Chapter 3: Tuesday afternoon

Editor’s Note:
The next documents contain further transcripts of meetings and patient interviews written by Dr Koehler Snr (Psychiatrist).

Notes of meeting, Nurse Raoul, Tuesday, 11/30; 4:50pm

Dr K: I got your message. What happened?

N.R: I didn’t do anything. I looked in her room to check on her and she was sitting there. Sitting up in the bed. She took one look at me and pulled back into the corner. She was all huddled up and clutching her pillow in front of her like she was hiding behind it, right? I talked nice and gentle. I said everything is okay. I stayed back in the doorway, keeping my distance since she was so scared. That didn’t seem to help so I stepped back even further.

N.R: Quick as a flash, she was off the bed and crawling underneath. So now she was hiding under the bed, right? And she wasn’t coming out of there. I even tried walking out and closing the door but when I checked through the window, she was still under the bed.

Dr K: Hmm!

N.R: I’ve seen patients do like that when they’ve been abused but it didn’t say she was abused in her file. If I’d known she was abused or raped or something, I woulda come in really gentle from the start, right? But I didn’t know.

Dr K: She wasn’t raped. There hasn’t been any long-term abuse. Don’t worry, I suspect this is more because you’re a stranger than anything else. You may have scared her when you first came in. I’ll go in and try to get her out from under the bed. Once I get her settled, I’ll introduce you and see if that helps. On the positive side, you managed to get more of a reaction from her than anyone else in the last 24 hours.

N.R: If this is a male thing, I could be swapping with Jin from 5 West.

Dr K: We’ll keep that in mind, but I don’t think we need to go that far. Will you find me a pad and some colored pencils?

Meeting concluded 4:58pm

Transcript of Patient Interview, Rebecca Freeman, Tuesday 11/30, 5:00pm

Patient still under bed. I sat on floor within view of patient.

Dr K: Hello, Bec. It’s Dr K. Do you remember me? I’m here now. Everything is okay. You’re quite safe.

After a little over fifteen minutes of almost continuous “safe talk” from me, patient crawled out from under bed. Patient immediately crawled into my lap and hugged herself into my chest, still holding tightly onto pillow.

Comment: Patient contact is an occupational hazard when working with children. Under current regulations, we aren’t permitted to touch our patients. We have guidelines to follow if they initiate contact with us. In most circumstances, we are to discourage the contact. In this case, the patient clearly initiated contact. In my professional opinion, the best outcome for the patient was to allow the contact.

Continued safe talk for another seven or eight minutes then gently moved patient off my lap to sit on the floor next to me. Then passed drawing pad and pencils to patient.

Continued safe talk but gave no direction as to drawing. Patient held pad tightly and stared at blank page for extended period of time without drawing. Eventually I decided to try giving some direction.

Dr K: Could you draw a picture of yourself? Draw how you are feeling right now.

Patient looked at me carefully when I talked and kept looking after I finished. After a moment her eyes dropped to the pad and then flicked back to me.

Dr K: (repeated request)

Patient put pillow down in lap with pad on pillow. Looked at me one more time then began drawing. Patient completely involved in drawing for nearly ten minutes. I made no attempt to observe her incomplete drawing. There was no sign of hesitation over what to draw next, no pauses when the pencil was not active on the page. Patient’s face was expressive as she drew – squints, winces, frowns, grimaces. After a time patient stopped drawing and sat looking at the picture she had drawn.

Dr K: May I see it?

Patient did not respond. I gripped edge of pad, tugged gently. Patient didn’t resist my taking pad. Drawing shows a very small, but highly detailed cat in the center of the page, closely surrounded in all directions by a high brick wall. A grid of bars covers the ceiling of the enclosure, trapping the cat inside. Cat appears thin, bony and unkempt. Cat sits curled around itself and stares mournfully up out of the enclosure. Overlarge eyes emphasize the pathetic appearance of the cat. Outside the brick wall, the rest of the page is blank space. Over on the edge of the space is a small set of bleachers facing toward the enclosure. A single person sits on the bleachers with a huge head and very tiny body with tiny little arms and legs. The little person has a face which is clearly recognizable as mine.

Dr K: I see. You feel trapped here inside the hospital. And here I am, a talking head over on the side. Who are these extra seats for?

Patient still not responding to direct questions – not even with body language.

Dr K: Bec, do you know why you are here?

No response.

Dr K: What is the last thing you remember? Before waking up here – what do you remember?

The question clearly sank in. I could see her thinking carefully. I handed her the pad and pencils. She took them and clutched the pad to her chest.

Dr K: Draw for me what you remember. Draw the last thing you remember before waking up here in the hospital.

Patient turned pad to a new page and started drawing without hesitation. Face was less expressive this time. Seemed to get calmer as she drew. Again no hesitation or pauses. Totally engrossed in her drawing. I considered shifting closer to her but recalled her journal entries where she described feelings of alarm when her surroundings changed as she drew.

Again had to tug pad away from her when she finished. Drawing is in a completely different style. This time, single long flowing lines hint at form without detail or substance. I speculate that the style indicates that the memory is vague and tenuous. The outline of a large seated man can be made out. Seated on his lap are the wispy outlines of a girl with her arms wrapped around his neck and her face buried into the side of his neck. They are both insubstantial, ghost-like creatures but even so, their embrace appears to be a significant event and is clearly the central focus of the drawing.

Dr K: Hmm. Your father brought in your latest journal and I’ve been reading it but I haven’t gotten to the end yet. I suspect this relates to Sunday night. So you have no memory of Monday?

Patient watches me as I speak. When I finish she doesn’t react for a moment. Then her eyes widen suddenly. She snatches pad back from me, turns to a new page and immediately starts drawing. She draws for some time. While she draws, I sit there and contemplate how this is such a different style of interview for me. The long wait while she draws, then careful scrutiny of the final picture and a few comments before she is drawing again. It’s a significantly different experience from our usual conversations. The long pauses allow me time to relax and run through various issues in my mind – something I rarely get to do in a typical day. Finally she finishes and then hands the pad to me.

Again the picture shows a complete change of style. This time there is a series of panels. Each of the panels is drawn in a simple style but with more detail than one might see in many cartoons. The first panel shows a raging river. The water froths and boils around a central rock. The rock looks somewhat like a bed and the spumes of water look like the furniture of a bedroom. Stretched out on the bed-like rock is a huge dog – St Bernard or something similar. Over to the side, a tilted slab of rock hints at an open door. Our cat, looking small and delicate, slinks through the door and into the room. In the second panel, the cat has joined the dog on the bed and is stretched out against its flank. The cat looks relaxed and peaceful. The dog has lifted its head and is nuzzling the face of our cat. In the third panel, the two sleep soundly with the cat warmly tucked in along the dog’s flank and their two heads snugly resting against each other. The river has dropped away to slide calmly past them with no sign of the earlier turbulence – and therefore the furniture is no longer there.

Dr K: Ah! I presume this is Dan and yourself on Sunday evening?

Patient took a moment and then gave the faintest of nods.

Dr K: And that’s the last thing you remember before waking up here?

Patient again took a moment, looking around the room, then gave a small nod.

Dr K: Well, never mind. I’m sure it will come back to you in time. We’ll take it as slowly as we can. I’m afraid I’ve spent more time here with you than I should. I have other patients to attend to. I’d like to come back later. Maybe you will draw something else for me.

Patient hesitated and then nodded.

Dr K: I have a friend I want you to meet. His name is Raoul. He is one of our nurses here at the hospital. His English isn’t so good but he is an amazing nurse. Last time he came in, you got scared. He’s a nice guy and he’s sorry for frightening you. Will you meet him?

After a short delay, I get a little nod. I press call button. We wait. Raoul opens door and stands in doorway.

N.R: Hello, Bec. I am Raoul. I am the nurse for you. Please don’t be afraid.

Patient flinches when door opens but then watches Raoul carefully. She doesn’t show any fear.

N.R: This is good, right? You and me are being friends. Raoul will care for Bec and make sure she’s okay. Are you wanting anything?

Patient watches Raoul.

N.R: Okay. Soon it will be dinner time. Raoul will bring dinner. Mmm! You hungry?

No reaction.

N.R: Very good. Is good, right? Soon Raoul brings dinner.

Raoul leaves. I stand up and pick up the pad and pencils. Patient tries to hold onto them but I shake head.

Dr K: I’m sorry, Bec. I can’t leave you with pencils when you are on your own.

Interview concluded 6:05pm.

Editor’s Note:
The next three pages are the three drawings referred to during this interview. They are drawn in pencil on hospital letterhead.

Editor’s Note:
Now we return to notes made by Dr Koehler Snr

Notes of meeting, Peter Freeman, Nurse Raoul, Tuesday, 11/30; 6:45pm

Dr K: Good evening, Mr Freeman.

Peter F: Please, call me Peter.

Dr K: Thank you, Peter. I was just on my way to visit Bec. We can walk together. Will Mrs Freeman be joining us?

Peter F: No. Louise isn’t coping well with what happened. Is there any news about Bec?

Dr K: She’s made some good progress. She’s awake and aware. She’s still not talking. I was with her about 2 hours ago and she was showing awareness of what was going on around her. She even did some drawings for me. I was going to try to get her to do another drawing now, but I don’t want to intrude on your time with her.

Peter F: I was only expecting to spend time sitting in the room with her, so it would be fine with me if she spends the time drawing.

Dr K: Here are the drawings she did for me before. That’s the first one. I asked her to show me how she was feeling.

Peter F: Hmm! It seems that she’s feeling trapped and isolated. Apparently you are just a spectator. If I’m reading this right, she doesn’t see you as someone who can do anything about her isolation. I wonder if these empty seats are supposed to be for us – her family. We’re supposed to be there but we aren’t.

Dr K: That seems reasonable. I’m not sure how to react to the idea that I’m simply a talking head. Mind you, I guess that it’s a fair summary of my profession. Over the next two pages are what she drew when I asked her about the last thing she remembered.

Peter F: I’m pretty sure this one refers to the party on Sunday evening that I told you about. I’m not sure if it refers to myself and Bec or to Laura DiMartino and her father. Either way, she was quite emotional at the time.

He turned the page and snorted.

Peter F: This is Dan’s room. This is like some of her mother’s drawings but different enough to be clearly Bec’s work. Bec often sleeps in Dan’s bed when she’s upset or feeling insecure. I had an inkling she did so on Sunday night and this would seem to confirm it.

He hesitated and looked sideways at me.

Peter F: I’m sure there are some who believe I should prevent that from happening but it would be hypocritical of me to stop them. I don’t believe there’s anything sexual going on between them. It’s simply a comfort thing. But then, they say the parents are always the last to know. Has she told you about anything like that? Sorry. Forget I asked. You’re her doctor. Of course you’re not going to tell me.

Pause.

Peter F: I worry about Bec. Of course I worry about her. I know the signs, probably better than most, and I’m quite sure that Dan isn’t taking advantage of her innocence. Except she’s a teenager and teenagers these days aren’t so innocent. What I’m not sure about is whether she’s taking advantage of him. Do you think I should stop them from sleeping together?