Chapter 1, Continued
One more thing needs to be clearly stated before I launch into this case. You may not think that psychiatrists are scientists, but we undergo intense medical training, learn best practices, and use a combination of neuroleptics and other meds with proven talk therapy approaches to help patients. I only mention that because what I’m about to share in these pages may seem to be “out there,” in the sense that it lacks rationality and science-based evidence.
For that reason, I have drawn extensively from my notes, as well as recollections from my journal to assemble them into a single, cohesive story. If there is any fault in the telling of events, that is my own, and my own completely. Again, not being a writer, I hope you’ll permit me the benefit of adding the word “cohesive”—if I may be so optimistic as to do so.
This case precipitated with the arrival of a young man, Mason Delabrey, age 19, at the hospital for evaluation. When he first arrived in my office, Mason looked so thin that I wondered if he was emaciated. He was dressed all in black, and his straight, long black hair hung low over his forehead making it difficult to see his eyes. When I held out my hand to shake his, Mason retreated inwardly. Uncertain yet hopeful, I kept my arm outstretched. It was only after an awkward pause that he hesitantly reached out to greet me. Though his hand was quite cold, I noticed his nails were not brittle. Neither could I see any lanugo hair on his face or neck—the furry or fine hair that is sometimes present with anorexia and which serves as the body’s strategy for preserving heat. Still, I made a mental note to check for disordered eating. However, the most salient issue on his admission report which I’d be addressing in my initial intake was an attempted suicide.
Mason chose to sit on the red sofa in my office. Seeing this, I joined him in a nearby, adjacent chair, so as not to sit behind a desk. I tried to match his posture, even subtly. He watched me through his long bangs, which he swept aside for a moment. There, I finally saw his entire face; it was soft and as white as a pearl with an anathema to the sun. His nose was long and slender, and his eyebrows, set beneath a large forehead, furrowed over his large brown eyes, all lending to an expression that seemed perpetually questioning and melancholy.
“You body matching me?” he asked. There was not the slightest hint of hostility in his tone, only a sense of curiosity.
“Body matching?” I asked.
“Mocking my movements.”
Caught off guard, I paused. I had gotten in the habit of doing this to attune to patients, but I couldn’t remember the last time a patient pointed this out. In rapid succession, a few possible responses to Mason’s query ran through my head. Finally, I realized if I was to connect with this young man, I needed to fess up.
“I’m not going to B.S. you, Mason. You’re right. But, I didn’t do it in a deceitful way. Sometimes it helps me sense what others are feeling. You’re very observant,” I said, purposely pointing out one of his strengths—and wondering how he would respond.
“So tell me, what am I feeling?” he insisted, not letting me off the hook.
I pressed my hands together and raised them up, my forefingers touching my lips and taking a breath. My chest heaved slightly on the exhale.
“I don’t know.” I shook my head. “I was hoping you’d tell me.” Instead of sharing, he just stared down at the floor. So, I thought I’d break the ice by explaining that I didn’t like to do standard tests, such as giving patients the Beck Depression Inventory or any of the anxiety inventories during an initial intake. I simply wanted to enter a person’s world and see how I might gain an understanding before coming to any conclusions, diagnostic or otherwise. “I do know that you’re in pain. Life is a continuum of experiences, and the best I can tell you, Mason, is that I’ve learned not to judge. So, I hope you’ll share with me . . .”
“What? Why I tried to kill myself?” he interrupted.
“Yes, I do want to know that. But what I was going to say was, ‘I hope you’ll share whatever can help me to help you.’”
There was another long period of silence. As I sat, I noticed a shaft of light coming through the screened window and forming a rectangle on the worn beige carpet between Mason’s feet and my own. I was just about to break in when he shared a rather vivid hallucination experience, as follows from sections of my chart notes and memory:
The patient’s affect was somewhat flat as he began talking:
“I don’t ever remember anything being so completely black. So black so that it made me catch my breath. I jerked my head from side to side to see where I was, but there was just this empty darkness. I remember clenching my hands and I could feel the coldness of my fingers in my palms. It felt good to feel them.”
The patient reported peering into the darkness when an arm reached forward, as if out of a cloud of nothingness. When I asked if this startled him, Mason stated he “wasn’t afraid,” which struck him as kind of “weirdly different.” He reported being more curious than anything. It was in this state of openness that he simply watched as the arm, an apparently disembodied arm, reached upwards and towards the side of his head.
The fingers, long and thin, touched him ever so gently on his left temple. With that, a hoarse, almost whispering voice asked him, “Are you a traveler?”
Upon hearing this question, the patient reported thinking, “Am I a traveler? What does that mean?” The patient pondered over this question as the fingers continued to lightly touch his temple. They felt warm to the touch, somehow inviting. Even though the body from which the arm reached out was not visible, this entity, or whatever it was, made him feel safe. Although he wasn’t a hundred percent sure, something inside told him what to say: “Yes. Yes, I’m a traveler.”
What happened next was abbreviated in my notes, but I’d like to share it here in its entirety. Mason said that someone, or something, dressed in a black shawl stepped out from the veil of darkness. When I asked Mason about any identifying features, he reported that because the figure was hooded, he was unable to describe any details about the face or even the sex.
Then, unexpectedly, in the blink of an eye this figure bear-hugged him. At that moment, according to the patient, “the blackness was suddenly replaced with the brightness of white light, white all over, a white so bright that for a moment it blinded me.” Simultaneously, he felt himself being catapulted upward, like a cannonball.
With this sense of upward movement came an overwhelming feeling he had never known before. It was, he described, like being enveloped in “a warm glow, kind of sweet, like warm honey and roses.” The glow, along with the sweet fragrance and sense of lightness, was intoxicating. It occurred to him for a moment that maybe this was like meeting God, but as soon as that thought occurred, the whiteness and light cleared away.
Suddenly, Mason realized he was in a garage, floating up near the ceiling. Before any thoughts could interfere, he recognized various objects like a rusty rake with a broken handle, the bent garbage can, the blue mountain bike. The word “Damn!” popped into his head with the realization that this wasn’t just any garage, but the garage at his parent’s home. He lived here!
Mason noticed that the garage was smoky, and the car was running. He felt his body descending, attracted to the car like a magnet, even though he hadn’t consciously told it where to move. That’s when he saw a figure collapsed across the front seat.
According to Mason, his body again moved without effort. He felt himself contacting and moving through the car door, which was still shut. He hovered closer to the body. He was looking at a profile of a pale face; the eyes were half shut, and each breath was heavy and labored. Suddenly it dawned on him. This young man was himself.
In my office, Mason screamed aloud, “Noooo!” as if he were reliving the moment. Although I am trained to be professionally neutral, I felt a chill surge through my body. I asked the patient to take a few slow breaths before telling me what he saw. After feeling composed again, he described a crushing pain.
No longer was he floating and witnessing. Instead, it was like a thousand needles pierced him. He tried to move his body, but each limb was heavy like large rocks. It took every ounce of his remaining strength to press the “off” button on the car’s dash. His arm slid over to the horn, which he pressed and pressed repeatedly while gasping and choking for air. The last thing he remembered thinking, he told me, was, “Please take my head out of this fucking vice.”
Mason’s next memory was waking up in the hospital with an IV drip in his arm. Before our session was up, we talked at length about what this traveler experience meant to him. Had he ever heard this traveler “voice” before? It was well recognized in the field that the first symptoms of schizophrenia often developed in late adolescence with hallucinations and delusions. But Mason’s experience seemed unusual to me, and I’d have to rule out other possible physical causes, including a brain concussion history.
Before our time was up, I asked Mason about his suicide and said that I wanted him to be safe. I was relieved when he promised not to harm himself and that he was willing to work on a safety plan with me. As he stood to leave my office, he paused at the door.
“Can you call my mom?” His voice was quivering, trailing off. “Tell her I’m sorry . . .”
“Sorry for what?”
“For this, for everything, for being such a fuck-up.” He stood frozen, looking blankly at the floor.
I cupped my hand ever so gently on the back of his shoulder, which felt so frail that I could clearly feel his scapula. “I’ll be talking to her. Would you like me to arrange for you to see her?”
A small, fragile voice, somewhere from deep inside of this tall six-foot tall young man answered with a single word, “Ok,” before shuffling out the door where an orderly was waiting to show him to his room.
Composing my SOAP notes (that’s psycho-lingo for one way to format and structure notes on a session: the Subjective, the Objective, the Assessment, and the Plan), I realized that even if his suicide attempt was caused by a triggering event, Mason clearly suffered from anhedonia and other signs of acute depression. The only thing he reportedly got pleasure from was drawing and sketching, but he had stopped doing those activities months ago.
Under the Plan section of my notes, I wrote that Mason might benefit from being included a group with our excellent art therapist, David. There was certainly enough reason to keep him hospitalized until we eliminated any possible self-harm and had his diagnosis and meds sorted out.
Most patients on my residential unit were a fair bit older than Mason. They were severely impaired, delusional and in crisis. Typically, they remained here for two or three weeks until they were stabilized on meds and returned to their home or family. Unfortunately, the families didn’t always welcome them back, and so more than a few ended up on the streets, biding their time until they boomeranged back to us. Mason didn’t really seem to fit in with our milieu, but we’d just have to make it work.
“Hey, it’s Bono! Oh my God, I love U2, you are so awesome!” A manic patient, Roy, beamed at me as I headed down the hall to a staff meeting.
“Hi Roy,” I smiled.
“You gonna play something for us? I can’t believe Bono is here. Look!” he said to Mr. Dibby, a middle-aged man with unipolar depression who rarely spoke. Mr. Dibby looked up, obviously unimpressed by my Bono impression.
“Coffee!!!” came a shout from Wanda, a thin older woman who was seated in the common area and could never seem to get enough caffeine.
“Is your rib open?” asked Frita, a slender woman in her thirties.
“No, I think it’s my jacket.”
“Coffee!!!” called out Wanda again, to no one in particular.
“Bono, don’t go! No, not before you sing,” pleaded Roy from behind.
“I’m not going anywhere Roy. I’ll check in on you later, okay?”
“Sunday Bloody Sunday, man!” My biggest fan moved and gyrated wildly.
“That’s wrong,” demanded Burt, a fifty year-old who was diagnosed with schizoaffective disorder. “You don’t know what you’re doing. I work here and you can’t do that!” Burt grabbed another patient’s coffee and spilled it all over himself. “I’m wet! I’m wet! Oh my God, I’m wet!” he shouted, trying to wipe the coffee off his shirt and pants.
“How do you get a cup of coffee around here? I paid for it! Coffee!!!” echoed in the hall behind me as I walked past the nurse’s station and turned down the hall.
Yes, these patients were sometimes delusional and might act out, but they weren’t scary violent like those living in the forensic unit of our hospital. I had spent time working on the forensic side, and it was no fun always looking over your shoulder to make sure you weren’t getting assaulted.
The most frightening patient in forensics was the behemoth of a man nicknamed “Sasquatch.” This name was not chosen lightly. Sasquatch stood almost seven feet tall. He refused to cut his hair or shave his beard, both of which were hopelessly matted and accentuated the impression of his being a dangerous, fierce and wooly animal. He lumbered about the unit clumsily, each foot slapping at the ground as his arms swung wildly along for the ride. He was probably over-medicated on Haldol, which might have accounted for the atypical body movement, but no doctor wanted to be responsible for reducing the dose of his antipsychotic cocktail.
He was in his mid-twenties, after an already long history of assault, paranoia and delusions, that Sasquatch tragically stabbed his brother in the eye and his sister in the throat with a carving knife at the family Thanksgiving dinner table. The sister bled out and died before the EMTs arrived, and the brother lost an eye. Sasquatch seemed genuinely remorseful about what he had done. While he rarely heard voices anymore like the one that told him to attack his brother and sister, he never pleaded for his release when his time came up for a mandatory court appearance. His mother continued to visit him with site supervision, but his father and brother refused to acknowledge him. Unlike those forensic patients who made progress and left the unit for weekend visits with family, Sasquatch was most likely a lifer.
I found a seat and settled in for the staff meeting around the rectangular table along with my unit’s other two clinicians, psychiatrist Dr. Rick Milton and Licensed Professional Counselor Sarah Brown. Also in attendance was our art therapist David and our pharmacist Mitch. Sitting at the head of the table and leading the group was Executive Director of the hospital, Dr. Beverly Howell. She oversaw the operation of all the units and had been here since the hospital’s inception twenty-five years prior. Beverly’s rosy complexion made her seem warm and approachable. But make no mistake. When her piercing brown eyes, framed by gray hair flecked with black undertones, turned in your direction, she communicated a very different impression. With Beverly you always knew where you stood, and she was usually right.
When my turn came to present the status of my cases, I started with Mason. In particular, I raised a concern as to whether he needed our level of hospital care. Wouldn’t a depression treatment center for young adults be a better fit? In response, Beverly divulged that the boy’s parents had requested and received, a mental health commitment hold. This had been pending, but was just approved by the court. She slid a thick packet of papers across the table in my direction.
“His father Edward Delabrey is a very influential attorney who has assisted this hospital on numerous occasions. So I want to be sure we offer him, uh, and his family, every accommodation.”
It flashed in my mind who she was talking about. Five years earlier, the hospital was sued for not protecting patients from a male nurse who had a history of sexually abusing patients in another state. He moved to Oregon, but the hospital didn’t do a thorough background check. Edward Delabrey had successfully represented the hospital in a high profile court case in which he discredited the female patient who had accused the nurse. He saved the hospital millions, but the whole incident left a bad taste in my mouth. Apparently, Delabrey’s law firm was on retainer and continued to help the hospital with all kinds of legal issues.
“The utilization manager says we’ve been low on census,” continued Beverly. “That’s not a reason to keep him, obviously, but that report gives us more than enough reason to admit him, possibly long-term.”
Glancing at the court order, I couldn’t disagree. I saw the list of reasons why Mason’s mother and father had co-signed the mental health hold. The evidence showed that Mason had been refusing depression medication prescribed by his family doctor, had threatened self-harm, and was recently hospitalized after lighting fireworks and setting off the fire alarm at his father’s law office. There was also the mention of an assault against a family member, but no details of that assault were given nor was any official charge ever made. Mason hadn’t shared this information with me, and the assault was something I’d have to clarify in our next session.
I must admit, I had to stifle a smile when reading about the fire alarm episode. There were times, I thought, when I would have wanted to do something like that to rattle my own father’s sense of propriety and smugness. Strangely, this stirred a memory about mythic philosopher and storyteller Michael Meade and his work on the father-son dynamic. I made a mental note to consider bringing Meade’s concepts into my work with this young man. While Mason’s outbreak hardly seemed reason enough for commitment, he certainly exhibited a pattern of behavior that was concerning. Just as I concluded the case discussion, David piped up and suggested that Mason might be a good fit for his art therapy group. I agreed and said I’d schedule him for it.
By the end of the day, as I wrapped up loose ends and filed away my notes, I felt a weariness overcome me. My mind was spinning with all that I’d have to unpack in my next meeting with Mason. That would include making a decision on meds and a definitive diagnosis, such as schizophrenia, unless I could rule that out. I’d also need to arrange to meet with his family and get greater insight into Mason’s behavior and the family dynamics—and learn about the assaults.
I looked out my window to check the weather. It was still dry out, despite a mix of clouds and sun. The heart-shaped leaves on the white-trunked aspen trees had already fallen, which was not surprising given it was late October. I put on my hat and jacket, and entered in my code to unlock the only door to the unit.
“Goodnight, Dr. Banks,” said our perpetually sanguine, red-headed receptionist by the main entrance.
“Goodnight Fran,” I said, forcing a smile.
Outside, the chilly air stung my face. I noticed the topiary shrubs alongside the walkway looked a little ragged, and I wondered how our longtime gardener Reggie could have possibly missed this.
The sky was streaked with long strands of pink and yellow. “Damn, another summer on the way out,” I mused wistfully, “I wonder how many more of these I’ll see?” I hinged open the creaky, metal gate leading to the street. Each time I opened that gate, it reminded me of my own creaky knees that had caused me to abandon jogging.
A few steps away, near my car, I spotted a short woman with long and bushy dark brown hair moving slowly along the sidewalk. She wore faded jeans and an unusual, multi-colored jacket. A large backpack hung from her stout frame and thick shoulders. I thought I saw something move, and I was surprised to see a small black and white spaniel balancing on her shoulders. As she knelt down to remove the backpack, the spaniel leapt down from its hairy perch.
After putting my briefcase inside the trunk of my car, the dog pranced up to me, tail wagging.
“Hey, nice dog.” I bent down to pet the pooch’s head.
“His name is Bear.” The dog’s owner smiled at me. Her face was round, her hair framing warm and inquisitive green eyes. Her skin was deeply tanned and leathery from exposure to the elements. “Damn, another summer on the way out. Makes you wonder just how many more of these you’ll see, don’t it?” As she finished, she gave me a sly wink.
Her exact repetition of what I had thought just moments earlier stopped me in my tracks. “Uh, yeah. I was just thinking that.”
“Gonna be getting cold soon. Bear and me be hitting the road, headed south to warm weather.”
“So you don’t live around here?” My eyes were drawn to a tassel hanging from her hair. Woven into the tassel was a long white feather. It caressed the side of her head and glistened like a jewel in the fading sunlight.
“Oh no,” she guffawed. The feather floated up and down, as if in agreement. “Nah, just stayed for the summer. We don’t live nowhere. Me and Bear, we’s travelers.”
“Travelers?” I spit out reflexively. It seemed a strange coincidence so soon after hearing Mason’s hallucination, but as I recalled from my time poring over Jung’s Red Book, there are no coincidences, only the manifestation of parallel events that live beyond the fringes of chance and probability.
“Yeah, I ain’t no panhandler. I don’t ask for money.” She started digging into her backpack, stood up and held out a small, intricately woven metal wrapped pendant no larger than a thumbnail. “Here, look. I make these. This one here’s a necklace. You can put a stone in here if you want.”
“That’s very nice,” I nodded, inspecting the detailed handiwork.
“Takes me about 12 hours to make this. And I make these jackets, too.” She extended her arms to model the creation, which was a patchwork of shapes and materials. She told me that the cuffs, which consisted of fabric adorned with metal holes, were recycled from old gym shoes.
“You’re really creative.” I pulled out my wallet and held out a $10 bill. “Please take this for you and Bear. Maybe you could use it?”
“Sure could, thanks,” she grinned, displaying a couple of missing teeth.
She suddenly crouched down and began digging in her backpack. I looked on, curiously, and so did Bear. No more than five seconds passed when she bolted upright and presented me with a pristine business card. I couldn’t believe that anything could come out of her crammed backpack without so much as a crease, a wrinkle or a smudge.
“Call me if you need anything. A necklace, or, well, I’m sure you need something I can offer, Ben.” She winked mischievously at me.
I blinked in surprise. Had I told her my name? I didn’t think so, and I felt a strong and immediate sense of uneasiness. Besides, I had absolutely no idea what she was hinting at with her vague offer.
“Gotta find the trainyard. It’s a big yard, called Albina. The Albina Train Yard. You know it?”
“Train. You mean riding the rails? Isn’t that dangerous?”
“Ain’t so bad. Only dangerous if the bulls get ya’. So long as you hop on or off outside of the yard, it’s okay.”
“That’s train security.” She zipped shut the pack and lifted Bear back onto her neck. “You know where Albina is?”
“North Portland, I think.”
“Oh, I’m Jacki,” she said, holding out her hand. She had a firm grip as she pumped my arm up and down several times.
“Did I meet you or . . . How’d you know my name?”
“Oh. You told me, right? Or, sometimes I just knows things, ain’t that right, Bear?” She chuckled and her dog barked, seemingly nodding its head. “I’m a traveler, so call me Traveler Jacki.”
“In that case, Bear and, uhm, Traveler Jacki . . . Good luck.”
“See ya’ round, Ben.”
For a few seconds I stood immobile, and everything seemed unnaturally quiet as I watched her walk along the sidewalk with Bear hunched low for the ride. I glanced at her card and found it contained no phone number. All it said was, Traveler Jacki and Bear at Your Service. Jobs Big and Small.
Oddly, when I got in my car and pulled forward, this unusual woman and her dog had seemingly vanished into thin air. Meeting her was discomforting, and I could only shrug my shoulders as I stuffed her bizarre calling card in my pocket.
End Chapter 1
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