A Grip on Reality Ch. 02

Banker Ben Mitchell had a rocky start in life, but lately things have begun to look up. His bank is a success, he's found a beautiful new wife and his industry peers have gathered to honor him. Then, at the moment of his triumph, he suffers a catastrophic psychiatric episode.

*****

When she got to the hospital on Monday morning, Gina Esposito found a note telling her to check in with her supervisor. A thrill of fear shot through her - the hospital had already had one round of lay-offs and the rumor mill said more were coming.

But when she found her supervisor she was relieved to learn that she wasn't being laid off. Her relief turned to dismay, however, when she heard she was being given a special assignment. "Effective immediately, you've got a new patient to work with. He's a VIP and Dr. Adenauer is going to be treating him personally, so you'd better be on your toes."

Gina tried not to roll her eyes as she took the file on her new patient. "Just what I need: wiping the ass of some senile old rich guy under the supervision of the chief medical officer," she thought disgustedly. But then she reminded herself that she was lucky to still have her job and she chided herself for her attitude.

She found herself doing that a lot. In fact, she thought, "It's been happening ever since that rat bastard ran out on me." Her then boyfriend had managed to get her pregnant even though she'd been on the pill. When he found out, he forgot his promise to marry her and promptly disappeared. Pregnant and unable to pay her rent by herself, Gina had had to move back in with her mother. "Still," she reminded herself, "if I hadn't gotten pregnant I wouldn't have Angela now." The thought of her little girl cheered her up as it always did, and she marched off to her new assignment with her normally cheerful attitude firmly back in place.

As she walked down the hallway, she went over her new patient's chart. "Well, I was wrong about the Alzheimer's," she thought. Apparently her patient, Benjamin Mitchell, was a 36-year-old white male in otherwise good health who had had a sudden psychiatric crisis on Saturday night. She flipped through a series of pages. "Wow, they put this poor guy through the wringer," she murmured. He had had a CAT scan, PET scan, MRI and a complete physical exam. Everything had come back normal.

"Great," she thought, "I wonder what I'm supposed to do with him?"

She found him in the rubber room. It wasn't really rubber, of course, mostly plastic-covered foam, but everybody at the hospital called it the rubber room. "He must have thrown a doozy," she thought, peering at the comatose figure through the peephole.

She turned to the night nurse who was preparing to go off duty. "What's he been like?" she asked.

"They took him down with diazepam during his psychotic episode and they kept him on it while they were testing him. Once they finished they brought him here and he's been sleeping it off ever since. My guess is that they'll start him on clozapine once his system has cleared and then see what happens."

Gina nodded. "Who's on duty, Ed or Harold?"

The nurse knew what she meant immediately.

"Harold's on today, if you need him."

Gina nodded again. Either one of the two big orderlies could handle the most violent patient, but Gina preferred Harold - he was a gentle giant. Ed always seemed to look for opportunities to inflict pain if a patient offered any resistance.

She went back to the peephole and looked again. To her surprise the patient was now sitting up, his back against the wall. He didn't appear agitated so Gina decided to take a chance. "Get Harold down here for me," she asked the other woman. "I'm going to go see how our boy is doing in there. He doesn't look dangerous, but it's nice to know help is available."

When she slipped the latch and opened the door, the patient looked up quickly, but otherwise didn't move. Nevertheless, Gina made sure to stay on the opposite side of the room.

When she made no further move, he looked at her blankly. "Who are you?"

"I'm Nurse Esposito," she said, "and you must be Mr. Mitchell. Is there anything I can do for you?" She watched him carefully, curious to hear what would be his first priority.

He surprised her. "Yes there is. Could you get me a cup of coffee?"

She thought about it momentarily, then decided a little caffeine couldn't hurt. She turned to the grill in the wall and said, "Harold, could you get a cup of coffee for Mr. Mitchell?" She turned back to look at Ben. "Cream and sugar?"

"Just sugar - two packs."

When she handed him the cardboard cup, he quickly took a sip, then made a face. "This is terrible," he said.

She laughed. "Tell me about it!" she replied. "I have to drink the stuff every day."

He gave a little smile, and she thought to herself that that was a positive sign. She also noted that he didn't stop drinking the coffee.

When he had finished the cup, he abruptly asked, "So where am I?"

She had anticipated the question and decided to answer it directly. "You're in Longview Psychiatric Hospital, Mr. Mitchell. You apparently suffered some kind of breakdown on Saturday night, and you were brought here for observation and treatment."

He looked at her strangely. "I remember being at a banquet, but after that I must have gone to sleep because I had terrible nightmares. At least I thought they were nightmares." He got a confused look on his face and suddenly asked, "What day is it?"

"It's Monday," she said quietly, waiting for his reaction.

"Monday!" he exclaimed. "Have I really been out of it that long? What is happening to me?"

Before Gina could reply there was a noise from the door behind her and in walked Dr. Bernard Adenauer, CEO and Chief Medical Officer of the Longview. "The great man himself," she thought sarcastically.

"I'll answer that question, Nurse," Dr. Adenauer, and Gina stepped hastily aside.

The doctor walked over and gravely shook his patient's hand. "Do you know me, Ben?"

Ben looked at him carefully and recognition dawned. "I feel like I've met you before. Oh yeah, you're Dr. Adenauer. You're the head of Longview."

The psychiatrist beamed at Ben like he was a bright boy in elementary school. "Excellent, Ben, it appears your memory is unimpaired. That's a very good sign."

Gina began making notes on her clipboard.

Ben repeated his question. "Dr. Adenauer, can you tell me what's wrong with me?"

"Well, Ben, we are not ready to make a definitive diagnosis at this point, but we have learned quite a bit. In case you don't remember, you had a major psychotic episode at the banquet that, ironically enough, was being held in your honor." He gave a little chuckle. "Apparently you frightened quite a lot of people with your behavior."

Ben groaned and looked down in embarrassment.

Gina snorted silently to herself. "So much for patient sensitivity!" she thought.

Dr. Adenauer was unperturbed. "When I heard of your episode and watched the video . . ."

Ben groaned again. "They have it on video?"

Adenauer nodded and continued unabated. "My immediate thought was that you were suffering from a glioma, a brain tumor. Pressure on your brain could explain such irrational behavior."

Watching Ben turn pale, Gina decided that her initial assessment of Dr. Adenauer's bedside manner had been too kind.

"Fortunately," the good doctor continued, "we have been able to rule that out as a possibility. Similarly, we have eliminated stroke, seizure, high blood sugar levels and virtually every other physical abnormality that could have caused such an event. You'll be happy to know that you are a very healthy young man."

"Except that I'm losing my mind," Ben said bitterly.

"We're not ready to make that call just yet," Adenauer responded. "You have had a single irregular event, nothing more. If it does not recur, we will conclude that it was a one-time occurrence of unknown origin. If it should recur, we will be in a position to evaluate what treatment might provide relief."

Ben looked at him suspiciously. "Do I have to stay here?"

"Oh, yes, I think that would be wise. In the first place, your presence here will make it easier for me and others like Nurse Esposito to interact with and observe you. Secondly, should a recurrence of the original episode transpire, you will be in a safe place."

Ben made a sour face. "For how long?"

"That we'll just have to see," the doctor said breezily. "Well, I must go now, but I'll see you later to begin therapy." He turned to Gina. "Nurse Esposito, would you come with me, please?"

Once they had left the rubber room, Dr. Adenauer turned and looked sharply at the nurse. "Mr. Mitchell is a very important patient, Ms. Esposito. Your responsibility will be to devote full time to him."

"Full time?" Gina gasped. "What about my other patients?"

Adenauer frowned impatiently. "Your other patients will be reassigned. You are to keep him company, interact with him and generally make a continuous assessment of his state of mind. I want you to observe him carefully for any signs of a recurrence. Keep careful notes of his thoughts and actions, and especially look for any indications of irrationality. Document everything. Do you understand?"

"I think so, Doctor, but I've never done anything like this before and . . ."

"Are you saying that you're incapable of performing these responsibilities, Nurse Esposito? Do you want me to find someone else to replace you?"

"Oh, no sir, I can do this, I assure you," she said hastily.

"That's good," he said. "This appears to be a rather unusual case, and I want to be sure we observe and record the course of his disease very carefully."

"Yes, doctor, I understand. You can count on me."

When the imposing figure of the chief medical officer had walked away, Gina rolled her eyes and shook her head. "Holy smoke, what was that all about? I thought he was going to fire me on the spot."

Taking a deep breath she returned to the rubber room and let herself inside. Mitchell glared up at her. "So, you're going to be my babysitter."

In her notebook, Gina wrote "Patient displays initial hostility." Mentally, she groaned, "This is not going to be a fun assignment."

That night over dinner Gina told her mother and brother about her new assignment. Her brother was a detective on the city police force. Ever since his marriage had broken up, Marco made it a habit of dropping by his mother's house for dinner once or twice a week. Gina accused him of being a mooch, but secretly she was delighted to have his company. She had always idolized her big brother growing up, and she enjoyed his company, even if he did like to tease her.

She was bemoaning her new assignment when Marco interrupted her. "What's your new patient's name?" he asked.

"You know I'm not supposed to talk about our patients," she said.

He rolled his eyes. "It's not as though I'm going to broadcast his name on Twitter," he said with exasperation. Seeing that she wasn't going to talk, he went on. "Okay, you said the guy freaked out at a banquet last weekend. Well, take a look at this."

With that he pulled out his IPad and connected to YouTube. In seconds Gina and her mother were looking at video obviously taken from the floor of the hotel ballroom. There was Ben Mitchell stepping up to the podium to accept Banker of the Year honors - and having a total meltdown in front of hundreds of guests.

As Gina looked on in amazement, her mother grew very nervous. "Is it safe for you to be working with this man?" she asked apprehensively.

Gina reassured her that she was perfectly safe; nevertheless, she was taken aback at the way Ben had transformed so quickly from a normal, seemingly happy individual into a stark raving mad man.

"So what does the boss head-shrinker say is the matter with this guy?" Marco asked irreverently.

"Dr. Adenauer hasn't made a diagnosis yet," Gina said stiffly, bristling at her brother's teasing.

"Well, I can tell you what's wrong with him, and I'm not even a rich doctor. Your boy's on drugs, for sure. I've seen it on the streets many times." Marco said confidently.

Gina gave him a baleful look. "Well you'd be wrong, smartypants. In the first place, they did a full medical work-up on him. He was clean: no drugs and not a drop of alcohol. In fact they say he doesn't drink at all. Anyway, they checked his arms and legs carefully: no needle marks. And two hundred people at the banquet ate the same food he did without any ill effects. So stick to your police work and leave the medical diagnoses to the professionals!"

Marco was undeterred. "Maybe so, but he sure looks drugged out to me." He shook his head. "Anyway, it's kind of a shame that it happened to him. From what I hear, he's a pretty good guy for a banker."

Both women were curious now, so Marco went back to his IPad and found the video of Mitchell's loan to the thwarted bank robber. When they'd finished watching, Marco added, "I figured the guy was crazy when I heard about this little stunt. If somebody attempts to rob a bank, you can't just let him go. But apparently it worked this time. It just goes to show, there really is an exception for every rule."

Gina said nothing, but she was impressed by the last video she'd seen. She decided to cut Ben Mitchell a little slack when she saw him the next day.

Gina had never had an assignment like her current one and she wasn't really sure what Adenauer wanted from her. How was a nurse supposed to find out anything about Ben's mental state? For that matter, how was she going to spend so much time with her patient without running out of things to talk about? And how was she going to achieve anything positive, given his depressed and somewhat antagonistic state of mind?

The next morning Gina strode into Ben's room with a sense of purpose. He greeted her with sarcasm. "Ah, my babysitter is back."

Gina was undeterred. "That's not a very nice way to say hello, especially since I went to the trouble to be nice to you." With that she revealed the cup of Starbucks she had brought with her and held it out to him.

His demeanor changed completely and he accepted the cup gratefully. His smile grew even broader when she handed him several packs of sugar. "Thank you," he said earnestly. "You don't know how much I've missed good coffee."

After a couple of minutes, he looked up at Gina with a wry grin. "Okay, Nurse Esposito, I guess I owe you a little cooperation. So what's on the agenda for today - word associations, Rorschach tests, block puzzles?"

Gina rolled her eyes, but she had an agenda so she ignored his jibes. After a lot of worrying, she had decided to start by exploring Ben's memories of what had happened immediately prior to his episode. She wanted to know in as much detail as possible everything that had happened before the onset of the attack, his emotions, his actions and his interactions with others.

As she posed her questions, everything he reported seemed completely normal and unremarkable to her. Nevertheless she kept at it lest she overlook anything of importance. When she felt she had exhausted that subject she gently pressed him to describe the episode itself. As she had anticipated, he was reluctant to do so, but she carefully explained that the details of his experience might prove helpful to Dr. Adenauer in diagnosing what had happened to Ben.

As she listened to his account of his experience, Gina found it surprisingly difficult to maintain her professional demeanor. Most psychotics she had dealt with seemed unaware that anything unusual was happening to them. The voices they heard or the impulses they felt were integral to them. But Ben's experience was different: he seemed completely aware of how aberrant his behavior had been. Gina could easily see how fearful he was at the way his mind had misfired.

The thing that seemed to disturb him most was the distortion of his perception. "I remember seeing a woman screaming, but instead of hearing her voice I felt a strong unpleasant taste in my mouth. At another point I ran my hand over the nap of the carpet and saw the color blue. It was the most frightening and disconcerting experience I've ever had."

"What you were experiencing is called 'synesthesia,'" Gina told him. "Basically, your senses became garbled and your brain interpreted sensations incorrectly. Synesthesia has been frequently observed but exactly what's happening is not well understood."

Ben was still upset by his memories of that experience, but he took a little comfort in the fact that there was a name for what had happened.

It was clear to Gina that Ben didn't want to delve any further into his episode. She didn't want to risk triggering another one so she suggested that they have an early lunch. As the two of them ate bland food off of paper plates, she wracked her brain to think of a safer topic she could explore with him. As she pondered the problem, she remembered Dr. Adenauer's comment about Ben's memory. Maybe that was the approach she should use. Come to think about it, that might offer a way she could get Ben to accept her too.

"Okay," Gina said briskly when they'd finished lunch, "let's change the subject. This afternoon is all about Ben Mitchell. I want to know everything about you."

"Sounds to me like you're in for a pretty dull time," Ben said.

"You let me be the judge of that," she responded. "Now let's get going."

With that she began to take him on a tour of his own life, asking him questions about every episode he could remember: his relationship with his parents, his likes and dislikes, emotions and preferences - in short, anything and everything that might possible reveal some insight or precursor to his sudden psychosis. Before she'd started she feared they might run out of things to discuss in short order. But once they started, time seemed to fly by, with each event eliciting yet more questions and more memories.

Gina wasn't so interested in the actual events of Ben's life; instead, she was looking for subtext, any insights that might reveal the mind of the patient before her. But it was impossible for her to hear his story and not become engaged by it. Gradually she began to draw conclusions about the man, not just the patient.

Before she started working with Ben, Gina had held certain stereotypes about businessmen in general and bankers in particular. But it quickly became clear to her that this one didn't fit her expectations. For example, he hadn't come from privilege. His father had been a mid-level manager, and she soon learned that Ben's mother had drunk any disposable income they might have had.

As she listened to Ben talk about his mother, she quickly understood why he avoided alcohol so assiduously. Even if he had inherited any genetic predisposition to alcoholism, Gina decided, the spectacle of his mother's degeneration had clearly left a mark so indelible that he would never be tempted.

But over and above the life lesson he had learned, Gina also observed the impact of his mother's disease on Ben. "It would have been easier on him if she had died suddenly," she found herself thinking. Yet instead of withdrawal or bitterness, Ben's reaction had been to bond more closely with his father, and she decided that indicated a significant level of resilience, something she admired.

Ben was just getting ready to talk about Elizabeth when they were interrupted by the 4:00-to-midnight nurse. "Sorry to barge in on you, Gina, but we won't be able to get the shift review and hand-over done if you don't stop."

Gina was startled and, promising Ben they would get started promptly the next morning, she hurried off. Later, as she retrieved her car from the hospital parking garage and headed home, she shook her head. "I've got to do a better job of managing my time," she thought ruefully. "I've got a ton of notes to type up when I get home."