brittled mind

14

"Hello again, Leonard. Do you remember me?" I look up and see Dr. Archek, recognizing her, I nod. "I'm one of the three clinical psychologists for this hospital, and I''m fortunate enough to be assigned to you," she half laughs. "I'm sorry our first meeting had to be legality issues. I'd love to have a better introduction," she says. "Meredith, please feel free to take your break," Meredith doesn't hesitate. "Dr. Archek?" I ask. She widens her eyes. "Am I crazy?" I ask. "Leonard, you're not. But if you were? Well I'd see nothing wrong with that. You did have a psychotic episode but that is a symptom of your illness- not the illness itself," she explains. "Leonard,-"

"Len"

"Len, we're going to have to consult with a full team tonight. To be honest, we don't know where to go medically, psychologically, nutritionally, or anything. We're stuck and need to meet together," Dr. Archek says. "What if I don't want to get anywhere?" I ask. "Then it's a good thing you don't make decisions," she jokes. "But, I get it, Len. More than you know," she says, leaving. "Dr. Boltzer will bring the team in here in about an hour," she informs me. 

I continue to lay, feeling lifeless in bed. I watch the ceiling. This isn't like last inpatient which was miserable enough with books and puzzles. Now, I have my arms across my body with a thin knitted blanket on me. What's more emasculating than being in a psych ward for food? What's more dehumanizing than being locked up and untrusted with your self? What's more humiliating?

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"Sorry to wake you, Len, but it's time for the meeting," Dr. Boltzer wakes me. I didn't even know I'd fallen asleep. "You've met me, Dr. Archek, and now meet your dietitian, Makoto Hirota, your social worker, Melissa Kephart. A neurosurgeon, Dr. Mehta may consult with you later, if we so decide," Dr. Boltzer introduces everyone. "As a psychiatrist, I was considering beginning the use of an SSRI for persistent generalized anxiety as well as a depressive disorder. I was also pondering the use of a class 1 antipsychotic for temporary episodic relief. Larysa-I mean, Dr. Archek, what's your stance on current psychological stability?" Dr. Boltzer starts. "From the clinical aspect, I agree an antipsychotic could alleviate current symptoms, however the idea of starting both an SSRI and a neuroleptic could pose more struggle. From the interpersonal perspective, I think that even though Len is sectioned, we should look to involve him in medication decisions," Dr. Archek answers. I'm a pre-medical student. I should know what they're talking about but it's all so blurry to my ears. 

"Mr. Hirota, we currently have him on the same feed rate we gave you this morning. We are looking to increase but fear refeeding syndrome. What is your opinion?"

"Because the patient is severely underweight and has restricted solid food intake, there is well over a 50% chance of refeeding syndrome. When he can reach lower liver enzyme levels, we'll begin introducing solids. When his body mass index is 10-12 at the very lowest, we can introduce increasing meal plans to reach target weights," he explains. 

"What target weights?" I feel a lump in my throat. "That's not important now," he sighs. I stare and he gives in.

"It's a series. The patient is an exact 99 pounds under his calculated ideal body weight. Gaining that fast could damage the body. At 50 percent of his ideal, we'll discuss dayroom and dining abilities. We would like him to reach 120 pounds by discharge, and continue to an optimal 150-160 in outpatient," he says. I know he's ashamed to have given me that much information. 

"Liz, what role would social work play in the early forms of treatment?" the hot potato of questions gets passed around. 

"I would make sure that Leonard's best interests are kept at the forefront. I'd also begin contacting outpatient professionals and planning family accommodations as well as being in touch with the university," she explains formally.