Am I ready for this? Did I think I would be? Who: Simone and Nishka What: Psychiatric consult Where: LA County Hospital When: Wednesday morning, 3/15 Notes: Complete
Simone wasn't a coffee drinker, but like anyone else who'd been through med school she had a serious caffeine habit nonetheless. She operated on black tea brewed strong, and this morning as usual she was trying to shove a bagel into her face at top speed while she read over a patient's file. Also trying not to leave poppy seeds in the pages. Or butter stains. Just trying to be a professional grown-up in general. She'd been working in L.A. for six weeks now, staying at a hotel until its beige corridors started to feel like home, and the new apartment (though beautiful) had her feeling a bit off-balance. Her private office felt the same way, new and fresh but unfamiliar, and she was happy to have the attachment to L.A. County Hospital just for consistency.
She finished her bagel, washed her hands in the breakroom sink, and gathered up her things before heading off to see her patient. She had a brisk, determined stride, leaning forward slightly as if walking against a strong wind, travel mug in hand and charts under her arm. Seeing a patient just after an overdose was often an emotionally raw experience, never predictable. Some people loudly rejected help, some people fell apart, some people were disconcertingly genial and seemingly clear-headed. A strange moment in anyone’s life, coming that close to the end of it.
And really, “emotionally raw” was the best case scenario; it was more troubling if the patient was distant or uncommunicative. All you had then was a face and a name, the scraps of a story from the file, and then—often enough—you never saw them again, never knew if they were okay or not.
So hopefully things would go better this morning. She double-checked the name and number in the file before knocking. "Nishka?"
Nish wasn't happy about spending another night in the hospital, but Dr. Peters had kept her for observation; he wanted more data from the heart monitor before he let her go.
Nish had just finished a particularly boring breakfast of tasteless oatmeal, milk, a tiny piece of cheese and a fruit cup, when a woman poked her head in. She looked up, shifting a little and readjusting the IV tube out of her way. “Hi,” she said somewhat passively. She assumed she was probably just here to take her tray or check her vitals.
"Hi," Simone said back, giving the woman a smile and a small wave as she came inside. "I'm the psychiatrist, my name's Dr. Fujita. Nice to meet you." She moved the chair a little closer to the bedside and offered her hand to Nishka as she sat down. "Dr. Peters probably told you I was going to come and see you, but if not, I'm here to figure out how you're doing and what you'll need, especially after you're discharged. Are you okay to talk with me a bit right now? How are you feeling today?"
Her expression changed when she heard the word ‘psychiatrist’, to something between amusement and annoyance. “Yeah, he told me,” she said, settling back a little into the upraised back of the bed behind her. “You're here to figure out if I'm crazy or not?” She knew there was more to it than that, but it was basically the point of the visit. Determine whether or not the patient is still suicidal and then release them back into the wild.
"Nobody really likes that word, do they?" Simone said, opening the file and taking the cap off her pen, although she didn't write anything down yet. "That would suck, if I was just going to waltz in here and judge your whole life based on one conversation. Decide whether you're crazy or not, whether you're capable of living your own life like anybody else. But that's not the idea. I just want to get a sense of how you're doing, and what might help you feel better. Because obviously everything isn't quite okay right now, is it?"
Nish took a deep breath and sighed it out slowly, nodding. “I guess you could say that,” she said quietly. She looked down at her hands, fidgeting with the edge of the blanket over her legs. “I'm not...very good at this. Talking about this stuff.” A wry smile tugged at her lips. “Though my boyfriend would be happy to know I'm talking to you.” Now she could make Rafe happy, tell him she finally talked to someone about what's bothering her. All she had to do was actually say something.
"Yeah? Has he been worried? Hassling you to talk to somebody?" Nish nodded, swallowing nervously, suddenly not wanting to talk at all, but the thought of Rafe's concerned face at least kept her from leaving. Simone was watching her, but taking in the whole room as well—the breakfast tray with the sad hospital food that was due to be picked up, the IV pump's soft shushing sounds, the shadows under her eyes.
"You don't have to be good at talking, lots of people don't know where to start. Life's probably been complicated lately, huh?" Simone said. Nish nodded again, embarrassed when sudden emotion filled her eyes with tears, and she hastily looked away, as if she could hide the reaction from the other woman.
Simone glanced down at the file, then back up at Nish. "So something's brought you to this point. Can you walk me through what's been going on the past few days? You can even start at the end and work backwards if you want, I'm pretty good at following a complicated story," she added with a crooked little smile.
A short bark of cynical laughter escaped her, followed swiftly by the tears running down her cheeks. She raised a hand to wipe them away, but more followed. Working backwards was the only way she could do it, because she had no idea where to begin. Even then it was hard to find words, or the courage to say them.
“I had nothing left,” she said, echoing her dream, tears coursing silently down her cheeks. “A few days ago...a…somebody,” she struggled for the right word to call him, “stole my diary from my apartment. He...photocopied it, forged fake entries and edited real ones...and posted them all over the lobby of my building.” She had to stop then, biting down on her cheek and taking a moment to keep from breaking down completely. “Some were about friends...and some were about clients. And now I have neither.” It wasn't entirely true now, since she had patched things up with Chris, and Rafe seemed to be satisfied that she hadn't actually written those things. But when she did it, it was all she could think about. Even now, she still harboured the fear that...Rafe still wasn't completely sure she was telling the truth.
She closed her eyes, reliving that night. She'd chased handfuls of pills with mouthfuls of vodka, the coke already in her system making her heart pound in her ears as the vicious texts and emails poured in. Her phone buzzing so much she finally had to yank the battery out to make it stop.
"That sounds horrible," Simone said, her own experience with her ex-husband making it a little more vivid to her. Miles poking through her emails, her texts, her browser history, looking for proof of something that wasn't happening. The sick, lurching feeling when she realised it. A diary would have been far worse, if she'd kept one. "What a violation. I think anybody would feel lost and overwhelmed if something like that happened. I'd be furious. It's such a personal betrayal too, somebody doing that to you." She paused. "And you decided to end your life?" Her tone was quiet but without judgement, as if she were just asking what Nish had planned for dinner. "Was it an impulse that night, or had you been thinking for awhile that you wanted to do that?"
Nish took a deep breath, wiping at her face, even though the tears didn't stop. She hadn't planned it...and it had been pure coincidence that she'd signed a new power of attorney days before, though she knew how it looked. After seeing her private thoughts posted all over the lobby, all she'd wanted was revenge. But when she started losing clients, losing friends…
“It just...happened. I was upset...and everything…everyone was making it worse. I didn't...plan it, but I knew what I was doing.” She remembered taking the last of the coke, but it hadn't been enough. That was why she went for the aspirin. She'd wanted to make sure it worked.
"Okay. So it was a bad moment and the tough stuff just outweighed your ability to cope," Simone said, illustrating an unbalanced scale with her hands. "It happens. What else has been going on in your life lately?" she asked. "Any other stressful stuff? I mean, I know nobody's at their best in a hospital first thing in the morning, but you really give off a vibe like you've been through the wringer."
Part of Nish wanted to smile, but couldn't get the muscles to work. Her life was stress, she wanted to say, be more specific. But instead she chose the easier thing to focus on, leaving her messed up sex life alone for now. “For the past month I've been working a case that…” she paused, trying to find words to describe it. “I would have done anything to get out of it. I was assigned by the State to defend someone who...well, he was a monster. And I knew he was guilty. Every day, I'd work on the file, read about what he'd done, trying to find a way to walk him through due process...but the longer I worked on it…” she paused again. She was somewhat more focused talking about the case than she had been about the diary, a little more detached, now that it was finally over. At the time though, she'd been a mess.
“I wasn't sleeping. And…” she hesitated here, knowing this may get reported, but the doctors already new about it. “I started using again. I had to, to get through it.” She knew Chris was worried about what she'd say, if she'd tell people where she got the coke, but it wouldn't happen. And so far, no one had asked.
Simone nodded. "I've seen that before, mostly with other people in my field—you work with a client who's been involved in seriously traumatic stuff, and the effect bleeds over into your own life. The traumatic thing might not have actually happened to you, but it still ends up being a weight you have to carry. So you look for a way to feel better, a way to treat the pain. Of course you do. Especially if it worked before." Nish nodded, looking back down at her hands in lap. There was no reason to comment on the fact that self-medicating with street drugs wasn't healthy; Nishka was already in the hospital, so belabouring the obvious wasn't helpful. "You say 'using again', so you'd stopped for a while? What worked for you then?"
She nodded again and then sighed. “Five years, seven months,” she rattled off. “Last time...my brother. He...well, he made sure I got clean.” She swallowed, worrying the edge of the blanket with her fingers. “I've been here before,” she indicated to the room, the equipment. “I was in a relationship that I...couldn't leave. I had no control over my own life.” So she'd tried to at least control her death, she thought but didn't say.
“He's on the other side of the country; last I heard he was doing some undercover thing,” she shrugged dismissively. “I don't expect him to come running every time I implode.”
"So you've really worked your way through a lot," Simone said, rolling her pen between her fingers as she listened, still not in note-taking mode but just absorbing the story. "You survived, you got clean, you took your life back. Nobody can take that away from you.
"And your brother's not around right now, okay, but who do you have in your life who you can count on? People who are on your team. You mentioned a boyfriend, are things okay with him?" Nish didn't answer, but paused to consider the question. Rafe had been there for her, the whole night after she was brought in. He stayed with her until he was sure she was okay, heard her out. He said he believed her, that she hadn't written those awful things, but...a big part of her was unsure. Doubted that he was telling her how he really felt. And was now unsure of where they really were with each other.
Now Simone did make a few notes to remind herself for later: brother on other side of country, undercover work? Boyfriend, other friends? "You said earlier that you lost friends when the stuff from your diary was stolen and made public, but do you think they might come around if you talk things through?”
She sighed softly and nodded. “Yeah, one...he's a friend and a client…” she paused then, choosing her words carefully, not wanting Chris to be identifiable from what she said. “There was stuff about him in there, and he was...mad. Really...really mad. And for good reason. But...he came to see me yesterday, and he forgave me. I think...both of us were just too tired to stay mad, but...I at least have him.” She'd need to talk to Rafe later, when she wasn't here, when she was home and stable. But for now...at least he was there for her. And that was all that mattered.
"Okay," Simone said, tilting her head for a moment as she thought about that. "So right now your relationships need some communication to sort things out, but it's not completely scorched earth. It seems like maybe it would help you to learn more about managing strong emotions, so that when bad stuff happens you don't feel so overwhelmed. Like you're imploding, to use the word you chose just now. And regulating emotions is a skill that can be taught, if you were interested in working on that. So are you? When you're discharged, are you going to be thinking, 'I'd like to focus a bit on getting better' or would you think, 'I don't need to do that'? You can be totally cards on the table here, I'm not gonna get mad or judgey about it."
Nish thought about that for a long time, looking down at her hands again, twisting together in her lap as her thoughts raced.
’You need this,’ she heard Loki's familiar, comforting voice.
’I don't want to. I don't want to talk to anyone,’ she replied, feeling small, vulnerable. She felt sudden comfort, as if a hand was rubbing her back.
’I know you don't,’ he soothed, ’But I can't help with this. You need to help yourself. You have to get stronger, there's so much we have to do.’ She took a deep breath and sighed it out slowly.
“I think so,” she said aloud to Simone. “I'm just...so tired. Of everything. It just seems like...an impossible mess to clean up. I can't do it by myself.” It was hard to admit aloud. She felt like she was trying to dig her way out of a hole that kept filling up faster and faster with dirt.
"That's really smart and mature, though, being able to admit that," Simone said, relieved that Nishka wasn't going to be so resistant that she refused to help herself. Easy to understand why people fought against it, but even so, it was tough to go home at night thinking she might try it again, and maybe this time no one will find her in time... "Of course you're tired—even just physically, being in the hospital takes all the good out of you. And you had that small heart attack, according to your chart, so you have every right to take it easy for awhile. But yeah, I'd like to get you into an outpatient therapy group. A lot of people find that's a bit easier than one-on-one therapy, because like, maybe there's something you don't want to admit to a stranger but somebody else will have the same issue and be willing to talk it out, so you can kinda piggy-back on their vulnerability. Listening to other people can make you feel less alone. You can be quiet and low-energy some days and there'll still be stuff to learn and absorb. And if everything's going to shit on another day, the group is a pressure valve. If you do want to try one-on-one therapy, of course, I'm taking new patients. So that's an option too, whatever you'd like to try."
Nish looked up at her nervously, uncomfortable at the idea of a group of people knowing her business. That was what got her into this mess, after all. But she had a point - hearing her own problems described by other people who were feeling them too might be good for her. And if there was a group, the attention wasn’t going to be all on her.
But she also considered the one-on-one therapy, which she was sure what Rafe would prefer. Someone to talk to her about things that were bothering her personally, kept to one person so she would feel more open to talking. And...the longer she was here, Nish was realizing that she didn’t hate Simone. She could tolerate her talking to her, about her. Asking her things. She seemed to know what she was doing. The other therapists she’d seen in the past...didn’t really seem to care at all.
So she nodded, to both ideas. “I’ll try,” she said, not making promises, but accepting the ideas in the spirit they were given. “And...if I had to talk to someone...you’re not so bad,” she said with a little smile. She was still resistant to the whole idea of therapy, but Rafe wanted it, and apparently Loki wanted it. She might as well give it a try.
Simone smiled back. "Hey, if you'll try it then we're on our way. I'm really glad to hear that, I hope we can get you feeling stronger and happier before too long. And if you're going to be getting support that way, then I see no reason why you shouldn't be able to finish recovering at home, where you'll be comfortable. Everybody feels better when they're in their own space with their own stuff. In their own bed. You'll really need to take it easy for awhile, not too much stress, okay? Work on taking care of yourself first."
Nish nodded, feeling a little better now that the decision had been made. And with the idea that she'd be going home. And now that she'd be going home, she never wanted to come back to the hospital. “I don't have to come back here, do I?” she asked. Maybe Simone had an office somewhere else. Or she made housecalls. “Do you make housecalls?” she echoed her thoughts aloud, a note of desperation in her voice.
"I do have an office, let me give you a card here—" Simone reached down for her purse to find her card case, popping it open and handing a card to Nishka. "This is my private practice in Newport, I run it with my partner Dr. Serfaty. You can call in and just let our admin assistant know that I saw you at L.A. County, she'll set something up. And this here is the card for the outpatient therapy group,” she added, giving Nishka a second card. “But yeah, if you'd be more comfortable starting off with a home appointment we could do that at first and work up to office visits."
Nish took the cards and looked down at them in her her lap, nodding. “I think I would...at least for now.” She managed a little smile, “you can meet my cat,” she added, sighing softly, “I miss him.” She played with the IV tube on her arm for a minute. “It doesn't say in there when I'm getting discharged, does it?” she asked hopefully. The longer she talked to Simone, the more she was starting to trust her, at least a little.
"Oh, I love cats," Simone said with a smile. "Haven't had one in years, maybe I should get one now that I'm in the new apartment. And no, Dr. Peters will be the one who makes the call on when you're discharged—he'll probably send a discharge nurse in to get you ready to go, when he thinks you're ready for it physically. Hopefully it won't be too long, so just hang in there, yeah?"
Nish looked down at her hands again, at the cards she was holding, and nodded. “Thanks,” she said, biting on her lip. After a slightly awkward moment, she looked up again, not smiling, but not frowning either. “I guess...I’ll see you soon then? How often do we...talk?”
"Why don't we shoot for once a week now, and as things get more settled we'll move to every other week?" Simone suggested, since that was the standard way she started out with patients who were in crisis. Some patients who were really struggling saw her twice a week, but that was usually if she wanted to keep a close eye on how they were tolerating a medication change. She checked her watch, which she wore on the bottom of her left wrist, and gathered up her bag and the chart. "I'll let you get some more rest for now, okay? Call my office and we'll talk soon. Take care, Nishka," she added, giving the other woman another smile before leaving.