
"Just my MLS," Kai attempted to say casually, but his voice was stilted and his lids slid shut again.
"I mean, if you're hurting this bad," Nikki said, not even bothering to sugarcoat, "why didn't you just go home?"
"Needed to see you." Kai attempted a smile. Then he shifted, groaning, his hands going to his thighs. He turned his head toward her, but said nothing further.
"Kai." Nikki frowned, even though he couldn't see it.
"I don't have anyone." He took a few careful deep breaths.
Nikki eased closer and smoothed her hand over his face. "You have your brother."
He swallowed, shook his head subtly. "He doesn't know me. He thinks he does."
"And I do?" Nikki couldn't hide the note of skepticism in her voice.
Kai didn't respond immediately. Instead, he sucked in a breath, pushed himself up and back so he was sitting with the wall supporting his back. (Nikki didn't have a headboard.) His face was still lined with pain, but either it had subsided slightly or he had recovered enough to partially mask it again.
Finally, he spoke, his voice quiet, "I'm not afraid when I'm with you."
Nikki's mouth twitched, and she studied his eyes, though he kept his vision focused off into space. Her heart raced in her chest, anxiety tickling the tiny hairs on her arm. In some ways, moments like these were more terrifying than even his mental break the day before. When are you going to tell Blondie how you feel about him? Marge had asked her earlier. Nikki swallowed hard.
"Afraid of what?" Nikki asked hesitantly, stalling.
Kai shook his head just enough to suggest the gesture, then beckoned her closer. "Sometimes I think you're the only friend I have. How fucked up am I?" Kai's voice broke, he grimaced and swallowed hard, kneading fingers into his left thigh.
Nikki crawled closer, so their faces were near, the whisper of each others' breath echoing off their lips. She studied his eyes, multifaceted and beautiful as ever, yet atypically unguarded. She could say something, as frightening as it was. Right now. She didn't know what had happened with the other girl, but Kai had come back to Nikki, more than once, and not just for sex. For comfort. No one had ever turned to Nikki for anything other than coffee or a quick fuck before. It just wasn't who she was.
I'm not afraid when I'm with you, Kai had said without explanation. He wasn't afraid. But she was. So she leaned in, kissing him. Hesitantly, chastely, before pulling back just enough to speak. "Can I do anything? Make you feel better?" She smoothed a hand over his crotch, but he didn't respond as he normally would. Finally, he pushed her hand away and wrapped it in his. With his other, he pulled her close, kissing her again. Deeper. But tenderly, without his usual hunger or desperation. It felt wonderful, but the fearful confusion destroyed her pleasure.
Nikki pulled back, checking his eyes again. "Do you have medicine with you you can take?"
Kai pulled his fingers through her hair. "Yes. But then I can't drive. And you have work soon."
"So? I'll drive you home, then take the bus."
Nikki sighed, planted a few kisses on the edge of his lips. "You've been too tired to fuck me. Or too upset. But we did anyway. You've never been hurting so bad you couldn't."
Kai's smile was faint, yet present, perplexing. "My pants pocket. There's a pill case."
Nikki fished the case out of Kai's jeans, then grabbed him a bottled water from the fridge. He was finally rolling off his brace socks, fingers working into the muscles of his thigh and around his knee. Once he'd freed his legs, he massaged his calves, and Nikki could see the muscles jumping beneath his skin, making his foot and toes twitch painfully. He was doing the swimmer thing again, holding his breath as long as he could.
Seeing him like this was unnerving, not only because he'd never allowed her to before, but because she felt helpless. Even the box in her palm, which rattled as she moved, seemed a vain attempt to help.
"It's going to get worse," she found herself saying as she handed him the box and water. "Even with those."
Kai opened the pill case, plucked two tablets out, and swallowed them quickly, offering a faint nod. "This is the beginning," he said. His face was grey, his eyes weary. He grimaced, and grabbed his left thigh.
"Then why did you come here?" Nikki asked again, sinking down beside him, surprised by the anguish in her voice. "I can't help you."
Kai shook his head, then gave up on his legs, lying back with an audible groan. He beckoned Nikki to him, then pulled her close to his body. "You've always seen me for what I am." She noticed he said "what," not "who," but let him continue. "You put up with my shit. You didn't panic when I stopped breathing. Or freak when I came in here yesterday acting like a junkie coming down from a bad high, cut up and trembling." His sentences were fragmented as he talked through his pain. He sucked in a shuddering breath. "And . . . you're always there when I wake up."
Nikki blinked, processing. For a long moment, they lay together in silence before she turned in his embrace, trying to study his face. He had his teeth clenched and was making an effort to breathe through his nose quietly, but she could hear subtle, barely audible grunts that were likely in tune with spasms she couldn't see.
"As opposed to Becca," Nikki finally said.
Kai groaned, but she wasn't entirely sure if it was from pain or in response. "No." He sighed, grunted. "OK. Yes. But that's not what I was trying to say." His grip on her loosened. “Can it just be enough I wanted to be with you? Just for a little while?”
She felt him hold his breath, then let out a barely strangled moan, followed by panting. Despite the medicine, his pain was obviously worsening. “Lay here a while, then I’ll take you home,” Nikki whispered, embracing him and planting a few stray kisses wherever she could. “You have to breathe for me, OK? In and out, slow and deep.” Nikki stroked his arm, then his side, before remembering the cuts and shifting lower. The muscles in his hip and thigh were tense, and she could occasionally feel one jump beneath her touch. Kai tried to obey, focusing on his breathing, and soon he’d drifted into a restless, drug-induced sleep. She knew he wouldn’t be out long, so she clung to him, inhaling his scent, her mind racing.
“I’m glad you came to me,” she whispered against him. It was the closest to three words she could manage out loud, even if he couldn’t hear her.
Continue to September 9, 2000 - Part III --------->